Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR)

<p><b>Background and Purpose:</b> The optimal management of blood pressure (BP) in acute stroke remains unclear. For ischemic stroke treated with intravenous thrombolysis, current guidelines suggest pharmacological intervention if systolic BP exceeds 180 mm Hg. We determined retrospectively the association of BP and antihypertensive therapy with clinical outcomes after stroke thrombolysis.</p> <p><b>Methods:</b> The SITS thrombolysis register prospectively recorded 11 080 treatments from 2002 to 2006. BP values were recorded at baseline, 2 hours, and 24 hours after thrombolysis. Outcomes were symptomatic (National Institutes of Health Stroke Scale score deterioration ≥4) intracerebral hemorrhage Type 2, mortality, and independence at (modified Rankin Score 0 to 2) 3 months. Patients were categorized by history of hypertension and antihypertensive therapy within 7 days after thrombolysis: Group 1, hypertensive treated with antihypertensives (n=5612); Group 2, hypertensive withholding antihypertensives (n=1573); Group 3, without history of hypertension treated with antihypertensives (n=995); and Group 4, without history of hypertension not treated with antihypertensives (n=2632). For 268 (2.4%) patients, these data were missing. Average systolic BP 2 to 24 hours after thrombolysis was categorized by 10-mm Hg intervals with 100 to 140 used as a reference.</p> <p><b>Results:</b> In multivariable analysis, high systolic BP 2 to 24 hours after thrombolysis as a continuous variable was associated with worse outcome (P<0.001) and as a categorical variable had a linear association with symptomatic hemorrhage and a U-shaped association with mortality and independence with systolic BP 141 to 150 mm Hg associated with most favorable outcomes. OR (95% CI) from multivariable analysis showed no difference in symptomatic hemorrhage (1.09 [0.83 to 1.51]; P=0.58) and independence (1.03 [0.93 to 1.10]; P=0.80) but lower mortality (0.82 [0.73 to 0.92]; P=0.0007) for Group 1 compared with Group 4. Group 2 had a higher symptomatic hemorrhage (1.86 [1.34 to 2.68]; P=0.0004) and mortality (1.62 [1.41 to 1.85]; P<0.0001) and lower independence (0.89 [0.80 to 0.99]; P=0.04) compared with Group 4. Group 3 had similar results as Group 1.</p> <p><b>Conclusions:</b> There is a strong association of high systolic BP after thrombolysis with poor outcome. Withholding antihypertensive therapy up to 7 days in patients with a history of hypertension was associated with worse outcome, whereas initiation of antihypertensive therapy in newly recognized moderate hypertension was associated with a favorable outcome.</p&gt

Safety of intravenous thrombolysis for acute ischemic stroke in patients receiving antiplatelet therapy at stroke onset

<p><b>Background and Purpose:</b> Antiplatelets (APs) may increase the risk of symptomatic intracerebral hemorrhage (ICH) following intravenous thrombolysis after ischemic stroke.</p> <p><b>Methods:</b> We assessed the safety of thrombolysis under APs in 11 865 patients compliant with the European license criteria and recorded between 2002 and 2007 in the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register (SITS-ISTR). Outcome measures of univariable and multivariable analyses included symptomatic ICH (SICH) per SITS Monitoring Study (SITS-MOST [deterioration in National Institutes of Health Stroke Scale >= 4 plus ICH type 2 within 24 hours]), per European Cooperative Acute Stroke Study II (ECASS II [deterioration in National Institutes of Health Stroke Scale >= 4 plus any ICH]), functional outcome at 3 months and mortality.</p> <p><b>Results:</b> A total of 3782 (31.9%) patients had received 1 or 2 AP drugs at baseline: 3016 (25.4%) acetylsalicylic acid (ASA), 243 (2.0%) clopidogrel, 175 (1.5%) ASA and dipyridamole, 151 (1.3%) ASA and clopidogrel, and 197 (1.7%) others. Patients receiving APs were 5 years older and had more risk factors than AP nave patients. Incidences of SICH per SITS-MOST (ECASS II respectively) were as follows: 1.1% (4.1%) AP naive, 2.5% (6.2%) any AP, 2.5% (5.9%) ASA, 1.7% (4.2%) clopidogrel, 2.3% (5.9%) ASA and dipyridamole, and 4.1% (13.4%) ASA and clopidogrel. In multivariable analyses, the combination of ASA and clopidogrel was associated with increased risk for SICH per ECASS II (odds ratio, 2.11; 95% CI, 1.29 to 3.45; P = 0.003). However, we found no significant increase in the risk for mortality or poor functional outcome, irrespective of the AP subgroup or SICH definition.</p> <p><b>Conclusion:</b> The absolute excess of SICH of 1.4% (2.1%) in the pooled AP group is small compared with the benefit of thrombolysis seen in randomized trials. Although caution is warranted in patients receiving the combination of ASA and clopidogrel, AP treatment should not be considered a contraindication to thrombolysis.</p&gt

