Effects of Tirofiban on Neurological Deterioration in Patients With Acute Ischemic Stroke: A Randomized Clinical Trial.

Importance: Evidence supports using antiplatelet therapy in patients with acute ischemic stroke. However, neurological deterioration remains common under the currently recommended antiplatelet regimen, leading to poor clinical outcomes. Objective: To determine whether intravenous tirofiban administered within 24 hours of stroke onset prevents early neurological deterioration in patients with acute noncardioembolic stroke compared with oral aspirin. Design, Setting, and Participants: This investigator-initiated, multicenter, open-label, randomized clinical trial with blinded end-point assessment was conducted at 10 comprehensive stroke centers in China between September 2020 and March 2023. Eligible patients were aged 18 to 80 years with acute noncardioembolic stroke within 24 hours of onset and had a National Institutes of Health Stroke Scale (NIHSS) score of 4 to 20. Intervention: Patients were assigned randomly (1:1) to receive intravenous tirofiban or oral aspirin for 72 hours using a central, web-based, computer-generated randomization schedule; all patients then received oral aspirin. Main Outcome: The primary efficacy outcome was early neurological deterioration (increase in NIHSS score ≥4 points) within 72 hours after randomization. The primary safety outcome was symptomatic intracerebral hemorrhage within 72 hours after randomization. Results: A total of 425 patients were included in the intravenous tirofiban (n = 213) or oral aspirin (n = 212) groups. Median (IQR) age was 64.0 years (56.0-71.0); 124 patients (29.2%) were female, and 301 (70.8%) were male. Early neurological deterioration occurred in 9 patients (4.2%) in the tirofiban group and 28 patients (13.2%) in the aspirin group (adjusted relative risk, 0.32; 95% CI, 0.16-0.65; P = .002). No patients in the tirofiban group experienced intracerebral hemorrhage. At 90-day follow-up, 3 patients (1.3%) in the tirofiban group and 3 (1.5%) in the aspirin group died (adjusted RR, 1.15; 95% CI, 0.27-8.54; P = .63), and the median (IQR) modified Rankin scale scores were 1.0 (0-1.25) and 1.0 (0-2), respectively (adjusted odds ratio, 1.28; 95% CI, 0.90-1.83; P = .17). Conclusions and Relevance: In patients with noncardioembolic stroke who were seen within 24 hours of symptom onset, tirofiban decreased the risk of early neurological deterioration but did not increase the risk of symptomatic intracerebral hemorrhage or systematic bleeding. Trial Registration: ClinicalTrials.gov Identifier: NCT04491695.

Development and validation of the perceived restorative soundscape scale for children.

Introduction: Prolonged exposure to noise environments can induce stress and fatigue, even impacting individuals' physical and mental health. Conversely, positive soundscapes can have a beneficial impact on health by alleviating stress and fatigue, promoting psychological recovery. To assess the restorative potential of soundscapes, various scales have been developed to create environments conducive to recovery. However, current research on perceptual restorativeness soundscape scales primarily focuses on adults, lacking a dedicated scale for children to evaluate the restorative potential of their surrounding acoustic environments from their perspective. Methods: Therefore, this study introduces the development and validation process of the Perceived Restorativeness of Soundscapes Scale for Children (PRSS-C) using survey questionnaires and data statistical analysis. Results: The study comprises two experiments. Experiment one aims to develop an effective PRSS-C, evaluating the restorative potential of soundscapes in different environments (urban center, urban suburb, and urban peripheral forest) among 185 children aged 10-12. Through a series of analyses, a dual-factor structure scale consisting of 15 items is developed, revealing that the restorative potential of soundscapes is lower in urban centers than in urban suburbs and lower in urban suburbs than in urban peripheral forests. Experiment two aims to further validate the effectiveness of PRSS-C. 244 children aged 10-12 assess the restorative potential of soundscapes in similar environments (two city parks) using the PRSS-C developed in experiment one. Factor analysis confirms the dual-factor structure, with assessment results indicating that the restorative potential of soundscapes in Temple of Heaven Park is lower than in the National Botanical Garden. This suggests that PRSS-C enables children to differentiate the restorative potential of soundscapes in similar environments within the same city, further confirming its effectiveness. Discussion: This study successfully develops and validates the PRSS-C through two experiments. The use of this scale allows for the assessment of the restorative potential of acoustic environments surrounding children, providing an effective tool for evaluating and creating positive soundscapes for children.

Stimulated Brillouin laser-based carrier recovery in a high-Q microcavity for coherent detection.

We demonstrate all-optical carrier recovery exploring a stimulated Brillouin laser (SBL) in a high-Q whispering-gallery-mode microcavity, to achieve coherent data detection without requiring an independent local oscillator laser. An ultra-high optical signal-to-noise ratio better than 70 dB is achieved for the recovered carrier, thanks to the fact that the generated SBL counter-propagates with the incoming data signal and experiences high SBS efficiency. High-frequency stability is obtained between the recovered carrier tone and the original data signal, enabling high-performance coherent detection without the need of electrical frequency drift compensation. This Letter offers a low complexity, high energy efficiency, and high robust carrier recovery solution.