Data blinding for the nEDM experiment at PSI

Psychological bias towards, or away from, prior measurements or theory predictions is an intrinsic threat to any data analysis. While various methods can be used to try to avoid such a bias, e.g. actively avoiding looking at the result, only data blinding is a traceable and trustworthy method that can circumvent the bias and convince a public audience that there is not even an accidental psychological bias. Data blinding is nowadays a standard practice in particle physics, but it is particularly difficult for experiments searching for the neutron electric dipole moment (nEDM), as several cross measurements, in particular of the magnetic field, create a self-consistent network into which it is hard to inject a false signal. We present an algorithm that modifies the data without influencing the experiment. Results of an automated analysis of the data are used to change the recorded spin state of a few neutrons within each measurement cycle. The flexible algorithm may be applied twice (or more) to the data, thus providing the option of sequentially applying various blinding offsets for separate analysis steps with independent teams. The subtle manner in which the data are modified allows one subsequently to adjust the algorithm and to produce a re-blinded data set without revealing the initial blinding offset. The method was designed for the 2015/2016 measurement campaign of the nEDM experiment at the Paul Scherrer Institute. However, it can be re-used with minor modification for the follow-up experiment n2EDM, and may be suitable for comparable projects elsewhere.

Measurement of the Permanent Electric Dipole Moment of the Neutron

We present the result of an experiment to measure the electric dipole moment (EDM) of the neutron at the Paul Scherrer Institute using Ramsey's method of separated oscillating magnetic fields with ultracold neutrons. Our measurement stands in the long history of EDM experiments probing physics violating time-reversal invariance. The salient features of this experiment were the use of a ^{199}Hg comagnetometer and an array of optically pumped cesium vapor magnetometers to cancel and correct for magnetic-field changes. The statistical analysis was performed on blinded datasets by two separate groups, while the estimation of systematic effects profited from an unprecedented knowledge of the magnetic field. The measured value of the neutron EDM is d_{n}=(0.0±1.1_{stat}±0.2_{sys})×10^{-26}  e.cm.

nEDM experiment at PSI: Data-taking strategy and sensitivity of the dataset

We report on the strategy used to optimize the sensitivity of our search for a neutron electric dipole moment at the Paul Scherrer Institute. Measurements were made upon ultracold neutrons stored within a single chamber at the heart of our apparatus. A mercury cohabiting magnetometer together with an array of cesium magnetometers were used to monitor the magnetic field, which was controlled and shaped by a series of precision field coils. In addition to details of the setup itself, we describe the chosen path to realize an appropriate balance between achieving the highest statistical sensitivity alongside the necessary control on systematic effects. The resulting irreducible sensitivity is better than 1 × 10−26e cm. This contribution summarizes in a single coherent picture the results of the most recent publications of the collaboration.

The n2EDM experiment at the Paul Scherrer Institute

We present the new spectrometer for the neutron electric dipole moment (nEDM) search at the Paul Scherrer Institute (PSI), called n2EDM. The setup is at room temperature in vacuum using ultracold neutrons. n2EDM features a large UCN double storage chamber design with neutron transport adapted to the PSI UCN source. The design builds on experience gained from the previous apparatus operated at PSI until 2017. An order of magnitude increase in sensitivity is calculated for the new baseline setup based on scalable results from the previous apparatus, and the UCN source performance achieved in 2016.

Conductance Spectroscopy of Exfoliated Thin Flakes of Nb xBi2Se3

We study unconventional superconductivity in exfoliated single crystals of a promising three-dimensional (3D) topological superconductor candidate, Nb-doped Bi₂Se₃ through differential conductance spectroscopy and magneto-transport. The strong anisotropy of the critical field along the out-of-plane direction suggests that the thin exfoliated flakes are in the quasi-2D limit. Normal metal-superconductor (NS) contacts with either high or low transparencies made by depositing gold leads onto Nb-doped Bi₂Se₃ flakes both show significant enhancement in zero bias conductance and coherence dips at the superconducting energy gap. Such behavior is inconsistent with conventional Blonder-Tinkham-Klapwijk theory. Instead, we discuss how our results are consistent with p-wave pairing symmetry, supporting the possibility of topological superconductivity in Nb-doped Bi₂Se₃. Finally, we observe signatures of multiple superconducting energy gaps, which could originate from multiple Fermi surfaces reported earlier in bulk crystals.

