Prior anticoagulation and bridging thrombolysis improve outcomes in patients with atrial fibrillation undergoing endovascular thrombectomy for anterior circulation stroke.

BACKGROUND: Where stroke occurs with pre-existing atrial fibrillation (AF)studies validating the safety and efficacy of bridging thrombolysis, and the use of endovascular thrombectomy (EVT) in the setting of prior anticoagulation, are limited to single-center reports. METHODS: In a retrospective analysis, AF patients undergoing EVT for anterior circulation large vessel occlusion stroke enrolled in a prospectively-maintained, international multicenter database (International Stroke Perfusion Imaging Registry (INSPIRE)) between 2016 and 2019 were studied. Patients were categorized by anticoagulation status: anticoagulated (warfarin/non-vitamin K oral anticoagulants) versus not anticoagulated. Patients not anticoagulated were further divided into intravenous thrombolysis versus no thrombolysis. Outcomes compared between groups included 90-day modified Rankin Scale, 90-day mortality, rates of symptomatic intracerebral hemorrhage (sICH), and good reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3). RESULTS: Of 563 AF patients, 118 (21%) were on anticoagulation. AF patients on anticoagulation showed improved 90-day functional outcomes (adjusted odds ratio (aOR) 1.68, 95% confidence interval (95% CI) 1.00 to 2.82). Mortality (26.3% vs 23.8%), sICH (4.5% vs 3.9%), and rates of good reperfusion (91.3% vs 88.0%) were similar between those anticoagulated and those not anticoagulated. Thrombolysis before EVT in AF patients was independently associated with improved 90-day functional outcomes (aOR 1.81, 95% CI 1.18 to 2.79) and reduced mortality (aOR 0.51, 95% CI 0.31 to 0.84), with similar sICH rates (3.4% vs 4.5%). CONCLUSIONS: Anticoagulated patients with AF who underwent EVT had improved 90-day functional outcomes and similar sICH rates. Thrombolysis before EVT in AF patients was associated with improved 90-day functional outcomes and reduced mortality.

Processing renewable and waste-based feedstocks with fluid catalytic cracking: Impact on catalytic performance and considerations for improved catalyst design.

Refiners around the globe are either considering or are actively replacing a portion of their crude oil inputs originating from fossil sources with alternative sources, including recycled materials (plastics, urban waste, mixed solid waste) and renewable materials (bio-mass waste, vegetable oils). In this paper, we explore such replacement, specifically focusing on the fluid catalytic cracking (FCC) operation. Five pyrolysis oils, obtained from municipal solid waste (MSW) and biogenic material (olive stones/pits), were fully characterized and tested at 10% loading against a standard fluid catalytic cracking (FCC) vacuum gasoil (VGO) feed in a bench scale reactor using an industrially available fluid catalytic cracking catalyst based on ultrastable Y zeolite to simulate fluid catalytic cracking co-processing. Despite having unique feed properties, including high Conradson carbon (e.g., up to 19.41 wt%), water (e.g., up to 5.7 wt%), and contaminants (e.g., up to 227 ppm Cl) in some cases, the five pyrolysis oils gave similar yield patterns as vacuum gasoil. Gasoline was slightly (ca. 1 wt%) higher in all cases and LPG slightly (ca. 1 wt%) lower. Olefinicity in the LPG streams were unchanged, bottoms and light cycle oil (LCO) showed no significant changes, while dry gas was slightly (up to -0.2 wt%) lower. Coke selectivity was also unchanged (maximum -7.7 wt%, relatively), suggesting minimal to no heat balance concerns when co-processing in an industrial fluid catalytic cracking unit. The results demonstrate the applicability of municipal solid waste and biogenic originating pyrolysis oils into a refinery. A catalyst design concept is explored, based on higher rare Earth oxide exchange and/or utilization of ZSM-5 zeolite, that would further minimize the impacts of replacing fossil oils with pyrolysis oils, namely one that shifts the 1% higher gasoline into LPG.

Half-stained thread in shoulder arthroscopy: an improved method of suture management.

Shoulder arthroscopy is used widely to treat a variety of shoulder pathologies. These include various diagnostic and stabilization procedures such as Bankart repair, treating SLAP lesions, capsular plication, and rotator cuff repair. Sutures are commonly used, particularly in stabilization procedures, with or without the use of suture anchors. Suture management is one of the prerequisites for a successful arthroscopic stabilization procedure. We describe a simple method of aiding suture management. In cases using the suture anchor, the preloaded suture is firstly removed from the anchor, and approximately half the length of the suture is stained with methylene blue. The suture is then reinserted into the same suture anchor. The suture anchor is used in the usual manner. During shoulder arthroscopy, one end of the suture is pulled, if necessary, to determine the direction of the thread, which is readily shown by the methylene blue. This simple maneuver helps the surgeon identify the desired direction of the thread and avoid the common problems of pulling out the suture and twisting the sutures.

Peroneal padding: an alternative to a peroneal post in hip arthroscopy.

Hip arthroscopy is commonly used both to diagnose and treat different underlying hip conditions. It may be performed either by a supine or lateral approach. A peroneal post is commonly used with a fracture table in both the supine and lateral positions to provide lateralization and traction of the femur. Adequate distraction of the hip joint may be difficult without the peroneal post. We achieved an effect similar to that of a peroneal post using a simple technique of peroneal padding. A long cushioning jelly bag is first wrapped around the peroneal post. It is then fixed by taping and further secured by bandaging. The patient is positioned so that the femur lies against this peroneal padding to provide optimal lateralization of the femur. Distraction of the hip joint is then performed by traction of the femur. We believe peroneal padding is a simple technique that allows adequate lateralization and good positioning of the femur.