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ABSTRACT:Background:Early reperfusion has the best likelihood for a favorable outcome in acute ischemic stroke (AIS) with large vessel occlusion (LVO). Our experience with mobile stroke unit (MSU) for direct to angiosuite (DTAS) transfer in AIS patients with suspected LVO is presented.Methods:Retrospective review of prospectively collected data from November 2019 to August 2022, of patients evaluated and transferred by the University of Alberta Hospital MSU and moved to angiosuite for endovascular thrombectomy (EVT).Result:A total of 41 cases were included. Nine were chosen for DTAS and 32 were shifted to angiosuite after stopping for computed tomography (CT) angiography of the head and neck (no-DTAS). Stroke severity measured by NIHSS (median with interquartile range (IQR)) was higher in patients of DTAS, 22 (14–24) vs 14.5 (5–25) in no-DTAS (p= 0.001). The non-contrast CT head in MSU showed hyperdense vessels in 8 (88.88%) DTAS vs 11 (34.35%) no-DTAS patients (p= 0.003). The EVT timelines (median with IQR, 90thpercentile) including “door to artery puncture time” were 31 (23–50, 49.2) vs 79 (39–264, 112.8) minutes, and “door to recanalization time” was 69 (49–110, 93.2) vs 105.5 (52–178, 159.5) minutes in DTAS vs no-DTAS group, respectively. The workflow times were significantly shorter in the DTAS group (p< 0.001). Eight (88.88%) out of 9 DTAS patients had LVO and underwent thrombectomy.Conclusions:MSU for DTAS in patients with high NIHSS scores, cortical signs, and CT showing hyperdense vessel is an effective strategy to reduce the EVT workflow time.

ABSTRACT:Background:Hyperacute treatment of acute stroke may lead to thrombolysis in stroke mimics (SM). Our aim was to determine the frequency of thrombolysis in SM in primary stroke centers (PSC) dependent on telestroke versus comprehensive stroke centers (CSC).Method:Retrospective review of prospectively collected data from the Quality improvement and Clinical Research (QuICR) registry, the Discharge Abstract Database (DAD), and The National Ambulatory Care Reporting System (NACRS) of consecutive patients treated with intravenous thrombolysis for acute ischemic stroke in Alberta (Canada) from April 2016 to March 2021.Result:A total of 2471 patients who received thrombolysis were included. Linking the QuICR registry to DAD 169 (6.83%) patients were identified as SM; however, on our review of the records, only 112 (4.53%) were actual SM. SMs were younger with a mean age of 61.66 (±16.15) vs 71.08 (±14.55) in stroke. National Institute of Health Stroke Scale was higher in stroke with a median (IQR) of 10 (5–17) vs 7 (5–10) in SM. Only one patient (0.89 %) in SM groups had a small parenchymal hemorrhage versus 155 (6.57%) stroke patients had a parenchymal hemorrhage. There was no death among patients of thrombolysed SM during hospitalization versus 276 (11.69%) in stroke. There was no significant difference in the rate of SM among thrombolysed patients between PSC 27 (5.36%) versus CSC 85 (4.3%) (P= 0.312). The most responsible diagnosis of SM was migraine/migraine equivalent, functional disorder, seizure, and delirium.Conclusion:The diagnosis of SM may not always be correct when the information is extracted from databases. The rate of thrombolysis in SM via telestroke is similar to treatment in person at CSC.

Intravenous thrombolysis with alteplase bolus followed by infusion is a global standard of care for patients with acute ischaemic stroke. We aimed to determine whether tenecteplase given as a single bolus might increase reperfusion compared with this standard of care.

Characterizing patients with Parkinson’s disease (PD) and cognitive impairment is important toward understanding their natural history. Understand clinical, treatment, and cost characteristics of patients with PD pre- and post-cognitive impairment (memory loss/mild cognitive impairment/dementia or dementia treatment) recognition. 2,711 patients with PD newly diagnosed with cognitive impairment (index) were identified using administrative claims data. They were matched (1:1) on age and gender to patients with PD and no cognitive impairment (controls). These two cohorts were compared on patient characteristics, healthcare resource utilization, and total median costs for 3 years pre- and post-index using Chi-square tests, t-tests, and Wilcoxon rank-sum tests. Logistic regression was used to identify factors predicting cognitive impairment. Comorbidity indices for patients with cognitive impairment increased during the 6-year study period, especially after the index. Enrollment in Medicare Advantage Prescription Drug plans vs. commercial (OR = 1.60), dual Medicare/Medicaid eligibility (OR = 1.36), cerebrovascular disease (OR = 1.24), and PD medication use (OR = 1.46) were associated with a new cognitive impairment diagnosis (all p < 0.05). A greater proportion of patients with cognitive impairment had hospitalizations and emergency department visits and higher median total healthcare costs than controls for each year pre- and post-index. In patients with PD newly diagnosed with cognitive impairment, comorbidity burden, hospitalizations, emergency department visits, and total costs peaked 1-year pre- and post-identification. These data coupled with recommendations for annual screening for cognitive impairment in PD support the early diagnosis and management of cognitive impairment in order to optimize care for patients and their caregivers.

Precise control of light is indispensable to modern optical communication devices especially as the size of such devices approaches the subwavelength scale. Plasmonic devices are suitable for the development of these optical devices due to the extreme field confinement and its ability to be controlled by tuning the carrier density at the metal/dielectric interface. Here, an electro-ionic controlled plasmonic device consisting of Au/graphene/ion-gel is demonstrated as an optical switch, where an external electric field modulates the real part of the electrical conductivity. The graphene layer enhances charge penetration and charge separation at the Au/graphene interface resulting in an increased photoinduced voltage. The ion-gel immobilized on the Au/graphene further enables the electrical tunability of plasmons which modulates the intensity of the reflected laser light. This work paves the way for developing novel plasmonic electro-optic switches for potential applications such as integrated optical devices.

