The effect of transdermal glyceryl trinitrate in acute stroke patients with carotid stenosis: data from the Efficacy of Nitric Oxide in Stroke trial

Background: There is concern that blood pressure lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the context of carotid stenosis. The effect of glyceryl trinitrate (GTN) on outcome in acute stroke patients with carotid stenosis is unclear. We sought to assess GTN’s effect in this context using data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Methods: ENOS randomised 4011 patients with acute stroke and raised systolic blood pressure to transdermal GTN or no GTN within 48 hours of onset. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split: 70%. Bilateral carotid stenosis was split: 50%. Data are odds ratios (OR) with 95% confidence intervals (CI) adjusted for baseline prognostic factors. Results: 2023 (60.5%) ischaemic stroke participants had carotid imaging. Compared with participants with 70% ipsilateral stenosis was associated with an unfavourable shift in mRS at 90 days (OR 1.88, 95% CI 1.44-2.44, p70% stenosis who received GTN had a favourable shift in mRS (OR 0.56, 95% CI 0.34-0.93, p=0.024) compared to those who received no GTN. Tendencies towards less dependency, albeit non-significant, were seen in 30-50% and 50-70% groups. No differences in mRS were seen across groups of bilateral stenosis or between those who received GTN or not. Conclusions:Severe ipsilateral carotid stenosis is associated with poorer functional outcome at 90 days following ischaemic stroke. GTN appears safe in acute stroke patients with ipsilateral or bilateral carotid stenosis

Book Reviews

Book Review 1Book Title: The Asian Elephant: Ecology and ManagementBook Author: R. SukumarCambridge University Press, 1989. Paperback edition 1991. 255 pp. ISBN: 0-521-360aO-3-XBook Review 2Book Title: Key to Parasitic NematodesBook Author: Edited by K.I. SkryabinPrinted by Amerind Publishing Co., New Delhi, distributed by E.J. Brill, Leiden, The Netherlands (1991). 4 Volumes; 1097 pages.Book Review 3Book Title: Fauna Iberica, Vol. 1. Mollusca CephalopodaBook Author: Angel Guerra SierraMuseo Nacional de Ciencias Naturales, Consejo Superior de Investigaciones Cientificas, Madrid, 1992. 327 pages and 19 colour photographs.Book Review 4Book Title: Roberts' Birds of Southern AfricaBook Author: Gordon L. Maclean6th edition 1993. John Voelcker Bird Book Fund. Cape Town.Book Review 5Book Title: Biochemical ProtozoologyBook Authors: Edited by Graham Coombs & Michael NorthTaylor & Francis Ltd, London/Washington DC 1991. 55 Chapters; 635 pages. ISBN 0-7484-0001-X.Book Review 6Book Title: The Living Deserts of Southern AfricaBook Author: Barry G. LovegroveFernwood Press, Vlaeberg (Cape Town), 1993. ISBN 0-9583154-7-7

The effect of transdermal glyceryl trinitrate in acute stroke patients with carotid stenosis: data from the Efficacy of Nitric Oxide in Stroke trial

Background: There is concern that blood pressure lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the context of carotid stenosis. The effect of glyceryl trinitrate (GTN) on outcome in acute stroke patients with carotid stenosis is unclear. We sought to assess GTN’s effect in this context using data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Methods: ENOS randomised 4011 patients with acute stroke and raised systolic blood pressure to transdermal GTN or no GTN within 48 hours of onset. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split: 70%. Bilateral carotid stenosis was split: 50%. Data are odds ratios (OR) with 95% confidence intervals (CI) adjusted for baseline prognostic factors. Results: 2023 (60.5%) ischaemic stroke participants had carotid imaging. Compared with participants with 70% ipsilateral stenosis was associated with an unfavourable shift in mRS at 90 days (OR 1.88, 95% CI 1.44-2.44, p70% stenosis who received GTN had a favourable shift in mRS (OR 0.56, 95% CI 0.34-0.93, p=0.024) compared to those who received no GTN. Tendencies towards less dependency, albeit non-significant, were seen in 30-50% and 50-70% groups. No differences in mRS were seen across groups of bilateral stenosis or between those who received GTN or not. Conclusions:Severe ipsilateral carotid stenosis is associated with poorer functional outcome at 90 days following ischaemic stroke. GTN appears safe in acute stroke patients with ipsilateral or bilateral carotid stenosis

