The current European Stroke Organisation expedited recommendation on tenecteplase (TNK) for acute ischemic stroke (AIS) advocates that TNK 0.25 mg/kg can be used alternatively to alteplase (tissue plasminogen activator [TPA]) for AIS of <4.5 hours duration, based on a meta-analytical approach establishing noninferiority. Since the publication of these guidelines, 4 additional randomized controlled clinical trials (RCTs) have provided further insight. We conducted an updated systematic review and meta-analysis including all available RCTs that investigated efficacy and safety of TNK 0.25 mg/kg compared with TPA for the treatment of AIS within 4.5 hours of onset. The primary outcome was defined as the excellent functional outcome at 3 months (modified Rankin Scale [mRS] score 0-1), whereas good functional outcome (mRS score 0-2), reduced disability at 3 months (≥1-point reduction across all mRS scores), symptomatic intracranial hemorrhage (sICH), and 3-month mortality were evaluated as secondary outcomes. Pooled estimates were calculated with random-effects model. A prespecified subgroup analysis was performed stratifying for TNK formulation, that is, original TNK vs biocopy: recombinant human TNK tissue-type plasminogen activator that is available in China and has a different production process. Eleven RCTs were included comprising a total of 3,788 patients treated with TNK vs 3,757 patients treated with TPA. TNK was associated with higher likelihood of excellent functional outcome (risk ratio [RR] 1.05, 95% CI 1.01-1.10; p = 0.012; I2 = 0%; risk difference 2.95%; 95% CI 0.76%-5.14%; p = 0.008; I2 = 0%) and reduced disability at 3 months (common odds ratio 1.10, 95% CI 1.01-1.19; p = 0.034; I2 = 0%) compared with TPA while good functional outcome (RR 1.03, 95% CI 0.99-1.07; p = 0.142; I2 = 28%) was similar between the groups. Regarding safety outcomes, similar rates of sICH (RR 1.12, 95% CI 0.83-1.53; p = 0.456; I2 = 0%) and 3-month mortality (RR 0.97, 95% CI 0.82-1.15; p = 0.727; I2 = 12%) were observed. When stratified for TNK regimen (original vs biocopy), statistical significance in achieving an excellent functional outcome at 3 months was retained for the original TNK (RR 1.05, 95% CI 1.00-1.10; p = 0.044; I2 = 0%). The updated meta-analysis confirms similar safety between TNK 0.25 mg/kg and TPA, while showing that TNK is superior to TPA regarding excellent functional outcome and reduced disability at 3 months. These findings support transitioning to TNK in clinical practice.

PurposeCommunity involvement in heritage preservation requires appropriate approaches. Sanciai (in Lithuanian: Šanciai) historic district in Kaunas (Lithuania) has long-lasting military and industrial heritage, valuable urban structure and connections to the natural frame of the city. Sanciai residents’ willingness to participate in heritage preservation and urban planning prompted the aim of this research – to develop, test and present the mapping methodology, that would be applicable in the process of community involvement into heritage identification, preservation, interpretation and creation process.Design/methodology/approachThe methods of research included analysis of literature and theoretical research, development and testing of the methodology for the community involvement in heritage identification, preservation, interpretation and creation process. The workshop methodology and interactive online map are presented in this research. The memory map methodology developed and presented in this research includes the elements of mental mapping, design thinking and citizen science.FindingsThe methodology was tested in spring of 2021 in two-day online workshops with the students of pro-gymnasium located in Sanciai. Workshop participants together with workshop coordinator and moderators created different layers of the mental map, collected stories from the members of community and gathered the data for online interactive Sanciai memory map. The evaluation of the methodology and workshop results allowed concluding that memory map methodology is a functioning participant, community and research-oriented approach that can be applied in diverse heritage and community related circumstances.Originality/valueThe originality of the research is determined by the synergistic nature of developed memory map methodology which complements traditional mental mapping with creative hands-on techniques, empathy-oriented tasks and interactive online tool. Moreover, the research reveals the importance of local-global connections in urban studies as active local community became the stimulus for memory map methodology. The two-fold aim of the methodology – community cohesion and empowerment as well as research data collection – contributes to the originality of the research as well.

Purpose This paper aims to design a novel test device and study the wear properties and the thermal mechanisms of roller pairs in dual-freedom sliding contacts. Design/methodology/approach On the transition process of lubrication regimes, experiments were conducted with various values of running speed and slip ratio obtained by two motorized spindles. Temperature and surviving time would be obtained of GCr15/GCr15 and DLC/GCr15 friction pairs. Micro photography was obtained with a PGI 3D stylus profiler and a confocal microscopy OLS4000-3D. An empirical mode decomposition method was used to eliminate measure errors. Findings Results showed that, even with little initial lubricant, rolling/sliding pairs still rotated for a certain time. With the synthetic actions of the dual-freedom sliding, the loss of lubrication and the tilt, interesting helical grooves appeared. Sliding speeds had remarkable effects on survive time, temperatures and surface topographies. In addition, the equilibrium values of the temperature and the surface roughness were obtained in sufficient oil supply. Extreme wear-out conditions were obtained with starved lubrication. Diamond-like carbon coatings showed better heat resistance and better wear resistance. Originality/value This work would be critical for the life design and the heat treatment of rolling bearings in the full flood lubrication and the starved lubrication. Peer review The peer review history for this article is available at: https://publons.com/publon/10.1108/ILT-05-2024-0164/

Purpose This study aims to improve the detection and quantification of cardiac issues, which are a leading cause of mortality globally. By leveraging past data and using knowledge mining strategies, this study seeks to develop a technique that could assess and predict the onset of cardiac sickness in real time. The use of a triple algorithm, combining particle swarm optimization (PSO), artificial bee colony (ABC) and support vector machine (SVM), is proposed to enhance the accuracy of predictions. The purpose is to contribute to the existing body of knowledge on cardiac disease prognosis and improve overall performance in health care. Design/methodology/approach This research uses a knowledge-mining strategy to enhance the detection and quantification of cardiac issues. Decision trees are used to form predictions of cardiovascular disorders, and these predictions are evaluated using training data and test results. The study has also introduced a novel triple algorithm that combines three different combination processes: PSO, ABC and SVM to process and merge the data. A neural network is then used to classify the data based on these three approaches. Real data on various aspects of cardiac disease are incorporated into the simulation. Findings The results of this study suggest that the proposed triple algorithm, using the combination of PSO, ABC and SVM, significantly improves the accuracy of predictions for cardiac disease. By processing and merging data using the triple algorithm, the neural network was able to effectively classify the data. The incorporation of real data on various aspects of cardiac disease in the simulation further enhanced the findings. This research contributes to the existing knowledge on cardiac disease prognosis and highlights the potential of leveraging past data for strategic forecasting in the health-care sector. Originality/value The originality of this research lies in the development of the triple algorithm, which combines multiple data mining strategies to improve prognosis accuracy for cardiac diseases. This approach differs from existing methods by using a combination of PSO, ABC, SVM, information gain, genetic algorithms and bacterial foraging optimization with the Gray Wolf Optimizer. The proposed technique offers a novel and valuable contribution to the field, enhancing the competitive position and overall performance of businesses in the health-care sector.

Background: Maternal cardiovascular health during and after pregnancy is influenced by various factors, including personal and family support. However, the specific impact of abnormal personal and family support on maternal outcomes remains understudied. Methods: Utilizing the TriNetX global health research network within the US Collaborative Network, we investigated the influence of abnormal personal and family support (ICD10CM:Z63) on maternal cardiovascular outcomes within one year post-pregnancy. Cohort 1 comprised women aged 15 to 60 with documented problems relating to primary and family support during or after childbirth between 2008 and 2023. Cohort 2 included a similar demographic with good primary and family support. Data were extracted from electronic health records, and the cohorts were matched based on diverse sociodemographic traits and medical comorbidities. Results: Our analysis revealed significant associations between problems relating to primary and family support during and after pregnancy and adverse maternal cardiovascular outcomes. Specifically, the presence of such challenges significantly increased the risk of major adverse cardiac and cerebrovascular events (MACCE) (OR: 4.823, 95% CI: 3.361 to 6.919, p&lt;0.001) and all-cause mortality (OR: 8.461, 95% CI: 5.184 to 13.812, p&lt;0.001). Interestingly, it was associated with a reduced risk of peripartum or postpartum preeclampsia (OR: 0.603, 95% CI: 0.403 to 0.903, p&lt;0.001). However, no significant association was observed between these personal and family support challenges and acute MI (OR: 1.092, 95% CI: 0.482 to 2.747, p=NS), ischemic stroke (OR: 1.403, 95% CI: 0.623 to 3.160, p=NS), hemorrhagic stroke (OR: 1.000, 95% CI: 0.416 to 2.404, p=NS), heart failure (OR: 1.075, 95% CI: 0.636 to 1.817, p=NS), or peripartum cardiomyopathy (OR: 0.586, 95% CI: 0.322 to 1.068, p=NS). Conclusion: Our findings highlight the significant impact of abnormal personal and family support on maternal cardiovascular health outcomes during and one year after pregnancy. Addressing challenges related to primary and family support during and after pregnancy may be crucial for reducing adverse outcomes and enhancing overall maternal well-being.

Background: Tumor endothelial marker 1 (TEM1 or CD248) is a transmembrane protein found in activated mesenchymal cells during embryo development. Its expression level becomes very low or undetectable in adult tissue. Re-expression of TEM1 in fibroblasts has been reported in hepatic, renal, and pulmonary fibrosis. We evaluated atrial TEM1 expression in atrial fibrillation (AF) and its relation with atrial fibrosis. Methods and Results: All data were presented as mean±standard error. Left atrial (LA) tissues were collected from 30 patients (pts) (mean age 64.0±1.6 yrs, male 76.7%) with AF underwent cardiac surgery (mitral and/or tricuspid valve surgery 96.7%) and maze procedure with LA appendage excision. Immunofluorescence (IF) staining showed TEM1 expressed in atrial cardiac fibroblasts (CFs) in the LA tissue of AF pts, but not in normal LA tissue (US Biomax). Primary human CFs were directly isolated from the LA tissue. IF staining showed TEM1 expression in the isolated CFs from AF pts but not in normal human CFs (ScienCell). Western blot could detect TEM1 expression in the LA tissues of all 30 AF pts. Sirius Red staining was used to visualize collagen and atrial fibrosis was quantified using a pixel-based method (Adobe Photoshop) by calculating the total numbers of red pixels and the percentage (%) of red pixels to total pixels. Atrial fibrosis was increased in AF pts compared with normal control (total number of red pixels: 160740±13066 vs. 50863±6357, % of red pixels to total pixels: 11.4±0.8 vs. 3.8±0.2%, all p&lt;0.001). There was a positive correlation between the expression level of TEM1 (ratio of TEM1/actin band density in western blot) with the severity of atrial fibrosis, including the total numbers of red pixels (r = 0.47, p = 0.01) and the % of red pixels to total pixels (r = 0.48, p = 0.01). TEM1 and galectin expression levels had positive correlation (r = 0.60, p &lt; 0.01). There were no correlations of atrial TEM1 expression with the LA diameter and CHA2DS2-VASc score. In vitro study showed TEM1 knockdown in cultured CFs with siRNA reduced cell proliferation (scrambled- vs TEM1-siRNA, BrdU absorbance: 1.84±0.05 vs 1.50±0.07, p&lt;0.05), increased starvation-induced cell apoptosis (cell death ELISA absorbance: 0.69±0.11 vs 2.88±0.05, p&lt;0.05) and decreased cell migration. Conclusions: There is increased TEM1 expression in atrial CFs in AF and its expression level is associated with atrial fibrosis. TEM1 expression changes the cell behaviors of CFs.

Heart failure is a complex syndrome and our understanding and therapeutic approach relies mostly on its phenotypic presentation. Notably, the heart is characterized as the most energy-consuming organ, being both a producer and consumer, in order to satisfy multiple cardiac functions: ion exchange, electromechanical coordination, excitation–contraction coupling, etc. By obtaining further knowledge of the cardiac energy field, we can probably better characterize the basic pathophysiological events occurring in heart disease patients and understand the metabolic substance changes, the relationship between the alteration of energy production/consumption, and hence energetic deficiency not only in the heart as a whole but in every single cardiac territory, which will hopefully provide us with the opportunity to uncover the beginning of the heart failure process. In this respect, using (a) newer imaging techniques, (b) biomedicine, (c) nanotechnology, and (d) artificial intelligence, we can gain a deeper understanding of this complex syndrome. This, in turn, can lead to earlier and more effective therapeutic approaches, ultimately improving human health. To date, the scientific community has not given sufficient attention to the energetic starvation model. In our view, this review aims to encourage scientists and the medical community to conduct studies for a better understanding and treatment of this syndrome.

ObjectiveHypoglycemia represents a serious acute complication in individuals with type 1 diabetes mellitus (T1DM). In order to more effectively identify and discriminate the occurrence of hypoglycemic events in patients with T1DM, this study aims to evaluate the impact of two distinct glucose monitoring systems—Flash Glucose Monitoring (FGM) and Continuous Glucose Monitoring (CGM)—on the management of blood glucose levels and the emotional responses associated with hypoglycemic episodes in individuals with T1DM.MethodIn this study, a total of 113 patients with type 1 diabetes mellitus were enrolled and allocated to two groups for the implementation of Glucose Monitoring Systems (GMS). The groups consisted of the FreeStyle Libre group (FGM, n=56) and the ipro2 group (CGM, n=57). Participants in both groups utilized GMS at least biannually and completed a set of three questionnaires: the Diabetes Monitoring and Treatment Satisfaction Questionnaire (DMTSQ), the Diabetes Specific Quality of Life (DQOL), and the Chinese Version of the Hypoglycemia Fear Survey II (CFHSII). Clinical data, CGM metrics, and questionnaire scores were collected at the initial visit and after a one-year follow-up period.ResultsThe glucose coefficient of variation (GCV) and the standard deviation of blood glucose (SDBG) were independently associated with Time Below Range (TBR). Specifically, GCV could predict TBR ≥12%, with a cut-off point of 40.55. This yielded a specificity of 88.10% and a sensitivity of 68.18% in the overall patient population. For the FreeStyle Libre group and the iPro2 group, the cut-off points were 38.69 and 40.55, respectively, with specificities of 0.74 and 0.92, and sensitivities of 0.73 and 0.86, respectively. In the FreeStyle Libre group, where the frequency of use was greater than or equal to five times per year, the hypoglycemic episodes (time/month) and CHFSII-B scores were significantly reduced at follow-up compared to baseline (7.80 ± 10.25 vs 13.95 ± 14.87; 27.37 ± 11.05 vs 38.90 ± 21.61, respectively, all P &amp;lt;0.05).ConclusionThe utilization of multiple Flash Glucose Monitoring (FGM) implementations proved to be valuable in discriminating the occurrence of hypoglycemia and mitigating the fear of hypoglycemic episodes in patients with type 1 diabetes. Within the parameters of Glucose Monitoring Systems (GMS), the glucose glycemic variability (GCV) was identified as a predictive factor for the risk of severe hypoglycemia (TBR &amp;gt; 12%). The optimal cut-off point for GCV was determined to be 40.55.