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1.
Sensors (Basel) ; 24(19)2024 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-39409409

RESUMO

This paper presents a passive Envelope Detector (ED) to be used for reception of OOK-modulated signals, such as in Wake-Up Receivers employed within Wireless Sensor Networks, widely used in the IoT. The main goal is implementing a temperature compensation mechanism in order to keep the passive ED input resistance roughly constant over temperature, making it a constant load for the preceding matching network and ultimately keeping the overall receiving chain sensitivity constant over temperature. The proposed ED was designed using STMicroelectronics 90 nm CMOS technology to receive 1 kbps OOK-modulated packets with a 433 MHz carrier frequency and a 0.6 V supply. The use of a block featuring a Proportional-to-Absolute Temperature (PTAT) current yields a 5 dB reduction in sensitivity temperature variation across the -40 °C to 120 °C range. Moreover, two different implementations were compared, one targeting minimal mismatch and the other one targeting minimal area. The minimal area version appears to be better in terms of estimated overall chain sensitivity at all temperatures despite a higher sensitivity spread.

2.
BMC Psychiatry ; 24(1): 715, 2024 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-39438856

RESUMO

OBJECTIVES: Sleep characteristics such as duration, continuity, and irregularity are associated with the risk of hypertension. This study aimed to investigate the association between sleep timing (including bedtime, wake-up time, and sleep midpoint) and the prevalence of hypertension. METHODS: Participants were selected from the Sleep Heart Health Study (n = 5504). Bedtime and wake-up times were assessed using sleep habit questionnaires. The sleep midpoint was calculated as the halfway point between the bedtime and wake-up time. Restricted cubic splines and logistic regression analyses were performed to explore the association between sleep timing and hypertension. RESULTS: A significant nonlinear association was observed between bedtime (Poverall<0.001; Pnonlinear<0.001), wake-up time (Poverall=0.024; Pnonlinear=0.076), sleep midpoint (Poverall=0.002; Pnonlinear=0.005), and the prevalence of hypertension after adjusting for potential confounders. Multivariable logistic regression showed that both late (> 12:00AM and 23:01PM to 12:00AM) and early (≤ 22:00PM) bedtimes were associated with an increased risk of hypertension compared to bedtimes between 22:01PM and 23:00PM. In addition, individuals with late (> 7:00AM) and early (≤ 5:00AM) wake-up times had a higher prevalence of hypertension than those with wake-up times ranging between 5:01AM and 6:00AM. Delaying the sleep midpoint (> 3:00AM) was also associated with an increased risk of hypertension. Furthermore, no significant interaction effect was found in the subgroup analyses stratified by age, sex, or apnea-hypopnea index. CONCLUSIONS: Our findings identified a nonlinear association between sleep timing and hypertension. Individuals with both early and late sleep timing had a high prevalence of hypertension.


Assuntos
Hipertensão , Sono , Humanos , Hipertensão/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Prevalência , Sono/fisiologia , Idoso , Fatores de Tempo , Fatores de Risco , Inquéritos e Questionários
3.
J Neurol Sci ; 466: 123265, 2024 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-39378794

