Suction force-suction distance relation during aspiration thrombectomy for ischemic stroke: A computational fluid dynamics study

Acute Ischemic Stroke (AIS) is the major type of stroke occurring in patients. Aspiration thrombectomy, which uses suction to remove the thrombosis, is a promising technique in the clinical treatment of AIS patients. In this research a computational fluid dynamics (CFD) analysis was conducted to model the blood flow dynamics in a simplified cerebral model during an aspiration thrombectomy procedure. The flow system being analysed was a typical in vitro cerebral flow model, and the system parameters were set based on the clinical and in vitro data reported in open literature. The simulated flow field features showed good correlation with the in vitro response as reported in literature. The CFD study provides detailed technical data including the peak velocity occurring at the catheter tip and the suction force-suction distance relation during the aspiration thrombectomy procedure, which are useful new knowledge and have the potential to influence future catheter design as well as clinical operational protocols used during thrombectomy intervention

Assessment of fracture risk tools in care home residents: a multi-centre observational pilot study.

BACKGROUND: Fragility fractures are common in care home residents but established tools have not been tested in this population. AIM: To identify the most practicable tool for use. METHODS: DESIGN: Multicentre prospective observational cohort pilot study. SETTING: 18 care homes in Boston, UK. ASSESSMENTS: fragility risk score at baseline with FRAX, QFractureScore, Garvan nomogram, body mass index and TUGT for each participant. OUTCOMES: falls, fractures, combined falls & fractures. Follow-up; 12 months. RESULTS: 217/618 (35%) residents in the 18 care homes were enrolled. 147 (68%) had mental capacity,70 (32%) did not. There were 325 falls and 10 fractures in participants during the study. At the same time there were 1671 falls and 103 fractures in residents not participating in the study. Multiple regression analyses showed that only age had a statistically significant association with falls (χ2(1) = 5.7775, p = 0.0162), fractures (χ2(1) = 4.7269, p = 0.0297) and combined falls & fractures (χ2(1) = 4.7269, p = 0.0297). C-statistics were: falls; FRAX 0.544, BMI 0.610, QFractureScore 0.554, Garvan nomogram 0.579, TUGT 0.656, fractures; FRAX 0.655, BMI 0.708, QFractureScore 0.736, Garvan nomogram 0.712, TUGT 0.590, combined falls and fractures, c-statistics were same as for fractures. Fifty-four participants (25%) died during follow-up. Charlson comorbidity index predicted mortality, R2 = 0.021 (p = 0.034). CONCLUSIONS: QFractureScore, BMI and Garvan nomogram were good predictors of fractures and combined falls and fractures Only age had statistically significant association with the outcomes. No tool was good predictor of falls

Continuous or intermittent? Which regiment of enteral nutrition is better for acute stroke patients? A systematic review and meta-analysis

Background and purpose: Enteral nutrition via nasogastric tube in acute stroke patients with dysphagia is an important determinant of patient outcomes. It is unclear whether intermittent or continuous feeding is more efficacious. The aim of this review is to examine the current evidence comparing the effectiveness of intermittent versus continuous feeding in stroke patients in terms of nutritional status, gastrointestinal intolerance and other complications. Methods: A systematic review of randomized controlled studies comparing intermittent with continuous nasogastric feeding in acute stroke patients was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) guidance using predefined search terms. The search was conducted in MEDLINE and EMBASE up to 1st March 2019. Two independent reviewers assessed study quality using the Joanna Briggs Institute Critical Appraisal Tool. Meta-analyses were conducted, where appropriate, using a random-effects model to pool risk ratio with corresponding 95% CI. Results: Three studies including a total of 184 patients were identified. All three were medium to low quality. The definition of intermittent enteral nutrition within each study varied considerably in terms of volume, rate and mode of delivery. Achievement of nutritional targets was the same for both feeding patterns in the one study it was reported. Only aspiration pneumonia and diarrhea were measured by all three studies. There was no significant difference in the incidence of aspiration pneumonia (RR 0.91, 95% CI 0.53-1.57, p=0.74, I2=50%) and diarrhea (RR 1.74, 95% CI 0.70-4.30, p=0.23, I2=42%) between the two patterns of feeding. Other outcomes including, vomiting, gastric retention, mortality, pre-albumin and nasogastric tube complications showed no significant differences. Conclusion: There is very little and low-quality evidence to inform patterns of enteral feeding after stroke. The available evidence shows no significant difference in nutritional achievement and complications between intermittent and continuous nasogastric tube feeding in acute stroke patients

The stroke oxygen pilot study: a randomized control trial of the effects of routine oxygen supplementation early after acute stroke--effect on key outcomes at six months

