Time spent at home poststroke: “home-time” a meaningful and robust outcome measure for stroke trials

<p><b>Background and Purpose:</b> Stroke outcome assessment requires some measure of functional recovery. Several instruments are in common use but all have recognized limitations. We examined duration of stay in the patient’s own home over the first 90 days since stroke—"home-time"—as an alternative outcome likely to show graded response with improved reliability.</p> <p><b>Methods:</b> We examined prospectively collected data from the GAIN International trial using analysis of variance with Bonferroni contrasts of adjacent modified Rankin scale score categories.</p> <p><b>Results:</b> We had full outcome data from 1717 of 1788 patients. Increasing home-time was associated with improved modified Rankin scale scores (P<0.0001). The relationship held across all modified Rankin scale grades except 4 to 5.</p> <p><b>Conclusions:</b> Home-time offers a robust, useful, and easily validated outcome measure for stroke, particularly across better recovery levels.</p&gt

Association between disability measures and healthcare costs after initial treatment for acute stroke

<p><b>Background and Purpose:</b> The distribution of 3-month modified Rankin scale (mRS) scores has been used as an outcome measure in acute stroke trials. We hypothesized that hospitalization and institutional care home stays within the first 90 days after stroke should be closely related to 90-day mRS, that each higher mRS category will reflect incremental cost, and that resource use may be less clearly linked to the National Institutes of Health Stroke Scale (NIHSS) or Barthel index.</p> <p><b>Methods:</b> We examined resource use data from the GAIN International trial comparing 90-day mRS with total length of stay in hospital or other institutions during the first 90 days. We repeated analyses using NIHSS and Barthel index scores. Relationships were examined by analysis of variance (ANOVA) with Bonferroni contrasts of adjacent score categories. Estimated costs were based on published Scottish figures.</p> <p><b>Results:</b> We had full data from 1717 patients. Length of stay was strongly associated with final mRS (P<0.0001). Each mRS increment from 0 to 1–2 to 3–4 was significant (mean length of stay: 17, 25, 44, 58, 79 days; P<0.0005). Ninety-five percent confidence limits for estimated costs (£) rose incrementally: 2493 to 3412, 3369 to 4479, 5784 to 7008, 7300 to 8512, 10 095 to 11 141, 11 772 to 13 560, and 2623 to 3321 for mRS 0 to 5 and dead, respectively. Weaker relationships existed with Barthel and NIHSS.</p> <p><b>Conclusions:</b> Each mRS category reflects different average length of hospital and institutional stay. Associated costs are meaningfully different across the full range of mRS outcomes. Analysis of the full distribution of mRS scores is appropriate for interpretation of treatment effects after acute stroke and more informative than Barthel or NIHSS end points.</p&gt

Allopurinol use yields potentially beneficial effects on inflammatory indices in those with recent ischemic stroke: a randomized, double-blind, placebo-controlled trial

<p><b>Background and Purpose</b>: Elevated serum uric acid level is associated with poor outcome and increased risk of recurrent events after stroke. The xanthine oxidase inhibitor allopurinol lowers uric acid but also attenuates expression of inflammatory adhesion molecules in murine models, reduces oxidative stress in the vasculature, and improves endothelial function. We sought to investigate whether allopurinol alters expression of inflammatory markers after acute ischemic stroke.</p> <p><b>Methods</b>: We performed a randomized, double-blind, placebo-controlled trial to investigate the safety, tolerability, and effect of 6 weeks’ treatment with high- (300 mg once a day) or low- (100 mg once a day) dose allopurinol on levels of uric acid and circulating inflammatory markers after ischemic stroke.</p> <p><b>Results</b>: We enrolled 50 patients with acute ischemic stroke (17, 17, and 16 in the high, low, and placebo groups, respectively). Mean (±SD) age was 70 (±13) years. Groups had similar characteristics at baseline. There were no serious adverse events. Uric acid levels were significantly reduced at both 7 days and 6 weeks in the high-dose group (by 0.14 mmol/L at 6 weeks, P=0.002). Intercellular adhesion molecule-1 concentration (ng/mL) rose by 51.2 in the placebo group, rose slightly (by 10.6) in the low-dose allopurinol group, but fell in the high-dose group (by 2.6; difference between groups P=0.012, Kruskal-Wallis test).</p> <p><b>Conclusion</b>: Allopurinol treatment is well tolerated and attenuates the rise in intercellular adhesion molecule-1 levels seen after stroke. Uric acid levels were lowered with high doses. These findings support further evaluation of allopurinol as a preventive measure after stroke.</p&gt

Growth of large single crystals of Rare Earth Hexaborides

Single crystal growth of several rare earth hexaborides has been carried out by the floating zone technique. A high power Xenon arc lamp image furnace was used for the crystal growth. Large high quality crystals of LaB$_{6}$, CeB$_{6}$, PrB$_{6}$ and NdB$_{6}$, about 1 cc in volume have been obtained. Crystals of all these compounds have also been grown using enriched $^{11}$B isotope for use in neutron scattering experiments.Comment: 3 pages, 3 figures, in press (J. Crystal Growth