RESUMO

OBJECTIVES: Wake-up stroke (WUPS) patients can be selected to intravenous thrombolysis (IVT) treatment based on the Magnetic Resonance Imaging (MRI) mismatch concept. However, recent studies suggest the introduction of modified MRI mismatch criteria, allowing IVT in WUPS patients with a partial mismatch. MATERIAL AND METHODS: WUPS patients treated with IVT in the NOR-TEST trial and consecutively thereafter at Stavanger University Hospital were included in this study. Patient selection for treatment was performed based on the clinical presentation and the MRI DWI/FLAIR mismatch criteria. MRI examinations were reassessed according to the modified DWI-FLAIR mismatch criteria, allowing partial mismatch. Improvement in NIHSS and mRS at 3 months were used to analyze clinical outcome, and the rate of intracranial hemorrhage (ICH) to analyze safety. RESULTS: 78 WUPS patients were treated with IVT. Only 68 of these patients were independent pre-stroke and included in the clinical analysis. When reassessing the MRI examinations, 41 (60 %) were rated as DWI/ FLAIR mismatch, 14 (21 %) as partial mismatch and 13 (19 %) as match. The results show that the patient groups had a mRS score 0-1 at 3 months measured as primary outcome to respectively 27 (65.9 %), 11 (78.6 %) and 8 (61.5 %); (P = 0.629). The mismatch group showed the best clinical improvement (3-points NIHSS reduction, p = 0.005). No ICH was seen in any of the groups. CONCLUSION: Our study extended the mismatch concept in clinical praxis to treat WUPS patients with partial mismatch, showing the best clinical outcome in the mismatch group.

4.
Nanotechnology ; 2024 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-39467330

RESUMO

Hf0.5Zr0.5O2(HZO) has drawn great attention owing to its excellent ferroelectricity, sub-10 nm scalability, and CMOS compatibility. With regard to increasingly restrict thermal budget and power consumption, conventional HZO films need further optimization to meet these demands. Here, we propose a middle layer (ML) strategy aiming to enhance ferroelectricity and inhibit wake-up effect of ferroelectric (FE) capacitors compatible with back-end of line (BEOL) under the low operating electric field. ZrO2, HfO2, and Al2O3were integrated into HZO film as different MLs. Among them, the device with ZrO2ML achieves the excellent double remnant polarization (2Pr) of 41.7 µC/cm2under the operating electric field of 2 MV/cm. Moreover, ultralow wake-up ratios of around 0.08 and 0.05 were observed under 2 MV/cm and 3 MV/cm, respectively. Additionally, the FE capacitor with ZrO2ML demonstrated an enhanced reliability characterizations, including a stable 2Pr of 40.7 µC/cm2after 4.3×109cycles. This work provides the perspective to optimize both the ferroelectricity and reliability, while maintains the ultralow wake-up ratio in HfO2-based ferroelectric through middle layer engineering. .

5.
J Med Cases ; 15(8): 167-170, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39091576

RESUMO

This case underscores the importance of treating neurological deficits of an acute stroke presentation despite initial negative diffusion-weighted imaging (DWI), especially in the acute phase when there is high clinical suspicion of stroke. Additionally, it highlights the appropriate use of a WAKE-UP protocol for patients that present with stroke symptoms without a well-defined inception time. A 71-year-old female presented to the emergency department with symptoms of dizziness and double vision upon wake-up. While clinical exam findings revealed left intranuclear ophthalmoplegia (INO) and inability to ambulate due to gait ataxia, magnetic resonance imaging (MRI) was negative for acute stroke. Despite negative DWI MRI, this patient's clinical exam findings of a left INO and gait ataxia were indicative of an ischemic stroke localizing to the medial longitudinal fasciculus (MLF), and the patient received thrombolytics. Repeat MRI about 48 h later revealed an acute infarct in the left midbrain with a DWI lesion in the MLF.

6.
Sensors (Basel) ; 24(13)2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-39000940

RESUMO

With the increasing frequency and severity of disasters and accidents, there is a growing need for efficient emergency alert systems. The ultra-high definition (UHD) broadcasting service based on Advanced Television Systems Committee (ATSC) 3.0, a leading terrestrial digital broadcasting system, offers such capabilities, including a wake-up function for minimizing damage through early alerts. In case of a disaster situation, the emergency alert wake-up signal is transmitted, allowing UHD TVs to be activated, enabling individuals to receive emergency alerts and access emergency broadcasting content. However, conventional methods for detecting the bootstrap signal, essential for this function, typically require an ATSC 3.0 demodulator. In this paper, we propose a novel deep learning-based method capable of detecting an emergency wake-up signal without the need for an ATSC 3.0. The proposed method leverages deep learning techniques, specifically a deep neural network (DNN) structure for bootstrap detection and a convolutional neural network (CNN) structure for wake-up signal demodulation and to detect the bootstrap and 2 bit emergency alert wake-up signal. Specifically, our method eliminates the need for Fast Fourier Transform (FFT), frequency synchronization, and interleaving processes typically required by a demodulator. By applying a deep learning in the time domain, we simplify the detection process, allowing for the detection of an emergency alert signal without the full suite of demodulator components required for ATSC 3.0. Furthermore, we have verified the performance of the deep learning-based method using ATSC 3.0-based RF signals and a commercial Software-Defined Radio (SDR) platform in a real environment.