An arbitrary-function light power controller

We describe the design, applications, and performance of a simple light power controller. The device is built on a fiber-coupled electro-optic modulator with an active electronic feedback. It can be used to actively stabilize laser power or to impress an arbitrary waveform onto the power. The bandwidth of the device is ∼70 kHz.

Observation of Gravitationally Induced Vertical Striation of Polarized Ultracold Neutrons by Spin-Echo Spectroscopy

We describe a spin-echo method for ultracold neutrons (UCNs) confined in a precession chamber and exposed to a |B0|=1  μT magnetic field. We have demonstrated that the analysis of UCN spin-echo resonance signals in combination with knowledge of the ambient magnetic field provides an excellent method by which to reconstruct the energy spectrum of a confined ensemble of neutrons. The method takes advantage of the relative dephasing of spins arising from a gravitationally induced striation of stored UCNs of different energies, and also permits an improved determination of the vertical magnetic-field gradient with an exceptional accuracy of 1.1  pT/cm. This novel combination of a well-known nuclear resonance method and gravitationally induced vertical striation is unique in the realm of nuclear and particle physics and should prove to be invaluable for the assessment of systematic effects in precision experiments such as searches for an electric dipole moment of the neutron or the measurement of the neutron lifetime.

Highly stable atomic vector magnetometer based on free spin precession

We present a magnetometer based on optically pumped Cs atoms that measures the magnitude and direction of a 1 μT magnetic field. Multiple circularly polarized laser beams were used to probe the free spin precession of the Cs atoms. The design was optimized for long-time stability and achieves a scalar resolution better than 300 fT for integration times ranging from 80 ms to 1000 s. The best scalar resolution of less than 80 fT was reached with integration times of 1.6 to 6 s. We were able to measure the magnetic field direction with a resolution better than 10 μrad for integration times from 10 s up to 2000 s.

Spectroscopy of Mn atoms isolated in solid ⁴He

We present an experimental study of the laser-induced luminescence spectra of Mn atoms in solid helium matrices. We observe transitions of the valence electron and of inner-shell electrons. We find that the Mn-He interaction perturbs the inner-shell transitions to a lesser extent than the valence-electron transitions. The observed lineshapes of the inner-shell transitions of Mn are similar to those of an inner-shell transition in Ba studied earlier. At the same time, they are more strongly perturbed than the corresponding transitions in Au and Cu under the same conditions. We suggest a qualitative explanation of these observations based on the atomic bubble model. Our results also suggest that the inner-shell transitions of Mn in solid He are more strongly perturbed than the same lines of Mn isolated in solid Ar or Kr matrices.

Spectroscopy of gold atoms isolated in liquid and solid 4He matrices

We present a systematic experimental study of absorption and fluorescence spectra of Au atoms in bulk liquid and solid helium matrices. The results are compared to the spectra of Cu atoms studied earlier. We investigate the dependence of the observed spectral lineshapes on the helium pressure. The observed splitting of the 5d(10)6p - 5d(9)6s(2) transitions of Au in hcp solid He gives evidence for an anisotropic trapping site structure formed either by a non-spherical atomic bubble or a four-vacancy center.

A Bell-Bloom experiment with polarization-modulated light of arbitrary duty cycle

We report on a study of polarization-modulation experiments on the 4 → 3 hyperfine component of the D1 transition in Cs vapor contained in a paraffin-coated cell. The laser beam's polarization was switched between left- and right-circular polarization at a rate of 200 Hz. Variations of the transmitted light power were recorded while varying the amplitude of a transverse magnetic field. The power shows electromagnetically induced transparency (EIT) resonances when the atomic Larmor frequency matches a harmonic of the modulation frequency. We made a quantitative study of the resonance amplitudes with square-wave modulations of various duty cycles, and find an excellent agreement with recent algebraic model predictions.

Spectroscopy of Cs2, RbCs, and Rb2 in solid 4He

We present comparative experimental and theoretical studies of the absorption and fluorescence spectra of the alkali-metal dimer molecules Cs(2) and RbCs immersed in a solid helium matrix, thereby extending our recent observations of Rb(2) in solid (4)He. The laser-excited molecular states are mostly quenched by the interaction with the He matrix. The quenching efficiently populates the second lowest excited state of the molecule, i.e., (1)  (3)Π((u)) that is metastable in the homonuclear dimers. Molecular excitation and emission bands are modeled by calculating Franck-Condon factors that give a reasonable agreement with the experimental findings.

Test of Lorentz invariance with spin precession of ultracold neutrons

A clock comparison experiment, analyzing the ratio of spin precession frequencies of stored ultracold neutrons and 199Hg atoms, is reported. No daily variation of this ratio could be found, from which is set an upper limit on the Lorentz invariance violating cosmic anisotropy field b perpendicular < 2 x 10(-20) eV (95% C.L.). This is the first limit for the free neutron. This result is also interpreted as a direct limit on the gravitational dipole moment of the neutron |gn| < 0.3 eV/c2 m from a spin-dependent interaction with the Sun. Analyzing the gravitational interaction with the Earth, based on previous data, yields a more stringent limit |gn| < 3 x 10(-4) eV/c2 m.

Positive ion induced solidification of 4He

We have observed bulk solidification of 4He induced by nucleation on positive alkali ions in pressurized superfluid helium. The ions are extracted into the liquid from alkali-doped solid He by a static electric field. The experiments prove the existence of charged particles in a solid structure composed of doped He that was recently shown to coexist with superfluid helium below the He solidification pressure. This supports our earlier suggestion that the Coulomb interaction of positive ions surrounded by a solid He shell (snowballs) and electrons trapped in spherical cavities (electron bubbles), together with surface tension, is responsible for the stability of that structure against melting. We have determined the density of charges in the sample by two independent methods.

Direct experimental limit on neutron-mirror-neutron oscillations

In case a mirror world with a copy of our ordinary particle spectrum would exist, the neutron n and its degenerate partner, the mirror neutron n', could potentially mix and undergo nn' oscillations. The interaction of an ordinary magnetic field with the ordinary neutron would lift the degeneracy between the mirror partners, diminish the n' amplitude in the n wave function and, thus, suppress its observability. We report an experimental comparison of ultracold neutron storage in a trap with and without superimposed magnetic field. No influence of the magnetic field is found and, assuming negligible mirror magnetic fields, a limit on the oscillation time taunn' > 103 s (95% C.L.) is derived.

Administration of 6-methoxybenzoxazolinone (MBOA) does not augment ovulatory responses in St. Croix White ewes superovulated with PMSG

