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  • 1
    In: JAMA, American Medical Association (AMA), Vol. 327, No. 18 ( 2022-05-10), p. 1782-
    Abstract: In nonurban areas with limited access to thrombectomy-capable centers, optimal prehospital transport strategies in patients with suspected large-vessel occlusion stroke are unknown. Objective To determine whether, in nonurban areas, direct transport to a thrombectomy-capable center is beneficial compared with transport to the closest local stroke center. Design, Setting, and Participants Multicenter, population-based, cluster-randomized trial including 1401 patients with suspected acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy in Catalonia, Spain, between March 2017 and June 2020. The date of final follow-up was September 2020. Interventions Transportation to a thrombectomy-capable center (n = 688) or the closest local stroke center (n = 713). Main Outcomes and Measures The primary outcome was disability at 90 days based on the modified Rankin Scale (mRS; scores range from 0 [no symptoms] to 6 [death] ) in the target population of patients with ischemic stroke. There were 11 secondary outcomes, including rate of intravenous tissue plasminogen activator administration and thrombectomy in the target population and 90-day mortality in the safety population of all randomized patients. Results Enrollment was halted for futility following a second interim analysis. The 1401 enrolled patients were included in the safety analysis, of whom 1369 (98%) consented to participate and were included in the as-randomized analysis (56% men; median age, 75 [IQR, 65-83] years; median National Institutes of Health Stroke Scale score, 17 [IQR, 11-21] ); 949 (69%) comprised the target ischemic stroke population included in the primary analysis. For the primary outcome in the target population, median mRS score was 3 (IQR, 2-5) vs 3 (IQR, 2-5) (adjusted common odds ratio [OR], 1.03; 95% CI, 0.82-1.29). Of 11 reported secondary outcomes, 8 showed no significant difference. Compared with patients first transported to local stroke centers, patients directly transported to thrombectomy-capable centers had significantly lower odds of receiving intravenous tissue plasminogen activator (in the target population, 229/482 [47.5%] vs 282/467 [60.4%]; OR, 0.59; 95% CI, 0.45-0.76) and significantly higher odds of receiving thrombectomy (in the target population, 235/482 [48.8%] vs 184/467 [39.4%]; OR, 1.46; 95% CI, 1.13-1.89). Mortality at 90 days in the safety population was not significantly different between groups (188/688 [27.3%] vs 194/713 [27.2%]; adjusted hazard ratio, 0.97; 95% CI, 0.79-1.18). Conclusions and Relevance In nonurban areas in Catalonia, Spain, there was no significant difference in 90-day neurological outcomes between transportation to a local stroke center vs a thrombectomy-capable referral center in patients with suspected large-vessel occlusion stroke. These findings require replication in other settings. Trial Registration ClinicalTrials.gov Identifier: NCT02795962
    Type of Medium: Online Resource
    ISSN: 0098-7484
    RVK:
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2022
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    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
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  • 2
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. 12 ( 2022-12), p. 3728-3740
    Abstract: We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion). Methods: Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics. Results: The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2–5] versus 3 [1–5], common odds ratio, 1.25 [95% CI, 1.06–1.48] ); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08–1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81–1.28] ). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16–1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51–0.75] ), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25–52]) and thrombectomy(mean difference 66 minutes [95% CI, 37–95] ). Conclusions: In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02795962.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 3
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. 3 ( 2023-03), p. 770-780
    Abstract: We aim to assess whether time of day modified the treatment effect in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion Trial), a cluster-randomized trial that did not demonstrate the benefit of direct transportation to a thrombectomy-capable center versus nearest local stroke center for patients with a suspected large vessel stroke triaged in nonurban Catalonia between March 2017 and June 2020. Methods: We performed a post hoc analysis of RACECAT to evaluate if the association between initial transport routing and functional outcome differed according to trial enrollment time: daytime (8:00 am –8:59 pm ) and nighttime (9:00 pm –7:59 am ). Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with ischemic stroke. Subgroup analyses according to stroke subtype were evaluated. Results: We included 949 patients with an ischemic stroke, of whom 258 patients(27%) were enrolled during nighttime. Among patients enrolled during nighttime, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days (adjusted common odds ratio [acOR] , 1.620 [95% CI, 1.020–2.551]); no significant difference between trial groups was present during daytime (acOR, 0.890 [95% CI, 0.680–1.163] ; P interaction =0.014). Influence of nighttime on the treatment effect was only evident in patients with large vessel occlusion(daytime, acOR 0.766 [95% CI, 0.548–1.072]; nighttime, acOR, 1.785 [95% CI, 1.024–3.112] ; P interaction 〈 0.01); no heterogeneity was observed for other stroke subtypes ( P interaction 〉 0.1 for all comparisons). We observed longer delays in alteplase administration, interhospital transfers, and mechanical thrombectomy initiation during nighttime in patients allocated to local stroke centers. Conclusions: Among patients evaluated during nighttime for a suspected acute severe stroke in non-urban areas of Catalonia, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days. This association was only evident in patients with confirmed large vessel occlusion on vascular imaging. Time delays in alteplase administration and interhospital transfers might mediate the observed differences in clinical outcome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02795962.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 4
    In: Antiviral Therapy, SAGE Publications, Vol. 10, No. 7 ( 2005-10), p. 841-847
    Abstract: To assess the baseline factors associated with haematological toxicity that lead to ribavirin or pegylated interferon (peginterferon) dosage reductions in hepatitis C and human immunodeficiency virus (HCV/HIV)-coinfected patients. Design Multicentre, prospective, observational study. Setting Eleven hospitals in Spain during the period 2002–2003. Subjects and methods One-hundred and forty-two HIV/HCV-coinfected patients received peginterferon-α2a plus ribavirin. Baseline characteristics and haematological parameters were recorded at baseline, week 4, 8, 12, 24 and 48. Cox's regression model was used to study the factors associated with the appearance of a haemoglobin level below 10g/dl (haemoglobin-endpoint), a neutrophil count below 750/mm 3 (neutrophil-endpoint) and a platelet count below 50,000/mm 3 (platelet-endpoint). Results Nineteen patients (13.4%) reached the haemoglobin-endpoint, 22.5% the neutrophil-endpoint and 7% the platelet-endpoint. Mean time of follow-up was 8 months (±3.5). A baseline haemoglobin level below 14g/dl [hazard ratio (HR): 3.65; 95% confidence interval (CI): 1.46–9.06] and treatment with zidovudine (HR: 3.25; 95% CI: 1.31–8.11) were the independent factors associated with the appearance of the haemoglobin-endpoint. A baseline neutrophil below 2050/mm 3 (HR: 3.59; 95% CI: 1.77–7.28) and baseline weight 〈 60 kg (HR: 2.21; 95% CI: 1.04–4.56) were independently associated with the appearance of the neutrophil-endpoint. Baseline platelet count (x1000/mm 3 decrease) (HR: 1.074; 95% CI: 1.04-1.11) was independently associated with the appearance of the platelet-endpoint. Conclusions Baseline factors allow the identification of a subset of HIV/HCV-coinfected patients who are prone to experience haematological toxicity during HCV antiviral therapy.
    Type of Medium: Online Resource
    ISSN: 1359-6535 , 2040-2058
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
    detail.hit.zdb_id: 2118396-X
    SSG: 15,3
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  • 5
    In: Inorganic Chemistry, American Chemical Society (ACS), Vol. 55, No. 21 ( 2016-11-07), p. 11216-11229
    Type of Medium: Online Resource
    ISSN: 0020-1669 , 1520-510X
    RVK:
    Language: English
    Publisher: American Chemical Society (ACS)
    Publication Date: 2016
    detail.hit.zdb_id: 7558-9
    detail.hit.zdb_id: 1484438-2
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  • 6
    In: International Archives of Urology and Complications, ClinMed International Library, Vol. 7, No. 1 ( 2021-12-31)
    Type of Medium: Online Resource
    ISSN: 2469-5742
    URL: Issue
    Language: Unknown
    Publisher: ClinMed International Library
    Publication Date: 2021
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  • 7
    In: Clinical Kidney Journal, Oxford University Press (OUP), Vol. 15, No. 3 ( 2022-02-22), p. 372-387
    Abstract: Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is ‘solved’ by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020–2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true.
    Type of Medium: Online Resource
    ISSN: 2048-8505 , 2048-8513
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 8
    In: European Journal of Nutrition, Springer Science and Business Media LLC, Vol. 60, No. 5 ( 2021-08), p. 2381-2396
    Type of Medium: Online Resource
    ISSN: 1436-6207 , 1436-6215
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 9
    In: ECS Meeting Abstracts, The Electrochemical Society, Vol. MA2022-02, No. 44 ( 2022-10-09), p. 1644-1644
    Abstract: Proton exchange membrane water electrolysis (PEMWE) offers a promising route for the production of green hydrogen from renewable energy sources and could be the master key to unlocking a future sustainable energy system (1). One of the main barriers delaying the wide-spread adoption of PEMWE technologies is the slow kinetics of the oxygen evolution reaction (OER) occurring at the anode and the need for high-cost, low-abundance precious metal electrocatalysts. Iridium-based oxides are still considered the only feasible option for practical applications due to their high activity and considerable corrosion stability under the harsh electrochemical reaction conditions. To improve the overall efficiency of PEMWEs, future electrocatalyst development strategies must concomitantly address performance metrics in terms of activity, stability and material cost. Towards enhancing iridium utilisation, efforts are aimed at increasing the electrochemical surface area of the catalyst per mass of iridium, thereby increasing the number of available electrocatalytic surface sites. In this regard, amorphous iridium oxide (IrO x ) nanoparticles have been shown to achieve a high intrinsic activity (2). However, this comes at the expense of catalyst stability (3) and a loss of intrinsic electronic conductivity (4) associated with the lower degree of crystallinity. By maximising the dispersion of Ir-based nanoparticles, the use of high surface area support materials have also been shown to improve OER performance (5, 6). However, to address long-term stability concerns for Ir-based OER catalysts, highly crystalline rutile iridium dioxide (IrO 2 ) materials may still offer the best prospects. The drawback of using this approach is that the formation of crystalline IrO 2 nanoparticles often involves high temperature thermal oxidative treatment causing particle growth and loss of surface area, ultimately leading to decreased OER activities (7). Therefore, novel synthesis methods that retain a high degree of crystallinity without a loss of surface area for IrO 2 nanoparticles are required. In this talk, we discuss two synthesis strategies geared towards the preparation of highly crystalline IrO 2 nanoparticles with high OER performance. Firstly, we present a novel wet-chemistry synthesis method that avoids the use of reducing agents and eliminates the need for high temperature thermal oxidative treatment. The resultant nano-sized IrO 2 nanoparticles were found to have excellent Ir mass-specific OER activity and durability attributed to the small nanoparticle size and high degree of crystallinity. Secondly, we present a novel metalorganic chemical deposition process as a simple, one-step preparation method for highly crystalline IrO 2 nanoparticles supported on Sb-doped tin oxide (ATO) (8). The superior OER performance was attributed to the epitaxial anchoring of well dispersed, crystalline IrO 2 nanoparticles onto the ATO support. We further discuss the versatility of the method to the application of other conductive oxide support materials such as indium tin oxide and F-doped tin oxide, with the ability of tuning the chemical state of the Ir-based nanoparticles by changing the reaction conditions, i.e., temperature and gas environment as well as the nature of the support. Finally, using a series detailed physico-chemical characterisation techniques to elucidate the nature the iridium phase, composition, morphology and structure, we relate these properties to the electrochemical activity and stability of the prepared materials for the OER. Herein, we highlight some of the challenges often encountered with the analysis of physical and electrochemical characterisation data for IrO 2 nanoparticles, particularly when supported on other oxide materials. Acknowledgements This work is funded by the Department of Science and Innovation (DSI, South Africa) Impala Platinum Holdings Limited (Implats) and the Federal Minister of Education and Research (BMBF, Germany). References K. Ayers, Current Opinion in Electrochemistry , 18 , 9 (2019). T. Reier, I. Weidinger, P. Hildebrandt, R. Kraehnert and P. Strasser, ECS Transactions , 58 , 39 (2013). T. Binninger, R. Mohamed, K. Waltar, E. Fabbri, P. Levecque, R. Kötz and T. J. Schmidt, Scientific Reports , 5 , 12167 (2015). M. Bernt, C. Schramm, J. Schröter, C. Gebauer, J. Byrknes, C. Eickes and H. A. Gasteiger, Journal of The Electrochemical Society , 168 , 084513 (2021). H.-S. Oh, H. N. Nong, T. Reier, A. Bergmann, M. Gliech, J. Ferreira de Araújo, E. Willinger, R. Schlögl, D. Teschner and P. Strasser, Journal of the American Chemical Society , 138 , 12552 (2016). A. Hartig-Weiss, M. Miller, H. Beyer, A. Schmitt, A. Siebel, A. T. S. Freiberg, H. A. Gasteiger and H. A. El-Sayed, ACS Applied Nano Materials , 3 , 2185 (2020). J. Quinson, Advances in Colloid and Interface Science , 303 , 102643 (2022). Z. S. H. S. Rajan, T. Binninger, P. J. Kooyman, D. Susac and R. Mohamed, Catalysis Science & Technology , 10 , 3938 (2020).
    Type of Medium: Online Resource
    ISSN: 2151-2043
    Language: Unknown
    Publisher: The Electrochemical Society
    Publication Date: 2022
    detail.hit.zdb_id: 2438749-6
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  • 10
    In: Comptes Rendus Palevol, Elsevier BV, Vol. 15, No. 7 ( 2016-09), p. 791-812
    Type of Medium: Online Resource
    ISSN: 1631-0683
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
    detail.hit.zdb_id: 2079766-7
    SSG: 13
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