7.
IEEE Trans Circuits Syst II Express Briefs ; 71(7): 3298-3302, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38961880

RESUMO

This brief presents an on-chip digital intensive frequency-locked loop (DFLL)-based wakeup timer with a time-domain temperature compensation featuring a embedded temperature sensor. The proposed compensation exploits the deterministic temperature characteristics of two complementary resistors to stabilize the timer's operating frequency across the temperature by modulating the activation time window of the two resistors. As a result, it achieves a fine trimming step (± 1 ppm), allowing a small frequency error after trimming (<± 20 ppm). By reusing the DFLL structure, instead of employing a dedicated sensor, the temperature sensing operates in the background with negligible power (2 %) and hardware overhead (< 1 %). The chip is fabricated in 40 nm CMOS, resulting in 0.9 pJ/cycle energy efficiency while achieving 8 ppm/ºC from -40ºC to 80ºC.

8.
Scand J Med Sci Sports ; 34(7): e14684, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38926910

RESUMO

INTRODUCTION: Tailoring physical activity interventions to individual chronotypes and preferences by time of day could promote more effective and sustainable behavior change; however, our understanding of circadian physical behavior patterns is very limited. OBJECTIVE: To characterize and compare 24-h physical behavior patterns expressed relative to clock time (the standard measurement of time-based on a 24-h day) versus wake-up time in a large British cohort age 46. METHODS: Data were analyzed from 4979 participants in the age 46 sweep of the 1970 British Cohort Study who had valid activPAL accelerometer data across ≥4 days. Average steps and upright time (time standing plus time stepping) per 30-min interval were determined for weekdays and weekends, both in clock time and synchronized to individual wake-up times. RESULTS: The mean weekday steps were 9588, and the mean weekend steps were 9354. The mean weekday upright time was 6.6 h, and the mean weekend upright time was 6.4 h. When synchronized to wake-up time, steps peaked 1 h after waking on weekdays and 2.5 h after waking on weekends. Upright time peaked immediately, in the first 30-min window, after waking on both weekdays and weekends. CONCLUSIONS: Aligning accelerometer data to wake-up times revealed distinct peaks in stepping and upright times shortly after waking. Activity built up more gradually across clock time in the mornings, especially on weekends. Synchronizing against wake-up times highlighted the importance of circadian rhythms and personal schedules in understanding population 24-h physical behavior patterns, and this may have important implications for promoting more effective and sustainable behavior change.


Assuntos
Acelerometria , Ritmo Circadiano , Exercício Físico , Humanos , Masculino , Feminino , Ritmo Circadiano/fisiologia , Pessoa de Meia-Idade , Acelerometria/instrumentação , Exercício Físico/fisiologia , Fatores de Tempo , Reino Unido , Caminhada/fisiologia
9.
Nanotechnology ; 35(38)2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38925105

RESUMO

Lu doped Hf0.5Zr0.5O2(HZO) ferroelectric films were prepared on Pt/TiN/SiO2/Si substrate by chemical solution deposition method, and an interfacial engineering strategy for improving the ferroelectric property was explored by capping the Lu doped HZO films with a cerium oxide layer. Compared with the Lu doped HZO film without the CeOxcoating layer, the Lu doped HZO film with the CeOxcoating layer has a larger remanent polarization (2Pr= 34.72µC cm-2) and presents weaker wake-up behavior, which result from the higher orthogonal phase ratio and the lower oxygen vacancy of the CeOxcoated Lu doped HZO film. In addition, the CeOxcoating can remarkably improve the fatigue resistance and retention performance of the Lu doped HZO films. It is hoped that the results can provide an effective approach for the realization of high-performance and highly reliable hafnium oxide based ferroelectric thin films.

