Transauricular nerve stimulation in acute ischaemic stroke requiring mechanical thrombectomy: Protocol for a phase 2A, proof-of-concept, sham-controlled randomised trial.

BACKGROUND: Labile blood pressure after acute ischaemic stroke requiring mechanical thrombectomy is independently associated with poor patient outcomes. OBJECTIVES: This study protocol describes is designed to determine whether transauricular nerve stimulation, improves baroreflex sensitivity, reduces blood pressure variability in the first 24 hours after acute ischaemic stroke requiring mechanical thrombectomy. DESIGN: PHASE 2A, PROOF-OF-CONCEPT, SHAM-CONTROLLED RANDOMISED TRIAL: Methods and Analysis: 36 individuals undergoing mechanical thrombectomy for acute ischaemic stroke with established hypertension aged >18 years will be randomly allocated to receive bilateral active or sham transauricular nerve stimulation for the duration of the mechanical thrombectomy procedure (AffeX-CT/001 investigational device). The intervention will be repeated for 1h the morning following the mechanical thrombectomy. Non-invasive blood pressure will be measured ≥2h for 24h after mechanical thrombectomy. Holter electrocardiographic monitoring will be recorded during transauricular nerve stimulation. Participants, clinicians and investigators will be masked to treatment allocations. The primary outcome will be the coefficient of variation of systolic blood pressure. Secondary outcomes include additional estimates of blood pressure variability and time/frequency-domain measures of autonomic cardiac modulation An adjusted sample size of 36 patients is required to have a 90% chance of detecting, as significant at the 5% level, a difference in the coefficient of variation in systolic blood pressure of 5±4mmHg between sham and active stimulation [assuming 5% non-compliance rate in each group]. Ethics: confirmed on 16 March 2023 by HRA and Health and Care Research Wales ethics committee (reference 23/WA/0013). DISCUSSION: This study will provide proof-of-concept data that examines whether non-invasive autonomic neuromodulation can be used to favourably modify blood pressure and autonomic control after acute ischaemic stroke requiring mechanical thrombectomy. TRIAL REGISTRATION: Trial registration number: NCT05417009.

Retraction: Comparison of Oral versus Intravenous Proton Pump Inhibitors in Preventing Re-bleeding from Peptic Ulcer after Successful Endoscopic Therapy.

[This retracts the article DOI: 10.7759/cureus.6741.].

CO2 Uptake and Physicochemical Properties of Carbonation-Cured Ternary Blend Portland Cement-Metakaolin-Limestone Pastes.

The feasibility of carbonation curing of ternary blend Portland cement-metakaolin-limestone was investigated. Portland cement was substituted by the combination of metakaolin and limestone at levels of 15%, 30%, and 45% by the mass. The ternary blends were cured with four different combinations of ambient and carbonation curing. The mechanical property, CO2 uptake, and mineralogical variations of the ternary blend pastes were investigated by means of compressive strength test, thermogravimetric analysis, and X-ray diffractometry. In addition, volume of permeable voids and sorptivity of the ternary blends were also presented to provide a fundamental idea of the pore characteristics of the blends. The test results showed that the increasing amount of metakaolin and limestone enhanced the CO2 uptake, reaching 20.7% for the sample with a 45% cement replacement level at 27 d of carbonation. Meanwhile, the compressive strength of the samples was reduced up to 65% upon excessive incorporation of metakaolin and limestone. The samples with a replacement level of 15% exhibited a comparable strength and volume of permeable voids to those of the sample without substitution, proving that the ternary blend Portland cement-metakaolin-limestone can be a viable option toward the development of eco-friendly binders.

Comparison of Oral versus Intravenous Proton Pump Inhibitors in Preventing Re-bleeding from Peptic Ulcer after Successful Endoscopic Therapy.

Introduction Perforation, obstruction, and bleeding remain the most frequently encountered complications of peptic ulcer disease (PUD). Bleeding may be in the form of hematemesis or melena. The treatment of choice in patients with a bleeding peptic ulcer is endoscopic ligation to maintain the hemostatic balance followed by the administration of proton pump inhibitors (PPIs). This study focuses on the evaluation and comparison of intravenous (IV) and oral PPIs in terms of prevention of re-bleeding after successful endoscopy for peptic ulcers. Methods A prospective, comparative study was conducted in a tertiary care hospital in Pakistan from January 1, 2018 to June 30, 2019. The trial included known cases of PUD admitted with active upper gastrointestinal bleeding (UGIB). They were randomly divided into two groups: one received oral pantoprazole and the other was administered IV pantoprazole. The outcomes for both groups were compared. Data was entered and analyzed using Statistical Package for the Social Sciences (SPSS) software version 23.0 (IBM, Armonk, NY) Results There were 96 (48%) patients in the IV pantoprazole group and 104 (52%) in the oral group. From 24 hours after the medication onwards, the IV pantoprazole group showed a significant improvement in hemoglobin (Hb) levels (p: 0.01); the group also showed improvement in supine systolic BP at 48 hours (p: 0.04) and in diastolic BP at both 12 and 48 hours as compared to the oral pantoprazole group (p: 0.05). The mean duration of hospital stay, need for blood transfusion and repeat endoscopy, re-bleeding, and mortality rates were similar for both groups (p: >0.05). Conclusion We could not find any statistically significant difference between oral and IV routes of pantoprazole administration in the prevention of rebleeding when used after successful therapeutic endoscopy in patients with bleeding PUDs.

Analytical framework for value added utilization of glass waste in concrete: Mechanical and environmental performance.

This work was designed to incorporate glass waste as partial replacement of coarse aggregate in concrete through optimization of its amount by assessment of mechanical and environmental performances. Fresh and hardened properties of glass waste concrete were evaluated and compared with the conventional concrete. Moreover, compressive strength was evaluated experimentally as well as analytically at different ages. While, environmental performance was evaluated with an assessment of CO2 footprint and volume utilization of raw materials for both types of concrete; conventional and glass waste concrete. Consequently, a sustainable concrete was selected that possesses high workability and mechanical performance, minimum CO2 footprint and least utilization of conventional natural raw materials. For optimization, corresponding values of designed parameters were translated into a framework for glass waste management by application of analytical hierarchy process (AHP) and technique for order preference by similarity to ideal solution (TOPSIS). Similar prioritization for all types of mixtures was achieved through proposed framework by applying such multi criteria decision making techniques. Proposed framework may further be used for adjusting the priority weights for each criterion according to the requirement as well as for extended evaluation of additional criteria.