Deriving modified rankin scores from medical records

<p><b>Background and Purpose:</b> Modified Rankin score (mRS) is traditionally graded using a face-to-face or telephone interview. Certain stroke assessment scales can be derived from a review of a patient’s case-record alone. We hypothesized that mRS could be successfully derived from the narrative within patient case-records.</p> <p><b>Methods:</b> Sequential patients attending our cerebrovascular outpatient clinic were included. Two independent, blinded clinicians, trained in mRS, assessed case-records to derive mRS. They scored “certainty” of their grading on a 5-point Likert scale. Agreement between derived and traditional face-to-face mRS was calculated using attribute agreement analysis.</p> <p><b>Results:</b> Fifty patients with a range of disabilities were included. Case-record appraisers were poor at deriving mRS (k=0.34 against standard). Derived mRS grades showed poor agreement between observers (k=0.33). There was no relationship between certainty of derived mRS and proportion of correct grades (P=0.727).</p> <p><b>Conclusion:</b> Accurate mRS cannot be derived from standard hospital records. Direct mRS interview is still required for clinical trials.</p&gt

Non-linear electrical response in a charge/orbital ordered Pr⁡0.63\Pr_{0.63}Ca0.37_{0.37}MnO3_3 crystal : the charge density wave analogy

Non-linear conduction in a charge-ordered manganese oxide Pr$_{0.63}$Ca$_{0.37}$MnO$_3$ is reported. To interpret such a feature, it is usually proposed that a breakdown of the charge or orbitally ordered state is induced by the current. The system behaves in such a way that the bias current may generate metallic paths giving rise to resistivity drop. One can describe this feature by considering the coexistence of localized and delocalized electron states with independent paths of conduction. This situation is reminiscent of what occurs in charge density wave systems where a similar non-linear conduction is also observed. In the light of recent experimental results suggesting the development of charge density waves in charge and orbitally ordered manganese oxides, a phenomenological model for charge density waves motion is used to describe the non-linear conduction in Pr$_{0.63}$Ca$_{0.37}$MnO$_3$. In such a framework, the non-linear conduction arises from the motion of the charge density waves condensate which carries a net electrical current.Comment: 13 pages, 6 figure

Structural, magnetic and electrical properties of single crystalline La_(1-x)Sr_xMnO_3 for 0.4 < x < 0.85

We report on structural, magnetic and electrical properties of Sr-doped LaMnO_3 single crystals for doping levels 0.4 < x < 0.85. The complex structural and magnetic phase diagram can only be explained assuming significant contributions from the orbital degrees of freedom. Close to x = 0.6 a ferromagnetic metal is followed by an antiferromagnetic metallic phase below 200 K. This antiferromagnetic metallic phase exists in a monoclinic crystallographic structure. Following theoretical predictions this metallic antiferromagnet is expected to reveal an (x^2-y^2)-type orbital order. For higher Sr concentrations an antiferromagnetic insulator is established below room temperature.Comment: 8 pages, 7 figure

Specific heat study of single crystalline Pr0.63_{0.63} Ca0.37_{0.37} MnO3_{3} in presence of a magnetic field

We present the results of a study of specific heat on a single crystal of Pr$_{0.63}$Ca$_{0.37}$MnO$_3$ performed over a temperature range 3K-300K in presence of 0 and 8T magnetic fields. An estimate of the entropy and latent heat in a magnetic field at the first order charge ordering (CO) transition is presented. The total entropy change at the CO transition which is $\approx$ 1.8 J/mol K at 0T, decreases to $\sim$ 1.5 J/mol K in presence of 8T magnetic field. Our measurements enable us to estimate the latent heat $L_{CO}$ $\approx$ 235 J/mol involved in the CO transition. Since the entropy of the ferromagnetic metallic (FMM) state is comparable to that of the charge-ordered insulating (COI) state, a subtle change in entropy stabilises either of these two states. Our low temperature specific heat measurements reveal that the linear term is absent in 0T and surprisingly not seen even in the metallic FMM state.Comment: 8 pages (in RevTEX format), 12 figures (in postscript format) Submitted to Phys. Rev.

Heat capacity studies of Ce and Rh site substitution in the heavy fermion antiferromagnet CeRhIn_5;: Short-range magnetic interactions and non-Fermi-liquid behavior

In heavy fermion materials superconductivity tends to appear when long range magnetic order is suppressed by chemical doping or applying pressure. Here we report heat capacity measurements on diluted alloyes of the heavy fermion superconductor CeRhIn_5;. Heat capacity measurements have been performed on CeRh_{1-y}Ir_{y}In_5; (y <= 0.10) and Ce_{1-x}La_{x}Rh_{1-y}Ir_{y}In_5; (x <= 0.50) in applied fields up to 90 kOe to study the affect of doping and magnetic field on the magnetic ground state. The magnetic phase diagram of CeRh_{0.9}Ir_{0.1}In_5; is consistent with the magnetic structure of CeRhIn_5; being unchanged by Ir doping. Doping of Ir in small concentrations is shown to slightly increase the antiferromagnetic transition temperature T_{N} (T_{N}=3.8 K in the undoped sample). La doping which causes disorder on the Ce sublattice is shown to lower T_{N} with no long range order observed above 0.34 K for Ce_{0.50}La_{0.50}RhIn_5;. Measurements on Ce_{0.50}La_{0.50}RhIn_5; show a coexistence of short range magnetic order and non-Fermi-liquid behavior. This dual nature of the Ce 4f-electrons is very similar to the observed results on CeRhIn_5; when long range magnetic order is suppressed at high pressure.Comment: 8 pages, 9 figure