The Persisting Burden of Intracerebral Haemorrhage: Can Effective Treatments Be Found?

Colin Josephson, Rustam Al-Shahi Salman, and colleagues discuss the effectiveness of treatments for intracerebral haemorrhage

Biochar successfully replaces activated charcoal for in vitro culture of two white poplar clones reducing ethylene concentration

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Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

OBJECTIVE: To identify possible avenues of sparing the internal mammary artery (IMA) for coronary artery bypass grafting (CABG) in women undergoing autologous breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. BACKGROUND: Optimal autologous reconstruction of the breast and coronary artery bypass grafting (CABG) are often mutually exclusive as they both require utilisation of the IMA as the preferred arterial conduit. Given the prevalence of both breast cancer and coronary artery disease, this is an important issue for women's health as women with DIEP flap reconstructions and women at increased risk of developing coronary artery disease are potentially restricted from receiving this reconstructive option should the other condition arise. METHODS: The largest clinical and cadaveric anatomical study (n=315) to date was performed, investigating four solutions to this predicament by correlating the precise requirements of breast reconstruction and CABG against the anatomical features of the in situ IMAs. This information was supplemented by a thorough literature review. RESULTS: Minimum lengths of the left and right IMA needed for grafting to the left-anterior descending artery are 160.08 and 177.80 mm, respectively. Based on anatomical findings, the suitable options for anastomosis to each intercostals space are offered. In addition, 87-91% of patients have IMA perforator vessels to which DIEP flaps can be anastomosed in the first- and second-intercostal spaces. CONCLUSION: We outline five methods of preserving the IMA for future CABG: (1) lowering the level of DIEP flaps to the fourth- and fifth-intercostals spaces, (2) using the DIEP pedicle as an intermediary for CABG, (3) using IMA perforators to spare the IMA proper, (4) using and end-to-side anastomosis between the DIEP pedicle and IMA and (5) anastomosis of DIEP flaps using retrograde flow from the distal IMA. With careful patient selection, we hypothesize using the IMA for autologous breast reconstruction need not be an absolute contraindication for future CABG

Prior antiplatelet therapy and outcome following intracerebral hemorrhage A systematic review

Objectives: Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH. Methods: The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language. Cohort studies of consecutive patients with ICH reporting mortality or functional outcome according to pre-ICH APT use were identified. Of 2,873 studies screened, 10 were judged to meet inclusion criteria by consensus of 2 authors. Additionally, we solicited unpublished data from all authors of cohort studies with >100 patients published within the last 10 years, and received data from 15 more studies. Univariate and multivariable-adjusted odds ratios (ORs) for mortality and poor functional outcome were abstracted as available and pooled using a random effects model. Results: We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished). Pre-ICH APT users had increased mortality in both univariate (OR 1.41, 95% confidence interval [CI] 1.21 to 1.64) and multivariable-adjusted (OR 1.27, 95% CI 1.10 to 1.47) pooled analyses. By contrast, the pooled OR for poor functional outcome was no longer significant when using multivariable-adjusted estimates (univariate OR 1.29, 95% CI 1.09 to 1.53; multivariable-adjusted OR 1.10, 95% CI 0.93 to 1.29). Conclusions: In cohort studies, APT use at the time of ICH compared to no APT use was independently associated with increased mortality but not with poor functional outcome. Neurology (R) 2010;75:1333-134

Seismic Hazard Analyses From Geologic and Geomorphic Data: Current and Future Challenges

AbstractThe loss of life and economic consequences caused by several recent earthquakes demonstrate the importance of developing seismically safe building codes. The quantification of seismic hazard, which describes the likelihood of earthquake‐induced ground shaking at a site for a specific time period, is a key component of a building code, as it helps ensure that structures are designed to withstand the ground shaking caused by a potential earthquake. Geologic or geomorphic data represent important inputs to the most common seismic hazard model (probabilistic seismic hazard analyses, or PSHAs), as they can characterize the magnitudes, locations, and types of earthquakes that occur over long intervals (thousands of years). However, several recent earthquakes and a growing body of work challenge many of our previous assumptions about the characteristics of active faults and their rupture behavior, and these complexities can be challenging to accurately represent in PSHA. Here, we discuss several of the outstanding challenges surrounding geologic and geomorphic data sets frequently used in PSHA. The topics we discuss include how to utilize paleoseismic records in fault slip rate estimates, understanding and modeling earthquake recurrence and fault complexity, the development and use of fault‐scaling relationships, and characterizing enigmatic faults using topography. Making headway in these areas will likely require advancements in our understanding of the fundamental science behind processes such as fault triggering, complex rupture, earthquake clustering, and fault scaling. Progress in these topics will be important if we wish to accurately capture earthquake behavior in a variety of settings using PSHA in the future