Field-Cycling Magnetic Resonance Imaging for identifying Minor Ischemic Stroke below 0.2 tesla

Acknowledgements The authors would like to thank radiographers Nichola Crouch, Mike Hendry, Laura Reid, Michelle Mauchline, and Arthur Ginsburg for their support with patient scans of FCI, Stacey Dawson for the study coordination, and the Scottish Stroke Research Network nurses, Janice Irvine, Annika Walch, Farah Muir and Sandra Williams who helped with patient recruitment. We also thank Alison Murray who contributed to study set up and 3T image interpretation. Funding for the scanner prototype was obtained from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 668119 (project “IDentIFY”) and funding for VM during write up came from the Chief Scientist Office (Grant TCS/19/44)Peer reviewe

Isosorbide Mononitrate and Cilostazol Treatment in Patients With Symptomatic Cerebral Small Vessel Disease: The Lacunar Intervention Trial-2 (LACI-2) Randomized Clinical Trial

Importance Cerebral small vessel disease (cSVD) is a common cause of stroke (lacunar stroke), is the most common cause of vascular cognitive impairment, and impairs mobility and mood but has no specific treatment.Objective To test the feasibility, drug tolerability, safety, and effects of 1-year isosorbide mononitrate (ISMN) and cilostazol treatment on vascular, functional, and cognitive outcomes in patients with lacunar stroke.Design, Setting, and Participants The Lacunar Intervention Trial-2 (LACI-2) was an investigator-initiated, open-label, blinded end-point, randomized clinical trial with a 2 × 2 factorial design. The trial aimed to recruit 400 participants from 26 UK hospital stroke centers between February 5, 2018, and May 31, 2021, with 12-month follow-up. Included participants had clinical lacunar ischemic stroke, were independent, were aged older than 30 years, had compatible brain imaging findings, had capacity to consent, and had no contraindications to (or indications for) the study drugs. Data analysis was performed on August 12, 2022.Interventions All patients received guideline stroke prevention treatment and were randomized to ISMN (40-60 mg/d), cilostazol (200 mg/d), ISMN-cilostazol (40-60 and 200 mg/d, respectively), or no study drug.Main Outcomes The primary outcome was recruitment feasibility, including retention at 12 months. Secondary outcomes were safety (death), efficacy (composite of vascular events, dependence, cognition, and death), drug adherence, tolerability, recurrent stroke, dependence, cognitive impairment, quality of life (QOL), and hemorrhage.Results Of the 400 participants planned for this trial, 363 (90.8%) were recruited. Their median age was 64 (IQR, 56.0-72.0) years; 251 (69.1%) were men. The median time between stroke and randomization was 79 (IQR, 27.0-244.0) days. A total of 358 patients (98.6%) were retained in the study at 12 months, with 257 of 272 (94.5%) taking 50% or more of the allocated drug. Compared with those participants not receiving that particular drug, neither ISMN (adjusted hazard ratio [aHR], 0.80 [95% CI, 0.59 to 1.09]; P = .16) nor cilostazol (aHR, 0.77 [95% CI, 0.57 to 1.05]; P = .10) alone reduced the composite outcome in 297 patients. Isosorbide mononitrate reduced recurrent stroke in 353 patients (adjusted odds ratio [aOR], 0.23 [95% CI, 0.07 to 0.74]; P = .01) and cognitive impairment in 308 patients (aOR, 0.55 [95% CI, 0.36 to 0.86]; P = .008). Cilostazol reduced dependence in 320 patients (aHR, 0.31 [95% CI, 0.14 to 0.72]; P = .006). Combination ISMN-cilostazol reduced the composite (aHR, 0.58 [95% CI, 0.36 to 0.92]; P = .02), dependence (aOR, 0.14 [95% CI, 0.03 to 0.59]; P = .008), and any cognitive impairment (aOR, 0.44 [95% CI, 0.23 to 0.85]; P = .02) and improved QOL (adjusted mean difference, 0.10 [95% CI, 0.03 to 0.17]; P = .005) in 153 patients. There were no safety concerns.Conclusions and Relevance These results show that the LACI-2 trial was feasible and ISMN and cilostazol were well tolerated and safe. These agents may reduce recurrent stroke, dependence, and cognitive impairment after lacunar stroke, and they could prevent other adverse outcomes in cSVD. Therefore, both agents should be tested in large phase 3 trials.Trial Registration ClinicalTrials.gov Identifier: NCT0345159

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

BACKGROUND: Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. METHODS: We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. RESULTS: Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. CONCLUSIONS: Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Advanced Heart Failure Treatment Options Among the Elderly

The aging human population has emerged as a critically important factor in health care, not only due to the unique physiologic and pathologic processes associated with aging but also because of the evolution of medical and surgical therapies that have increased quality and quantity of life. Heart failure is a disease found most commonly among older populations in whom it is associated with high morbidity and mortality. Heart failure disproportionately affects the elderly, and it stands to reason that the most terminal stage, known as advanced heart failure (AHF), is more common among the elderly. Despite limited data, treatment options for AHF patients, including heart transplantation and left ventricular assist device (LVAD) therapy, have demonstrated improved quality and quantity of life. Similarly, a well-structured palliative care program may offer symptom relief and social support without the need for high-risk surgical options. Furthermore, as the therapeutic window (risk/benefit ratio) is narrower among elderly patients, the potential for positive outcomes from AHF options must be carefully evaluated together with patient-specific risks in the context of palliative care discussions. Therefore, the decision to leverage these options must be balanced with not only age, but also frailty, comorbidities, and cognition, functional, social and nutritional status to determine the right candidates for each therapy. This review strives to inform providers on the relevant considerations when leveraging AHF options among elderly patients. We conclude by providing a personalized model for care developed at a large tertiary care hospital that has performed more than 1,600 AHF procedures (870 heart transplants, 745 LVADs)