10.
Artigo em Inglês | MEDLINE | ID: mdl-38791798

RESUMO

BACKGROUND: The COVID-19 lockdown had a profound effect on everyday life, including sleep health. This systematic review and meta-analysis evaluated changes in quantitative sleep parameters during the first lockdown compared with pre-lockdown in the general population. METHODS: A search in scientific databases was performed to identify eligible observational studies from inception to 8 February 2023. We performed a random effects meta-analysis of those studies reporting (a) means of sleep duration, time in bed (TIB), and sleep timing (bedtime and wake-up time); (b) the percentages of atypical sleep duration before and during the lockdown; (c) the percentages of change in sleep duration and sleep timing. RESULTS: A total of 154 studies were included. A small increase in sleep duration (0.25 standardized mean difference, 95% CI 0.180-0.315) was found, with 55.0% of the individuals reporting changes, predominantly an increase (35.2%). The pooled relative risk for sleeping more than 8/9 h per night was 3.31 (95% IC 2.60-4.21). There was a moderately significant delay in sleep timing and a surge in napping. CONCLUSION: An increase in sleep duration and napping, and delayed sleep timing were observed. High-quality studies should evaluate whether these parameters have now become chronic or have returned to pre-lockdown values.


Assuntos
COVID-19 , Sono , COVID-19/epidemiologia , Humanos , Quarentena , Fatores de Tempo , SARS-CoV-2 , Duração do Sono
11.
ACS Appl Mater Interfaces ; 16(19): 24987-24998, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38712685

RESUMO

For traditional ferroelectric field-effect transistors (FeFETs), enhancing the polarization domain of bulk ferroelectric materials is essential to improve device performance. However, there has been limited investigation into the enhancement of polarization field in two-dimensional (2D) ferroelectric material such as CuInP2S6 (CIPS). In this study, similar to bulk ferroelectric materials, CIPS exhibited enhanced polarization field upon application of external cyclic voltage. Moreover, unlike traditional ferroelectric materials, the polarization enhancement of CIPS is not due to redistribution of the defect but rather originates from a mechanism: the long-distance migration of Cu ions. We termed this mechanism the "wake-up-like effect". After incorporating the wake-up-like effect into the graphene/CIPS/WSe2 FeFET device, we successfully increased the hysteresis window and enhanced the current on/off ratio by 4 orders of magnitude. Moreover, the FeFET yielded remarkable achievements, such as multilevel nonvolatile memory with 21 distinct conductance levels, a high on/off ratio exceeding 106, a long retention time exceeding 103 s, and neuromorphic computing with 93% accuracy at recognizing handwritten digits. Introducing the wake-up-like effect to 2D CIPS may pave the way for innovative approaches to achieve advanced multilevel nonvolatile memory and neuromorphic computing capabilities for next-generation micro-nanoelectronic devices.

