Reasons for prehospital delay in acute ischemic stroke

Background Prehospital delay reduces the proportion of patients with stroke treated with recanalization therapies. We aimed to identify novel and modifiable risk factors for prehospital delay. Methods and Results We included patients with an ischemic stroke confirmed by diffusion-weighted magnetic resonance imaging, symptom onset within 24 hours and hospitalized in the Stroke Center of the University Hospital Basel, Switzerland. Trained study nurses interviewed patients and proxies along a standardized questionnaire. Prehospital delay was defined as >4.5 hours between stroke onset-or time point of wake-up-and admission. Overall, 336 patients were enrolled. Prehospital delay was observed in 140 patients (42%). The first healthcare professionals to be alarmed were family doctors for 29% of patients (97/336), and a quarter of these patients had a baseline National Institute of Health Stroke Scale score of 4 or higher. The main modifiable risk factor for prehospital delay was a face-to-face visit to the family doctor (adjusted odds ratio, 4.19; 95% CI, 1.85-9.46). Despite transport by emergency medical services being associated with less prehospital delay (adjusted odds ratio, 0.41; 95% CI, 0.24-0.71), a minority of patients (39%) who first called their family doctor were transported by emergency medical services to the hospital. The second risk factor was lack of awareness of stroke symptoms (adjusted odds ratio, 4.14; 95% CI, 2.36-7.24). Conclusions Almost 1 in 3 patients with a diffusion-weighted magnetic resonance imaging-confirmed ischemic stroke first called the family doctor practice. Face-to-face visits to the family doctor quadrupled the odds of prehospital delay. Efforts to reduce prehospital delay should address family doctors and their staffs as important partners in the prehospital pathway. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02798770

Mechanistic studies of sulfur-carbon bond formation by metal-dependent enzymes

Sulfur is an essential element for all living organisms. In a large variety of relevant compounds like amino acids, cofactors and other natural products carbon-sulfur bonds are found. The understanding of the mechanistic details of carbon sulfur bond formation catalyzed by enzymes is from particular interest. The gained knowledge can be used for the discovery of new biosynthetic pathways of sulfur containing natural products as well as for the design of artificial enzymes able to perform carbon-sulfur bond formation. In this thesis we investigate bacterial and fungal enzymes that catalyze carbon-sulfur bond formation. First, we characterized the catalytic activity of an unusual class of glutathione-S-transferases. These enzymes require a bivalent metal ion to activate their thiol substrate for nucleophilic attack onto carbon electrophiles. In vitro reconstitution of these enzymes, variation of the electrophile, the catalytic metal and the reaction conditions, compounded with structural studies revealed important insight into the catalytic mechanism of enzyme-catalyzed metal-dependent C-S bond formation. Secondly, we examined a distantly related class of metalloenzymes that occur in bacteria and fungi. These metalloenzymes are oxygen-dependent and catalyze oxidative coupling of histidine derivatives with cysteine derivatives by forming a new C-S bond. This reaction is a key step in ergothioneine biosynthesis. Kinetic and structural examination of these enzymes were used to study the subtle but functionally significant differences between fungal and bacterial enzymes. Overall, we have broadened our knowledge of enzymes forming carbon-sulfur bonds and containing a DinB domain, along with discovering a new class of fungal cysteine dioxygenase

Selenocysteine as a Substrate, an Inhibitor and a Mechanistic Probe for Bacterial and Fungal Iron‐Dependent Sulfoxide Synthases

Sulfoxide synthases are non-heme iron enzymes that participate in the biosynthesis of thiohistidines, such as ergothioneine and ovothiol A. The sulfoxide synthase EgtB from Chloracidobacterium thermophilum (CthEgtB) catalyzes oxidative coupling between the side chains of N-α-trimethyl histidine (TMH) and cysteine (Cys) in a reaction that entails complete reduction of molecular oxygen, carbon-sulfur (C-S) and sulfur-oxygen (S-O) bond formation as well as carbon-hydrogen (C-H) bond cleavage. In this report, we show that CthEgtB and other bacterial sulfoxide synthases cannot efficiently accept selenocysteine (SeCys) as a substrate in place of cysteine. In contrast, the sulfoxide synthase from the filamentous fungus Chaetomium thermophilum (CthEgt1) catalyzes C-S and C-Se bond formation at almost equal efficiency. We discuss evidence suggesting that this functional difference between bacterial and fungal sulfoxide synthases emerges from different modes of oxygen activation