The objective of this investigation was to examine the effects of 6-methoxy-benzoxazolinone (MBOA), a plant compound that resembles melatonin and alters ovarian function in rodents, in combination with PMSG on superovulatory responses in the cycling ewe. In Experiment I, St. Croix White ewes (n = 44) were synchronized (intra-vaginal progestin sponge) for 14days followed by hCG (750 IU) at 1 day after sponge removal (day 0). Ewes were assigned to one of six treatments administered on day -1: Control (no PMSG or MBOA; n = 7); PMSG (1000 IU i.m.; n = 7); Low MBOA (0.43 mg/kg i.m.; n = 7); High MBOA (1.15 mg/kg i.m.; n = 7); Low MBOA + PMSG (n = 8); High MBOA + PMSG (n = 8). In Experiment II, St. Croix White ewes (n = 24) were synchronized (progestin CIDR) for 14 days followed by hCG on day 1 after CIDR removal (day 0). Ewes were assigned to one of three treatments administered on day -1: Control (n = 8); PMSG (n = 8); Low MBOA+PMSG (n = 8). Laparoscopy was performed on day 9 to assess numbers of corpora lutea (CL) and visible follicles on each ovary. Blood samples were collected on day -13, -1, 0, 1, and days 6 or 7-12 for analysis of serum progesterone (P4) by RIA. Treatment groups receiving PMSG (alone or with MBOA) exhibited greater (P < 0.05) serum concentrations of P4 post-synchrony than Control and MBOA-only groups. Ovulation rate was lower (P < 0.05) for Control and MBOA-only treated ewes than ewes receiving PMSG. Ovulation rate in ewes treated with MBOA alone was similar (P > 0.10) to Controls, and PMSG treatment alone did not differ (P > 0.10) from MBOA + PMSG treatment. Ewes treated with PMSG alone did not differ (P > 0.10) in follicle number from High MBOA + PMSG treated ewes, however, Low MBOA + PMSG treated ewes had greater numbers of follicles at day 9 (P < 0.05) than the PMSG or High MBOA + PMSG groups in Experiment I; although, this was not replicated in Experiment II with numbers of follicles in the Low MBOA + PMSG group being similar (P > 0.10) to PMSG alone. In summary, the addition of MBOA in combination with PMSG as part of a synchronization-superovuation protocol in the ewe did not increase ovulation rate.

Cs*Hen exciplexes in solid He4

We present a theoretical and experimental study of the laser-induced formation process and of the emission spectra of Cs*He(n) exciplexes in the hcp and bcc phases of solid helium. Two different exciplex molecules are detected: a linear triatomic Cs*He2, which can exist in two electronic states: APi(1/2) and BPi(3/2), and a larger complex, where six or seven He atoms form a ring around a single cesium atom in the 6P(1/2) state. A theoretical model is presented, which allows the interpretation of the experimentally observed spectra.

Design and Performance of Laser-Pumped Cs-Magnetometers for the Planned UCN EDM Experiment at PSI

We designed laser-pumped cesium vapor magnetometers in the M x configuration for the control and stabilization of magnetic field fluctuations and gradients in a new experiment searching for a permanent electric dipole moment of the neutron. The intrinsic sensitivity of the device was determined to be 30 fT in a measurement bandwidth of 1 Hz, limited by laser noise. In the shot noise limit the magnetometer can reach a sensitivity of 7 fT for 1 s integration time. Test measurements of the stability of a 2 µT magnetic field in a threefold magnetic shield have revealed fluctuations on the order of 200 fT to 300 fT with integration times in the range of 2 s to 100 s. Those fluctuations were traced back to the stability of the power supply used to generate the magnetic field. The laser-pumped magnetometer fulfills the requirements set by the planned neutron electric dipole moment experiment.

Discovery of dumbbell-shaped Cs*Hen exciplexes in solid 4He

We have observed several new spectral features in the fluorescence of cesium atoms implanted in the hcp phase of solid helium following laser excitation to the 62P states. Based on calculations of the emission spectra using semiempirical Cs-He pair potentials the newly discovered lines can be assigned to the decay of specific Cs*Hen exciplexes: an apple-shaped Cs(APi3/2)He2 and a dumbbell-shaped Cs(APi1/2)Hen exciplex with a well-defined number n of bound helium atoms. While the former has been observed in other environments, it was commonly believed that exciplexes with n>2 might not exist. The calculations suggest Cs(APi1/2)He7 to be the most probable candidate for that exciplex, in which the helium atoms are arranged on a ring around the waist of the dumbbell-shaped electronic density distribution of the cesium atom.