12.
Neurol Sci ; 45(10): 4871-4879, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38772977

RESUMO

OBJECTIVES: Wake-up Stroke (WUS) accounts for about 25% of all ischemic strokes. Differences according to sex in the WUS subgroup has been poorly investigated so far, so we aimed to assess these differences by differentiating the enrolled population based on treatment administered. MATERIALS & METHODS: We retrospectively analysed clinical and imaging data of WUS patients admitted to our hospital between November 2013 and December 2018 dividing them in two groups: rTPA-treated and non-rTPA treated group. To point out outcome differences we evaluated: NIHSS at 7 days or at discharge, mRS at discharge and ΔNIHSS. RESULTS: We enrolled 149 WUS patients, 74 rTPA treated and 75 non-rTPA treated. Among rTPA treated patients, time from last known well (LKW) to Emergency Department (ED) admission was longer in females than males (610 vs 454 min), while females had a higher ΔNIHSS than males (5 vs 3). Finally, among non-rTPA treated patients, females were older than males (85 vs 79 years), had a higher pre-admission mRS (although very low in both cases), had a longer length of stay (17 vs 13 days) and shown a higher NIHSS at discharge (4 vs 2) compared to males. CONCLUSIONS: Females not receiving thrombolytic treatment had worse functional outcome than males, showing a higher NIHSS at discharge but, in contrast, when treated with rTPA they showed better neurological recovery as measured by a greater ΔNIHSS. We emphasize the importance of a prompt recognition of WUS in females since they seem to benefit more from rTPA treatment.


Assuntos
Fibrinolíticos , AVC Isquêmico , Ativador de Plasminogênio Tecidual , Humanos , Feminino , Masculino , Idoso , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Ativador de Plasminogênio Tecidual/uso terapêutico , AVC Isquêmico/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Caracteres Sexuais , Pessoa de Meia-Idade , Resultado do Tratamento , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica
13.
J Clin Sleep Med ; 20(4): 545-553, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38561941

RESUMO

STUDY OBJECTIVES: Previous studies have highlighted the importance of sleep patterns for human health. This study aimed to investigate the association of sleep timing with all-cause and cardiovascular disease mortality. METHODS: Participants were screened from two cohort studies: the Sleep Heart Health Study (SHHS; n = 4,824) and the Osteoporotic Fractures in Men Study (n = 2,658). Sleep timing, including bedtime and wake-up time, was obtained from sleep habit questionnaires at baseline. The sleep midpoint was defined as the halfway point between the bedtime and wake-up time. Restricted cubic splines and Cox proportional hazards regression analyses were used to examine the association between sleep timing and mortality. RESULTS: We observed a U-shaped association between bedtime and all-cause mortality in both the SHHS and Osteoporotic Fractures in Men Study groups. Specifically, bedtime at 11:00 pm and waking up at 7:00 am was the nadir for all-cause and cardiovascular disease mortality risks. Individuals with late bedtime (> 12:00 am) had an increased risk of all-cause mortality in SHHS (hazard ratio 1.53, 95% confidence interval 1.28-1.84) and Osteoporotic Fractures in Men Study (hazard ratio 1.27, 95% confidence interval 1.01-1.58). In the SHHS, late wake-up time (> 8:00 am) was associated with increased all-cause mortality (hazard ratio 1.39, 95% confidence interval 1.13-1.72). No significant association was found between wake-up time and cardiovascular disease mortality. Delaying sleep midpoint (> 4:00 am) was also significantly associated with all-cause mortality in the SHHS and Osteoporotic Fractures in Men Study. CONCLUSIONS: Sleep timing is associated with all-cause and cardiovascular disease mortality. Our findings highlight the importance of appropriate sleep timing in reducing mortality risk. CITATION: Ma M, Fan Y, Peng Y, et al. Association of sleep timing with all-cause and cardiovascular mortality: the Sleep Heart Health Study and the Osteoporotic Fractures in Men Study. J Clin Sleep Med. 2024;20(4):545-553.


