Background Intraventricular hemorrhage occurs due to intracerebral hemorrhage with intraventricular extension or without apparent parenchymal involvement, known as primary intraventricular hemorrhage. Aims We evaluated the prognosis of primary intraventricular hemorrhage patients in the CLEAR III trial (Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage). Methods In patients with primary intraventricular hemorrhage versus those with secondary intraventricular hemorrhage, we compared intraventricular alteplase response and outcomes including modified Rankin Scale, Barthel Index, National Institutes of Health Stroke Scale (NIHSS), and extended Glasgow Outcome Scale (eGOS) at 30, 180, and 365 days. Outcomes were also compared in primary intraventricular hemorrhage patients who received intraventricular alteplase versus placebo (normal saline) and in matched primary and secondary intraventricular hemorrhage patients using inverse-probability-weighted regression adjustment. Results Of 500 patients enrolled in CLEAR III, 46 (9.2%) had primary intraventricular hemorrhage. Combining both treatment groups, primary intraventricular hemorrhage patients had larger intraventricular hemorrhage volumes (median: 34.2 mL vs. 20.8 mL, p < 0.01) but similar intraventricular hemorrhage removal (51.0% vs. 59.0%, p = 0.24) compared to secondary intraventricular hemorrhage patients, respectively. Confirming previous studies, primary intraventricular hemorrhage patients achieved better NIHSS, modified Rankin Scale, Barthel Index, and eGOS scores at days 30, 180, and 365, respectively (all p < 0.01), although mortality was similar to secondary intraventricular hemorrhage patients; matching analysis yielded similar results. Primary intraventricular hemorrhage patients who received intraventricular alteplase ( n = 19) and saline ( n = 27) achieved similar outcomes. Conclusions In CLEAR III, primary intraventricular hemorrhage patients who survived achieved better long-term outcomes than surviving secondary intraventricular hemorrhage patients with similar mortality. Outcomes and safety were similar between primary intraventricular hemorrhage patients receiving alteplase and those receiving saline.
Drawing attention to the immediate beauty of language and the distracting superficiality of ornate expression, James offers style as a means for representing and contemplating Italy. This essay argues that an emphasis on stylistic surface illustrates how contemplations of Italy dramatized a distinct struggle of James’s writing career: how to balance the perceived necessity of plot, read as an historical impulse, with the rich surface of style, understood as an embrace of extra-temporal spectacle.
Italian American ethnic identity has long been constituted by struggles and inequalities endured by Italians in post-unification rural Italy and their subsequent racialized oppression in urban centers of the US North in the era of mass migration. Until now, the presumed stability of mass migration identity has created the general terms for understanding Italian America. In this essay, a New Orleans microhistory illuminated through the 1849 newspaper Il Monitore del Sud, the first Italian-language newspaper published in the United States, reshapes foundational understandings of Italian American identity. The newspaper's antebellum account of New Orleans Italian America includes nationalist aesthetic expressions and political affiliations that American political discourse has not yet found an adequate language to describe and that Italian American studies has not yet confronted. In bringing this prehistory to light, my work with antebellum Italian Americans complicates understandings of multi-ethnic collectivity by examining how intercultural myth-making underwrites communal historiography. Together, the ethnic perceptions memorialized in Il Monitore del Sud and the power operations revealed in concurrent civic records expose how collective conditions of white supremacy come to be naturalized and forgotten, becoming history's flotsam. The creation of Italian America's communal historiography, I argue, shows us something larger about the operations of US white supremacy: how its emotional logic depends simultaneously on the exploitation of vulnerable others and the enactment of vulnerability from within the exploiting group.
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