Dynamical MCG mapping with an atomic vapor magnetometer

We have developed a magnetometer based on magnetic resonance in cesium vapor optically pumped by resonant laser radiation, which has the sensitivity and bandwidth to record human magnetocardiograms. The device is operated as a first-order gradiometer in a weakly shielded environment and allows us to record 2-dimensional field maps by shifting the subject with respect to a single sensor and making time-sequential measurements. We discuss the magnetometer technique and its performance as well as obtained results, which include a comparison of MCG data recorded with our single channel optical magnetometer with SQUID measurements from a commercial multi-channel device as well as from SQUID reference data. The results obtained so far in the detection of cardiomagnetic signals using the optical magnetometer make us confident that the technique has a high potential to serve as an alternative to SQUID detection.

Dynamical mapping of the human cardiomagnetic field with a room-temperature, laser-optical sensor

The magnetic field produced by the human heart carries valuable information for medical research, as well as for diagnostics and screening for disease. We have developed an optical method that allows us to produce movies of the temporal dynamics of the human cardiomagnetic field map. While such movies have been generated before with the help of SQUIDmagnetometers, our technique operates at room temperature and promises substantial economic advantages.

Diagnostic value of bone and tumour markers in patients with malignant diseases

INTRODUCTION

Biochemical bone markers, such as the bone isoenzyme form of alkaline phosphatase, have been used to assess the bone formation phase of bone turnover in health and disease. Skeletal metastases often occur in patients with malignancies. Recent developments suggest that bone markers could be valuable clinical tools for the management of patients with metastatic bone disease.

PATIENTS AND METHODS

Serum levels of BAP, along with serum levels of beta-CrossLap, were measured in a large group (n = 200) of patients with newly-diagnosed or progressive cancer of the prostate, breast, colon, liver and pancreas. Tumour markers such as PSA, CEA, CA 19-9, AFP, CA 15-3 and bone marker levels were correlated with the presence or absence of bone scan-documented metastases.

RESULTS

Both of the bone markers examined were elevated in a high proportion of patients with confirmed metastases to bone. All patients with prostate, breast and colon carcinoma showed elevated beta-CrossLap values. The determined values of beta-CrossLap and BAP were significantly correlated with the number of skeletal metastases.

CONCLUSION

Markers of biochemical bone remodeling can be used in assessing and managing patients with malignancies that metastasize to bone. These markers are abnormally raised in the blood of patients with metastatic bone disease.

Optical detection of nonradiating alkali atoms in solid helium

We have detected by optical means nonfluorescing 85Rb and 87Rb atoms implanted in a body centered cubic 4He crystal. In contrast to cesium the resonance fluorescence of rubidium is strongly quenched by the helium matrix, and the weak resonance absorption of the two Rb isotopes was detected using a double resonance technique. From a comparative study of the (optically detected) magnetic resonance spectra of 85Rb, 87Rb, and 133Cs we infer their effective g(F) factors and conclude that they are not perturbed by the He matrix at a level of 2 x 10(-4). We show further that optical pumping of Rb proceeds via depopulation, whereas for Cs it proceeds via repopulation.

Endosonography of insulin-secreting and clinically non-functioning neuroendocrine tumors of the pancreas: criteria for benignancy and malignancy

OBJECTIVE

Endosonography is a powerful tool in the diagnosis of gastroenteropancreatic neuroendocrine tumors. This study was performed in order to characterize endosonographic criteria of malignant and benign neuroendocrine pancreatic tumors focussing on those typically presented to endocrinologists, i.e. insulin-secreting tumors and clinically non-functioning tumors in MEN-1.

DESIGN

We studied six benign insulinomas, four hormone inactive benign neuroendocrine adenomas in MEN-1, and three non-metastatic neuroendocrine carcinomas with clinically symptomatic insulin secretion.

METHODS

Endosonography was performed using Pentax FG 32 UA endosonoscope with a longitudinal 7.5 MHz sector array.

