Clinical and Experimental Emergency Medicine

Neurology

Short-term functional outcomes and treatment trends for branch atheromatous disease and lacunar infarction: a retrospective cohort study of a nationwide multicenter registry: Gaku Fujiwara, Hideki Oka, Akihiro Fujii; Clin Exp Emerg Med 2024;11(4):365-371. Published online July 19, 2024; DOI: https://doi.org/10.15441/ceem.24.220

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Short-term functional outcomes and treatment trends for branch atheromatous disease and lacunar infarction: a retrospective cohort study of a nationwide multicenter registry

Clin Exp Emerg Med. 2024;11(4):365-371. Published online July 19, 2024

DOI: https://doi.org/10.15441/ceem.24.220

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Short-term functional outcomes and treatment trends for branch atheromatous disease and lacunar infarction: a retrospective cohort study of a nationwide multicenter registry

Clin Exp Emerg Med. 2024;11(4):365-371. Published online July 19, 2024

DOI: https://doi.org/10.15441/ceem.24.220

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Objective
Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not well understood, and its relationship with the functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes. Methods In this multicenter cohort study, we retrospectively analyzed data from 27 hospitals that contributed to the Saiseikai Stroke Database (2013–2021). We used multivariable logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of BAD compared with lacunar infarction (LI) for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included, and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI. Results Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (aOR, 2.77; 95% CI, 2.42–3.17; relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients. Conclusion BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.

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Predicting early neurological deterioration in acute branch atheromatous disease without reperfusion therapy: a machine learning model
Li Zeng, Wei He, Xiuxiu Lu, Liangbing Zhang
Frontiers in Neuroscience.2026;[Epub] CrossRef
Dual Antiplatelet Therapy in Acute Branch Atheromatous Disease (BAD)‐Related Stroke: A Multicenter Propensity‐Matched Cohort Analysis
Haizhou Hu, Shengde Li, Yu Zhang, Yuhui Sha, Yaping Zhou, Feng Feng, Yicheng Zhu, Lixin Zhou, Bin Peng, Jun Ni
CNS Neuroscience & Therapeutics.2026;[Epub] CrossRef
Impact of non-amyloid cerebral small vessel disease on the efficacy and safety of argatroban in acute ischemic stroke: a retrospective cohort study
Fen Liu, Qiang Wu, Yan Lin, Jie Chen
Frontiers in Neurology.2026;[Epub] CrossRef
Impact of Preemptive vs. Conventional Tirofiban Administration on the Outcomes in Acute Branch Atheromatous Disease: A Propensity Score‐Weighted Cohort Study
Chunying Li, Ying Jin, Xing Liu, Ying Liu, Weikang Yang, Yue Wang, Dongsheng Ju
CNS Neuroscience & Therapeutics.2026;[Epub] CrossRef
Intravenous Thrombolysis for Minor Ischemic Stroke in Chinese Populations: A Secondary Meta-Analysis of Comparative Cohort Studies
João Vitor Andrade Fernandes, João Victor de Oliveira Ramos, Maurus Marques de Almeida Holanda
The Neurohospitalist.2026;[Epub] CrossRef
Cerebral autoregulation in patients with acute lacunar infarction: a reliable predictor of outcome
Xiang‐Kun Si, Song Xue, Xin Zhou, Ya‐Nan Guo, Wen‐Yu Du, Yang Qu, Xin Sun, Zhen‐Ni Guo
Annals of Clinical and Translational Neurology.2025; 12(4): 724. CrossRef
Association Between Argatroban and Outcomes of Branch Atheromatous Disease: A Propensity‐Matched Analysis From MRI‐Based Study
Shengde Li, Haizhou Hu, Yaping Zhou, Ping Zhang, Guofang Chen, Hongying Bai, Bin Liu, Lixin Zhou, Yicheng Zhu, Bin Peng, Jun Ni
CNS Neuroscience & Therapeutics.2025;[Epub] CrossRef
Efficacy and Safety of Tenecteplase in the Treatment of Acute Branch Atheromatous Disease: A Retrospective Multicenter Case–Control Study
Lili Zhu, Shengqi Fu, Ying Zhang, Baoyang Shi, Haoran Li, Fanchao Meng, Peng Ji, Dongya Zhang, Yanjun Zhang, Yuan Xu, Bo Jiang, Xiaofei Gao, Lijuan Liu, Weifeng Chen, Li Ruan, Shaolei Zhang, Yang Yang
Neurology and Therapy.2025; 14(5): 2187. CrossRef
Blood Pressure Variability and 90‐Day Functional Outcome in Branch Atheromatous Disease‐Related Stroke: A Multicenter Prospective Study
Yaping Zhou, Shengde Li, Haizhou Hu, Yi‐Cheng Zhu, Bin Peng, Lixin Zhou, Jun Ni
The Journal of Clinical Hypertension.2025;[Epub] CrossRef