Advanced Heart Failure Treatment Options Among the Elderly

The aging human population has emerged as a critically important factor in health care, not only due to the unique physiologic and pathologic processes associated with aging but also because of the evolution of medical and surgical therapies that have increased quality and quantity of life. Heart failure is a disease found most commonly among older populations in whom it is associated with high morbidity and mortality. Heart failure disproportionately affects the elderly, and it stands to reason that the most terminal stage, known as advanced heart failure (AHF), is more common among the elderly. Despite limited data, treatment options for AHF patients, including heart transplantation and left ventricular assist device (LVAD) therapy, have demonstrated improved quality and quantity of life. Similarly, a well-structured palliative care program may offer symptom relief and social support without the need for high-risk surgical options. Furthermore, as the therapeutic window (risk/benefit ratio) is narrower among elderly patients, the potential for positive outcomes from AHF options must be carefully evaluated together with patient-specific risks in the context of palliative care discussions. Therefore, the decision to leverage these options must be balanced with not only age, but also frailty, comorbidities, and cognition, functional, social and nutritional status to determine the right candidates for each therapy. This review strives to inform providers on the relevant considerations when leveraging AHF options among elderly patients. We conclude by providing a personalized model for care developed at a large tertiary care hospital that has performed more than 1,600 AHF procedures (870 heart transplants, 745 LVADs)

Diseño y validación de una escala de estilos afectivos

La presente investigación tiene como objetivo general diseñar un cuestionario para evaluar los estilos afectivos. Se diseño un instrumento con 90 ítems, distribuidos en cuatro variables: independencia, codependencia, interdependencia y dependencia. El cual fue sometido a una revisión de seis jueces. A partir de esta evaluación se redujo el cuestionario a 30 ítems, aplicado a un grupo de 20 personas adultas: 10 mujeres y 10 hombres entre los 18 y 35 años. La muestra se selecciono de una forma aleatoria, sin tener en cuenta que los sujetos presentaran algún trastorno emocional evidente. Los resultados obtenidos arrojaron que el 90% de esta población tiende a tener un estilo interdependiente y el 10% mostró una orientación al estilo codependiente. Como esta es la primera aplicación se deja abierta la posibilidad de futuras aplicaciones donde se logre mejorar diversos aspectos del instrumento.The investigation inside this document takes as a general target to design a questionnaire to evaluate the affective styles. It was designed an instrument with 90 items distributed in four variables: Independence, Co-dependency, Interdependence and Dependency. This instrument was submitted to a review of six judges. The questionnaire came down to 30 items once the evaluation was made and it was applied to a group of 20 adult persons: 10 women and 10 men between 18 and 35 years. The sample was selected randomly, without bearing in mind the fact that the subjects were presenting some obvious emotional disorder. The results threw that 90 % of this population tend towards an interdependent style and 10 % showed an orientation to the codependent style. Since this is the first application, the possibilities of future applications to improve widely different aspects of the instrument have been left opened

Combining hands-on and virtual experiments for enhancing fluid mechanics teaching: A design-based research study

Fluid Mechanics courses comprise both theoretical and laboratory modules. In developing nations, computer-assisted techniques are not commonly applied in Fluid Mechanics instruction. Forced by the COVID-19 pandemic, South American universities are, however, using them for online teaching. This contribution presents an 8-semester (2016–2019) educational intervention over an undergraduate Fluid Mechanics course. It mainly blends physical (hands-on) and virtual experiments (computer fluid dynamics-based simulations) for the laboratory module, which are complemented by flipped classroom-based prompts for the theoretical module. The intervention follows design-based research as a research method and is guided via conjecture mapping and fidelity of implementation standards. Our results suggest that the intervention improves fluid mechanics laboratory instruction, although improvements depend upon the participation of other educational actors such as teaching assistants and laboratory technicians to some extent. Laboratory report grades (the assessment instrument) follow the Gompertz probability distribution. Following UNESCO standards, a portion of the intervention output is shared as open educational resources. This contribution encourages upscaling the educational intervention through the formation of cooperative clusters to build common-pool Fluid Mechanics resources. Learning scientists have underlined the need to better understand laboratory instruction processes. They have been addressed in very few instances in developing countries. We believe that this study has the potential to provide valuable insights on the matter.Fil: Gutierrez, Ronald R.. Pontificia Universidad Católica de Perú; PerúFil: Escusa, Frank. Pontificia Universidad Católica de Perú; PerúFil: Lyon, Joseph A.. Purdue University; Estados UnidosFil: Magana, Alejandra J.. Purdue University; Estados UnidosFil: Cabrera, Jose H.. Pontificia Universidad Católica de Perú; PerúFil: Pehovaz, Richard. Pontificia Universidad Católica de Perú; PerúFil: Link, Oscar. Universidad de Concepción; ChileFil: Rivillas Ospina, German. Universidad del Norte; ColombiaFil: Acuña, Guillermo J.. Universidad Pontificia Bolivariana; ColombiaFil: Kuroiwa, Julio M.. Universidad Nacional de Ingenieria; PerúFil: Guzman, Monica X.. Universidad Católica Boliviana; BoliviaFil: Latosinski, Francisco Guillermo. Universidad Nacional del Litoral; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentin