Nonconvulsive status epilepticus associated with periodic lateralized epileptiform discharges in a patient with syphilis

AbstractNonconvulsive status epilepticus (NCSE) has been increasingly recognized as a cause of impaired level of consciousness in the ICU and emergency rooms. The confirmation of NCSE is largely based on the EEG, given the nonspecific and pleomorphic clinical manifestations. Debate remains over electroencephalograms (EEG) criteria for NCSE. Periodic lateralized epileptiform discharges (PLEDs), have sparked controversy with regard to being part of the ictal vs. interictal spectrum. We report a case of a patient with syphilis who had cognitive decline and damaged consciousness with PLEDs and T2 hyperintensity at temporal and occipital lobe in MRI. After antiepileptic treatment only, his consciousness improved markedly together with the EEG in few days, while the change of MRI was still serious. In this case PLEDs is the sign of NCSE and change of MRI is limbic encephalitis (LE). This report discusses the association of PLEDs and NCSE, and supports the concept of PLEDs as an ictal pattern in some condition

Effect of Hyperglycemia at Presentation on Outcomes in Acute Large Artery Occlusion Patients Treated With Solitaire Stent Thrombectomy

Background: Sporadic data showed hyperglycemia at presentation is associated with poor outcomes in patients with acute ischemic stroke (AIS) under mechanical thrombectomy (MT) treatment.Objective: This study aims to evaluate the relationship of admission hyperglycemia and outcomes in patients treated with solitaire stent thrombectomy.Methods: This multicenter prospective study registered patients with AIS due to anterior circulation large vessel occlusion (LVO) suitable for MT with Solitaire stent retriever. We analyzed the influence of admission hyperglycemia (≥7.8 mmol/L) and serum glucose on functional independence which is defined as modified Rankin Scale score (mRS) of 0–2, symptomatic intracranial hemorrhage (sICH) and several outcomes of interest using univariable and multiple logistic regression analysis.Results: This study involved 17 stroke centers across China and consecutively recruited 149 patients. Patients with hyperglycemia at presentation less frequently exhibited a functional independence at 3 months than patients without hyperglycemia (22.2 vs. 66.4%; odds ratio 0.75, 95% confidence interval 0.61–0.92; P = 0.005). Higher glucose levels were correlated with worse outcome (per 1 mmol/L increase in glucose: odds ratio for mRS score 0–2 at 3 months 0.17, 95% confidence interval 0.06–0.45; P < 0.001) at 3 months and sICH (per 1 mmol/L increase in glucose: odds ratio for sICH was 8.2, 95% confidence interval 1.13–29.57; P < 0.001) after thrombectomy.Conclusions: Higher admission serum glucose and hyperglycemia were independently correlated with lower functional independence at 3 months in patients treated with Solitaire stent thrombectomy of anterior circulation LVO. Higher admission serum glucose was also associated with sICH after thrombectomy

Dual Antiplatelet Treatment up to 72 Hours after Ischemic Stroke

BackgroundDual antiplatelet treatment has been shown to reduce recurrence of stroke compared to aspirin alone when initiated early after an acute stroke. The effect of clopidogrel and aspirin versus aspirin alone within 72 hours of acute cerebral ischemia from atherosclerosis has not been well studied.MethodsWe conducted a randomized, double-blind, placebo-controlled, 2-by-2 factorial trial in patients with mild ischemic stroke or high-risk transient ischemic attack (TIA) of presumed atherosclerotic cause, not receiving thrombolysis or thrombectomy in 222 hospitals in China. Patients were randomly assigned within 72 hours after symptom onset in a 1:1 ratio, to receive clopidogrel (300mg on day 1, 75mg daily on days 2-90) and aspirin (100-300mg on day1, 100mg daily on days 2-21), or clopidogrel placebo and aspirin (100-300mg on day1, 100mg daily on days 2-90). There was no interaction between this component of the factorial trial design trial and a second part that tested immediate vs delayed stain treatment and is reported separately. The primary efficacy outcome was a new stroke, and the primary safety outcome was moderate-to-severe bleeding, both within 90 days.ResultsA total of 6100 patients were enrolled, 3050 assigned to each trial group. The qualifying event for enrollment was TIA in 13%. Approximately 13% of patients were assigned to a treatment group within 24 hours and 87% were assigned between 24 and 72 hours of onset of stroke. A new stroke occurred in 222 (7.3%) in the clopidogrel-aspirin group, and 279 (9.2%) in the aspirin group (hazard ratio, 0.79; 95% confidence interval [CI], 0.66-0.94; P=0.008). Moderate-to-severe bleeding occurred in 27 (0.9%) and 13 patients (0.4%), respectively (hazard ratio, 2.08; 95% CI, 1.07-4.04, P=0.03).ConclusionsAmong patients with mild ischemic stroke or high-risk TIA of presumed atherosclerotic cause, combined clopidogrel-aspirin initiated within 72 hours of onset was superior to aspirin alone in reducing the risk of new stroke at 90 days but was associated with a low but increased risk of moderate-to-severe bleeding

Analysis of Fuel Cell Stack Performance Attenuation and Individual Cell Voltage Uniformity Based on the Durability Cycle Condition

Based on the dynamic cycle condition test of a 4.5 kW fuel cell stack, the performance attenuation and individual cell voltage uniformity of the proton exchange membrane fuel cell (PEMFC) stack was evaluated synthetically. The performance decay period of the fuel cell stack was 180–600 h, the decrease of voltage and power was evaluated by rate and amplitude. The results show that the performance of the fuel cell stack decreased with the increase of test time and current density. When the test was carried out to 600 h, under rated operating conditions, the voltage attenuation rate was 130 μV/h, and the voltage reduced by 71 mV, with a decrease of 10.41%. The power attenuation rate was 0.8 W/h, with a decrease of 10.42%. The statistical parameter variation coefficient was used to characterize the voltage consistency of individual cells. It was found that the voltage uniformity is worse at the high current density point and with a long-running process. The variation coefficient was 3.1% in the worst performance

Effects of oxygen-containing functional groups on carbon materials in supercapacitors: A review

Carbon materials play an indispensable role in supercapacitor devices. However, carbon materials based on the electric double-layer energy storage mechanisms limit the energy density improvement of supercapacitors. The introduction of additional redox pseudocapacitance through oxygen-containing functional groups is a novel strategy to improve the specific capacity of carbon materials. Whereas the influence mechanism of oxygen-containing functional groups on carbon-based electrode materials needs to be explored in-depth. Here, we summarize the types, introductions and characterization methods of oxygen-containing functional groups in carbon materials, and emphatically explain the effect of oxygen-containing functional groups on the structure and physico-chemical properties of carbon-based electrode materials for supercapacitors at the mechanism level, which has not been reported in previous reviews. Different types or content differences of oxygen-containing functional groups can cause changes in the polarity, surface energy, adsorption energy, impedance, energy bands and other aspects of carbon materials, and even lead to defects affecting the structure and physicochemical properties. The mutual constraint relationship between high specific capacity and excellent conductivity caused by the content of oxygen-containing functional groups is also pointed out. Carbon materials with rich oxygen are expected to be developed in lithium/sodium-ion batteries, fuel cells, electrocatalysis, sensor devices, biomedicine and other fields

A High-Efficiency Cooperative Control Strategy of Active and Passive Heating for a Proton Exchange Membrane Fuel Cell

The key to overcome PEMFC cold start failure is to raise the stack temperature above 0 °C before the electrochemical reaction. As the electrochemical reaction progresses, reaction heat is released inside the stack, which will heat the PEMFC stack. This heating method is called passive heating, referred to as PH in this article. Another method, called active heating, or simplified to AH in this article, involves artificially adding a device to the stack to input extra heat to the stack to increase the stack temperature more quickly and reduce the icing rate of the stack water. In this study, an optimal cooperative control strategy of AH and PH is explored by integrating AH and PH. The most effective cold start can be achieved when the temperature of the stack is raised to −20 °C by using AH with the reaction heat of the stack itself. This study provides guidance for optimizing the cold start performance of a PEMFC

Comparative Analysis of SCMOC and Models Rainstorm Forecasting Performance in Qinling Mountains and Their Surrounding Areas

Taking CMPA (CMA Multi-source Merged Precipitation Analysis System) analysis data as a reference, the research analyzes the forecast performance of ECMWF, CMA-Meso, and SCMOC (National Meteorological Center grid precipitation forecast guidance product) in 74 rainstorm cases in 2020 and 2021 in Qinling Mountains and their surrounding areas by using the dichotomy classical verification score comprehensive diagram and the object-oriented MODE spatial verification method, based on the circulation classification in rainstorm weather. The research conclusions are as follows: (1) based on the high- and low-altitude circulation situation and focused on the direct impact system, rainstorms in the Qinling Mountains and their surrounding areas can be divided into five patterns. (2) Point-to-point verification shows that SCMOC has obvious advantages in rainstorm forecast, but the disadvantage is that the Bias is relatively high. CMA-Meso has advantages in RST (weak weather system) decentralized rainstorm forecast. (3) MODE verification shows that the number of ECMWF and SCMOC independent objects is significantly lower than that of observation, the forecast area of regional rainstorm objects of SCMOC is significantly larger, the SCMOC scattered rainstorm objects are missed, and the number of independent precipitation objects of CMA-Meso is higher than that of the other two precipitation products. (4) The forecast object area and intensity of SCMOC and observation match best in the XFC (westerly trough) circulation situation, while ECMWF has the best results for the forecast of FGXFC (subtropical high westerly trough) rainstorms

