Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals

Randomized trials have demonstrated the efficacy of craniectomy for the treatment of malignant cerebral edema following ischemic stroke. We sought to determine the prevalence and outcomes related to this by using a national database.Patient discharges with ischemic stroke as the primary diagnosis undergoing craniectomy were queried from the US Nationwide Inpatient Sample from 1999 to 2008. A subpopulation of patients was identified that underwent thrombolysis. Two primary end points were examined: in-hospital mortality and discharge to home/routine care. To facilitate interpretations, adjusted prevalence was calculated from the overall prevalence and two age-specific logistic regression models. The predictive margin was then generated using a multivariate logistic regression model to estimate the probability of in-hospital mortality after adjustment for admission type, admission source, length of stay, total hospital charges, chronic comorbidities, and medical complications.After excluding 71,996 patients with the diagnosis of intracranial hemorrhage and posterior intracranial circulation occlusion, we identified 4,248,955 adult hospitalizations with ischemic stroke as a primary diagnosis. The estimated rates of hospitalizations in craniectomy per 10,000 hospitalizations with ischemic stroke increased from 3.9 in 1999-2000 to 14.46 in 2007-2008 (p for linear trend<0.001). Patients 60+ years of age had in-hospital mortality of 44% while the 18-59 year old group was found to be 24% (p = 0.14). Outcomes were comparable if recombinant tissue plasminogen activator had been administered.Craniectomy is being increasingly performed for malignant cerebral edema following large territory cerebral ischemia. We suspect that the increase in the annual incidence of DC for malignant cerebral edema is directly related to the expanding collection of evidence in randomized trials that the operation is efficacious when performed in the correct patient population. In hospital mortality is high for all patients undergoing this procedure

Low-Spin Heme b3 in the Catalytic Center of Nitric Oxide Reductase from Pseudomonas nautica

Biochemistry, 2011, 50 (20), pp 4251–4262 DOI: 10.1021/bi101605pRespiratory nitric oxide reductase (NOR) was purified from membrane extract of Pseudomonas (Ps.) nautica cells to homogeneity as judged by polyacrylamide gel electrophoresis. The purified protein is a heterodimer with subunits of molecular masses of 54 and 18 kDa. The gene encoding both subunits was cloned and sequenced. The amino acid sequence shows strong homology with enzymes of the cNOR class. Iron/heme determinations show that one heme c is present in the small subunit (NORC) and that approximately two heme b and one non-heme iron are associated with the large subunit (NORB), in agreement with the available data for enzymes of the cNOR class. Mössbauer characterization of the as-purified, ascorbate-reduced, and dithionite-reduced enzyme confirms the presence of three heme groups (the catalytic heme b(3) and the electron transfer heme b and heme c) and one redox-active non-heme Fe (Fe(B)). Consistent with results obtained for other cNORs, heme c and heme b in Ps. nautica cNOR were found to be low-spin while Fe(B) was found to be high-spin. Unexpectedly, as opposed to the presumed high-spin state for heme b(3), the Mössbauer data demonstrate unambiguously that heme b(3) is, in fact, low-spin in both ferric and ferrous states, suggesting that heme b(3) is six-coordinated regardless of its oxidation state. EPR spectroscopic measurements of the as-purified enzyme show resonances at the g ∼ 6 and g ∼ 2-3 regions very similar to those reported previously for other cNORs. The signals at g = 3.60, 2.99, 2.26, and 1.43 are attributed to the two charge-transfer low-spin ferric heme c and heme b. Previously, resonances at the g ∼ 6 region were assigned to a small quantity of uncoupled high-spin Fe(III) heme b(3). This assignment is now questionable because heme b(3) is low-spin. On the basis of our spectroscopic data, we argue that the g = 6.34 signal is likely arising from a spin-spin coupled binuclear center comprising the low-spin Fe(III) heme b(3) and the high-spin Fe(B)(III). Activity assays performed under various reducing conditions indicate that heme b(3) has to be reduced for the enzyme to be active. But, from an energetic point of view, the formation of a ferrous heme-NO as an initial reaction intermediate for NO reduction is disfavored because heme [FeNO](7) is a stable product. We suspect that the presence of a sixth ligand in the Fe(II)-heme b(3) may weaken its affinity for NO and thus promotes, in the first catalytic step, binding of NO at the Fe(B)(II) site. The function of heme b(3) would then be to orient the Fe(B)-bound NO molecules for the formation of the N-N bond and to provide reducing equivalents for NO reduction

Determination of nutrient salts by automatic methods both in seawater and brackish water: the phosphate blank

9 páginas, 2 tablas, 2 figurasThe main inconvenience in determining nutrients in seawater by automatic methods is simply solved: the preparation of a suitable blank which corrects the effect of the refractive index change on the recorded signal. Two procedures are proposed, one physical (a simple equation to estimate the effect) and the other chemical (removal of the dissolved phosphorus with ferric hydroxide).Support for this work came from CICYT (MAR88-0245 project) and Conselleria de Pesca de la Xunta de GaliciaPeer reviewe

The subcortical role of language processing: high level linguistic features such as ambiguity-resolution and the human brain; an fMRI study

In the present study, we were interested in the neurofunctional representations of ambiguity processing by using functional magnetic resonance imaging (fMRI). Twelve right-handed, healthy adults aged between 21 and 29 years (6 male, 6 female) underwent an ambiguity resolution task with 4 different conditions (dominant vs. non-dominant; dominant vs. distractor; non-dominant vs. distractor; distractor vs. distractor). After subtraction of the corresponding control task (distractor vs. distractor) we found significant activation especially in the thalamus and some parts of the basal ganglia (caudate nucleus, putamen). Our findings implicate a participation of the thalamus and other basal ganglia circuits in high level linguistic functions and match with theoretical considerations on this highly controversial topic. Subcortical neural circuits probably become activated when the language processing system cannot rely entirely on automatic mechanisms but has to recruit controlled processes as well. Furthermore, we found broad activation in the inferior parietal lobule, the prefrontal gyrus, pre-SMA and SMA and the cingulate cortex. This might reflect a strategic semantic search mechanism which probably can be illustrated with connectionist models of language processing. According to this, we hypothesize a neuroregulatory role for the thalamus and basal ganglia in regulating and monitoring the release of preformulated language segments for motor programming and semantic verification. According to our findings there is strong evidence, that especially the thalamus, the caudate nucleus, the cingulate cortex, the inferior parietal lobule and the prefrontal cortex are responsible for an accurate ambiguity resolution in the human brain

The EPR-Detectable Copper of Nitrous Oxide Reductase as a Model for Cu_A in Cytochrome c Oxidase: A Multifrequency Electron Paramagnetic Resonance Investigation

Nitrous oxide reductase (N2OR) is the terminal reductase in a respiratory chain converting N2O to N2 in the denitrifying bacteria: N2O+2H++2e−→N2+H2O ([1]) Principal aspects of the subject have been covered recently, and these reviews may be consulted for primary reference.1,2 The high activity form of the enzyme from Pseudomonas stutzeri (N2OR I) has two identical subunits, each carrying a mixed-valence [Cu(1.5)...Cu(1.5)], S = 1/2 complex.3 A catalytically inactive derivative of the enzyme (N2OR V) has also the mixed-valence EPR-detectable site.4,5</sup

Characteristics of fluent and non-fluent primary progessive aphasia

Primary progressive aphasia (PPA) is a dementia with primarily deterioration of language abilities. The aim of the current study was to describe patterns of language decline using the Aachen Aphasia Test (AAT), with a view to differentiate the characteristics of fluent and non-fluent PPA. 20 patients were assessed in a retrospective study, 14 of them repeatedly. Patients with fluent PPA were significantly more impaired in the AAT-spontaneous speech rating scale semantic structure and in the subtest confrontation naming than patients with non-fluent PPA. In advanced stages of the disease, no intergroup differences were present any more. Mild and fast progression of language decline could be documented. A change of fluent to non-fluent PPA could be observed in two patients