Assuntos
Doenças Cardiovasculares , Fraturas por Osteoporose , Masculino , Humanos , Doenças Cardiovasculares/complicações , Sono , Polissonografia , Estudos de Coortes
14.
ACS Appl Mater Interfaces ; 16(17): 22122-22130, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38626418

RESUMO

The recent discovery of ferroelectricity in pure ZrO2 has drawn much attention, but the information storage and processing performances of ferroelectric ZrO2-based nonvolatile devices remain open for further exploration. Here, a ZrO2 (∼8 nm)-based ferroelectric capacitor using RuO2 oxide electrodes is fabricated, and the ferroelectric orthorhombic phase evolution under electric field cycling is studied. A ferroelectric remnant polarization (2Pr) of >30 µC/cm2, leakage current density of ∼2.79 × 10-8 A/cm2 at 1 MV/cm, and estimated polarization retention of >10 years are achieved. When the ferroelectric capacitor is connected with a transistor, a memory window of ∼0.8 V and eight distinct states can be obtained in such a ferroelectric field-effect transistor (FeFET). Through the conductance manipulation of the FeFET, a high object image recognition accuracy of ∼93.32% is achieved on the basis of the CIFAR-10 dataset in the convolutional neural network (CNN) simulation, which is close to the result of ∼94.20% obtained by floating-point-based CNN software. These results demonstrate the potential of ferroelectric ZrO2 devices for nonvolatile memory and artificial neural network computing.

15.
Can J Neurol Sci ; : 1-7, 2024 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-38639107

RESUMO

BACKGROUND: We investigated the impact of workflow times on the outcomes of patients treated with endovascular thrombectomy (EVT) in the late time window. METHODS: Individual patients' data who underwent EVT in the late time window (onset to imaging >6 hours) were pooled from seven registries and randomized clinical trials. Multiple time intervals were analyzed. Mixed-effects logistic regression was used to estimate the likelihood of functional independence at 90 days (modified Rankin Scale 0-2). Mixed-effects negative binomial regression was used to evaluate the relationship between patient characteristics and workflow time intervals. RESULTS: 608 patients were included. The median age was 70 years (IQR: 58-71), 307 (50.5%) were female, and 310 (53.2%) had wake-up strokes. Successful reperfusion was achieved in 493 (81.2%) patients, and 262 (44.9%) achieved 90-day mRS 0-2. The estimated odds of functional independence decreased by 13% for every 30 minute delay from emergency department (ED) arrival to imaging time and by 7% from ED arrival to the end of EVT in the entire cohort. Also, the estimated odds of functional independence decreased by 33% for every 30 minute delay in the interval from arterial puncture to end of EVT, 16% in the interval from arrival in ED to end of EVT and 6% in the interval from stroke onset to end of EVT among patients who had a wake-up stroke. CONCLUSION: Faster workflow from ED arrival to end of EVT is associated with improved functional independence among stroke patients treated in the late window.

16.
J Thromb Thrombolysis ; 57(5): 797-804, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38662115

RESUMO

OBJECTIVE: This purpose of this study is to investigate the effectiveness and safety of utilizing the arterial spin-labeling (ASL) combined with diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) combined with DWI double mismatch in the endovascular treatment of patients diagnosed with wake-up stroke (WUS). METHODS: In this single-center trial, patients diagnosed with WUS underwent thrombectomy if acute ischemic lesions were observed on DWI indicating large precerebral circulation occlusion. Patients with no significant parenchymal hypersignal on FLAIR and ASL imaging showing a hypoperfusion tissue to infarct core volume ratio of at least 1.2 were included. The participants were divided into groups receiving endovascular thrombectomy plus medical therapy or medical therapy alone, based on their subjective preference. Functional outcomes were assessed using the ordinal score on the modified Rankin scale (mRs) at 90 days, along with the rate of functional independence. RESULTS: In this study, a total of 77 patients were included, comprising 38 patients in the endovascular therapy group and 39 patients in the medical therapy group. The endovascular therapy group exhibited more favorable changes in the distribution of functional prognosis measured by mRs at 90 days, compared to the medical therapy group (adjusted common odds ratio, 3.25; 95% CI, 1.03 to 10.26; P < 0.01). Additionally, the endovascular therapy group had a higher proportion of patients achieving functional independence (odds ratio, 4.0; 95% CI, 1.36 to 11.81; P < 0.01). Importantly, there were no significant differences observed in the incidence of intracranial hemorrhage or mortality rates between the two groups. CONCLUSION: Guided by the ASL-DWI and FLAIR-DWI double mismatch, endovascular thrombectomy combined with standard medical treatment appears to yield superior functional outcomes in patients with WUS and large vessel occlusion compared to standard medical treatment alone.


Assuntos
Imagem de Difusão por Ressonância Magnética , Procedimentos Endovasculares , Marcadores de Spin , Trombectomia , Humanos , Trombectomia/métodos , Imagem de Difusão por Ressonância Magnética/métodos , Masculino , Feminino , Procedimentos Endovasculares/métodos , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/cirurgia , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/cirurgia , AVC Isquêmico/terapia , AVC Isquêmico/fisiopatologia
17.
Stroke ; 55(4): 895-904, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38456303

RESUMO

BACKGROUND: Stroke with unknown time of onset can be categorized into 2 groups; wake-up stroke (WUS) and unwitnessed stroke with an onset time unavailable for reasons other than wake-up (non-wake-up unwitnessed stroke, non-WUS). We aimed to assess potential differences in the efficacy and safety of intravenous thrombolysis (IVT) between these subgroups. METHODS: Patients with an unknown-onset stroke were evaluated using individual patient-level data of 2 randomized controlled trials (WAKE-UP [Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke], THAWS [Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes With Alteplase at 0.6 mg/kg]) comparing IVT with placebo or standard treatment from the EOS (Evaluation of Unknown-Onset Stroke Thrombolysis trial) data set. A favorable outcome was prespecified as a modified Rankin Scale score of 0 to 1 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage at 22 to 36 hours and 90-day mortality. The IVT effect was compared between the treatment groups in the WUS and non-WUS with multivariable logistic regression analysis. RESULTS: Six hundred thirty-four patients from 2 trials were analyzed; 542 had WUS (191 women, 272 receiving alteplase), and 92 had non-WUS (42 women, 43 receiving alteplase). Overall, no significant interaction was noted between the mode of onset and treatment effect (P value for interaction=0.796). In patients with WUS, the frequencies of favorable outcomes were 54.8% and 45.5% in the IVT and control groups, respectively (adjusted odds ratio, 1.47 [95% CI, 1.01-2.16]). Death occurred in 4.0% and 1.9%, respectively (P=0.162), and symptomatic intracranial hemorrhage in 1.8% and 0.3%, respectively (P=0.194). In patients with non-WUS, no significant difference was observed in favorable outcomes relative to the control (37.2% versus 29.2%; adjusted odds ratio, 1.76 [0.58-5.37]). One death and one symptomatic intracranial hemorrhage were reported in the IVT group, but none in the control. CONCLUSIONS: There was no difference in the effect of IVT between patients with WUS and non-WUS. IVT showed a significant benefit in patients with WUS, while there was insufficient statistical power to detect a substantial benefit in the non-WUS subgroup. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: CRD42020166903.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Feminino , Ativador de Plasminogênio Tecidual , Fibrinolíticos , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/induzido quimicamente , AVC Isquêmico/tratamento farmacológico , Hemorragias Intracranianas/etiologia , Isquemia Encefálica/tratamento farmacológico
18.
Front Pediatr ; 12: 1367337, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38464893