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Critical Care | Education & Simulation

Physician awareness of fluid volume administered with intravenous antibiotics: a structured interview-based study: Jaleh Aghaie, Marianne Lisby, Marie Kristine Jessen; Clin Exp Emerg Med 2025;12(1):66-75. Published online May 23, 2024; DOI: https://doi.org/10.15441/ceem.24.219

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Physician awareness of fluid volume administered with intravenous antibiotics: a structured interview-based study

Clin Exp Emerg Med. 2025;12(1):66-75. Published online May 23, 2024

DOI: https://doi.org/10.15441/ceem.24.219

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Physician awareness of fluid volume administered with intravenous antibiotics: a structured interview-based study

Clin Exp Emerg Med. 2025;12(1):66-75. Published online May 23, 2024

DOI: https://doi.org/10.15441/ceem.24.219

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Objective
Fluids administered as drug diluents with intravenous (IV) medicine constitute a substantial fraction of fluids in inpatients. Whether physicians are aware of fluid volumes administered with IV antibiotics for patients with suspected infections is unclear. Moreover, whether this leads to adjustments in 24-hour fluid administration/antibiotics is unknown. Methods This cross-sectional interview-based study was conducted in three emergency departments. Physicians were interviewed after prescribing around-the-clock IV antibiotics for ≥24 hours to patients with suspected infection. A structured interview guide assessed the physicians’ awareness, considerations, and practices when prescribing IV antibiotics. The 24-hour antibiotic fluid volume was calculated. Results We interviewed 100 physicians. The 24-hour fluid volume administered with IV antibiotics was 400 mL (interquartile range, 300–400 mL). Overall, 53 physicians (53%) were unaware of the fluid volume administered with IV antibiotics. Moreover, 76 (76%) did not account for the antibiotic fluid volume in the 24-hour fluid administration, and 96 (96%) indicated that they would not adjust prescribed fluids after receiving information about 24-hour antibiotic fluid volume administered for their patient. No comorbidities associated with fluid intolerance were the primary reason for not adjusting prescribed fluids/ antibiotics. Approximately 79 (79%) opted for visibility of fluid volumes administered with IV antibiotics in the medical record. Conclusion The majority of physicians were unaware of fluid volumes administered as a drug diluent with IV antibiotics. The majority chose not to make post-prescribing adjustments to their planned fluid administration; they regarded their patient as fluid tolerant. The physicians opted for visibility of fluid volumes administered as diluents during the prescribing process.

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Medical Emergencies

The efficacy of hyperbaric oxygen therapy for skin perfusion following peripheral tissue injury due to usage of inotropes and vasopressors: a case report: Nien Hsiu Suen, Chang Hae Pyo, Hyun Kyung Park, Keun Hong Park, Dongsun Choi; Clin Exp Emerg Med 2024;11(4):387-391. Published online February 16, 2024; DOI: https://doi.org/10.15441/ceem.23.119

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The efficacy of hyperbaric oxygen therapy for skin perfusion following peripheral tissue injury due to usage of inotropes and vasopressors: a case report

Clin Exp Emerg Med. 2024;11(4):387-391. Published online February 16, 2024

DOI: https://doi.org/10.15441/ceem.23.119

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The efficacy of hyperbaric oxygen therapy for skin perfusion following peripheral tissue injury due to usage of inotropes and vasopressors: a case report

Clin Exp Emerg Med. 2024;11(4):387-391. Published online February 16, 2024

DOI: https://doi.org/10.15441/ceem.23.119

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Hyperbaric oxygen therapy (HBOT) has garnered significant attention as a therapeutic modality with potential benefits across a variety of medical conditions, ranging from wound healing and ischemic conditions to neurologic disorders and radiation-induced tissue damage. HBOT involves the administration of 100% oxygen at higher-than-atmospheric pressures, which increases the amount of oxygen dissolved in body fluids and tissues. Those elevated oxygen levels are proposed to facilitate tissue repair, reduce inflammation, and promote angiogenesis. This case report presents a compelling instance of the usefulness of HBOT in promoting skin perfusion and healing following peripheral tissue injury caused by administration of inotropic and vasopressor agents to a septic shock patient.

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Hyperbaric oxygen therapy in inflammatory bowel disease: Current evidence and research progress
Zhe-Heng Li, Wen-Song Ge
World Chinese Journal of Digestology.2026; 34(3): 236. CrossRef
Norepinephrine/Vasopressin

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Hyperbaric oxygen therapy in managing fingertip injury after the thenar and V—Y flap procedure: A case series
Mendy Hatibie Oley, Maximillian Christian Oley, Albertus Djarot Noersasongko, Yudhaputra Setiadhi, Vania Sukarno, Muhammad Faruk
International Journal of Surgery Case Reports.2025;[Epub] CrossRef

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Critical Care | Cardiovascular

Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study: Ahmet Çağrı Aykan, Tayyar Gökdeniz, İlker Gül, Ezgi Kalaycıoğlu, Can Yücel Karabay, Faruk Boyacı, Engin Hatem, Scott D. Weingart, İhsan Dursun; Clin Exp Emerg Med 2023;10(3):280-286. Published online May 15, 2023; DOI: https://doi.org/10.15441/ceem.23.015

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Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study

Clin Exp Emerg Med. 2023;10(3):280-286. Published online May 15, 2023

DOI: https://doi.org/10.15441/ceem.23.015

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Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study

Clin Exp Emerg Med. 2023;10(3):280-286. Published online May 15, 2023

DOI: https://doi.org/10.15441/ceem.23.015

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Objective
Severe pulmonary embolism (PE) has a high mortality rate, which can be lowered by thrombolytic therapy (TT). However, full-dose TT is associated with major complications, including life-threatening bleeding. The aim of this study was to explore the efficacy and safety of extended, low-dose administration of tissue plasminogen activator (tPA) on in-hospital mortality and outcomes in massive PE.
Methods
This was a single-center, prospective cohort trial at a tertiary university hospital. A total of 37 consecutive patients with massive PE were included. A peripheral intravenous infusion was used to administer 25 mg of tPA over 6 hours. The primary endpoints were in-hospital mortality, major complications, pulmonary hypertension, and right ventricular dysfunction. The secondary endpoints were 6-month mortality and pulmonary hypertension and right ventricular dysfunction 6 months after the PE.
Results
The mean age of the patients was 68.76±14.54 years. The mean pulmonary artery systolic pressure (PASP; 56.51±7.34 mmHg vs. 34.16±2.81 mmHg, P<0.001) and right/left ventricle diameter (1.37±0.12 vs. 0.99±0.12, P<0.001) decreased significantly after TT. Tricuspid annular plane systolic excursion (1.43±0.33 cm vs. 2.07±0.27 cm, P<0.001), myocardial performance index (0.47±0.08 vs. 0.55±0.07, P<0.001), and systolic wave prime (9.6±2.8 vs. 15.3±2.6) increased significantly after TT. No major bleeding or stroke was observed. There was one in-hospital death and two additional deaths within 6 months. No cases of pulmonary hypertension were identified during follow-up.
Conclusion
The results of this pilot study suggest that an extended infusion of low-dose tPA is a safe and effective therapy in patients with massive PE. This protocol was also effective in decreasing PASP and restoring right ventricular function.

