Risk of “silent stroke” in patients older than 60 years: risk assessment and clinical perspectives

With the increasing size of the elderly population and evolving imaging technology, silent brain infarction (SBI) has garnered attention from both the public and the physicians. Over 20% of the elderly exhibit SBI, and the prevalence of SBI increases steadily with age, ie, 30%–40% in those older than 70 years. Well-known cardiovascular risk factors such as hypertension has been identified as a risk factor of SBI (odds ratio [OR] = 3.47) Besides this, blood pressure (BP) reactivity to mental stress, morning BP surges, and orthostatic BP changes have been demonstrated to contribute to the presence of SBI. Further, a metabolic syndrome not only as a whole syndrome (OR =2.18) but also as individual components could have an influence on SBI. Increased C-reactive protein and interleukin-6, coronary artery disease, body mass index, and alcohol consumption have also been associated with SBI. The ORs and possible mechanisms have been discussed in this article. Overt stroke, dementia, depression, and aspiration pneumonia were all associated with SBI. (overt stroke: hazard ratio [HR] =1.9, 95% confidence interval [CI]: 1.2–2.8; dementia: HR =2.26, 95% CI: 1.09–4.70). We also looked into their close relationship with SBI in this review

Leukoaraiosis is associated with pneumonia after acute ischemic stroke

Diagnostic criteria for stroke associated pneumonia based on the CDC criteria. (DOCX 25 kb

Ca\u3csup\u3e2+\u3c/sup\u3e Extrusion by NCX is Compromised in Olfactory Sensory Neurons of OMP\u3csup\u3e-/-\u3c/sup\u3e Mice

Background: The role of olfactory marker protein (OMP), a hallmark of mature olfactory sensory neurons (OSNs), has been poorly understood since its discovery. The electrophysiological and behavioral phenotypes of OMP knockout mice indicated that OMP influences olfactory signal transduction. However, the mechanism by which this occurs remained unknown. Principal Findings: We used intact olfactory epithelium obtained from WT and OMP-/- mice to monitor the Ca2+ dynamics induced by the activation of cyclic nucleotide-gated channels, voltage-operated Ca2+ channels, or Ca2+ stores in single dendritic knobs of OSNs. Our data suggested that OMP could act to modulate the Ca2+-homeostasis in these neurons by influencing the activity of the plasma membrane Na+/ Ca2+-exchanger (NCX). Immunohistochemistry verifies colocalization of NCX1 and OMP in the cilia and knobs of OSNs. To test the role of NCX activity, we compared the kinetics of Ca2+ elevation by stimulating the reverse mode of NCX in both WT and OMP2/2 mice. The resulting Ca2+ responses indicate that OMP facilitates NCX activity and allows rapid Ca2+ extrusion from OSN knobs. To address the mechanism by which OMP influences NCX activity in OSNs we studied protein-peptide interactions in real-time using surface plasmon resonance technology. We demonstrate the direct interaction of the XIP regulatory-peptide of NCX with calmodulin (CaM). Conclusions: Since CaM also binds to the Bex protein, an interacting protein partner of OMP, these observations strongly suggest that OMP can influence CaM efficacy and thus alters NCX activity by a series of protein-protein interactions. © 2009 Kwon et al

An Energy-Efficient Algorithm for Classification of Fall Types Using a Wearable Sensor

Objective: To mitigate damage from falls, it is essential to provide medical attention expeditiously. Many previous studies have focused on detecting falls and have shown that falls can be accurately detected at least in a laboratory setting. However, a very few studies have classified the different types of falls. To this end, in this paper, a novel energy-efficient algorithm that can discriminate the five most common fall types was developed for wearable systems. Methods: A wearable system with an inertial measurement unit sensor was first developed. Then, our novel algorithm, temporal signal angle measurement (TSAM), was used to classify the different types of falls at various sampling frequencies, and the results were compared with those from three different machine learning algorithms. Results: The overall performance of the TSAM and that of the machine learning algorithms were similar. However, the TSAM outperformed the machine learning algorithms at frequencies in the range of 10-20 Hz. As the sampling frequency dropped from 200 to 10Hz, the accuracy of the TSAM ranged from 93.3% to 91.8%. The sensitivity and specificity ranges from 93.3% to 91.8%, and 98.3% to 97.9%, respectively for the same frequency range. Conclusion: Our algorithm can be utilized with energy-efficient wearable devices at low sampling frequencies to classify different types of falls. Significance: Our system can expedite medical assistance in emergency situations caused by falls by providing the necessary information to medical doctors or clinicians.1