RESULTS

Tumor diameter was larger in malignant tumors (19 - 70 / 47.0 +/- 25.9 mm) than in benign lesions (2.3 - 19 / 9.7 +/- 5.8 mm). Hypoechoic echogeneity was more or less present in benign and in malignant tumors and could not be used as a criteria for differential diagnosis. Heterogeneous or multinodular structure on endosonographic imaging however, was an exclusive feature of malignant tumors. Echo-free areas representing cystic transformation or necrosis and vascular invasion were additional signs of malignancy.

CONCLUSIONS

Molecular genetic diagnosis of MEN-1 and new therapeutic developments such as endoscopic surgery make sufficient imaging procedures in the management of neuroendocrine pancreatic tumors mandatory. Besides valid detection and exact localization, endosonography provides criteria for benign and malignant tumors and thus may be helpful in planning therapeutic strategies.

Diffusion of Cs atoms in Ne buffer gas measured by optical magnetic resonance tomography

Optical magnetic resonance tomography uses optical pumping and the paramagnetic Faraday effect to image spin density distributions in optically thin media. In this paper we present an apparatus that allows to measure the distribution of spin-polarized Cs atoms, which we applied to study the diffusion of Cs in Ne buffer gas by time-resolved 2D-mapping of the evolution of an initial inhomogeneous spin distribution. The diffusion constant D0 for Cs in a Ne buffer gas of 1013 mbar is determined as 0.20(1) cm2\s.

Urokinase activates the Jak/Stat signal transduction pathway in human vascular endothelial cells

Endothelial cells demonstrate high urokinase expression and upregulation of urokinase receptors in response to vascular injury. Urokinase receptor binding facilitates endothelial cell migration into an arterial wound; however, the signaling cascade induced by the urokinase receptor in this cell type is incompletely understood. Because the Janus kinase (Jak)/signal transducer and activator of transcription (Stat) pathway seems to be important for vessel function, we investigated the hypothesis that urokinase receptor binding activates Jak/Stat signaling in human vascular endothelial cells. Incubation of endothelial cells with urokinase-type plasminogen activator (uPA,1 nmol/L) induced a rapid and pronounced increase in tyrosine phosphorylation of several proteins with a molecular weight between 80 to 90 and 130 to 140 kDa. The same pattern of tyrosine phosphorylation was found after treatment with 1 nmol/L ATF, the urokinase amino-terminal fragment, which is devoid of proteolytic activity but still binds to the urokinase receptor. Using coimmunoprecipitation techniques, we demonstrated that the activated urokinase receptor is associated with 2 cytoplasmic tyrosine kinases of the Jak family, viz, Jak1 and Tyk2. uPA and ATF induced a time-dependent activation of both kinases, as shown by immunoprecipitation and Western blot analysis. Using electrophoretic mobility shift and supershift assays, we then demonstrated that Stat1 is rapidly activated in endothelial cells in response to uPA and ATF. Furthermore, Stat1 specifically binds to the regulatory elements interferon-gamma activation site/interferon-stimulated response element. The uPA-induced, time-dependent translocation of Stat1 to cell nuclei was confirmed by confocal microscopy study and immunoblotting of nuclear extracts with an anti-Stat1 antibody. This study provides evidence for a novel signaling pathway for uPA in human vascular endothelial cells. Direct activation of the Jak/Stat system via the uPA-receptor complex may be an important mechanism for endothelial cell migration and/or proliferation during angiogenesis and after vascular injury.

The Jak/Stat pathway and urokinase receptor signaling in human aortic vascular smooth muscle cells

The binding of urokinase plasminogen activator (uPA) to its specific receptor (uPAR) facilitates migration of vascular smooth muscle cells (VSMC). However, the signaling cascade utilized by the urokinase receptor is only incompletely understood. We investigated intracellular uPA/uPAR signaling in human aortic VSMC from the cell membrane to the nucleus. uPA binding to VSMC induced a rapid and pronounced increase in tyrosine phosphorylation of several proteins with molecular masses of 53-60, 85-90, and 130-140 kDa. By using co-immunoprecipitation techniques and in vitro kinase assays, the uPAR-associated proteins were identified as Janus (Jak) and Src non-receptor protein-tyrosine kinases (PTK) Jak1, Tyk2, and p59(fyn), p53/56(lyn), p53/59(hck), and p55(fgr). Furthermore, uPA induced a time-dependent reversible translocation of the Stat1 (signal transducer and activator of transcription) protein to the VSMC nuclei, as shown by confocal microscopy studies. Using an electrophoretic mobility shift assay, we then demonstrated that Stat1 is rapidly activated in response to stimulation with uPA and specifically binds to the DNA regulatory elements GAS (interferon-gamma activation site) and ISRE (interferon-stimulated response element). Mobility supershift experiments confirmed DNA-protein complexes containing Stat1 protein. Migration experiments with double immunofluorescence staining revealed polarization of uPAR, and colocalization with Jak1 and Tyk2 to the leading edge of the migrating cells. Under the same conditions, Jak2, Jak3, and the Src-PTKs remained randomly distributed over the entire body of the cells. Our studies therefore suggest that, in VSMC, the uPAR-signaling complex utilizes at least two different mechanisms, a direct signaling pathway utilizing the Jak/Stat cascade and a second signal transduction mechanism via Src-like protein-tyrosine kinases. uPA-induced signaling via Jak/Stat is most likely involved in the regulation of cell migration, while the functional purpose of the uPA-associated Src-PTK activation remains to be elucidated.

Sixty-minute alteplase protocol: a new accelerated recombinant tissue-type plasminogen activator regimen for thrombolysis in acute myocardial infarction

OBJECTIVES

Our aim was to design and evaluate a new and easily administered recombinant tissue-type plasminogen activator (rt-PA) regimen for thrombolysis in acute myocardial infarction (AMI) based on established pharmacokinetic data that improve the reperfusion success rate.

BACKGROUND

Rapid restoration of Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow is a primary predictor of mortality after thrombolysis in AMI. However, TIMI grade 3 patency rates 90 min into thrombolysis of only 50% to 60% indicate an obvious need for improved thrombolytic regimens.

METHODS

Pharmacokinetic simulations were performed to design a new rt-PA regimen. We aimed for a plateau tissue-type plasminogen activator (t-PA) plasma level similar to that of the first plateau of the Neuhaus regimen. These aims were achieved with a 20-mg rt-PA intravenous (i.v.) bolus followed by an 80-mg i.v. infusion over 60 min (regimen A). This regimen was tested in a consecutive comparative trial in 80 patients versus 2.25 10(6) IU of streptokinase/60 min (B), and 70 mg (C) or 100 mg (D) of rt-PA over 90 min. Subsequently, a confirmation trial of regimen A in 254 consecutive patients was performed with angiographic assessment by independent investigators of patency at 90 min.

RESULTS

The comparative phase of the trial yielded, respectively, TIMI grade 3 and total patency (TIMI grades 2 and 3) of 80% and 85% (regimen A), 35% and 50% (B), 50% and 55% (C) and 60% and 70% (D). In the confirmation phase of the trial, regimen A yielded 81.1% TIMI grade 3 and 87.0% total patency. At follow-up angiography 7 (4.1%) of 169 vessels had reoccluded. In-hospital mortality rate was 1.2%. Nadir levels of fibrinogen, plasminogen and alpha2-antiplasmin were 3.6 +/- 0.8 mg/ml, 60 +/- 21% and 42 +/- 16%, respectively (mean +/- SD). Fifty-seven patients (22.4%) suffered from bleeding; 3.5% needed blood transfusions.

CONCLUSIONS

The 60-min alteplase thrombolysis in AMI protocol achieved a TIMI grade 3 patency rate of 81.1% at 90 min with no indication of an increased bleeding hazard; it was associated with a 1.2% overall mortality rate. These results are substantially better than those reported from all currently utilized regimens. Head to head comparison with established thrombolytic regimens in a large-scale randomized trial is warranted.