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2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults
Mark A. Creager, Geoffrey D. Barnes, Jay Giri, Debabrata Mukherjee, William Schuyler Jones, Allison E. Burnett, Teresa Carman, Ana I. Casanegra, Lana A. Castellucci, Sherrell M. Clark, Mary Cushman, Kerstin de Wit, Jennifer M. Eaves, Margaret C. Fang, Jos
JACC.2026; 87(13): 1626. CrossRef
2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Mark A. Creager, Geoffrey D. Barnes, Jay Giri, Debabrata Mukherjee, William Schuyler Jones, Allison E. Burnett, Teresa Carman, Ana I. Casanegra, Lana A. Castellucci, Sherrell M. Clark, Mary Cushman, Kerstin de Wit, Jennifer M. Eaves, Margaret C. Fang, Jos
Circulation.2026;[Epub] CrossRef
Personalised viscoelastometry-guided systemic thrombolysis for high- and intermediate-high-risk acute pulmonary embolism in the ICU: a single-centre randomised controlled interventional feasibility trial
András Kállai, Anna Párkányi, Máté Berczi, Dalma Skultéti, János Domonkos Stubnya, Hanna Dóra Szász, Gergely Szombath, Adrienne Fehér, Zsolt Dániel Iványi, János Gál, János Fazakas
Intensive Care Medicine Experimental.2026;[Epub] CrossRef
Kết quả ngắn hạn và trung hạn điều trị thuyên tắc động mạch phổi bằng thuốc Alteplase tại Viện Tim mạch, Bệnh viện Bạch Mai
Nguyễn Mai Hương, Nguyễn Thị Thu Hương, Lê Hồng An, Tạ Mạnh Cường, Nguyễn Đức Hòa, Mai Thị Kim Liên
Tạp chí Tim mạch học Việt Nam.2026;[Epub] CrossRef
Trials Review
Omar Sheikh, Jun Li, Robert Lookstein, Stavros Konstantinides
Clinics in Chest Medicine.2026;[Epub] CrossRef
Reduced-Dose Tenecteplase in High-Risk Pulmonary Embolism
Jennifer Hammond, Dean Cataldo, Christopher Allison, Seth Kelly
The Journal of Emergency Medicine.2025; 71: 67. CrossRef
Fibrinolytic uses in the emergency department: a narrative review
Brit Long, William J. Brady, Michael Gottlieb
The American Journal of Emergency Medicine.2025; 89: 85. CrossRef
Pulmonary Embolism: Unanswered Questions and Ongoing Evidence Gaps
Omar Elmadhoun, Michael P. Merren, Patrick M. Wieruszewski, Juan G. Ripoll, Jeffrey Huang, Harish Ramakrishna
Journal of Cardiothoracic and Vascular Anesthesia.2025; 39(9): 2498. CrossRef
Low-dose Systemic Tissue-type-plasminogen-activator Compared to Conventional Anti-coagulation for the Treatment of Intermediate-high Risk Pulmonary Embolism
Alan De la Rosa, Adrian Rojas Murguia, Michael J. Brockman, Debabrata Mukherjee, Manu Rajachandran, Nils P. Nickel
Cardiovascular & Hematological Disorders-Drug Targets.2025; 25(1): 46. CrossRef
Shock Index and Physiological Stress Index for reestratifying patients with intermediate-high risk pulmonary embolism
Marcos Valiente Fernández, Amanda Lesmes González de Aledo, Francisco de Paula Delgado Moya, Isaías Martín Badía, Elena Álvaro Valiente, Nerea Blanco Otaegui, Pablo Risco Torres, Ignacio Saéz de la Fuente, Silvia Chacón Alves, Lidia Orejón García, María S
Medicina Intensiva (English Edition).2024; 48(6): 309. CrossRef
Safety and Efficacy of Reduced-Dose Versus Full-Dose Alteplase for Acute Pulmonary Embolism: A Multicenter Observational Comparative Effectiveness Study*
Roman Melamed, David M. Tierney, Ranran Xia, Caitlin S. Brown, Kristin C. Mara, Matthew Lillyblad, Abbey Sidebottom, Brandon M. Wiley, Ivan Khapov, Ognjen Gajic
Critical Care Medicine.2024; 52(5): 729. CrossRef
Management of high-risk pulmonary embolism in the emergency department: A narrative review
Samuel G. Rouleau, Scott D. Casey, Christopher Kabrhel, David R. Vinson, Brit Long
The American Journal of Emergency Medicine.2024; 79: 1. CrossRef
Addressing the rising trend of high‐risk pulmonary embolism mortality: Clinical and research priorities
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Academic Emergency Medicine.2024; 31(3): 288. CrossRef
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Medicina Intensiva.2024; 48(6): 309. CrossRef