Inhibitory Synapses Are Repeatedly Assembled and Removed at Persistent Sites In Vivo

Older concepts of a hard-wired adult brain have been overturned in recent years by in vivo imaging studies revealing synaptic remodeling, now thought to mediate rearrangements in microcircuit connectivity. Using three-color labeling and spectrally resolved two-photon microscopy, we monitor in parallel the daily structural dynamics (assembly or removal) of excitatory and inhibitory postsynaptic sites on the same neurons in mouse visual cortex in vivo. We find that dynamic inhibitory synapses often disappear and reappear again in the same location. The starkest contrast between excitatory and inhibitory synapse dynamics is on dually innervated spines, where inhibitory synapses frequently recur while excitatory synapses are stable. Monocular deprivation, a model of sensory input-dependent plasticity, shortens inhibitory synapse lifetimes and lengthens intervals to recurrence, resulting in a new dynamic state with reduced inhibitory synaptic presence. Reversible structural dynamics indicate a fundamentally new role for inhibitory synaptic remodeling—flexible, input-specific modulation of stable excitatory connections.National Eye Institute (Grant RO1 EY017656 and RO1 EY011894)National Institutes of Health (U.S.) (P41EB015871-26A1, 4R44EB012415-02, and NSF CBET-0939511)Singapore-MIT AllianceSingapore-MIT Alliance for Research and Technology CenterRuth L. Kirschstein National Research Service Award (F31AG044061)National Institutes of Health (U.S.) (Pre-Doctoral Training Grant T32GM007287

A Patient With Dysphagia due to an Aortic Aneurysm

Dysphagia aortica is difficulty in swallowing caused by extrinsic compression of the esophagus due to an ectatic, tortuous, or aneurysmatic atherosclerotic thoracic aorta. This condition is very uncommon, and it is usually associated with old age, women with short stature, hypertension, and kyphosis. We report herein a case involving a patient with dysphagia who had an aortic aneurysm

Improved Sugar Production by Optimizing Planetary Mill Pretreatment and Enzyme Hydrolysis Process

This paper describes an optimization of planetary mill pretreatment and saccharification processes for improving biosugar production. Pitch pine (Pinus rigida) wood sawdust waste was used as biomass feedstock and the process parameters optimized in this study were the buffering media, the milling time, the enzyme quantity, and the incubation time. Glucose yields were improved when acetate buffer was used rather than citrate buffer. Initially, with each process variable tests, the optimal values were 100 minutes of milling, an enzyme concentration of 16 FPU/g-biomass, and a 12-hour enzymatic hydrolysis. Typically, interactions between these experimental conditions and their effects on glucose production were next investigated using RSM. Glucose yields from the Pinus rigida waste exceeded 80% with several of the conditions tested, demonstrating that milling can be used to obtain high levels of glucose bioconversion from woody biomass for biorefinery purposesopen

Appropriateness of rabies post-exposure prophylaxis in pediatric patients visiting the emergency department due to animal bite

Purpose To study the appropriateness of rabies post-exposure prophylaxis (rPEP) for children with animal bite who visited the emergency department (ED). Methods The study enrolled children younger than 18 years with animal bite who visited the National Medical Center ED between January 2014 and October 2017. The children’s electronic medical records were retrospectively reviewed. Data for analysis included age, sex, body parts bitten by animals, species of animals, regions where animal bites occurred, history of recent antibiotics therapy and tetanus vaccination, and justification by the 2017 Guidelines for Rabies Control in Korea and implementation of rPEP. In children who underwent unjustified rPEP or did not undergo justified one, we recorded their guardians’ opinion for or against rPEP. Results Of the 63 enrolled children, rPEP was justified for 38 children by the Korean guidelines. Of the 38 children, 35 actually underwent rPEP. Among the remaining 3 children, 2 did not undergo the prophylaxis as per the guardians’ requests. Among the 25 children whose rPEP was not justified, 8 underwent the prophylaxis. Of these 8 children, 7 did based on the guardians’ requests. Conclusion In this study, inappropriate rPEP was usually affected by the guardians’ requests, regardless of the criteria for such prophylaxis. Thus, their requests for or against rPEP should be discussed with emergency physicians who are aware of the relevant criteria to prevent occurrence of rabies or unnecessary use of medical resources