Quantum corrected geodesics

We compute the graviton-induced corrections to the trajectory of a classical test particle. We show that the motion of the test particle is governed by an effective action given by the expectation value (with respect to the graviton state) of the classical action. We analyze the quantum corrected equations of motion for the test particle in two particular backgrounds: a Robertson Walker spacetime and a 2+1 dimensional spacetime with rotational symmetry. In both cases we show that the quantum corrected trajectory is not a geodesic of the background metric.Comment: LaTeX file, 15 pages, no figure

Gauge Dependence of the High-Temperature 2-Loop Effective Potential for the Higgs Field

The high-temperature limit of the 2-loop effective potential for the Higgs field is calculated from an effective 3d theory, in a general covariant gauge. It is shown explicitly that a gauge-independent result can be extracted for the equation of state from the gauge-dependent effective potential. The convergence of perturbation theory is estimated in the broken phase, utilizing the gauge dependence of the effective potential.Comment: 13 LaTeX-pages + 2 ps-figure (Instructions added to uudecode the ps-file.

Vegetation's Red Edge: A Possible Spectroscopic Biosignature of Extraterrestrial Plants

Earth's deciduous plants have a sharp order-of-magnitude increase in leaf reflectance between approximately 700 and 750 nm wavelength. This strong reflectance of Earth's vegetation suggests that surface biosignatures with sharp spectral features might be detectable in the spectrum of scattered light from a spatially unresolved extrasolar terrestrial planet. We assess the potential of Earth's step-function-like spectroscopic feature, referred to as the "red edge", as a tool for astrobiology. We review the basic characteristics and physical origin of the red edge and summarize its use in astronomy: early spectroscopic efforts to search for vegetation on Mars and recent reports of detection of the red edge in the spectrum of Earthshine (i.e., the spatially integrated scattered light spectrum of Earth). We present Earthshine observations from Apache Point Observatory to emphasize that time variability is key to detecting weak surface biosignatures such as the vegetation red edge. We briefly discuss the evolutionary advantages of vegetation's red edge reflectance, and speculate that while extraterrestrial "light harvesting organisms" have no compelling reason to display the exact same red edge feature as terrestrial vegetation, they might have similar spectroscopic features at different wavelengths than terrestrial vegetation. This implies that future terrestrial-planet-characterizing space missions should obtain data that allow time-varying, sharp spectral features at unknown wavelengths to be identified. We caution that some mineral reflectance edges are similar in slope and strength to vegetation's red edge (albeit at different wavelengths); if an extrasolar planet reflectance edge is detected care must be taken with its interpretation.Comment: 19 pages, 6 figures, to appear in Astrobiolog

