Association between intravenous tirofiban and intracranial hemorrhage in acute large vessel occlusion stroke: insight from the RESCUE BT randomized placebo-controlled trial.

BACKGROUND: The aim of this study is to investigate the association between intravenous tirofiban and symptomatic intracranial hemorrhage (SICH) in patients with acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO) receiving endovascular thrombectomy (EVT) within 24 h of time last known well (LKW). METHODS: Patients with AIS-LVO who were randomly assigned to receive intravenous tirofiban or placebo before EVT within 24 h of time LKW and had follow-up brain non-contrast computed tomography within 24 h after stopping tirofiban treatment were derived from "RESCUE BT": a multicenter, randomized, placebo-controlled, double-blind trial. All eligible patients were divided into SICH and NO-SICH groups. Subgroup analyses were performed to explore for heterogeneity. RESULTS: Of 945 patients included in this cohort, there were 76 (8.0%) in the SICH group and 869 (92.0%) in the NO-SICH group. The incidence of SICH was not higher in patients receiving intravenous tirofiban compared with placebo (adjusted risk ratio (RR), 1.51; 95% confidence interval (CI), 0.97-2.36; P = 0.07). Subgroup analyses showed that age greater than 67-year-old (adjusted RR, 2.18; 95% CI 1.18-4.00), NIHSS greater than 16 (adjusted RR, 1.88; 95% CI 1.06-3.34), and cardioembolism (adjusted RR, 3.73; 95% CI 1.66-8.35) were associated with increased SICH risk. CONCLUSIONS: In patients with acute large vessel occlusion stroke, intravenous tirofiban before EVT within 24 h of time from last known well is not associated with increased risk of SICH. Patients who are older, have more severe neurological deficits, or with cardioembolism are at higher risk of SICH with intravenous tirofiban. TRIAL REGISTRATION NUMBER: URL: http://www.chictr.org.cn ; Unique identifier: ChiCTR-INR-17014167.

Concurrent Estimation of Finger Flexion and Extension Forces Using Motoneuron Discharge Information.

OBJECTIVE: A reliable neural-machine interface offers the possibility of controlling advanced robotic hands with high dexterity. The objective of this study was to develop a decoding method to estimate flexion and extension forces of individual fingers concurrently. METHODS: First, motor unit (MU) firing information was identified through surface electromyogram (EMG) decomposition, and the MUs were further categorized into different pools for the flexion and extension of individual fingers via a refinement procedure. MU firing rate at the populational level was calculated, and the individual finger forces were then estimated via a bivariate linear regression model (neural-drive method). Conventional EMG amplitude-based method was used as a comparison. RESULTS: Our results showed that the neural-drive method had a significantly better performance (lower estimation error and higher correlation) compared with the conventional method. CONCLUSION: Our approach provides a reliable neural decoding method for dexterous finger movements. SIGNIFICANCE: Further exploration of our method can potentially provide a robust neural-machine interface for intuitive control of robotic hands.

Dexterous Force Estimation during Finger Flexion and Extension Using Motor Unit Discharge Information.

With the development of advanced robotic hands, a reliable neural-machine interface is essential to take full advantage of the functional dexterity of the robots. In this preliminary study, we developed a novel method to estimate isometric forces of individual fingers continuously and concurrently during dexterous finger flexion and extension. Specifically, motor unit (MU) discharge activity was extracted from the surface high-density electromyogram (EMG) signals recorded from the finger extensors and flexors, respectively. The MU information was separated into different groups to be associated with the flexion or extension of individual fingers and was then used to predict individual finger forces during multi-finger flexion and extension tasks. Compared with the conventional EMG amplitude-based method, our method can obtain a better force estimation performance (a higher correlation and a smaller estimation error between the predicted and the measured force) when a linear regression model was used. Further exploration of our method can potentially provide a robust neural-machine interface for intuitive control of robotic hands.

Delayed fatigue in finger flexion forces through transcutaneous nerve stimulation.

OBJECTIVE: Weakness of the hand is a major impairment which limits independent living. Neuromuscular electrical stimulation (NMES) is a common approach to help restore muscle strength. Traditional NMES directly over the muscle often leads to a rapid onset of muscle fatigue. In this study, we investigated the force sustainability of finger flexor muscles using a transcutaneous nerve stimulation approach. APPROACH: Finger flexion forces and high-density electromyogram (HD EMG) signals were obtained while electrical stimulation was applied to the ulnar and median nerve bundles through a stimulation grid on the proximal arm segment. Stimulation was also applied to the finger flexor muscle belly targeting the motor point, serving as a control condition. The force produced from the two stimulation approaches were initially matched, and muscle fatigue was subsequently induced with 5 min of continuous stimulation. The rate of decay of the force and EMG amplitude were quantified, and the spatial distribution of the muscle activation during the sustained contraction was also evaluated. MAIN RESULTS: The proximal nerve stimulation approach induced a slower decay in both force and EMG, compared with the stimulation at the motor point. The spatial distribution of the elicited muscle activation showed that the proximal nerve stimulation led to a distributed activation across the intrinsic and extrinsic finger flexor muscles and also activated a wider area within the extrinsic muscle. SIGNIFICANCE: Our findings demonstrated that the stimulation of the proximal nerve bundles can elicit sustained force output and delayed decrease in the rate of force decline. This is potentially due to a spatially distributed activation of the muscle fibers, compared with the traditional motor point stimulation. Future development of our nerve stimulation approach may enable prolonged usage during rehabilitation or assistance for better functional outcomes.