ABSTRACT
BACKGROUND: Standard treatment for eligible patients presenting with acute ischemic stroke (AIS) is thrombolysis with tissue plasminogen activators alteplase or tenecteplase. Current guidelines recommend monitoring patients in an intensive care unit (ICU) for 24 h after thrombolytic therapy. However, recent studies have questioned the need for prolonged ICU monitoring. This retrospective cohort study aims to identify potential candidates for early transition to a lower level of care by assessing risk factors for neurological deterioration, symptomatic intracranial hemorrhage (sICH), or need for ICU intervention within 24 h post-thrombolysis. METHODS: This retrospective cohort study included adult patients 18 years and older with AIS who received thrombolysis. Patients were excluded if they were transferred to another facility, if they were transitioned to comfort care or hospice care within 24 h, or if they lacked imaging and National Institutes of Health Stroke Scale (NIHSS) score data. The primary end point was incidence of sICH between 0-12 and 12-24 h. Secondary end points included the need for ICU intervention and rates of neurological deterioration. RESULTS: The analysis included 204 patients who received the full dose of alteplase. Among them, ten patients (4.9%) developed sICH, with the majority (n = 7) occurring within 12 h post-thrombolysis. Sixty-two patients required ICU interventions within 12 h compared with four patients after 12 h. Twenty-four patients had neurological deterioration within 12 h, and seven patients had neurological deterioration after 12 h. Multivariable analysis identified mechanical thrombectomy and increased blood pressure at presentation as predictors of ICU need beyond 12 h post-thrombolysis. CONCLUSIONS: Our study demonstrates that sICH, neurological deterioration, and need for ICU intervention rarely occur beyond 12 h after thrombolytic administration. Patients presenting with blood pressures < 140/90 mm Hg, NIHSS scores < 10, and not undergoing mechanical thrombectomy may be best candidates for early de-escalation. Larger prospective studies are needed to more fully evaluate the safety, feasibility, and financial impact of early transition out of the ICU.
ABSTRACT
BACKGROUND: Elevated intracranial pressure (ICP) is a neurological emergency in patients with acute brain injuries. Such a state requires immediate and effective interventions to prevent potential neurological deterioration. Current clinical guidelines recommend hypertonic saline (HTS) and mannitol as first-line therapeutic agents. Notably, HTS is conventionally administered through central venous catheters (CVCs), which may introduce delays in treatment due to the complexities associated with CVC placement. These delays can critically affect patient outcomes, necessitating the exploration of more rapid therapeutic avenues. This study aimed to investigate the safety and effect on ICP of administering rapid boluses of 3% HTS via peripheral intravenous (PIV) catheters. METHODS: A retrospective cohort study was performed on patients admitted to Sisters of Saint Mary Health Saint Louis University Hospital from March 2019 to September 2022 who received at least one 3% HTS bolus via PIV at a rate of 999 mL/hour for neurological emergencies. Outcomes assessed included complications related to 3% HTS bolus and its effect on ICP. RESULTS: Of 216 3% HTS boluses administered in 124 patients, complications occurred in 8 administrations (3.7%). Pain at the injection site (4 administrations; 1.9%) and thrombophlebitis (3 administrations; 1.4%) were most common. The median ICP reduced by 6 mm Hg after 3% HTS bolus administration (p < 0.001). CONCLUSIONS: Rapid bolus administration of 3% HTS via PIV catheters presents itself as a relatively safe approach to treat neurological emergencies. Its implementation could provide an invaluable alternative to the traditional CVC-based administration, potentially minimizing CVC-associated complications and expediting life-saving interventions for patients with neurological emergencies, especially in the field and emergency department settings.
Subject(s)
Catheterization, Peripheral , Intracranial Hypertension , Humans , Saline Solution, Hypertonic/administration & dosage , Female , Retrospective Studies , Middle Aged , Male , Intracranial Hypertension/drug therapy , Intracranial Hypertension/etiology , Intracranial Hypertension/therapy , Adult , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/instrumentation , Catheterization, Peripheral/methods , Aged , Intracranial Pressure/drug effects , Emergencies , Brain Injuries/therapyABSTRACT
The surface cleaning of metals plays a pivotal role in ensuring their overall performance and functionality. Dielectric barrier discharge (DBD) plasma, due to its unique properties, has been considered to be a good alternative to traditional cleaning methods. The confinement of DBD plasma in microreactors brings additional benefits, including excellent stability at high pressures, enhanced density of reactive species, reduced safety risks, and less gas and energy consumption. In the present work, we demonstrated a DBD plasma-based method for the degradation of stains from metal surfaces in a microreactor. Aluminum plates with capsanthin stains were used to investigate the influence of operational parameters on the decolorization efficiency, including plasma discharge power, plasma processing time, and O2 content in the atmosphere. The results revealed that an increase in plasma discharge power and plasma processing time together with an appropriate amount of O2 in the atmosphere promote the degradation of capsanthin stains. The optimum processing condition was determined to be the following: plasma power of 11.3 W, processing time of 3 min, and Ar/O2 flow rate of 48/2 sccm. The evolution of composition, morphology, bonding configuration, and wettability of aluminum plates with capsanthin and lycopene stains before and after plasma treatment were systematically investigated, indicating DBD plasma can efficiently degrade stains from the surface of metals without damage. On this basis, the DBD plasma cleaning approach was extended to degrade rhodamine B and malachite green stains from different metals, suggesting it has good versatility. Our work provides a simple, efficient, and solvent-free approach for the surface cleaning of metals.
ABSTRACT
Streptococcus bovis/Streptococcus equinus complex includes the subspecies Streptococcus alactolyticus. The prevalence of systemic infection in humans with S alactolyticus is scarce. We present a case of infective endocarditis complicated with hemorrhagic and ischemic stroke in a healthy 31-year-old woman.
ABSTRACT
Passive daytime radiative cooling (PDRC) is an energy-saving technology without an additional energy supply or environmental pollution. At present, most PDRC coatings for buildings are only aiming at high solar reflectivity (RS) and high mid-infrared emissivity (EMIR) while ignoring practicalities such as adhesion strength, scalability, and durability. In this work, modified calcined kaolin/(ethylene trifluorochloroethylene copolymer-polydimethylsiloxane) (MK/(FEVE-PDMS)) coating with super practicability is prepared by using MK as a filler, FEVE as an adhesive, and PDMS as a hydrophobic modifier. The RS and EMIR of the coating are 92.5 and 94.6%, respectively. The MK/(FEVE-PDMS) coating exhibits superhydrophobicity, with an advancing contact angle (ACA) of 160.2° and a hysteresis contact angle of 7.3°. At an average solar irradiance of 742.78 W m-2, the coating achieved a temperature drop of 13.12 °C (shielded with PE film) and 3.09 °C (without shielding), respectively, relative to the environment. The coating adheres firmly to the substrate with an adhesion strength of class 2. The superhydrophobicity of the coating provides excellent durability and ease of repair, which can resist UV aging and mechanical damage. The durable superhydrophobicity gives the coating long-term stability in PDRC performance. Additionally, the cheap raw materials and the preparation process, consistent with the production of existing paints, show excellent scalability. Moreover, the energy consumption simulation results show that the energy saving ratio of the coating is more than 10% in the densely populated Yangtze River Delta and Pearl River Delta. The durable self-cleaning radiative coating developed in this work has potential application prospects in areas where the demand for cooling in summer is large and the demand for heating in winter is small.