Age-dependent differences in demographics, risk factors, co-morbidity, etiology, management, and clinical outcome of acute ischemic stroke

Background : Comparisons between younger and older stroke patients including comorbidities are limited. Methods : Prospective data of consecutive patients with first ever acute ischemic stroke were compared between younger (≤ 45 years) and older patients (> 45 years). Results : Among 1004 patients, 137 (14 %) were ≤ 45 years. Younger patients were more commonly female (57 % versus 34 %; p < 0.0001), had a lower frequency of diabetes (1 % versus 15 %; p < 0.0001), hypercholesterolemia (26 % versus 56 %; p < 0.0001), hypertension (19 % versus 65 %; p < 0.0001), coronary heart disease (14 % versus 40 %; p < 0.0001), and a lower mean Charlson co-morbidity index (CCI), (0.18 versus 0.84; p < 0.0001). Tobacco use was more prevalent in the young (39 % versus 26 %; P < 0.0001). Large artery disease (2 % versus 21 %; p < 0.0001), small artery disease (3 % versus 12 %; p = 0.0019) and atrial fibrillation (1 % versus 17 %; p = 0.001) were less common in young patients, while other etiologies (31 % versus 9 %; p < 0.0001), patent foramen ovale or atrial septal defect (44 % versus 26 %; p < 0.0001), and cervical artery dissection (26 % versus 7 %; p < 0.0001) were more frequent. A favorable outcome (mRS 0 or 1) was more common (57.4 % versus 46.9 %; p = 0.023), and mortality (5.1 % versus 12 %; p = 0.009) was lower in the young. After regression analysis, there was no independent association between age and outcome (p = 0.206) or mortality (p = 0.073). Baseline NIHSS score (p < 0.0001), diabetes (p = 0.041), and CCI (p = 0.002) independently predicted an unfavorable outcome. Conclusions : Younger patients were more likely to be female, had different risk factors and etiologies and fewer co-morbidities. There was no independent association between age and clinical outcome or mortalit

Integrating out the heaviest quark in N--flavour ChPT

We extend a known method to integrate out the strange quark in three flavour chiral perturbation theory to the context of an arbitrary number of flavours. As an application, we present the explicit formulae to one--loop accuracy for the heavy quark mass dependency of the low energy constants after decreasing the number of flavours by one while integrating out the heaviest quark in N--flavour chiral perturbation theory.Comment: 18 pages, 1 figure. Text and references added. To appear in EPJ

On the low energy end of the QCD spectrum

The energy gap of QCD is now understood very well. There is no doubt that the expansion in powers of the two lightest quark masses does represent a very useful tool for the analysis of the low energy structure. Concerning the expansion in powers of m_s, however, the current situation leaves much to be desired. While some of the lattice results indicate, for instance, that the violations of the Okubo-Iizuka-Zweig rule in the quark condensate and in the decay constants are rather modest, others point in the opposite direction. I am confident that the dust will settle soon, so that the effective coupling constants that govern the dependence of the various quantities of physical interest on m_s can be determined, to next-to-next-to-leading order of the chiral expansion. The range of validity of ChPT can be extended by means of dispersive methods. The properties of the physical states occurring in the spectrum of QCD below KKbar threshold can reliably be investigated on this basis. In particular, as shown only rather recently, general principles of quantum field theory lead to an exact formula that expresses the mass and width of resonances in terms of observable quantities. The formula removes the ambiguities inherent in the analytic continuation from the real axis into the complex plane, which plagued previous determinations of the pole positions of broad resonances.Comment: Talks given at QCD08 and Confinement

Assessing the perspective of well-being of older patients with multiple morbidities by using the LAVA tool-a person-centered approach

