BACKGROUNDThe effectiveness of endovascular therapy in patients with stroke caused by basilarartery occlusion has not been well studied.
METHODSWe randomly assigned patients within 6 hours after the estimated time of onset of a stroke due to basilar-artery occlusion, in a 1:1 ratio, to receive endovascular therapy or standard medical care. The primary outcome was a favorable functional outcome, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 to 6, with 0 indicating no disability, 3 indicating moderate disability, and 6 indicating death) at 90 days. The primary safety outcomes were symptomatic intracranial hemorrhage within 3 days after the initiation of treatment and mortality at 90 days.
RESULTSA total of 300 patients were enrolled (154 in the endovascular therapy group and 146 in the medical care group). Intravenous thrombolysis was used in 78.6% of the patients in the endovascular group and in 79.5% of those in the medical group. Endovascular treatment was initiated at a median of 4.4 hours after stroke onset. A favorable functional outcome occurred in 68 of 154 patients (44.2%) in the endovascular group and 55 of 146 patients (37.7%) in the medical care group (risk ratio, 1.18; 95% confidence interval [CI], 0.92 to 1.50). Symptomatic intracranial hemorrhage occurred in 4.5% of the patients after endovascular therapy and in 0.7% of those after medical therapy (risk ratio, 6.9; 95% CI, 0.9 to 53.0); mortality at 90 days was 38.3% and 43.2%, respectively (risk ratio, 0.87; 95% CI, 0.68 to 1.12).
CONCLUSIONSAmong patients with stroke from basilar-artery occlusion, endovascular therapy and medical therapy did not differ significantly with respect to a favorable functional outcome, but, as reflected by the wide confidence interval for the primary outcome, the results of this trial may not exclude a substantial benefit of endovascular therapy. Larger trials are needed to determine the efficacy and safety of endovascular therapy for basilar-artery occlusion. (Funded by the Dutch Heart Foundation and others; BASICS ClinicalTrials.gov number, NCT01717755; Netherlands Trial Register number, NL2500.
Plywood is normally produced with urea-formaldehyde and/or phenol-formaldehyde adhesives. However, the former is considerably toxic and environmentally damaging, while the latter is expensive, thus motivating the search for alternative raw materials in plywood production. The castor oil-based polyurethane adhesive developed at the São Carlos Institute of Chemistry, University of São Paulo, is an environmentally friendly vegetal oil-based polymer that is harmless to humans. The wood species Eucalyptus grandis offers favorable properties for plywood the manufacture. The study reported on here involved the use of castor oil-based polyurethane adhesive to produce plywood with Eucalyptus grandis layers. The plywood's performance was evaluated based on the results of physical and mechanical tests recommended by the Brazilian code, ABNT. Tests results showed higher values than those reported in the literature and recommended by the ABNT, indicating that the castor oil-based polyurethane adhesive is a promising glue for the manufacture of plywood
OBJECTIVE:To study tremor in patients with X-linked recessive spinobulbar muscular atrophy or Kennedy's disease.METHODS:Ten patients (from 7 families) with a genetic diagnosis of Kennedy's disease were screened for the presence of tremor using a standardized clinical protocol and followed up at a neurology outpatient clinic. All index patients were genotyped and showed an expanded allele in the androgen receptor gene.RESULTS:Mean patient age was 37.6 years and mean number of CAG repeats 47 (44-53). Tremor was present in 8 (80%) patients and was predominantly postural hand tremor. Alcohol responsiveness was detected in 7 (88%) patients with tremor, who all responded well to treatment with a β-blocker (propranolol).CONCLUSION:Tremor is a common feature in patients with Kennedy's disease and has characteristics similar to those of essential tremor.
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