Association between disability measures and healthcare costs after initial treatment for acute stroke

<p><b>Background and Purpose:</b> The distribution of 3-month modified Rankin scale (mRS) scores has been used as an outcome measure in acute stroke trials. We hypothesized that hospitalization and institutional care home stays within the first 90 days after stroke should be closely related to 90-day mRS, that each higher mRS category will reflect incremental cost, and that resource use may be less clearly linked to the National Institutes of Health Stroke Scale (NIHSS) or Barthel index.</p> <p><b>Methods:</b> We examined resource use data from the GAIN International trial comparing 90-day mRS with total length of stay in hospital or other institutions during the first 90 days. We repeated analyses using NIHSS and Barthel index scores. Relationships were examined by analysis of variance (ANOVA) with Bonferroni contrasts of adjacent score categories. Estimated costs were based on published Scottish figures.</p> <p><b>Results:</b> We had full data from 1717 patients. Length of stay was strongly associated with final mRS (P<0.0001). Each mRS increment from 0 to 1–2 to 3–4 was significant (mean length of stay: 17, 25, 44, 58, 79 days; P<0.0005). Ninety-five percent confidence limits for estimated costs (£) rose incrementally: 2493 to 3412, 3369 to 4479, 5784 to 7008, 7300 to 8512, 10 095 to 11 141, 11 772 to 13 560, and 2623 to 3321 for mRS 0 to 5 and dead, respectively. Weaker relationships existed with Barthel and NIHSS.</p> <p><b>Conclusions:</b> Each mRS category reflects different average length of hospital and institutional stay. Associated costs are meaningfully different across the full range of mRS outcomes. Analysis of the full distribution of mRS scores is appropriate for interpretation of treatment effects after acute stroke and more informative than Barthel or NIHSS end points.</p&gt

Enhancement of flexibility in multi-energy microgrids considering voltage and congestion improvement: Robust thermal comfort against reserve calls

In recent years, multi-energy microgrid (MEM) has gained increasing interest, which could use clean and efficient electro-thermal resources, multi-energy storages (MESs) and demand response potential to improve the flexibility of MEM. However, maximizing the flexibility potential of MEM and alongside managing the electrical parameters (EPs) is a challenging modeling problem. In this paper, a probabilistic nonlinear model is presented to maximize the flexibility with all the power grid constraints taking into account EPs constraints using power flow. To this end, voltage profile and congestion improvement, robust thermal comfort provision during reserve call and MESs utilization are the key properties of the proposed model. The outcome of suggested model ensures sustainability in the MEM performance, which is an essential feature in modern smart cities. The presented model is applied to a distribution network in the UK and results illustrate how equipment scheduling and demand response leads to observe the EPs limitation and maximizes MEM flexibility. The achieved results show a decrease in MEM revenue (decrease of 34% and 24% without and with reserve commitment, respectively) and in contrast, a significant increase in flexibility compared to non-compliance with EPs constraints

Heat transfer in a channel with inclined target surface cooled by single array of centered impinging jets

An experimental investigation has been carried out to study the heat transfer characteristics in a channel with heated target plate inclined at an angle cooled by single array of equally spaced centered impinging jets for three different jet Reynolds numbers (Re=9300, 14400 and 18800). Air ejected from an array of orifices impinges on the heated target surface The target plate forms the leading edge of a gas turbine blade cooled by jet impingement technique. The work includes the effect of jet Reynolds numbers and feed channel aspect ratios (H/d = 5, 7, 9 where H=2.5, 3.5, 4.5 cm and d=0.5 cm) on the heat transfer characteristics for a given orifice jet plate configuration with equally spaced centered holes with outflow exiting in both directions (with inclined heated target surface). In general, It has been observed that, H/d=9 gives the maximum heat transfer over the entire length of the target surface as compared to all feed channel aspect ratios. H/d=9 gives 3% more heat transfer from the target surface as compared to H/d=5 (for Re=14400). Also, it has been observed that the magnitude of the averaged local Nusselt number increases with an increase in the jet Reynolds number for all the feed channel aspect ratios studied

Enchondroma of the scaphoid: a case report

Enchondroma represents a common bone tumor of the hand. The scaphoid is a rare location. We report the case of a scaphoid enchondroma presenting as chronic wrist pain following a relatively minor trauma. The diagnosis was suggested by radiological study and then confirmed by histological study after biopsy. Enucleation and vascularized bone graft with osteosynthesis provided good results. The clinical, radiological and therapeutic aspects of this rare condition are discussed

MicroRNA-129-1 acts as tumour suppressor and induces cell cycle arrest of GBM cancer cells through targeting IGF2BP3 and MAPK1

Background MicroRNA-129-1 (miR-129-1) seems to behave as a tumour suppressor since its decreased expression is associated with different tumours such as glioblastoma multiforme (GBM). GBM is the most common form of brain tumours originating from glial cells. The impact of miR-129-1 downregulation on GBM pathogenesis has yet to be elucidated. Methods MiR-129-1 was overexpressed in GBM cells, and its effect on proliferation was investigated by cell cycle assay. MiR-129-1 predicted targets (CDK6, IGF1, HDAC2, IGF2BP3 and MAPK1) were also evaluated by western blot and luciferase assay. Results Restoration of miR-129-1 reduced cell proliferation and induced G1 accumulation, significantly. Several functional assays confirmed IGF2BP3, MAPK1 and CDK6 as targets of miR-129-1. Despite the fact that IGF1 expression can be suppressed by miR-129-1, through 30-untranslated region complementary sequence, we could not find any association between IGF1 expression and GBM. MiR-129-1 expression inversely correlates with CDK6, IGF2BP3 and MAPK1 in primary clinical samples. Conclusion This is the first study to propose miR129-1 as a negative regulator of IGF2BP3 and MAPK1 and also a cell cycle arrest inducer in GBM cells. Our data suggests miR-129-1 as a potential tumour suppressor and presents a rationale for the use of miR-129-1 as a novel strategy to improve treatment response in GBM

The Virtual International Stroke Trials Archive

BACKGROUND AND PURPOSE: Stroke has global importance and it causes an increasing amount of human suffering and economic burden, but its management is far from optimal. The unsuccessful outcome of several research programs highlights the need for reliable data on which to plan future clinical trials. The Virtual International Stroke Trials Archive aims to aid the planning of clinical trials by collating and providing access to a rich resource of patient data to perform exploratory analyses. METHODS: Data were contributed by the principal investigators of numerous trials from the past 16 years. These data have been centrally collated and are available for anonymized analysis and hypothesis testing. RESULTS: Currently, the Virtual International Stroke Trials Archive contains 21 trials. There are data on \u3e15,000 patients with both ischemic and hemorrhagic stroke. Ages range between 18 and 103 years, with a mean age of 69+/-12 years. Outcome measures include the Barthel Index, Scandinavian Stroke Scale, National Institutes of Health Stroke Scale, Orgogozo Scale, and modified Rankin Scale. Medical history and onset-to-treatment time are readily available, and computed tomography lesion data are available for selected trials. CONCLUSIONS: This resource has the potential to influence clinical trial design and implementation through data analyses that inform planning

Enhancing brain tumor classification with transfer learning across multiple classes: an in-depth analysis.

This study focuses on leveraging data-driven techniques to diagnose brain tumors through magnetic resonance imaging (MRI) images. Utilizing the rule of deep learning (DL), we introduce and fine-tune two robust frameworks, ResNet 50 and Inception V3, specifically designed for the classification of brain MRI images. Building upon the previous success of ResNet 50 and Inception V3 in classifying other medical imaging datasets, our investigation encompasses datasets with distinct characteristics, including one with four classes and another with two. The primary contribution of our research lies in the meticulous curation of these paired datasets. We have also integrated essential techniques, including Early Stopping and ReduceLROnPlateau, to refine the model through hyperparameter optimization. This involved adding extra layers, experimenting with various loss functions and learning rates, and incorporating dropout layers and regularization to ensure model convergence in predictions. Furthermore, strategic enhancements, such as customized pooling and regularization layers, have significantly elevated the accuracy of our models, resulting in remarkable classification accuracy. Notably, the pairing of ResNet 50 with the Nadam optimizer yields extraordinary accuracy rates, reaching 99.34% for gliomas, 93.52% for meningiomas, 98.68% for non-tumorous images, and 97.70% for pituitary tumors. These results underscore the transformative potential of our custom-made approach, achieving an aggregate testing accuracy of 97.68% for these four distinct classes. In a two-class dataset, Resnet 50 with the Adam optimizer excels, demonstrating better precision, recall, F1 score, and an overall accuracy of 99.84%. Moreover, it attains perfect per-class accuracy of 99.62% for 'Tumor Positive' and 100% for 'Tumor Negative', underscoring a remarkable advancement in the realm of brain tumor categorization. This research underscores the innovative possibilities of DL models and our specialized optimization methods in the domain of diagnosing brain cancer from MRI images

Effect of chlorpromazine on intact and irradiated aliquot ctdsDNA samples

Bagkground:Chlorpromazine is widely used in human medicine in the therapy of schizophrenia, organic psychosis and the manic phase of manic depressive illness. It expressed a selective cytotoxicity and the results of genotoxicity were positive. Objectives: This study is designed to explore the effect of chlorpromazine on irradiated and non irradiated calf thymus double strands DNA (ctdsDNA) molecule. Methods: Aliquots of irradiated (subjected to UVB light) and non-radiated ctdsDNA samples were incubatyed with different concentrations of chlorpromazine. Further series of experiments studied the simultaneous effects of chlorpromazine and UVB light on aliquots of ctdsDNA, The changes in optic densities of ctdsDNA aliquots were mointered and recorded bu UVspectrophotometer at 260 nm. Results: Chlorpromazine exerts dual effects on non-radiated ctdsDNA aliquots represented by hyperchromasia and hypochromasia in regard to its concentration. It potentiates the effect of UVB radiation on ctdsDNA molecules. Its effect is differed in respect to the radiation status. Conclusion: chlorpromazine exerts several effects on aliquot ctdsDNA samples which are related to the nature of DNA molecule as well as to the concentration of chlorpromazine.Also chlorpromazine potentiates the hyperchromasic effect of UVB radiation on aliquot ctdsDNA samples but it produces completely damage of DNA molecule when the aliquot ctdsDNA samples irradiated in presence of chlorpromazine