BACKGROUND: Older patients with multiple morbidities are a particularly vulnerable population that is likely to face complex medical decisions at some time in their lives. A patient-centered medical care fosters the inclusion of the patients’ perspectives, priorities, and complaints into clinical decision making. METHODS: This article presents a short and non-normative assessment tool to capture the priorities and problems of older patients. The so-called LAVA (“Life and Vitality Assessment”) tool was developed for practical use in seniors in the general population and for residents in nursing homes in order to gain more knowledge about the patients themselves as well as to facilitate access to the patients. The LAVA tool conceptualizes well-being from the perspectives of older individuals themselves rather than from the perspectives of outside individuals. RESULTS: The LAVA tool is graphically presented and the assessment is explained in detail. Exemplarily, the outcomes of the assessments with the LAVA of three multimorbid older patients are presented and discussed. In each case, the assessment pointed out resources as well as at least one problem area, rated as very important by the patients themselves. CONCLUSIONS: The LAVA tool is a short, non-normative, and useful approach that encapsulates the perspectives of well-being of multimorbid patients and gives insights into their resources and problem areas. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-021-02342-3

Performance of the LHCb Vertex Detector Alignment Algorithm determined with Beam Test Data

LHCb is the dedicated heavy flavour experiment at the Large Hadron Collider at CERN. The partially assembled silicon vertex locator (VELO) of the LHCb experiment has been tested in a beam test. The data from this beam test have been used to determine the performance of the VELO alignment algorithm. The relative alignment of the two silicon sensors in a module and the relative alignment of the modules has been extracted. This alignment is shown to be accurate at a level of approximately 2 micron and 0.1 mrad for translations and rotations, respectively in the plane of the sensors. A single hit precision at normal track incidence of about 10 micron is obtained for the sensors. The alignment of the system is shown to be stable at better than the 10 micron level under air to vacuum pressure changes and mechanical movements of the assembled system.Comment: accepted for publication in NIM

Electromagnetic corrections in eta --> 3 pi decays

We re-evaluate the electromagnetic corrections to eta --> 3 pi decays at next-to-leading order in the chiral expansion, arguing that effects of order e^2(m_u-m_d) disregarded so far are not negligible compared to other contributions of order e^2 times a light quark mass. Despite the appearance of the Coulomb pole in eta --> pi+ pi- pi0 and cusps in eta --> 3 pi0, the overall corrections remain small.Comment: 21 pages, 11 figures; references updated, version published in EPJ

Two-loop representations of low-energy pion form factors and pi-pi scattering phases in the presence of isospin breaking

Dispersive representations of the pi-pi scattering amplitudes and pion form factors, valid at two-loop accuracy in the low-energy expansion, are constructed in the presence of isospin-breaking effects induced by the difference between the charged and neutral pion masses. Analytical expressions for the corresponding phases of the scalar and vector pion form factors are computed. It is shown that each of these phases consists of the sum of a "universal" part and a form-factor dependent contribution. The first one is entirely determined in terms of the pi-pi scattering amplitudes alone, and reduces to the phase satisfying Watson's theorem in the isospin limit. The second one can be sizeable, although it vanishes in the same limit. The dependence of these isospin corrections with respect to the parameters of the subthreshold expansion of the pi-pi amplitude is studied, and an equivalent representation in terms of the S-wave scattering lengths is also briefly presented and discussed. In addition, partially analytical expressions for the two-loop form factors and pi-pi scattering amplitudes in the presence of isospin breaking are provided.Comment: 57 pages, 12 figure

Double-blind, placebo-controlled first in human study to investigate an oral vaccine aimed to elicit an immune reaction against the VEGF-Receptor 2 in patients with stage IV and locally advanced pancreatic cancer

