Pretreatment with statins improves early outcome in patients with first-ever ischaemic stroke: a pleiotropic effect of statins or a beneficial effect of hypercholesterolemia?

Background: Data from different studies suggest a favourable association between pretreatment with statins or hypercholesterolemia and outcome after ischaemic stroke. We examined whether there were differences in in-hospital mortality according to the presence or absence of statin therapy in a large population of first-ever ischaemic stroke patients and assessed the influence of statins upon early death and spontaneous neurological recovery. Methods: In 2,082 consecutive patients with first-ever ischaemic stroke collected from a prospective hospital-based stroke registry during a period of 19 years (1986-2004), statin use or hypercholesterolemia before stroke was documented in 381 patients. On the other hand, favourable outcome defined as grades 0-2 in the modified Rankin scale was recorded in 382 patients. Results: Early outcome was better in the presence of statin therapy or hypercholesterolemia (cholesterol levels were not measured) with significant differences between the groups with and without pretreatment with statins in in-hospital mortality (6% vs 13.3%, P = 0.001) and symptom-free (22% vs 17.5%, P = 0.025) and severe functional limitation (6.6% vs 11.5%, P = 0.002) at hospital discharge, as well as lower rates of infectious respiratory complications during hospitalization. In the logistic regression model, statin therapy was the only variable inversely associated with in-hospital death (odds ratio 0.57) and directly associated with favourable outcome (odds ratio 1.32)

A new chronological framework and site formation history for Cova del Gegant (Barcelona): Implications for Neanderthal and Anatomically Modern Human occupation of NE Iberian Peninsula

The chronological framework for Neanderthal occupation and demise across Europe continues to be debated. In particular, there is still uncertainty regarding the nature, timing and regional expressions of the Middle to Upper Palaeolithic transition associated with the disappearance of Neanderthals and the broader expansion of modern human populations in Europe around 42e40 thousand years ago (ka). The geographical and chronological distribution of Neanderthal populations also remains difficult to evaluate owing to the practical challenges of directly dating human fossils at many sites, and the fact that a large proportion of Neanderthals sites lie close to, or well-beyond, the limits of radiocarbon dating. Cova del Gegant e one of the few sites in north-eastern Iberian Peninsula to yield Neanderthal fossil remains, associated Mousterian archaeological layers, and occupations related to the Middle and Upper Palaeolithic transition e is a key locality for informing these ongoing debates. Here we provide a comprehensive chronological framework for the Cova del Gegant site using multiple radiometric dating techniques (uranium-thorium (UeTh), radiocarbon and luminescence dating), sedimentological and micromorphological analyses, and Bayesian modelling. This integrated chronostratigraphic approach enables us to reliably reconstruct site formation processes and history, and undertake improved correlations with other sites regionally. The results allow us to sub-divide the Cova del Gegant sequence into three sections spanning ~94 ka to ~32 ka, namely: a Middle Palaeolithic sequence covering ~94e59 ka, a Châtelperronian/Aurignacian section spanning ~43e39 ka, and a Late Aurignacian/Gravettian section spanning ~34e32 ka. The Neanderthal fossil remains accumulated in the cave between the end of Marine Isotope Stage (MIS) 5/MIS 4 and the beginning of MIS 3, during two different events dated to ~72e67 ka and ~60e52 ka. The chronological framework for Cova del Gegant is in accordance with that reported for other Middle and Upper Palaeolithic sites in north-eastern Iberian Peninsula, and reveals a record of successive human occupation coinciding with a period of progressive global cooling and lowering sea levels (end of MIS 5 through to MIS 2). Sedimentological evidence points to the emergence of a coastal platform in front of the cave and indicates that local palaeoenvironmental conditions likely benefited human displacements along the littoral margin, and favoured repeated occupation of the cave during the Late Pleistocene

Clinical predictors of lacunar syndrome not due to lacunar infarction

Background: Lacunar syndrome not due to lacunar infarct is poorly characterised. This single centre, retrospective study was conducted to describe the clinical characteristics of patients with lacunar syndrome not due to lacunar infarct and to identify clinical predictors of this variant of lacunar stroke. Methods: A total of 146 patients with lacunar syndrome not due to lacunar infarction were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986-2004). Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 146 patients with lacunar syndrome not due to lacunar infarct were compared with those of the 733 patients with lacunar infarction. Results: Lacunar syndrome not due to lacunar infarct accounted for 16.6% (146/879) of all cases of lacunar stroke. Subtypes of lacunar syndromes included pure motor stroke in 63 patients, sensorimotor stroke in 51, pure sensory stroke in 14, atypical lacunar syndrome in 9, ataxic hemiparesis in 5 and dysarthria-clumsy hand in 4. Valvular heart disease, atrial fibrillation, sudden onset, limb weakness and sensory symptoms were significantly more frequent among patients with lacunar syndrome not due to lacunar infarct than in those with lacunar infarction, whereas diabetes was less frequent. In the multivariate analysis, atrial fibrillation (OR = 4.62), sensorimotor stroke (OR = 4.05), limb weakness (OR = 2.09), sudden onset (OR = 2.06) and age (OR = 0.96) were independent predictors of lacunar syndrome not due to lacunar infarct. Conclusions: Although lacunar syndromes are highly suggestive of small deep cerebral infarctions, lacunar syndromes not due to lacunar infarcts are found in 16.6% of cases. The presence of sensorimotor stroke, limb weakness and sudden onset in a patient with atrial fibrillation should alert the clinician to the possibility of a lacunar syndrome not due to a lacunar infarct

Arquitectura colonial temprana en el área maya: registro material y documentación escrita

Architecture is one of the more complex human manifestations since it agglutinates a whole range of aspects of great relevance. On the one hand, it synthesizes the form to conceive the space according to his different uses or functions; on the other hand, it also marks those aspects hierarchically considering the situation inside the surfaces, the materials and also the functions. In addition, from the study of a construction we might get excellent data as the techniques, the systems of extraction of materials, the commercial availability of prime matters, or the commercial routes that allow to palliate the deficiencies of the communities in certain historical periods and how they affect their every day life. Considering the importance of a building as the materialization of a social, economic, or religious reality, in this paper I analyze the religious constructions of the early colonial period as a source of study of the first one hundred years of Hispanic dominion in the Mayan area. Obviously, besides the examples contributed by archaeology, some excellent textual references have been analyzed that affect the form to construct during this period of clear cultural syncretism.La arquitectura es una de las manifestaciones humanas más complejas dado que aglutina toda una gama de aspectos de gran relevancia. Por un lado, sintetiza la forma de concebir el espacio según sus diferentes usos o funciones; por otro, marca jerarquizaciones en los mismos teniendo en cuenta la situación dentro de las superficies, los materiales y también las funciones. Además, del estudio de una construcción se desprenden datos tan relevantes como las técnicas, los sistemas de extracción de materiales, la disponibilidad de materias primeras o las rutas comerciales que permiten paliar las deficiencias de las comunidades en determinados períodos históricos y cómo afectan su cotidianidad. Considerando la importancia de un edificio en tanto materialización de una realidad social, económica, religiosa, etc., en este estudio se pretende analizar las construcciones religiosas del período colonial temprano como fuente de estudio del primer siglo de dominio hispano en el área maya. Obviamente, además de los ejemplos aportados por la arqueología, se han analizado las referencias textuales relevantes que inciden en la forma de construir durante este período, de claro sincretismo cultural