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Cardiovascular

Short-term effects of fibrinolytic therapy on the hemodynamic parameters of patients with intermediate- and high-risk pulmonary embolism: Hamza Çıldır, Ersin Aksay, Emre Şancı, Başak Bayram, Neşe Çolak, Can Sevinç; Clin Exp Emerg Med 2022;9(1):47-53. Published online March 31, 2022; DOI: https://doi.org/10.15441/ceem.21.073

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Short-term effects of fibrinolytic therapy on the hemodynamic parameters of patients with intermediate- and high-risk pulmonary embolism

Clin Exp Emerg Med. 2022;9(1):47-53. Published online March 31, 2022

DOI: https://doi.org/10.15441/ceem.21.073

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Short-term effects of fibrinolytic therapy on the hemodynamic parameters of patients with intermediate- and high-risk pulmonary embolism

Clin Exp Emerg Med. 2022;9(1):47-53. Published online March 31, 2022

DOI: https://doi.org/10.15441/ceem.21.073

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Objective
We aimed to determine the effect of fibrinolytic therapy on hemodynamic parameters at 4 hours after treatment and bleeding complications in patients with intermediate- and high-risk pulmonary embolism.
Methods
This single-center, retrospective, cohort study included patients with intermediate- and high-risk pulmonary embolism treated with fibrinolytics. Their demographic and clinical characteristics, complications, and vital signs at the initiation of and 4 hours after fibrinolytic therapy were evaluated. The primary outcome was the change in the patients’ vital signs at 4 hours after fibrinolytic therapy, compared by the Mann-Whitney U-test.
Results
Seventy-nine patients were included in this study. The systolic and diastolic blood pressures of the high-risk group at 4 hours after fibrinolytic therapy were higher than those at the initiation of fibrinolytic therapy (80 mmHg vs. 99 mmHg, P = 0.029; 49 mmHg vs. 67 mmHg, P = 0.011, respectively). In the intermediate-risk group, the oxygen saturation increased (94% vs. 96%, P = 0.004) and pulse rate decreased (104 beats/min vs. 91 beats/min, P < 0.001).
Conclusion
Blood pressure at 4 hours after fibrinolytic therapy increased in patients with high-risk pulmonary embolism. Also, oxygen saturation and pulse rate improved in intermediate-risk patients.

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Assessing the safety of interrogating cardiac-implantable electronic devices with brand-mismatched remote interrogators: a pilot study: Tinh Le, James Neuenschwander, Parker Cordial, Mackenzie Sankoe, Ankur Parekh, Brian Hiestand, WF Peacock; Clin Exp Emerg Med 2022;9(1):24-28. Published online March 31, 2022; DOI: https://doi.org/10.15441/ceem.21.065

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Assessing the safety of interrogating cardiac-implantable electronic devices with brand-mismatched remote interrogators: a pilot study

Clin Exp Emerg Med. 2022;9(1):24-28. Published online March 31, 2022

DOI: https://doi.org/10.15441/ceem.21.065

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Assessing the safety of interrogating cardiac-implantable electronic devices with brand-mismatched remote interrogators: a pilot study

Clin Exp Emerg Med. 2022;9(1):24-28. Published online March 31, 2022

DOI: https://doi.org/10.15441/ceem.21.065

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Objective
Remote cardiac implantable electronic device (CIED) interrogators, originally developed for home use, have been proven to be efficacious in clinical settings, especially emergency departments. Concern exists that attempting to interrogate a CIED with the remote interrogator of a different brand, i.e., a brand-mismatched interrogator, may cause device malfunction. The aim of this study was to determine if intentionally attempting to interrogate a CIED with a brand-mismatched remote interrogator resulted in device malfunction.
Methods
A total of 75 ex vivo CIEDs manufactured by various companies underwent attempted interrogation by a brand-mismatched remote interrogator. CIED settings were compared before and after attempted mismatch interrogation. A total of 30 in vivo CIEDs were then randomized for an attempted 2-minute mismatched remote interrogation by one of the two possible mismatched remote interrogators. CIED settings were compared before and after attempted mismatch interrogation.
Results
Of 150 ex vivo brand-mismatched interrogations, no device setting changes or malfunctions occurred; no remote interrogators connected to a mismatched CIED, and no devices were turned off. In the 30 patients undergoing brand-mismatched interrogations, the mean (standard deviation) age was 71.6 ( ± 14.7) years, 16 (53%) were male, with 24 pacemakers (80%), four pacemaker/implantable cardioverter defibrillators (13%), and two implantable cardioverter defibrillators (7%). Of the 30 mismatched interrogations performed, no device setting changes or malfunctions occurred; no remote interrogators connected to a mismatched CIED, and no devices turned off.
Conclusion
In a total 180 attempted brand-mismatched CIED interrogations, no CIED malfunctions occurred. This suggests that the use of remote CIED interrogators when device manufacturer is unknown is unlikely to result in adverse CIED-related events.

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Neurology

Characteristics of blood tests in patients with acute cerebral infarction who developed symptomatic intracranial hemorrhage after intravenous administration of recombinant tissue plasminogen activator: Chungjo Lee, Ji Ung Na, Jang Hee Lee, Sang Kuk Han, Pil Cho Choi, Young Hwan Lee, Sang O Park, Dong Hyuk Shin; Clin Exp Emerg Med 2019;6(2):160-168. Published online June 28, 2019; DOI: https://doi.org/10.15441/ceem.18.056

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Characteristics of blood tests in patients with acute cerebral infarction who developed symptomatic intracranial hemorrhage after intravenous administration of recombinant tissue plasminogen activator

Clin Exp Emerg Med. 2019;6(2):160-168. Published online June 28, 2019

DOI: https://doi.org/10.15441/ceem.18.056

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Characteristics of blood tests in patients with acute cerebral infarction who developed symptomatic intracranial hemorrhage after intravenous administration of recombinant tissue plasminogen activator

Clin Exp Emerg Med. 2019;6(2):160-168. Published online June 28, 2019

DOI: https://doi.org/10.15441/ceem.18.056

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Objective
Patients suspected as having acute ischemic stroke usually undergo blood tests, including coagulation-related indexes, because thrombocytopenia and coagulopathy are contraindications for recombinant tissue plasminogen activator (rtPA) administration. We aimed to identify blood test indexes associated with symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke who received intravenous rtPA.
Methods
This retrospective observational study included patients diagnosed with acute ischemic stroke who were treated with intravenous rtPA at the emergency department of a tertiary hospital in Seoul between February 2008 and January 2018. Blood test indexes were compared between the sICH and non-sICH groups. Logistic regression and receiver-operating characteristic curve analyses were performed.
Results
In this study, 375 patients were finally included. Of 375 patients, 42 (11.2%) showed new intracranial hemorrhage on follow-up brain computed tomography, of whom 14 (3.73%) had sICH. Platelet count, aspartate aminotransferase and lactate dehydrogenase levels were significantly different between the sICH and non-sICH groups, and platelet count showed statistical significance in the regression analysis. Significantly lower platelet counts were observed in the sICH group than in the non-sICH group (174,500 vs. 228,000/mm³, P=0.020). The best cutoff platelet count was 195,000/mm³, and patients with platelet counts of <195,000/mm³ had a 5.4- times higher risk of developing sICH than those with platelet counts of ≥195,000/mm³.
Conclusion
Platelet count was the only independent parameter associated with sICH among the blood test indexes. Mild thrombocytopenia may increase the risk of sICH after intravenous administration of rtPA.