Introduction: Post-stroke hypoxia is common, and may adversely affect outcome. We have recently shown that oxygen supplementation may improve early neurological recovery. Here, we report the six-month outcomes of this pilot study. Methods: Patients with a clinical diagnosis of acute stroke were randomized within 24 h of admission to oxygen supplementation at 2 or 3 L/min for 72 h or to control treatment (room air). Outcomes (see below) were assessed by postal questionnaire at 6 months. Analysis was by intention-to-treat, and statistical significance was set at p#0.05. Results: Out of 301 patients randomized two refused/withdrew consent and 289 (148 in the oxygen and 141 in the control group) were included in the analysis: males 44%, 51%; mean (SD) age 73 (12), 71 (12); median (IQR) National Institutes of Health Stroke Scale score 6 (3, 10), 5 (3, 10) for the two groups respectively. At six months 22 (15%) patients in the oxygen group and 20 (14%) in the control group had died; mean survival in both groups was 162 days (p= 0.99). Median (IQR) scores for the primary outcome, the modified Rankin Scale, were 3 (1, 5) and 3 (1, 4) for the oxygen and control groups respectively. The covariate-adjusted odds ratio was 1.04 (95% CI 0.67, 1.60), indicating that the odds of a lower (i.e. better) score were non-significantly higher in the oxygen group (p= 0.86). The mean differences in the ability to perform basic (Barthel Index) and extended activities of daily living (NEADL), and quality of life (EuroQol) were also non-significant. Conclusions: None of the key outcomes differed at 6 months between the groups. Although not statistically significant and generally of small magnitude, the effects were predominantly in favour of the oxygen group; a larger trial, powered to show differences in longer-term functional outcomes, is now on-going. Trial Registration: Controlled-Trials.com ISRCTN12362720; Eudract.ema.europa.eu 2004-001866-4

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group. Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed. Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulated via discussion and consensus. In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group

Quantum error correction : an introductory guide

Quantum error correction protocols will play a central role in the realisation of quantum computing; the choice of error correction code will influence the full quantum computing stack, from the layout of qubits at the physical level to gate compilation strategies at the software level. As such, familiarity with quantum coding is an essential prerequisite for the understanding of current and future quantum computing architectures. In this review, we provide an introductory guide to the theory and implementation of quantum error correction codes. Where possible, fundamental concepts are described using the simplest examples of detection and correction codes, the working of which can be verified by hand. We outline the construction and operation of the surface code, the most widely pursued error correction protocol for experiment. Finally, we discuss issues that arise in the practical implementation of the surface code and other quantum error correction codes

Bismuth coordination networks containing deferiprone: synthesis, characterisation, stability and antibacterial activity

A series of bismuth–dicarboxylate–deferiprone coordination networks have been prepared and structurally characterised. The new compounds have been demonstrated to release the iron overload drug deferiprone on treatment with PBS and have also been shown to have antibacterial activity against H. pylori

ScotGrid: Providing an Effective Distributed Tier-2 in the LHC Era

ScotGrid is a distributed Tier-2 centre in the UK with sites in Durham, Edinburgh and Glasgow. ScotGrid has undergone a huge expansion in hardware in anticipation of the LHC and now provides more than 4MSI2K and 500TB to the LHC VOs. Scaling up to this level of provision has brought many challenges to the Tier-2 and we show in this paper how we have adopted new methods of organising the centres, from fabric management and monitoring to remote management of sites to management and operational procedures, to meet these challenges. We describe how we have coped with different operational models at the sites, where Glagsow and Durham sites are managed "in house" but resources at Edinburgh are managed as a central university resource. This required the adoption of a different fabric management model at Edinburgh and a special engagement with the cluster managers. Challenges arose from the different job models of local and grid submission that required special attention to resolve. We show how ScotGrid has successfully provided an infrastructure for ATLAS and LHCb Monte Carlo production. Special attention has been paid to ensuring that user analysis functions efficiently, which has required optimisation of local storage and networking to cope with the demands of user analysis. Finally, although these Tier-2 resources are pledged to the whole VO, we have established close links with our local physics user communities as being the best way to ensure that the Tier-2 functions effectively as a part of the LHC grid computing framework..Comment: Preprint for 17th International Conference on Computing in High Energy and Nuclear Physics, 7 pages, 1 figur

Determinants and outcomes of stroke following percutaneous coronary intervention by indication

Background and Purpose— Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented. Methods— The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization). Results— A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43–67.05) and 21.05 (13.25–33.44) for elective and 5.00 (3.96–6.31) and 6.25 (5.03–7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64–2.43) and 0.63 (0.35–1.15), respectively. Conclusions— Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur