Influence of age on outcome from thrombolysis in acute stroke: a controlled comparison in patients from the Virtual International Stroke Trials Archive (VISTA)

<p><b>Background and Purpose:</b> Thrombolysis for acute ischemic stroke in patients aged >80 years is not approved in some countries due to limited trial data in the very elderly. We compared outcomes between thrombolysed and nonthrombolysed (control) patients from neuroprotection trials to assess any influence of age on response.</p> <p><b>Method:</b>Among patients with ischemic stroke of known age, pretreatment severity (baseline National Institutes of Health Scale Score), and 90-day outcome (modified Rankin Scale score; National Institutes of Health Scale score), we compared the distribution of modified Rankin score in thrombolysed patients with control subjects by Cochran-Mantel-Haenszel test and then logistic regression after adjustment for age and baseline National Institutes of Health Scale score. We examined patients ≤80 and ≥ 81 years separately and then each age decile.</p> <p><b>Results:</b> Rankin data were available for 5817 patients, 1585 thrombolysed and 4232 control subjects; 20.5% were aged >80 years (mean ± SD, 85.1 ± 3.4 years). Baseline severity was higher among thrombolysed than control subjects (median National Institutes of Health Scale score 14 versus 13, P<0.05). The distribution of modified Rankin Scale scores was better among thrombolysed patients (P<0.0001; OR, 1.39; 95% CI, 1.26 to 1.54). The association occurred independently with similar magnitude among young (P<0.0001; OR, 1.42; 95% CI, 1.26 to 1.59) and elderly (P=0.002; OR, 1.34; 95% CI, 1.05 to 1.70) patients. ORs were consistent across all age deciles >30 years; outcomes assessed by National Institutes of Health Scale score gave supporting significant findings, and dichotomized modified Rankin Scale score outcomes were also consistent.</p> <p><b>Conclusions:</b> Outcome after thrombolysis for acute ischemic stroke was significantly better than in control subjects. Despite the expected poorer outcomes among elderly compared with young patients that is independent of any treatment effect, the association between thrombolysis treatment and improved outcome is maintained in the very elderly. Age alone should not be a barrier to treatment.</p&gt

Review of Territory: On the Development of Landscape and City by ETH Studio Basel: Contemporary City Institute. With contributions by Roger Diener, Liisa Gunnarsson, Mathias Gunz, Vesna Jovanović, Marcel Meili, Christan Müller Inderbitzin, and Christian Schmid

Book review of Territory: On the Development of Landscape and City by ETH Studio Basel: Contemporary City Institute

Adherence to secondary stroke prevention strategies - Results from the German stroke data bank

Only very limited data are available concerning patient adherence to antithrombotic medication intended to prevent a recurrent stroke. Reduced adherence and compliance could significantly influence the effects of any stroke prevention strategies. This study from a large stroke data bank provides representative data concerning the rate of stroke victims adhering to their recommended preventive medication. During a 2-year period beginning January 1, 1998, all patients with acute stroke or TIA in 23 neurological departments with an acute stroke unit were included in the German Stroke Data Bank. Data were collected prospectively, reviewed, validated and processed in a central data management unit. Only 12 centers with a follow-up rate of 80% or higher were included in this evaluation. 3,420 patients were followed up after 3 months, and 2,640 patients were followed up one year after their stroke. After one year, 96% of all patients reported still adhere to at least one medical stroke prevention strategy. Of the patients receiving aspirin at discharge, 92.6% reported to use that medication after 3 months and 84% after one year, while 81.6 and 61.6% were the respective figures for clopidogrel, and 85.2 and 77.4% for oral anticoagulation. Most patients who changed medication switched from aspirin to clopidogrel. Under the conditions of this observational study, adherence to stroke prevention strategies is excellent. The highest adherence rate is noticed for aspirin and oral anticoagulation. After one year, very few patients stopped taking stroke preventive medication. Copyright (C) 2003 S. Karger AG, Basel

Local Current Distribution and "Hot Spots" in the Integer Quantum Hall Regime

In a recent experiment, the local current distribution of a two-dimensional electron gas in the quantum Hall regime was probed by measuring the variation of the conductance due to local gating. The main experimental finding was the existence of "hot spots", i.e. regions with high degree of sensitivity to local gating, whose density increases as one approaches the quantum Hall transition. However, the direct connection between these "hot spots" and regions of high current flow is not clear. Here, based on a recent model for the quantum Hall transition consisting of a mixture of perfect and quantum links, the relation between the "hot spots" and the current distribution in the sample has been investigated. The model reproduces the observed dependence of the number and sizes of "hot spots" on the filling factor. It is further demonstrated that these "hot spots" are not located in regions where most of the current flows, but rather, in places where the currents flow both when injected from the left or from the right. A quantitative measure, the harmonic mean of these currents is introduced and correlates very well with the "hot spots" positions

Constructive aspects of Riemann's permutation theorem for series

The notions of permutable and weak-permutable convergence of a series $\sum_{n=1}^{\infty}a_{n}$ of real numbers are introduced. Classically, these two notions are equivalent, and, by Riemann's two main theorems on the convergence of series, a convergent series is permutably convergent if and only if it is absolutely convergent. Working within Bishop-style constructive mathematics, we prove that Ishihara's principle \BDN implies that every permutably convergent series is absolutely convergent. Since there are models of constructive mathematics in which the Riemann permutation theorem for series holds but \BDN does not, the best we can hope for as a partial converse to our first theorem is that the absolute convergence of series with a permutability property classically equivalent to that of Riemann implies \BDN. We show that this is the case when the property is weak-permutable convergence

Calcitonin gene-related peptide receptor antagonist BIBN 4096 BS for the acute treatment of migraine

Background: Calcitonin gene–related peptide (CGRP) may have a causative role in migraine. We therefore hypothesized that a CGRP-receptor antagonist might be effective in the treatment of migraine attacks. Methods: In an international, multicenter, double-blind, randomized clinical trial of BIBN 4096 BS, a highly specific and potent nonpeptide CGRP-receptor antagonist, 126 patients with migraine received one of the following: placebo or 0.25, 0.5, 1, 2.5, 5, or 10 mg of BIBN 4096 BS intravenously over a period of 10 minutes. A group-sequential adaptive treatment-assignment design was used to minimize the number of patients exposed. Results: The 2.5-mg dose was selected, with a response rate of 66 percent, as compared with 27 percent for placebo (P=0.001). The BIBN 4096 BS group as a whole had a response rate of 60 percent. Significant superiority over placebo was also observed with respect to most secondary end points: the pain-free rate at 2 hours; the rate of sustained response over a period of 24 hours; the rate of recurrence of headache; improvement in nausea, photophobia, phonophobia, and functional capacity; and the time to meaningful relief. An effect was apparent after 30 minutes and increased over the next few hours. The overall rate of adverse events was 25 percent after the 2.5-mg dose of the drug and 20 percent for the BIBN 4096 BS group as a whole, as compared with 12 percent for placebo. The most frequent side effect was paresthesia. There were no serious adverse events. Conclusions: The CGRP antagonist BIBN 4096 BS was effective in treating acute attacks of migraine

Dipyridamole plus aspirin versus aspirin alone in the secondary prevention after TIA or stroke: a meta-analysis by risk

Objectives: Our aim was to study the effect of combination therapy with aspirin and dipyridamole (A+D) over aspirin alone (ASA) in secondary prevention after transient ischemic attack or minor stroke of presumed arterial origin and to perform subgroup analyses to identify patients that might benefit most from secondary prevention with A+D. Data sources: The previously published meta-analysis of individual patient data was updated with data from ESPRIT (N=2,739); trials without data on the comparison of A+D versus ASA were excluded. Review methods: A meta-analysis was performed using Cox regression, including several subgroup analyses and following baseline risk stratification. Results: A total of 7,612 patients (5 trials) were included in the analyses, 3,800 allocated to A+D and 3,812 to ASA alone. The trial-adjusted hazard ratio for the composite event of vascular death, non-fatal myocardial infarction and non-fatal stroke was 0.82 (95% confidence interval 0.72-0.92). Hazard ratios did not differ in subgroup analyses based on age, sex, qualifying event, hypertension, diabetes, previous stroke, ischemic heart disease, aspirin dose, type of vessel disease and dipyridamole formulation, nor across baseline risk strata as assessed with two different risk scores. A+D were also more effective than ASA alone in preventing recurrent stroke, HR 0.78 (95% CI 0.68 – 0.90). Conclusion: The combination of aspirin and dipyridamole is more effective than aspirin alone in patients with TIA or ischemic stroke of presumed arterial origin in the secondary prevention of stroke and other vascular events. This superiority was found in all subgroups and was independent of baseline risk. ---------------------------7dc3521430776 Content-Disposition: form-data; name="c14_creators_1_name_family" Halke

Equation of state of a superfluid Fermi gas in the BCS-BEC crossover

We present a theory for a superfluid Fermi gas near the BCS-BEC crossover, including pairing fluctuation contributions to the free energy similar to that considered by Nozieres and Schmitt-Rink for the normal phase. In the strong coupling limit, our theory is able to recover the Bogoliubov theory of a weakly interacting Bose gas with a molecular scattering length very close to the known exact result. We compare our results with recent Quantum Monte Carlo simulations both for the ground state and at finite temperature. Excellent agreement is found for all interaction strengths where simulation results are available.Comment: 7 pages, 4 figures, published version in Europhysics Letters, a long preprint with details will appear soo

High accuracy binary black hole simulations with an extended wave zone

We present results from a new code for binary black hole evolutions using the moving-puncture approach, implementing finite differences in generalised coordinates, and allowing the spacetime to be covered with multiple communicating non-singular coordinate patches. Here we consider a regular Cartesian near zone, with adapted spherical grids covering the wave zone. The efficiencies resulting from the use of adapted coordinates allow us to maintain sufficient grid resolution to an artificial outer boundary location which is causally disconnected from the measurement. For the well-studied test-case of the inspiral of an equal-mass non-spinning binary (evolved for more than 8 orbits before merger), we determine the phase and amplitude to numerical accuracies better than 0.010% and 0.090% during inspiral, respectively, and 0.003% and 0.153% during merger. The waveforms, including the resolved higher harmonics, are convergent and can be consistently extrapolated to $r\to\infty$ throughout the simulation, including the merger and ringdown. Ringdown frequencies for these modes (to $(\ell,m)=(6,6)$) match perturbative calculations to within 0.01%, providing a strong confirmation that the remnant settles to a Kerr black hole with irreducible mass $M_{\rm irr} = 0.884355\pm20\times10^{-6}$ and spin $S_f/M_f^2 = 0.686923 \pm 10\times10^{-6}