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Insight of action mechanism of Astragaloside IV for relieving of cerebral ischemic injury in a rat model of middle cerebral artery occlusion reperfusion via proteomics and network pharmacology
Xin-Hua Zhu, Xin Yu, Xiang-Wen Kong, Yi Zhang, Si-Liang Jiang, Jun-Hong Chai, Jun Liang, Hai-Xue Kuang, Yong-Gang Xia
Journal of Natural Medicines.2025; 79(3): 591. CrossRef
Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis
Jiacheng Sun, Christina Lam, Lauren Christie, Christopher Blair, Xingjuan Li, Freda Werdiger, Qing Yang, Andrew Bivard, Longting Lin, Mark Parsons
Frontiers in Neurology.2023;[Epub] CrossRef

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Diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch is associated with better neurologic response to intravenous thrombolytic therapy in acute ischemic stroke patients: Jong Yeong Jeong, Sang Kuk Han, Dong Hyuk Shin, Ji Ung Na, Hyun Jung Lee, Pil Cho Choi, Jeong Hun Lee; Clin Exp Emerg Med 2015;2(1):31-37. Published online March 31, 2015; DOI: https://doi.org/10.15441/ceem.14.043

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Diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch is associated with better neurologic response to intravenous thrombolytic therapy in acute ischemic stroke patients

Clin Exp Emerg Med. 2015;2(1):31-37. Published online March 31, 2015

DOI: https://doi.org/10.15441/ceem.14.043

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Diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch is associated with better neurologic response to intravenous thrombolytic therapy in acute ischemic stroke patients

Clin Exp Emerg Med. 2015;2(1):31-37. Published online March 31, 2015

DOI: https://doi.org/10.15441/ceem.14.043

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Objective
To investigate differences in the effect of intravenous (IV) thrombolysis regarding the mismatch of diffusion-weighted imaging–fluid-attenuated inversion recovery (DWI-FLAIR) among acute ischemic stroke patients who visited the emergency department (ED) within 3 hours from the onset of symptoms.
Methods
Among ED patients presenting with an acute ischemic stroke between January 2011 and May 2013 at a tertiary hospital, those who underwent magnetic resonance imaging before IV thrombolytic therapy were included in this retrospective study. Patients were divided into DWI-FLAIR mismatch and match groups. National Institutes of Health Stroke Scale (NIHSS) scores obtained initially, 24 hours after thrombolytic therapy, and on discharge, and early neurologic improvement (ENI) and major neurologic improvement (MNI) were compared.
Results
During the study period, 50 of the 213 acute ischemic stroke patients who presented to the ED were included. The DWI-FLAIR mismatch group showed a statistically significantly greater reduction in NIHSS both at 24 hours after thrombolytic therapy and upon discharge than did the match group (5.5 vs. 1.2, P<0.001; 6.0 vs. 2.3, P<0.01, respectively). Moreover, ENI and MNI were significantly greater for the DWI-FLAIR mismatch group than for the match group (27/36 vs. 2/14, P<0.001; 12/36 vs. 0/14, P=0.012, respectively).
Conclusion
Among acute ischemic stroke patients who visited the ED within 3 hours from the onset of symptoms, patients who showed DWI-FLAIR mismatch showed a significantly better response to IV thrombolytic therapy than did the DWI-FLAIR match group in terms of neurologic outcome.

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Cerebrovascular Diseases.2021; 50(6): 738. CrossRef

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The evaluation and management of thermal injuries: 2014 update: Jimmy Toussaint, Adam J. Singer; Clin Exp Emerg Med 2014;1(1):8-18. Published online September 30, 2014; DOI: https://doi.org/10.15441/ceem.14.029

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The evaluation and management of thermal injuries: 2014 update

Clin Exp Emerg Med. 2014;1(1):8-18. Published online September 30, 2014

DOI: https://doi.org/10.15441/ceem.14.029

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The evaluation and management of thermal injuries: 2014 update

Clin Exp Emerg Med. 2014;1(1):8-18. Published online September 30, 2014

DOI: https://doi.org/10.15441/ceem.14.029

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Burns are among the most common injuries presenting to the emergency department. While burns, especially large ones, may be associated with significant morbidity and mortality, most are minor and can be managed by emergency practitioners and discharged home with close follow-up. In contrast, patients with large burns require aggressive management of their airway, breathing and circulation in order to reduce mortality and morbidity. While early endotracheal intubation of patients with actual or impending airway compromise and aggressive fluid resuscitation have been emphasized, it appears that the pendulum may have swung a bit too far towards the extreme. The current review will briefly cover the epidemiology, pathogenesis and diagnosis of burn injuries with greater emphasis on airway and fluid management. We will also discuss the local management of the burn wound, which is all that is required for most burn patients in the emergency department.

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