BACKGROUND: The investigational oral DNA vaccine VXM01 targets the vascular endothelial growth factor receptor 2 (VEGFR-2) and uses Salmonella typhi Ty21a as a vector. The immune reaction elicited by VXM01 is expected to disrupt the tumor neovasculature and, consequently, inhibit tumor growth. VXM01 potentially combines the advantages of anti-angiogenic therapy and active immunotherapy. METHODS/DESIGN: This phase I trial examines the safety, tolerability, and immunological and clinical responses to VXM01. The randomized, placebo-controlled, double blind dose-escalation study includes up to 45 patients with locally advanced and stage IV pancreatic cancer. The patients will receive four doses of VXM01 or placebo in addition to gemcitabine as standard of care. Doses from 10(6) cfu up to 10(10) cfu of VXM01 will be evaluated in the study. An independent data safety monitoring board (DSMB) will be involved in the dose-escalation decisions. In addition to safety as primary endpoint, the VXM01-specific immune reaction, as well as clinical response parameters will be evaluated. DISCUSSION: The results of this study shall provide the first data regarding the safety and immunogenicity of the oral anti-VEGFR-2 vaccine VXM01 in cancer patients. They will also define the recommended dose for phase II and provide the basis for further clinical evaluation, which may also include additional cancer indications. TRIAL REGISTRATION: EudraCT No.: 2011-000222-29, NCT01486329, ISRCTN6880927

Features of Idebenone and Related Short-Chain Quinones that Rescue ATP Levels under Conditions of Impaired Mitochondrial Complex I

Short-chain quinones have been investigated as therapeutic molecules due to their ability to modulate cellular redox reactions, mitochondrial electron transfer and oxidative stress, which are pathologically altered in many mitochondrial and neuromuscular disorders. Recently, we and others described that certain short-chain quinones are able to bypass a deficiency in complex I by shuttling electrons directly from the cytoplasm to complex III of the mitochondrial respiratory chain to produce ATP. Although this energy rescue activity is highly interesting for the therapy of disorders associated with complex I dysfunction, no structure-activity-relationship has been reported for short-chain quinones so far. Using a panel of 70 quinones, we observed that the capacity for this cellular energy rescue as well as their effect on lipid peroxidation was influenced more by the physicochemical properties (in particular logD) of the whole molecule than the quinone moiety itself. Thus, the observed correlations allow us to explain the differential biological activities and therapeutic potential of short-chain quinones for the therapy of disorders associated with mitochondrial complex I dysfunction and/or oxidative stress

Willingness to pay for municipality hospital services in rural Japan: a contingent valuation study

<p>Abstract</p> <p>Background</p> <p>The Japanese healthcare system has undergone reforms to address the struggles that municipality hospitals face. Reform guidelines clearly define criteria for administrative improvement. However, criteria to evaluate the demand for healthcare provisions in rural Japan, including the needs of rural residents for municipality hospitals in particular have not been specified. The purpose of this paper is to measure residents' willingness to pay (WTP) for municipality hospital services using the contingent valuation method, and to evaluate municipality hospital valuation on the basis of WTP. K town, located in the Hokkaido prefecture of Japan, was selected as the location for this study. Participants were recruited by a town hall healthcare administrator, hospital and clinic staff, and a local dentist. Participants were asked what amount they would be willing to pay as taxes to continue accessing the services of the municipality hospital for one year by using open-ended questions in face-to-face interviews.</p> <p>Findings</p> <p>Forty-eight residents were initially recruited, and 40 participants were selected for the study (response rate 83%). As compared to K town's population, this data slanted toward the elderly, although there was no significant difference in frequency among the characteristics. The median WTP was estimated at 39,484 yen ($438.71), with a 95$308.95-615.96). Logistic regression revealed no significant factors affecting WTP.</p> <p>Conclusions</p> <p>If the total amount of residents' WTP for the municipality hospital were to be estimated by this result, it would calculate with 129,586,000 yen ($1,439,844). This is approximately equal to the amount of money to be transferred from the general account of the government of K town, more than one-half of the town tax of K town, and about two-fold in comparison to Japan as a whole. This showed that K town's residents placed a high valuation on the municipality hospital, which nearly equalled the amount that the K town government provided to the municipality hospital to cover its annual deficit. K town residents had come to expect not only general clinical practice, but also emergency medical services and night practice provided by their own town's municipality hospital. WTP can be used as a measure of hospital evaluation because it reflects the importance of the hospital to the residents in its region.</p