Thrombolysis for Wake-Up Stroke Versus Non-Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis.

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.

Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes with Alteplase at 0.6 mg/kg in Clinical Practice: THAWS2 Study.

INTRODUCTION: The aim of this study was to determine the safety and efficacy of intravenous (IV) alteplase at 0.6 mg/kg for patients with acute wake-up or unclear-onset strokes in clinical practice. METHODS: This multicenter observational study enrolled acute ischemic stroke patients with last-known-well time >4.5 h who had mismatch between DWI and FLAIR and were treated with IV alteplase. The safety outcomes were symptomatic intracranial hemorrhage (sICH) after thrombolysis, all-cause deaths, and all adverse events. The efficacy outcomes were favorable outcome defined as an mRS score of 0-1 or recovery to the same mRS score as the premorbid score, complete independence defined as an mRS score of 0-1 at 90 days, and change in NIHSS at 24 h from baseline. RESULTS: Sixty-six patients (35 females; mean age, 74 ± 11 years; premorbid complete independence, 54 [82%]; median NIHSS on admission, 11) were enrolled at 15 hospitals. Two patients (3%) had sICH. Median NIHSS changed from 11 (IQR, 6.75-16.25) at baseline to 5 (3-12.25) at 24 h after alteplase initiation (change, -4.8 ± 8.1). At discharge, 31 patients (47%) had favorable outcome and 29 (44%) had complete independence. None died within 90 days. Twenty-three (35%) also underwent mechanical thrombectomy (no sICH, NIHSS change of -8.5 ± 7.3), of whom 11 (48%) were completely independent at discharge. CONCLUSIONS: In real-world clinical practice, IV alteplase for unclear-onset stroke patients with DWI-FLAIR mismatch provided safe and efficacious outcomes comparable to those in previous trials. Additional mechanical thrombectomy was performed safely in them.

Improving the ferroelectric properties of Lu doped Hf0.5Zr0.5O2thin films by capping a CeOxlayer.

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.

Enhancing ferroelectric performance in hafnia-based MFIS capacitor through interface passivation and bulk doping.

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.

Workflow and Outcome of Thrombectomy in Late Time Window: A Pooled Multicenter Analysis.

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.

Endovascular thrombectomy in wake-up stroke guided by arterial spin-labeling and fluid-attenuated inversion recovery versus diffusion-weighted imaging mismatch on MRI.

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.

Sex differences in Wake-Up Stroke patients characteristics and outcomes.

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.

The Effect of Using Anchored Wake Time to Derive 24-h Device Measured Circadian Physical Behavior Patterns.

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.

A Deep Learning-Based Emergency Alert Wake-Up Signal Detection Method for the UHD Broadcasting System.

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.

A Self-Localization Algorithm for Mobile Targets in Indoor Wireless Sensor Networks Using Wake-Up Media Access Control Protocol.

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.

Sex differences in imaging and clinical characteristics of patients from the WAKE-UP trial.

BACKGROUND AND PURPOSE: Sex-based differences in acute ischemic stroke are a well-known phenomenon. We aimed to explore these differences between women and men in the Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke (WAKE-UP) trial. METHODS: We compared baseline demographic and imaging characteristics (visual fluid-attenuated inversion recovery [FLAIR] positivity, relative FLAIR signal intensity, collateral status) between women and men in all screened patients. In randomized patients (i.e., those with diffusion-weighted imaging (DWI)-FLAIR mismatch), we evaluated a modifying role of sex on the treatment effect of alteplase in multivariable logistic regression, with treatment adjusted for National Institute of Health Stroke Scale (NIHSS) score and age. Dependent variables were modified Rankin Scale (mRS) score of 0-1 at 90 days and distribution of mRS scores at 90 days. RESULTS: Of 1362 screened patients, 529 (38.8%) were women. Women were older than men, had higher baseline NIHSS scores and smoked less frequently. FLAIR positivity of the DWI lesion was equally present in women (174/529, 33.1%) and men (273/833, 33.3%; p = 1.00) and other imaging variables also did not differ between the sexes. In a total of 503 randomized patients, of whom 178 were women (35.4%), sex did not modify the treatment effect of alteplase on mRS score 0-1 or on the total distribution of mRS scores. CONCLUSION: As in many other stroke trials, more men than women were included in the WAKE-UP trial, but the presence of a visual DWI-FLAIR mismatch and the relative FLAIR signal intensity did not differ between the sexes. The treatment effect of alteplase was not modified by sex.

Experimental study of endurance characteristics of Al-doped HfO2ferroelectric capacitor.

In this work, the endurance characteristics of Al-doped HfO2(HAO)-based metal-ferroelectric-metal (MFM) capacitors (which were annealed at 1000 °C) with various doping concentrations were investigated. The doping concentration was optimized for the high annealing temperature (1000 °C) process. To investigate the impact of cycling pulses on the endurance characteristics of HAO-based MFM capacitor, the rise/fall time (tr/f) and hold time (th) for the cycling pulses were varied. Moreover, by adopting the recoverable fatigue process, the endurance characteristics under repetitive wake-up/fatigue processes were studied. The HAO capacitors achieved the remnant polarization (2Pr) of 23.767µC cm-2at pristine state under the high annealing temperature. Furthermore, it was demonstrated that the endurance characteristics (∼108cycles) of the HAO capacitors were comparable to them of other HfO2-based ferroelectric capacitors. Lastly but not least, it turned out that the amount of oxygen and oxygen vacancies in the HAO thin film was dependent of doping concentrations for the film. The impact of oxygen and oxygen vacancies was quantitatively analyzed, in detail, with TEM, XPS and GIXRD analysis.

Wake-Up Receiver for Underwater Acoustic Communication Using in Shallow Water.

A data frame transmitted over the underwater acoustic channel usually begins with a preamble. Therefore, underwater communication systems have a dedicated receiver that constantly listens to the preamble signals. A receiver that is to work effectively in shallow waters must have solutions that effectively reduce the impact of the permanently occurring multipath propagation. The article presents a solution based on complementary broadband signals. Initial tests were carried out using the Watermark simulator to determine its reliability in such a difficult propagation environment. The results of experimental tests carried out in a model pool are also included. Details of the implementation of the wake-up receiver are presented.

Modeling of Packet Error Rate Distribution Based on Received Signal Strength Indications in OMNeT++ for Wake-Up Receivers.

Wireless sensor network (WSN) with energy-saving capabilities have drawn considerable attention in recent years, as they are the key for long-term monitoring and embedded applications. To improve the power efficiency of wireless sensor nodes, a wake-up technology was introduced in the research community. Such a device reduces the system's energy consumption without affecting the latency. Thereby, the introduction of wake-up receiver (WuRx)-based technology has grown in several sectors. The use of WuRx in a real environment without consideration of physical environmental conditions, such as the reflection, refraction, and diffraction caused by different materials, that affect the reliability of the whole network. Indeed, the simulation of different protocols and scenarios under such circumstances is a success key for a reliable WSN. Simulating different scenarios is required to evaluate the proposed architecture before its deployment in a real-world environment. The contribution of this study emerges in the modeling of different link quality metrics, both hardware and software metrics that will be integrated into an objective modular network testbed in C++ (OMNeT++) discrete event simulator afterward are discussed, with the received signal strength indicator (RSSI) for the hardware metric case and the packet error rate (PER) for the software metric study case using WuRx based on a wake-up matcher and SPIRIT1 transceiver. The different behaviors of the two chips are modeled using machine learning (ML) regression to define parameters such as sensitivity and transition interval for the PER for both radio modules. The generated module was able to detect the variation in the PER distribution as a response in the real experiment output by implementing different analytical functions in the simulator.

Proteomic analysis of the initial wake up of vibrio splendidus persister cells.

Vibrio splendidus is a ubiquitous pathogen that causes various diseases in aquaculture with a wide range of hosts. In our previous studies, we showed that L-glutamic acid was the optimal carbon source that could revive V. splendidus persister cells. In our present study, single cell observation under microscopy showed that V. splendidus could revive using L-glutamic acid as carbon source. A proteomic analysis was carried out to further illustrate the initial wake up of persister cells with L-glutamic acid. To collect the initially revived cells, SDS-PAGE was used to determine the revived time. The total proteins from the persister cells and the revived cells were analyzed using LC‒MS/MS. A total of 106 proteins, including 42 downregulated proteins and 64 upregulated proteins, were identified. GO analysis of the differentially expressed proteins (DEPs) showed that biological processes, including protein complex assembly, protein oligomerization, and arginine metabolism; cellular components, including extracellular membrane, plasma membrane and ribosome; and molecular functions, including the activities of arginine binding and structural constituent of ribosome, were enriched. KEGG analysis showed that lipopolysaccharide biosynthesis, porphyrin and chlorophyll metabolism, and peptidoglycan biosynthesis were upregulated, while the ribosome was downregulated. This is the first time to study the initial wake up of persister cells based on proteomic analysis, and the results revealed the main pathways involved in the early resuscitation of V. splendidus persister cells.

Development and external validation of a stability machine learning model to identify wake-up stroke onset time from MRI.

OBJECTIVES: To develop and externally validate a machine learning (ML) model based on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) to identify the onset time of wake-up stroke from MRI. METHODS: DWI and FLAIR images of stroke patients within 24 h of clear symptom onset in our hospital (dataset 1, n = 410) and another hospital (dataset 2, n = 177) were included. Seven ML models based on dataset 1 were developed to estimate the stroke onset time for binary classification (≤ 4.5 h or > 4.5 h): Random Forest (RF), support vector machine with kernel (svmLinear) or radial basis function kernel (svmRadial), Bayesian (Bayes), K-nearest neighbor (KNN), adaptive boosting (AdaBoost), and neural network (NNET). ROC analysis and RSD were performed to evaluate the performance and stability of the ML models, respectively, and dataset 2 was externally validated to evaluate the model generalization ability using ROC analysis. RESULTS: svmRadial achieved the best performance with the highest AUC and accuracy (AUC: 0.896, accuracy: 0.878), and was the most stable (RSD% of AUC: 0.08, RSD% of accuracy: 0.06). The svmRadial model was then selected as the final model, and the AUC of the svmRadial model for predicting the onset time external validation was 0.895, with 0.825 accuracy. CONCLUSIONS: The svmRadial model using DWI + FLAIR is the most stable and generalizable for identifying the onset time of wake-up stroke patients within 4.5 h of symptom onset. KEY POINTS: • Machining learning model helps clinicians to identify wake-up stroke patients within 4.5 h of symptom onset. • A prospective study showed that svmRadial model based on DWI + FLAIR was the most stable in predicting the stroke onset time. • External validation showed that svmRadial model has good generalization ability in predicting the stroke onset time.

Surrogate biomarkers of outcome for wake-up ischemic stroke.

BACKGROUND: Wake-up ischemic stroke (IS) has been usually excluded from acute stroke therapy options for being outside of the safe treatment window. We identified risk factors, and clinical or molecular biomarkers that could be therapeutic targets for wake-up stroke prevention, thus hopefully leading to a decrease in its mortality and disability in medium to long-term outcome. METHODS: 4251 ischemic stroke (IS) patients from a prospectively registered database were recruited; 3838 (90.3%) had known onset-symptom time, and 413 (9.7%) were wake-up strokes. The main endpoint was to analyze the association between different serum biomarkers with wake-up IS episodes and their progression. Leukocytes count, serum levels of C-reactive protein, fibrinogen, interleukin 6 (IL-6), and vitamin D were analyzed as inflammation biomarkers; N-terminal pro-B-type Natriuretic-Peptide and microalbuminuria, used as atrial/endothelial dysfunction biomarkers; finally, glutamate levels as excitotoxicity biomarker. In addition, demographic, clinical and neuroimaging variables associated with the time-evolution of wake-up IS patients and functional outcome at 3 months were evaluated. Good and poor functional outcome were defined as mRS ≤2 and mRS > 2 at 3 months, respectively. RESULTS: Wake-up IS showed a poorer outcome at 3-months than in patients with known on-set-symptom time (59.1% vs. 48.1%; p < 0.0001). Patients with wake-up IS had higher levels of inflammation biomarkers; IL-6 levels at admission (51.5 ± 15.1 vs. 27.8 ± 18.6 pg/ml; p < 0.0001), and low vitamin D levels at 24 h (5.6 ± 5.8 vs. 19.2 ± 9.4 ng/ml; p < 0.0001) are worthy of attention. In a logistic regression model adjusted for vitamin D, OR was 15.1; CI 95%: 8.6-26.3, p < 0.0001. However, we found no difference in vitamin D levels between patients with or without clinical-DWI mismatch (no: 18.95 ± 9.66; yes: 17.84 ± 11.77 ng/mL, p = 0.394). No difference in DWI volume at admission was found (49.3 ± 96.9 ml in wake-up IS patients vs. 51.7 ± 98.2 ml in awake IS patients; p = 0.895). CONCLUSIONS: Inflammatory biomarkers are the main factors that are strongly associated with wake-up IS episodes. Wake-up IS is associated with lower vitamin D levels. These data indicate that vitamin D deficiency could become a therapeutic target to reduce wake-up IS events.

Investigating the Association between Wake-Up Stroke and Obstructive Sleep Apnea: A Meta-Analysis.

BACKGROUND: Management of wake-up stroke (WUS) is always a challenge as no clear time of onset could be ascertained, and how to choose an appropriate therapy remains unclear. Sleep-disordered breathing (SDB) has been regarded as a potential risk factor to WUS, yet no consensus was achieved. Motivated by the need for a deeper understanding of WUS and its association with sleep apnea, meta-analyses summarizing the available evidence of respiratory events and indices were conducted, and sensitivity analysis was also used for heterogeneity. METHODS: Electronic databases were systematically searched, and cross-checking was done for relevant studies. Collected data included demographic characteristics, and sleep apnea parameters were extracted with stroke patients divided into WUS and NWUS groups. Clinical data of stroke patients accompanied with sleep apnea syndrome (OSA, SAS, and severe SAS) were also extracted for meta-analysis. RESULTS: A total of 13 studies were included in the analysis. The meta-analysis results showed that OSA, SAS, and severe SAS were significantly higher in WUS patients. A significantly higher AHI (WMD 7.74, 95% CI: 1.38-14.11; p = 0.017) and ODI (WMD of 3.85, 95% CI: 0.261-7.438; p = 0.035) than NWUS patients was also observed in the analysis of respiratory indices. CONCLUSION: WUS patients have severer SDB problems compared to NWUS patients suggesting that respiratory events during sleep might be underlying the induction of WUS. Besides, the induction of WUS was significantly associated with men rather than women. Therefore, early diagnosis and management of potential WUS patients should benefit from the detection of SDB status and respiratory effects.

Supine blood pressure normalised by daytime series values is independently associated with ischaemic wake-up stroke.

PURPOSE: Wake-up stroke constitutes up to 1/4 of all ischaemic strokes; however, its pathomechanisms remain largely unknown. Although low nocturnal blood flow may be the underlying cause, little is known about blood pressure (BP) characteristic of wake-up stroke patients. The aim of our study was to look for differences in BP variables between wake-up stroke and known-onset stroke patients and to seek BP indices which could distinguish wake-up stroke patients from other stroke patients. MATERIALS AND METHODS: In the study, we included ischaemic stroke patients in whom office BP measurement and Ambulatory BP monitoring (ABPM) were recorded at day 7, after acute hypertensive response. The daytime period was defined as the interval from 6 a.m. to 10 p.m. From ABPM, we obtained parameters of BP variability. Additionally, we calculated the BP percentage differences defined as (supine office BP-average daytime BP)/average daytime BP for systolic, diastolic, and mean blood pressure. We calculated analogous indices for night-time. The univariate and multivariate relationships between BP variables and wake-up stroke were analysed. RESULTS: Among the recruited 120 patients (aged 61.6 ± 12.3; 88 [73%] males; the baseline National Institutes of Health stroke scale score 4 [3-8]), 36 (30%) had wake-up stroke. In a univariate analysis, the systolic and mean daytime and night-time BP differences were significantly lower in patients with wake-up stroke [(-1.92 (-11.55 to 3.95) vs 4.12 (-2.48 to 11.31), p = 0.006 and -6.20 (-12.32 to 7.42) vs 2.00 (-6.86 to 11.65), p = 0.029 for daytime, respectively; 0.00 (-9.79 to 11.82) vs 9.84 (0.00 to 18.25), p = 0.003 and 0.51 (-8.49 to 12.08) vs 7.82 (-2.47 to 20.39), p = 0.026, for night-time, respectively]. After adjustment for possible confounders, the systolic BP difference remained significantly associated with wake-up stroke (odds ratio = 0.96, 95% confidence interval = 0.92-1.00, p = 0.039). CONCLUSION: The subacute office-ambulatory BP difference including the dynamic (systolic BP), but not static BP component was independently associated with wake-up stroke.

Wake-Up Receiver-Based Routing for Clustered Multihop Wireless Sensor Networks.

The Wireless Sensor Network (WSN) is one of the most promising solutions for the supervision of multiple phenomena and for the digitisation of the Internet of Things (IoT). The Wake-up Receiver (WuRx) is one of the most trivial and effective solutions for energy-constrained networks. This technology allows energy-autonomous on-demand communication for continuous monitoring instead of the conventional radio. The routing process is one of the most energy and time-consuming processes in WSNs. It is, hence, crucial to conceive an energy-efficient routing process. In this paper, we propose a novel Wake-up Receiver-based routing protocol called Clustered WuRx based on Multicast wake-up (CWM), which ensures energy optimisation and time-efficiency at the same time for indoor scenarios. In our proposed approach, the network is divided into clusters. Each Fog Node maintains the routes from each node in its cluster to it. When a sink requires information from a given node, it's corresponding Fog Node uses a multicast wake-up mechanism to wake up the intended node and all the intermediate nodes that will be used in the routing process simultaneously. Measurement results demonstrate that our proposed approach exhibits higher energy efficiency and has drastic performance improvements in the delivery delay compared with other routing protocols.