Outbreak of severe vomiting in dogs associated with a canine enteric coronavirus, United Kingdom

The lack of population health surveillance for companion animal populations leaves them vulnerable to the effects of novel diseases without means of early detection. We present evidence on the effectiveness of a system that enabled early detection and rapid response to a canine gastroenteritis outbreak in the United Kingdom. In January 2020, prolific vomiting among dogs was sporadically reported in the United Kingdom. Electronic health records from a nationwide sentinel network of veterinary practices confirmed a significant increase in dogs with signs of gastroenteric disease. Male dogs and dogs living with other vomiting dogs were more likely to be affected. Diet and vaccination status were not associated with the disease; however, a canine enteric coronavirus was significantly associated with illness. The system we describe potentially fills a gap in surveillance in neglected populations and could provide a blueprint for other countries

Examining the validity of the Athlete Engagement Questionnaire (AEQ) within a Portuguese sport setting

Sport psychology literature suggests that understanding engagement levels is pivotal to promote positive sporting experiences among athletes. The purpose of this study was to examine the psychometric properties of the Athlete Engagement Questionnaire among Portuguese sport athletes. Two distinct samples of Portuguese athletes from different competitive levels were collected, and the results of a confirmatory factor analysis demonstrated a good fit of the model to the data. A review of the psychometric properties indicated that all factors showed good composite reliability, convergent validity, and discriminant validity. In addition, a multi-groups analysis showed the invariance of the model in two independent samples providing evidence of cross validity. Implications of these results for scholars and coaches are discussed and guidelines for future studies are suggested

Broken seniority symmetry in the semimagic proton mid-shell nucleus ⁹⁵Rh

Lifetime measurements of low-lying excited states in the semimagic ( N = 50 ) nucleus 95Rh have been performed by means of the fast-timing technique. The experiment was carried out using γ -ray detector arrays consisting of LaBr3(Ce) scintillators and germanium detectors integrated into the DESPEC experimental setup commissioned for the Facility for Antiproton and Ion Research (FAIR) Phase-0, Darmstadt, Germany. The excited states in 95Rh were populated primarily via the β decays of 95Pd nuclei, produced in the projectile fragmentation of a 850 MeV/nucleon 124Xe beam impinging on a 4 g / cm2 9Be target. The deduced electromagnetic E2 transition strengths for the γ -ray cascade within the multiplet structure depopulating from the isomeric Iπ = 21 / 2+ state are found to exhibit strong deviations from predictions of standard shell model calculations which feature approximately conserved seniority symmetry. In particular, the observation of a strongly suppressed E2 strength for the 13 / 2+ → 9 / 2+ ground state transition cannot be explained by calculations employing standard interactions. This remarkable result may require revision of the nucleon-nucleon interactions employed in state-of-the-art theoretical model calculations, and might also point to the need for including three-body forces in the Hamiltonian

Baryons: What, When and Where?

We review the current state of empirical knowledge of the total budget of baryonic matter in the Universe as observed since the epoch of reionization. Our summary examines on three milestone redshifts since the reionization of H in the IGM, z = 3, 1, and 0, with emphasis on the endpoints. We review the observational techniques used to discover and characterize the phases of baryons. In the spirit of the meeting, the level is aimed at a diverse and non-expert audience and additional attention is given to describe how space missions expected to launch within the next decade will impact this scientific field.Comment: Proceedings Review for "Astrophysics in the Next Decade: JWST and Concurrent Facilities", ed. X. Tielens, 38 pages, 10 color figures. Revised to address comments from the communit

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy