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Background: Dual antiplatelet therapy (DAPT) with clopidogrel is one of the initial treatment regimens for early neurological deterioration (END) in branch atheromatous disease (BAD). However, its effectiveness is affected by cytochrome P450 2C19 polymorphism. Prasugrel, with reduced cytochrome P450 2C19 interactions, has been approved for cerebrovascular diseases in Japan. Aim: To explore the efficacy of DAPT with prasugrel and with clopidogrel in preventing END. Methods: Patients with BAD, admitted within 48 h of symptom onset between June 2022 and September 2023, were enrolled. The primary endpoint was the proportion of patients with END within 7 days, which was defined as an increase of 1 point or more on the National Institutes of Health Stroke Scale (NIHSS). Patients meeting specific magnetic resonance imaging (MRI) criteria, including lesions of ≥15 mm in the lenticulostriate artery (LSA) region or infarcts extending to the ventral side of the paramedian pontine region, were included. The patients were randomly assigned to the clopidogrel with loading and prasugrel without loading groups and administered common medications. Results: The study included 9 and 10 patients in clopidogrel and prasugrel groups, of whom 56% and 50% had END, respectively. The prasugrel group had earlier exacerbations after admission (days 0–1) than that of the clopidogrel group (days 1–2). The bleeding complications of both groups were not significantly different. Conclusion: The two groups had similar proportions of patients with END, suggesting comparable efficacies of both drugs for patients with BAD. [ABSTRACT FROM AUTHOR]

In a fire, stairways are the primary avenues for building evacuation. Previous studies focused on investigating evacuation flow through evacuation drills in a high-rise office building to assess the accuracy of evacuation scenarios and compared them with evacuation dynamics. However, the effectiveness of evacuation drills in estimating many scenarios is limited by actual drills. The evacuation simulations present a promising approach to objectively evaluating evacuation scenarios. This study verifies whether evacuation simulations can faithfully replicate actual evacuation flow and effectively predict suitable evacuation scenarios or potentially involve parameter calibration. Through a comprehensive comparison analysis, this study scrutinized the reliability of evacuation simulations and calibrated the simulation parameters. The analysis revealed that factors, including adjustments to the door width, personal space considerations for occupants in both conflict and normal situations and variations in staircase structure configuration, can significantly influence the evacuation flow within staircases. Manipulating these parameters in simulations would enable a more precise replication of evacuation flow within staircases, thereby enhancing the simulation's accuracy in target evacuation scenarios. The findings of this research have underscored the significance of employing advanced simulation techniques to model evacuation dynamics accurately, facilitating a robust framework for devising effective emergency evacuation strategies in high-rise office buildings. [ABSTRACT FROM AUTHOR]

Roving eye movement (RoEM), commonly seen in unconscious patients with significant cortical dysfunction but without apparent brainstem damage, has unclear prognostic significance. We describe a case of presumed hypoglycemic encephalopathy with RoEM, where the patient emerged from a 4‐day coma. While previous reports often associate RoEM cases with poor prognosis, cases with favorable outcomes exist, particularly among young patients or those with reversible conditions. Our findings highlight the variable neurological prognosis of RoEM, suggesting the possibility of improved consciousness and neurological recovery in certain pathologies, thus enhancing our understanding of RoEM's implications. [ABSTRACT FROM AUTHOR]

To investigate the fire danger of mattresses, combustion experiments were conducted with a mattress installed at different heights above the floor to better understand their combustion behavior. The installation height was varied because the height of a mattress varies depending on the bed frame, and the combustion behavior is expected to change with the installation height. Experiments with a mattress installed at 0–515 mm above the floor revealed that the fire growth was faster, and the maximum heat release rate (HRR) increased with installation height. In contrast, in a series of experiments where a mattress was installed above a water pool, the flame spread rates and HRR histories were comparable for all installation heights. This demonstrate that the combustion behavior of the mattress was affected by the combustion of the molten mattress material that dropped to the floor, and this effect was influenced by the mattress installation height. Furthermore, we analyzed the HRR per unit area of mattress construction material using cone calorimeter tests to mimic the combustion taking place on the floor. Combining these results with the relation between the length of the burning part of a mattress at the front of flame spread and the HRR, we proposed a model for predicting the HRR history of mattress for a flame ignition at the center of its longitudinal side. The derived predictive model for the HRR history of mattress combustion emphasize that it is necessary to understand factors such as the intense radiant heat from the pool fire. [ABSTRACT FROM AUTHOR]

The main aim of this study is to investigate the numerical analysis of phased evacuation and validate the feasibility of high-rise buildings using the control volume model. Based on the same spatial configuration, the number of participants on each floor, and four-phased evacuations of an actual fire drill conducted by a Japanese academic group in 2018, the numerical analysis results for these phased evacuations of this high-rise building have been investigated. The numerical results are in good agreement with the fire drill data in the aspects of the total number of people reaching the ground floor, the space-time feature curve and the first participant on each floor descending to the ground floor. The changes in the number of waiting participants versus time on each floor were obtained and compared in this study with the fire drill data to comprehend the transient situations of the internal participants in this high-rise building during the phased evacuation. Furthermore, the results of the first-order approximation method of NFPA, the Melinek and Booth method and the Route B calculation of the Japanese Building Center Verification Method for the total building evacuation are presented to discuss the differences between the phased evacuation and the total building evacuation. [ABSTRACT FROM AUTHOR]

This article discusses the case of a 70-year-old Japanese woman with antiphospholipid antibody syndrome (APS) who experienced recurrent cerebral infarctions despite standard treatment. The patient was treated with hydroxychloroquine (HCQ) in addition to anticoagulant therapy, which successfully prevented further strokes for 18 months. The article highlights the potential effectiveness of HCQ in reducing thrombotic events in APS patients and suggests that combination therapy with HCQ may be beneficial for those who do not respond to conventional treatments. The findings provide hope for challenging cases of APS. [Extracted from the article]

Background: A shorter onset‐to recanalization (O2R) time in mechanical thrombectomy for acute ischemic stroke (AIS) results in better outcomes. Thus, we should reduce the door‐to‐puncture (D2P) time. Aim: To evaluate the effectiveness of a triage system named "Code AIS." We adopted the emergency large vessel occlusion (ELVO) screen as a screening test. Methods: Using the ELVO screening test, Code AIS was invoked when ≥1 positive results were obtained without witnessed seizures. The Code AIS system requires the assembly of neurologists, neurosurgeons, and an endovascular team in the emergency department before a patient arrives at the hospital. In total, 104 consecutive patients who underwent thrombectomy after emergency transport from January 2015 to December 2022 were included. The Code AIS system was initiated on February 17, 2022, and patients were divided into the pre‐Code AIS and Code AIS era groups. D2P time, outcome, and other parameters were compared between the groups. Results: Eighty‐eight and 16 cases were in the pre‐Code AIS and Code AIS era groups, respectively. Background factors, including age, sex, and etiology, did not differ between the groups. The median (interquartile range) time of D2P in the Code AIS era was 60 (41–102) min and significantly shortened compared to 135 (109–161) min in the pre‐Code AIS era (p < 0.001). The proportion of patients with favorable outcomes (modified Rankin Scale score, 0–2) improved significantly from 33% (pre‐Code AIS era) to 63% (Code AIS era) (p = 0.047). Conclusion: Using Code AIS, we succeeded in shortening D2P time and improving patient outcomes. [ABSTRACT FROM AUTHOR]