Invariance of Charge of Laughlin Quasiparticles

A Quantum Antidot electrometer has been used in the first direct observation of the fractionally quantized electric charge. In this paper we report experiments performed on the integer i = 1, 2 and fractional f = 1/3 quantum Hall plateaus extending over a filling factor range of at least 27%. We find the charge of the Laughlin quasiparticles to be invariantly e/3, with standard deviation of 1.2% and absolute accuracy of 4%, independent of filling, tunneling current, and temperature.Comment: 4 pages, 5 fig

Prevention of Decline in Cognition after Stroke Trial (PODCAST): a study protocol for a factorial randomised controlled trial of intensive versus guideline lowering of blood pressure and lipids

Background Stroke is a common cause of cognitive impairment and dementia. However, effective strategies for reducing the risk of post-stroke dementia remain undefined. Potential strategies include intensive lowering of blood pressure and/or lipids. Methods/Design Design: multi-centre prospective randomised open-label blinded-endpoint controlled partial-factorial phase IV trial in secondary and primary care. Participants: 100 participants from 30 UK Stroke Research Network sites who are post- ischemic stroke or intracerebral haemorrhage by three to seven months. Interventions - all patients (1:1): intensive versus guideline blood pressure lowering (target systolic < 125 mmHg versus < 140 mmHg). Interventions - ischemic stroke (1:1): intensive versus guideline lipid lowering (target low density lipoprotein-cholesterol (LDL-c) < 1.4 mmol/l versus < 3 mmol/l). Hypotheses: does ‘intensive’ blood pressure lowering therapy and/or ‘intensive’ lipid control reduce cognitive decline and dementia in people with ischemic stroke; and does ‘intensive’ blood pressure lowering therapy reduce cognitive decline and dementia in patients with hemorrhagic stroke. Primary outcome: Addenbrooke’s Cognitive Examination-Revised. Secondary outcomes: feasibility of recruitment and retention of participants, tolerability and safety of the interventions, achieving and maintaining the blood pressure and lipid targets, maintaining differences in systolic blood pressure (> 10 mmHg) and low density lipoprotein-cholesterol (> 1 mmol/l) between the treatment groups, and performing clinic and telephone follow-up of cognition measures. Randomisation: using stratification, minimization and simple randomization. Blinding: participants receive open-label management. Cognition is assessed both unblinded (in clinic) and blinded (by telephone) to treatment. Adjudication of events (dementia, vascular, serious adverse events) is blinded to management. Discussion The PODCAST trial is ongoing with 78 patients recruited to date from 22 sites. Outcomes of cognitive impairment and dementia are accruing. Trial registration ISRCTN8556238

Вивчення процесу синтезу нанокристалічних плівок двооксиду титану в розряді магнетронного типу за його оптичними та плазмодинамічними характеристиками

Наведено результати експериментального дослiдження плазмодинамiчних i оптичних характеристик цилiндричного газового розряду магнетронного типу в умовах безперервного контролю спектра, випромiнюваного плазмою в дiапазонi 350–820 нм. Визначено умови для синтезу бiнарної сполуки TiО₂, якi забезпечуються пiдтримкою величини iнтенсивностi спектральних лiнiй реагуючих компонентiв i плазмоутворюючого газу. Розглянуто можливiсть контролю умов одержання плiвок TiО₂ як по спектральних характеристиках плазми розряду, так i по змiнi розрядної напруги. Елiпсометричнi дослiдження нанокристалiчних плiвок двооксиду титану показали наявнiсть залежностi показника переломлення вiд товщини плiвки.We present the results of experimental researches of plasmodynamic and optical characteristics of a magnetron-type cylindrical gas discharge. The study was carried out provided a permanent monitoring of the spectrum emitted by plasma in the range 350–820 nm. For the synthesis of binary compound TiO₂, we have determined conditions which can be ensured by a support of the intensity of spectral lines emitted by reacting components and plasma-forming gas. A possibility to control the conditions of the fabrication of a TiO₂ film with the use of both the spectral characteristics of a discharge plasma and a variation of the discharge voltage has been analyzed. Ellipsometric and spectral studies of nanocrystalline titanium dioxide films revealed the dependence of the refractive index of a film on the film thickness.Приведены результаты экспериментального исследования плазмодинамических и оптических характеристик цилиндрического газового разряда магнетронного типа в условиях непрерывного контроля спектра, излучаемого плазмой в диапазоне 350–820 нм. Определены условия для синтеза бинарного соединения TiО₂, которые обеспечиваются поддержанием величины интенсивности спектральных линий реагирующих компонент и плазмообразующего газа. Рассмотрена возможность контроля условий получения пленок TiO₂ как по спектральным характеристикам плазмы разряда, так и по изменению разрядного напряжения. Эллипсометрические и спектральные исследования нанокристаллических пленок диоксида титана показали наличие зависимости показателя преломления от толщины пленки

Stress corrosion cracking in Al-Zn-Mg-Cu aluminum alloys in saline environments

Copyright 2013 ASM International. This paper was published in Metallurgical and Materials Transactions A, 44A(3), 1230 - 1253, and is made available as an electronic reprint with the permission of ASM International. One print or electronic copy may be made for personal use only. Systematic or multiple reproduction, distribution to multiple locations via electronic or other means, duplications of any material in this paper for a fee or for commercial purposes, or modification of the content of this paper are prohibited.Stress corrosion cracking of Al-Zn-Mg-Cu (AA7xxx) aluminum alloys exposed to saline environments at temperatures ranging from 293 K to 353 K (20 °C to 80 °C) has been reviewed with particular attention to the influences of alloy composition and temper, and bulk and local environmental conditions. Stress corrosion crack (SCC) growth rates at room temperature for peak- and over-aged tempers in saline environments are minimized for Al-Zn-Mg-Cu alloys containing less than ~8 wt pct Zn when Zn/Mg ratios are ranging from 2 to 3, excess magnesium levels are less than 1 wt pct, and copper content is either less than ~0.2 wt pct or ranging from 1.3 to 2 wt pct. A minimum chloride ion concentration of ~0.01 M is required for crack growth rates to exceed those in distilled water, which insures that the local solution pH in crack-tip regions can be maintained at less than 4. Crack growth rates in saline solution without other additions gradually increase with bulk chloride ion concentrations up to around 0.6 M NaCl, whereas in solutions with sufficiently low dichromate (or chromate), inhibitor additions are insensitive to the bulk chloride concentration and are typically at least double those observed without the additions. DCB specimens, fatigue pre-cracked in air before immersion in a saline environment, show an initial period with no detectible crack growth, followed by crack growth at the distilled water rate, and then transition to a higher crack growth rate typical of region 2 crack growth in the saline environment. Time spent in each stage depends on the type of pre-crack (“pop-in” vs fatigue), applied stress intensity factor, alloy chemistry, bulk environment, and, if applied, the external polarization. Apparent activation energies (E a) for SCC growth in Al-Zn-Mg-Cu alloys exposed to 0.6 M NaCl over the temperatures ranging from 293 K to 353 K (20 °C to 80 °C) for under-, peak-, and over-aged low-copper-containing alloys (~0.8 wt pct), they are typically ranging from 20 to 40 kJ/mol for under- and peak-aged alloys, and based on limited data, around 85 kJ/mol for over-aged tempers. This means that crack propagation in saline environments is most likely to occur by a hydrogen-related process for low-copper-containing Al-Zn-Mg-Cu alloys in under-, peak- and over-aged tempers, and for high-copper alloys in under- and peak-aged tempers. For over-aged high-copper-containing alloys, cracking is most probably under anodic dissolution control. Future stress corrosion studies should focus on understanding the factors that control crack initiation, and insuring that the next generation of higher performance Al-Zn-Mg-Cu alloys has similar longer crack initiation times and crack propagation rates to those of the incumbent alloys in an over-aged condition where crack rates are less than 1 mm/month at a high stress intensity factor