Selenocysteine as a Substrate, an Inhibitor and a Mechanistic Probe for Bacterial and Fungal Iron-Dependent Sulfoxide Synthases

Sulfoxide synthases are non-heme iron enzymes that participate in the biosynthesis of thiohistidines, such as ergothioneine and ovothiol A. The sulfoxide synthase EgtB from Chloracidobacterium thermophilum (CthEgtB) catalyzes oxidative coupling between the side chains of N-α-trimethyl histidine (TMH) and cysteine (Cys) in a reaction that entails complete reduction of molecular oxygen, carbon-sulfur (C-S) and sulfur-oxygen (S-O) bond formation as well as carbon-hydrogen (C-H) bond cleavage. In this report, we show that CthEgtB and other bacterial sulfoxide synthases cannot efficiently accept selenocysteine (SeCys) as a substrate in place of cysteine. In contrast, the sulfoxide synthase from the filamentous fungus Chaetomium thermophilum (CthEgt1) catalyzes C-S and C-Se bond formation at almost equal efficiency. We discuss evidence suggesting that this functional difference between bacterial and fungal sulfoxide synthases emerges from different modes of oxygen activation

Generation and structure of extremely large clusters in pulsed jets

Extremely large xenon clusters with sizes exceeding the predictions of the Hagena scaling law by several orders of magnitude are shown to be produced in pulsed gas jets. The cluster sizes are determined using single-shot single-particle imaging experiments with short-wavelength light pulses from the free-electron laser in Hamburg (FLASH). Scanning the time delay between the pulsed cluster source and the intense femtosecond x-ray pulses first shows a main plateau with size distributions in line with the scaling laws, which is followed by an after-pulse of giant clusters. For the extremely large clusters with radii of several hundred nanometers the x-ray scattering patterns indicate a grainy substructure of the particles, suggesting that they grow by cluster coagulation

The 3D-Architecture of Individual Free Silver Nanoparticles Captured by X-Ray Scattering

The diversity of nanoparticle shapes generated by condensation from gaseous matter reflects the fundamental competition between thermodynamic equilibration and the persistence of metastable configurations during growth. In the kinetically limited regime, intermediate geometries that are favoured only in early formation stages can be imprinted in the finally observed ensemble of differently structured specimens. Here we demonstrate that single-shot wide-angle scattering of femtosecond soft X-ray free-electron laser pulses allows three-dimensional characterization of the resulting metastable nanoparticle structures. For individual free silver particles, which can be considered frozen in space for the duration of photon exposure, both shape and orientation are uncovered from measured scattering images. We identify regular shapes, including species with fivefold symmetry and surprisingly large aspect ratio up to particle radii of the order of 100 nm. Our approach includes scattering effects beyond Born’s approximation and is remarkably efficient—opening up new routes in ultrafast nanophysics and free-electron laser science.ISSN:2041-172

Time-resolved x-ray imaging of a laser-induced nanoplasma and its neutral residuals

The evolution of individual, large gas-phase xenon clusters, turned into a nanoplasma by a high power infrared laser pulse, is tracked from femtoseconds up to nanoseconds after laser excitation via coherent diffractive imaging, using ultra-short soft x-ray free electron laser pulses. A decline of scattering signal at high detection angles with increasing time delay indicates a softening of the cluster surface. Here we demonstrate, for the first time a representative speckle pattern of a new stage of cluster expansion for xenon clusters after a nanosecond irradiation. The analysis of the measured average speckle size and the envelope of the intensity distribution reveals a mean cluster size and length scale of internal density fluctuations. The measured diffraction patterns were reproduced by scattering simulations which assumed that the cluster expands with pronounced internal density fluctuations hundreds of picoseconds after excitation.ISSN:1367-263

Imaging plasma formation in isolated nanoparticles with ultrafast resonant scattering ARTICLES YOU MAY BE INTERESTED IN

We have recorded the diffraction patterns from individual xenon clusters irradiated with intense extreme ultraviolet pulses to investigate the influence of light-induced electronic changes on the scattering response. The clusters were irradiated with short wavelength pulses in the wavelength regime of different 4d inner-shell resonances of neutral and ionic xenon, resulting in distinctly different optical properties from areas in the clusters with lower or higher charge states. The data show the emergence of a transient structure with a spatial extension of tens of nanometers within the otherwise homogeneous sample. Simulations indicate that ionization and nanoplasma formation result in a light-induced outer shell in the cluster with a strongly altered refractive index. The presented resonant scattering approach enables imaging of ultrafast electron dynamics on their natural timescale