Comparison of dosing errors between tenecteplase and alteplase for management of acute ischemic stroke.

BACKGROUND: Acute ischemic stroke (AIS) is a medical emergency leading to morbidity and mortality. Thrombolytic therapy is currently the mainstay for the management of AIS owing to its improvement in neurologic function at 3 months. OBJECTIVES: The objective of this study was to compare the frequency of dosing errors made with tenecteplase versus alteplase administration in management of AIS. The secondary objectives evaluated efficacy outcomes of intensive care unit length of stay (LOS), hospital LOS, and time from door to needle and safety outcomes of bleeding and all-cause mortality between groups. METHODS: This multicenter retrospective cohort study included patients with AIS treated with thrombolytics (tenecteplase or alteplase). The study evaluated patients at 9 different hospitals in a Texas Network between August 2018 and August 2020. RESULTS: There were 3808 patients evaluated for inclusion and 359 were included: 171 in the tenecteplase group and 188 in the alteplase group. There were no differences found in dosing errors between tenecteplase and alteplase (25.7% vs. 32.4%, P = 0.16). There was no difference in all-cause mortality (tenecteplase 1.8% vs. alteplase 5.3%, P = 0.09) or bleeding events (tenecteplase 8.8% vs. alteplase 7.4%, P = 0.64). Patients who received tenecteplase had improved door to needle time < 60 minutes (tenecteplase 60% vs. alteplase 49%, P = 0.04). CONCLUSION: There was no difference in dosing errors between tenecteplase and alteplase for the management of AIS. Tenecteplase was associated with shorter door to needle times, which may be caused by simpler administration times. Institutions could consider strategies to mitigate dosing errors for thrombolytic therapies.

A Comparison of Midazolam and Propofol for Deep Sedation in Patients with Acute Respiratory Distress Syndrome Requiring Neuromuscular Blocking Agents.

Purpose: The optimal agent for deep sedation in patients undergoing continuous infusion (CI) neuromuscular blocking agent (NMBA) use for acute respiratory distress syndrome (ARDS) is unknown. The purpose of this study is to compare the efficacy and safety of propofol and midazolam in ARDS patients requiring CI NMBA. Methods: A multi-center, retrospective study was performed in mechanically ventilated (MV) adult patients requiring CI NMBA for management of ARDS. The primary outcome was to compare the time to liberation from MV in patients sedated with propofol vs midazolam. Results: In the 109 patients included, there was no difference in time to MV liberation with propofol as compared to midazolam (121 hr [Interquartile range (IQR) 67 195] vs 98 hr [IQR 48, 292], P = .72). Median time to sedation emergence after NMBA discontinuation was shorter in patients receiving propofol (12.9 hr [IQR 19.8, 72.5] vs 31.5 hr [IQR 6.4, 34.6], P < .01). There were no significant differences in time to therapeutic sedation, ICU stay, mortality, and adverse events. Conclusion: Propofol may be an effective and safe alternative to midazolam for patients undergoing CI NMBA for ARDS. Additionally, patients receiving propofol may have a quicker return to light sedation after NMBA discontinuation.

Perioperative pain management and outcomes in patients who -discontinued or continued pre-existing buprenorphine therapy.

OBJECTIVE: This study compared opioid utilization and clinical outcomes in surgical patients receiving maintenance buprenorphine therapy who discontinued versus those who continued buprenorphine treatment perioperatively. Lack of high-quality evidence, conflicting results in previous studies, and the possible need for reinduction after discontinuing therapy present clinicians with the complicated dilemma of choosing the best strategy to control post-operative pain in patients receiving buprenorphine. DESIGN: A multicenter, retrospective cohort study. PARTICIPANTS: Hospitalized patients between January 1, 2017 and December 12, 2019 who underwent any type of surgery, had a documentation of an outpatient buprenorphine prescription or inpatient order, and received buprenorphine for 5 or more days prior to the procedure were included. MAIN OUTCOME MEASURE(S): The primary objective was to compare mean 24-hour morphine milligram equivalent (MME) utilization post-operatively between patients who discontinued buprenorphine preoperatively versus those who continued therapy throughout the perioperative period. RESULTS: Fifty-one patients met the inclusion criteria for this study. Of these, 42 patients were continued on buprenorphine through surgery, while nine patients had a documentation of discontinuation preoperatively. The 24-hour post-operative MME utilization (interquartile range) was 58.8 (18-100.8) in patients who continued therapy through surgery versus 152.6 (114.5-236) in patients who discontinued therapy preoperatively (p = 0.005). There were no significant differences in post-operative pain scores or length of stay between groups. CONCLUSION: Post-operative opioid use was significantly lower in patients who continued buprenorphine compared with those who discontinued buprenorphine preoperatively.

A hybrid underwater robot for multidisciplinary investigation of the ocean twilight zone.

Mesobot, an autonomous underwater vehicle, addresses specific unmet needs for observing and sampling a variety of phenomena in the ocean's midwaters. The midwater hosts a vast biomass, has a role in regulating climate, and may soon be exploited commercially, yet our scientific understanding of it is incomplete. Mesobot has the ability to survey and track slow-moving animals and to correlate the animals' movements with critical environmental measurements. Mesobot will complement existing oceanographic assets such as towed, remotely operated, and autonomous vehicles; shipboard acoustic sensors; and net tows. Its potential to perform behavioral studies unobtrusively over long periods with substantial autonomy provides a capability that is not presently available to midwater researchers. The 250-kilogram marine robot can be teleoperated through a lightweight fiber optic tether and can also operate untethered with full autonomy while minimizing environmental disturbance. We present recent results illustrating the vehicle's ability to automatically track free-swimming hydromedusae (Solmissus sp.) and larvaceans (Bathochordaeus stygius) at depths of 200 meters in Monterey Bay, USA. In addition to these tracking missions, the vehicle can execute preprogrammed missions collecting image and sensor data while also carrying substantial auxiliary payloads such as cameras, sonars, and samplers.

A comparison of the quasi-static mechanical and non-linear viscoelastic properties of the human semitendinosus and gracilis tendons.

BACKGROUND: Over 50-% of anterior cruciate ligament reconstructions are performed using semitendinosus and gracilis tendon autografts. Despite their increased use, there remains little quantitative data on their mechanical behavior. Therefore, the objective of this study was to investigate the quasi-static mechanical and non-linear viscoelastic properties of human semitendinosus and gracilis tendons, as well as the variation of these properties along their length. METHODS: Specimens were subjected to a series of uniaxial tensile tests: 1-h static stress-relaxation test, 30 cycle cyclic stress-relaxation test and load to failure test. To describe the non-linear viscoelastic behavior, the quasi-linear viscoelastic theory was utilized to model data from the static stress-relaxation experiment. FINDINGS: The constants describing the viscoelastic behavior were similar between the proximal and distal halves of the gracilis tendon. The proximal half of the semitendinosus tendon, however, had a greater viscous response than its distal half, which was also significantly higher than the proximal gracilis tendon. In terms of the quasi-static mechanical properties, the properties were similar between the proximal and distal halves of the semitendinosus tendon. However, the distal gracilis tendon showed a significantly higher tangent modulus and ultimate stress compared to its proximal half, which was also significantly higher than the distal semitendinosus tendon. INTERPRETATION: The results of this study demonstrate differences between the semitendinosus and gracilis tendons in terms of their quasi-static mechanical and non-linear viscoelastic properties. These results are important for establishing surgical preconditioning protocols and graft selection.