RESUMO

Objectives: To describe the use and outcomes of the neurological wake-up test (NWT) in pediatric severe traumatic brain injury (pTBI). Design: Retrospective single-center observational cohort study. Setting: Medical-surgical tertiary pediatric intensive care unit (PICU) in a university medical center and Level 1 Trauma Center. Patients: Children younger than 18 years with severe TBI [i.e., Glasgow Coma Scale (GCS) of ≤8] admitted between January 2010 and December 2020. Subjects with non-traumatic brain injury were excluded. Measurements and main results: Of 168 TBI patients admitted, 36 (21%) met the inclusion criteria. Median age was 8.5 years [2 months to 16 years], 5 patients were younger than 6 months. Median initial Glasgow Coma Scale (GCS) and Glasgow Motor Scale (GMS) was 6 [3-8] and 3 [1-5]. NWTs were initiated in 14 (39%) patients, with 7 (50%) labelled as successful. Fall from a height was the underlying injury mechanism in those seven. NWT-failure occurred in patients admitted after traffic accidents. Sedation use in both NWT-subgroups (successful vs. failure) was comparable. Cause of NWT-failure was non-arousal (71%) or severe agitation (29%). Subjects with NWT failure subsequently had radiological examination (29%), repeat NWT (43%), continuous interruption of sedation (14%) or intracranial pressure (ICP) monitoring (14%). The primary reason for not doing NWTs was intracranial hypertension in 59%. Compared to the NWT-group, the non-NWT group had a higher PRISM III score (18.9 vs. 10.6), lower GCS/GMS at discharge, more associated trauma, and circulatory support. Nine patients (25%) died during their PICU admission, none of them had an NWT. Conclusion: We observed limited use of NWTs in pediatric severe TBI. Patients who failed the NWT were indistinguishable from those without NWT. Both groups were more severely affected compared to the NWT successes. Therefore, our results may indicate that only a select group of severe pTBI patients qualify for the NWT.

19.
Nanotechnology ; 35(23)2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38430571

RESUMO

In recent times, there has been a notable surge of interests in hafnia (HfO2)-based ferroelectrics, primarily due to their remarkable ferroelectric properties employed in ultra-thin configurations, alongside their compatibility with the conventional CMOS manufacturing process. In order to harness the full potential of HfO2-based films for high-performance non-volatile memory applications, it is imperative to enhance their ferroelectric characteristics and durability. This study introduces a straightforward approach aimed at augmenting the ferroelectric performance of HfxZr1-xO2(HZO) films deposited on silicon (Si) substrates through the engineering of oxygen vacancies (VO). The results of this endeavor demonstrate a significant enhancement in ferroelectric performance, characterized by a 2Pr value of 47µC cm-2and impressive endurance, enduring up to 108cycles under an 8 MV cm-1electric field without the need of a wake-up process. This marked improvement can be attributed to a dual-pronged approach, involving the incorporation of an Al2O3interlayer and the introduction of Al atoms into the HZO film. The Al2O3interlayer primarily serves to mitigate the presence of oxygen vacancies at the interface, while the introduction of Al dopants elevates the concentration of oxygen vacancies within the bulk material. This modulation of oxygen vacancy concentration proves instrumental in facilitating the formation of a ferroelectric o-III phase within the HZO-based films, thereby further augmenting their ferroelectric performance. This innovative and effective strategy offers an alternative avenue for enhancing the ferroelectric properties of materials characterized by a fluorite crystal structure.

20.
Sensors (Basel) ; 24(3)2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38339519

RESUMO

Indoor localization of a mobile target represents a prominent application within wireless sensor network (WSN), showcasing significant values and scientific interest. Interference, obstacles, and energy consumption are critical challenges for indoor applications and battery replacements. A proposed tracking system deals with several factors such as latency, energy consumption, and accuracy presenting an innovative solution for the mobile localization application. In this paper, a novel algorithm introduces a self-localization algorithm for mobile targets using the wake-up media access control (MAC) protocol. The developed tracking application is based on the trilateration technique with received signal strength indication (RSSI) measurements. Simulations are implemented in the objective modular network testbed in C++ (OMNeT++) discrete event simulator using the C++ programming language, and the RSSI values introduced are based on real indoor measurements. In addition, a determination approach for finding the optimal parameters of RSSI is assigned to implement for the simulation parameters. Simulation results show a significant reduction in power consumption and exceptional accuracy, with an average error of 1.91 m in 90% of cases. This method allows the optimization of overall energy consumption, which consumes only 2.69% during the localization of 100 different positions.

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