Biomechanical Analysis of Various Reconstructive Methods for the Mandibular Body and Ramus Defect Using a Free Vascularized Fibula Flap

Several different methods exist for reconstructing the mandibular body and ramus defect with the use of a free vascularized fibula flap, but none have adequately addressed the long-term mechanical stability and osseointegration. The aim of this study is to compare the biomechanics of different surgical methods and to investigate the best approach for reconstructing the mandibular body and ramus defect. Five finite element models based on different reconstructive methods were simulated. Stress, strain, and displacement of connective bone sections were calculated for five models and compared. The models were printed using a 3D printer, and stiffness was measured using an electromechanical universal testing machine. The postoperative follow-up cone beam computed tomography (CBCT) was taken at different time points to analyze bone mineral density of connective bone sections. The results showed that the “double up” (DU) model was the most efficient for reconstructing a mandibular body and ramus defect by comparing the mechanical distribution of three sections under vertical and inclined loading conditions of 100 N. The stiffness detection showed that stiffness in the DU and “double down” (DD) models was higher compared with the “single up” (SU), “single down” (SD), and “distraction osteogenesis” (DO) models. We used the DU model for the surgery, and postoperative follow-up CBCT showed that bone mineral density of each fibular connective section increased gradually with time, plateauing at 12 weeks. We conclude that a free vascularized fibula flap of the DU type was the best approach for the reconstruction of the mandibular body and ramus defect. Preoperative finite element analysis and stiffness testing were shown to be very useful for maxillofacial reconstruction

Headache Secondary to Isolated Sphenoid Sinus Fungus Ball: Retrospective Analysis of 6 Cases First Diagnosed in the Neurology Department

Fungal sphenoid sinusitis is easily misdiagnosed in clinic, particularly for patients with normal immunological status. Due to the anatomic characteristics of sphenoid sinus, patients presented with various nonspecific symptoms and complications. Headache is the most common presentation, but location of headache is not fixed. We intended to analyze 6 cases of headache secondary to the isolated sphenoid sinus fungus ball (SSFB) which were first diagnosed in the Neurology Department. There was significant female predominance with mean ages of 55 years. They had repeatedly headache history from months to years. The headache was unilateral and usually on the side of lesions. Medication of pain relievers worked well in the beginning of SSFB, but not in the late stage of disease. Notably, all patients did not present positive nervous systemic signs. A preoperative computed tomography (CT) scan or magnetic resonance imaging (MRI) demonstrated the inflammation in sphenoid sinus. Some cases showed calcification in soft tissue or bone lesions of sinus wall. All of 6 patients undertook transnasal endoscopic sphenoidotomy without antifungal therapy after operation. Characteristic fungus ball (FB) was detected after histopathological examination. No headache recurrence was found after average 15.5 months follow-up. Our results suggested that transnasal endoscopic sphenoidotomy is the treatment of choice to remove the FB in sphenoid sinus with a low rate of morbidity and recurrence

Determination and Pharmacokinetic Study of Three Diterpenes in Rat Plasma by UHPLC-ESI-MS/MS after Oral Administration of Rosmarinus officinalis L. Extract

Rosmarinus officinalis L. is commonly used as a spice and flavoring agent. Diterpenes are the main active compounds of R. officinalis. An Ultra High Performance Liquid Chromatography-Tandem Mass Spectrometry (UHPLC-ESI-MS/MS) method was developed for the determination of carnosol, rosmanol, and carnosic acid isolated from R. officinalis in rat plasma, and applied to a pharmacokinetic study after oral administration of R. officinalis extract. Sample preparation involved a liquid-liquid extraction of the analytes with ethyl acetate. Butylparaben was employed as an internal standard (I.S.). Chromatographic separation was carried out on a C18 column (ACQUITY UPLC® HSS T3, 1.8 μm, 2.1 mm × 100 mm) with a gradient system consisting of the mobile phase solution A (0.1% formic acid in water) and solution B (acetonitrile) at the flow rate of 0.3 mL/min. The quantification was obtained using multiple reaction monitoring (MRM) mode with electrospray ionization (ESI). The UHPLC-MS/MS assay was validated for linearity, accuracy, precision, extraction recovery, matrix effect and stability. This study described a simple, sensitive and validated UHPLC-MS/MS method for the simultaneous determination of three diterpene compounds in rat plasma after oral administration of R. officinalis extract, and investigated on their pharmacokinetic studies as well