BACKGROUND:Evidence supporting the early addition of antiplatelet therapy to intravenous thrombolysis in patients with acute ischaemic stroke remains inconclusive. We aimed to investigate the efficacy and safety of early oral dual antiplatelet therapy (DAPT), started within 6 h of onset, as an adjunct to intravenous thrombolysis. METHODS:TAPIS was a randomised, double-blind, placebo-controlled trial done in 60 hospitals across China. We enrolled patients treated with intravenous thrombolysis for ischaemic stroke, with a National Institutes of Health Stroke Scale score of 4-10. We randomly assigned (1:1) patients to receive oral aspirin plus ticagrelor (DAPT group) or corresponding placebo within 6 h of stroke onset, either before, during, or after receiving thrombolysis. Ticagrelor or placebo was continued for days 2-7 in each group, with open-label aspirin administered for days 2-90. Patients, clinicians, and investigators were masked to the group assignment. The primary efficacy outcome was an excellent functional outcome (modified Rankin Scale score 0-1) at 90 days. The primary safety outcome was symptomatic intracranial haemorrhage within 36 h. This trial was registered with ClinicalTrials.gov (NCT06316570) and is completed. FINDINGS:Between April 3, 2024, and Sept 30, 2025, we randomly assigned 1382 patients to the early DAPT (n=690 [49·9%]) or placebo (n=692 [50·1%]) groups. The median age was 65·6 years (IQR 58·3-72·0), 991 (71·7%) were men, and 391 (28·3%) were women. At 90 days, 474 (68·7%) patients in the early DAPT group and 429 (62·0%) in the placebo group achieved excellent functional outcomes (risk ratio 1·11 [95% CI 1·03-1·20; p=0·0089). Symptomatic intracranial haemorrhage within 36 h occurred in six (0·9%) patients in the early DAPT group versus five (0·7%) in the control group (risk ratio 1·20 [95% CI 0·37-3·93; p=0.76). INTERPRETATION:Among patients treated with intravenous thrombolysis for moderate ischaemic stroke, initiation of oral DAPT within 6 h of onset improved the likelihood of excellent functional outcomes at 90 days. Although no significant between-group difference in symptomatic intracranial haemorrhage was detected, wide CIs precluded exclusion of a small increased risk. FUNDING:National Natural Science Foundation of China, Capital's Funds for Health Improvement and Research, Noncommunicable Chronic Diseases-National Science and Technology Major Project, Beijing Municipal Science & Technology Commission, and the New Cornerstone Science Foundation.
OBJECTIVES:Prevalence, outcome and causal implication of neonatal survival-associated major morbidities remain the central focus of quality improvement of maternal-fetal and neonatal medicine. We aimed to estimate baseline information of neonatal intensive and critical care by analyzing surviving data of all hospitalized neonates from livebirth population. SUBJECTS AND METHODS:We prospectively collected a datafile consisting of 10,840 (13.72%) cases as all hospitalized neonates from 79,012 livebirths in Handan in 2020, a sub-provincial region with 9.41 million population and intermediate-to-high level of socioeconomic development in north China. The diagnoses of diseases requiring intensive and/or critical care, and causes of deaths, were categorized, and perinatal and disease-specific risks of death were estimated by multivariable logistic regression models. RESULTS:Livebirth-based incidence of major perinatal comorbidities were 19.7‰ for congenital pneumonia/early onset sepsis, 12.1‰ intraventricular hemorrhage, 8.7‰ birth asphyxia, 8.7‰ respiratory distress syndrome (RDS), 7.7‰ sepsis and 6.8‰ congenital anomalies (CA). Case-fatality rate (cause-specific mortality rate referring to livebirths) of major diseases were 47.1% (0.2‰) pulmonary hemorrhage, 26.9% (0.1‰) necrotizing enterocolitis, 15.6% (0.2‰) late onset sepsis, 14.1% (1.2‰) RDS, 11.3% (0.8‰) CA, and 11% (1.0‰) asphyxia. There were 242 (2.2%) died in hospital (3.1‰ of all livebirths), 52.1% being in the preterm, 49.2% in low birthweight, and <40% in those <28 weeks of gestation, or <1000 g birthweight, respectively. Death risks associated with the perinatal and neonatal morbidities were markedly declined with variable magnitudes as estimated by multivariable logistic regression models. CONCLUSIONS:The incidence rates of major perinatal comorbidities, neonatal mortality rates, and major risks to the overall and specific outcome of all the hospitalized neonates in Handan, denote baseline characteristics and efficiency of the regional perinatal-neonatal care system.
Objective: To analyze the clinical significance of the emergency green channel in the treatment of patients with acute chest pain. Methods: Sixty patients with acute chest pain treated between September 2022 and July 2024 were selected as the subjects of this study. They were divided into groups based on the order of treatment: the first 30 patients were included in the Green Channel group, where the emergency green channel was employed, while the remaining 30 patients were placed in the Regular Emergency group, receiving standard emergency treatment. The rescue time, hospitalization time, pain scores, incidence of adverse reactions, and quality of life between the Green Channel group and the Regular Emergency group were compared. Results: The rescue time and hospitalization time of the Green Channel group were shorter than those of the Regular Emergency group, with statistical significance (P < 0.05). The pain scores at 30, 60, 120, and 240 minutes after rescue in the Green Channel group were lower than those in the Regular Emergency group, with statistical significance (P < 0.05). The incidence of adverse reactions such as recurrent acute attacks, arrhythmia, heart failure, stroke, and shock in the Green Channel group was lower than that in the Regular Emergency group, with statistical significance (P < 0.05). The treatment satisfaction rate and success rate in the Green Channel group were 93.33% and 93.33%, respectively, while those in the Regular Emergency group were 73.33% and 73.33%. Both the satisfaction and success rates in the Green Channel group were higher than those in the Regular Emergency group, with statistical significance (P < 0.05). The quality of life in the Green Channel group was also higher than that in the Regular Emergency group, with statistical significance (P < 0.05). Conclusion: The emergency green channel plays a significant role in the treatment of patients with acute chest pain and is worthy of widespread clinical application.
Die Entwicklung von Immuntherapien, insbesondere Immuncheckpoint-Inhibitoren, die auf PD-1/PD-L1 abzielen, hat die Behandlungsergebnisse für Patienten mit Speiseröhrenkrebs verbessert. Doch nicht alle Patientengruppen profitieren von den Wirkstoffen. Kürzlich wurden neue Arten von Biomarkern eingeführt, um das Ansprechen auf die Immuntherapie vorherzusagen. Die Aussagekraft dieser berichteten Biomarker ist jedoch umstritten, und es bleiben viele Herausforderungen bestehen. In dieser Übersichtsarbeit möchten wir die aktuelle klinische Evidenz zusammenfassen und ein umfassendes Verständnis der berichteten Biomarker vermitteln. Wir diskutieren auch die Grenzen der vorliegenden Biomarker und geben unsere eigene Einschätzung, möchten unsere Leserinnen und Leser aber bitten, ihr eigenes Urteil zu bilden.