We report a novel structure – macroporous TiO2decorated with V2O5/Ag nanoparticles – for enhanced visible photocatalytic activity by efficient charge carrier separation and enhanced visible light absorption. They are found to be much superior to TiO2∕V2O5, TiO2/Ag and V2O5/Ag composite particles. V2O5particles are found to reduce the recombination of photogenerated carriers from TiO2under UV exposure by charge transfer mechanism along with the increased absorption in the visible region. Further decoration with Ag nanoparticles enables efficient absorption of light over the visible region due to the localized surface plasmon resonance. In addition, Ag nanoparticles act as effective electron traps for the photogenerated electrons from V2O5and enhances the photocatalytic activity in the visible region. Rate constant values obtained for TiO2∕V2O5and TiO2∕V2O5/Ag heterostructures are 0.009 and 0.014 min−1respectively. Heterostructures are also found to be recyclable in nature making them highly suitable for visible photocatalytic applications.

In this Letter, we report on the design, fabrication, and implementation of a novel plasmon-mode-driven low-threshold near-infrared (NIR) random laser (RL) in the 850–900 nm range based on plasmonic ZnS@Au core-shell scatterers. Plasmon modes in the NIR region are used for nanoscale scatterer engineering of ZnS@Au core-shell particles to enhance scattering, as against pristine ZnS. This plasmonic scattering enhancement coupled with femtosecond (fs) laser pumping is shown to cause a three-fold lasing threshold reduction from 325  μJ/cm^2 to 100  μJ/cm^2 and a mode Q-factor enhancement from 200 to 540 for ZnS@Au-based RL, as compared to pristine ZnS-based RL. Local field enhancement due to plasmonic ZnS@Au scatterers, as evidenced in the finite-difference time-domain simulation, further adds to this enhancement. This work demonstrates a novel scheme of plasmonic mode coupling in the NIR region and fs excitation in a random laser photonic system, overcoming the inherent deficiencies of weak absorption of gain media and poor scattering cross sections of dielectric scatterers for random lasing in the NIR spectrum.

Copper oxide doped titania nanocatalysts preparation was carried out by combustion synthesis method. The precursor compounds for the preparation of these nanocatalysts were titanium iso propoxide, glycine, copper nitrate and strontium nitrate. The prepared catalysts were characterized by Energy dispersive X-ray analysis (EDX), X-ray diffraction (XRD), Scanning electron microscopy (SEM), BET Surface area measurement and Infrared spectroscopy (FTIR). Total acidity of the prepared catalysts were determined by temperature programmed desorption of ammonia (TPD-NH3). There was no characteristic peak of copper oxide in the XRD pattern. The photo activity of these prepared catalysts was examined for the degradation of methylene blue dye, which is a common environmental pollutant. These catalysts can be used to degrade the dye from water and thus helps the aquatic life.

Dupilumab is approved as an add-on maintenance therapy for patients (≥6 years) with moderate-to-severe asthma. Better understanding of real-world effectiveness is needed.

Introduction/Objective: Predictive risk models identifying patients at high risk for specific outcomes may provide valuable insights to providers and payers regarding points of intervention and modifiable factors. The goal of our study was to build predictive risk models to identify patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) at high risk for progression to end stage kidney disease (ESKD), mortality, and hospitalization for cardiovascular disease (CVD), cerebrovascular disease (CeVD), and heart failure (HF).Methods: This was a retrospective observational cohort study utilizing administrative claims data in patients with CKD (stage 3-4) and T2D aged 65 to 89 years enrolled in a Medicare Advantage Drug Prescription plan offered by Humana Inc. between 1/1/2012 and 12/31/2017. Patients were enrolled ≥1 year pre-index and followed for outcomes, including hospitalization for CVD, CeVD and HF, ESKD, and mortality, 2 years post-index. Pre-index characteristics comprising demographic, comorbidities, laboratory values, and treatment (T2D and cardiovascular) were evaluated and included in the models. LASSO technique was used to identify predictors to be retained in the final models followed by logistic regression to generate parameter estimates and model performance statistics. Inverse probability censoring weighting was used to account for varying follow-up time.Results: We identified 169 876 patients for inclusion. Declining estimated glomerular filtration rate (eGFR) increased the risk of hospitalization for CVD (38.6%-61.8%) and HF (2-3 times) for patients with eGFR 15 to 29 mL/min/1.73 m2compared to patients with eGFR 50 to 59 mL/min/1.73 m2. Patients with urine albumin-to-creatinine ratio (UACR) ≥300 mg/g had greater chance for hospitalization for CVD (2.0 times) and HF (4.9 times), progression to ESKD (2.9 times) and all-cause mortality (2.4 times) than patients with UACR <30 mg/g. Elevated hemoglobin A1c (≥8%) increased the chances for hospitalization for CVD (21.3%), CeVD (45.4%), and death (20.6%). Among comorbidities, history of HF increased the risk for ESKD, mortality, and hospitalization for CVD, CeVD, and HF.Conclusions: The predictive models developed in this study could potentially be used as decision support tools for physicians and payers, and the risk scores from these models can be applied to future outcomes studies focused on patients with T2D and CKD.

Hedgehog (Hh) signalling plays an important role in a number of malignancies, yet its clinical significance in breast cancer is unclear. In a cohort of 279 patients with invasive ductal carcinoma (IDC) of the breast, we found that expression of Hh ligand was associated with increased risk of metastasis, breast cancer specific death and the basal-like phenotype. A paracrine signature, encompassing high epithelial Hh ligand and high stromal Gli1 was an independent predictor for overall survival in multivariate analysis. In two independent histological progression series (n=301), Hh expression increased with atypia.