Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke: incidence and association with atrial fibrillation

<p><b>Background and Purpose:</b> Mechanisms of early neurologic deterioration after treatment with intravenous, recombinant, tissue-type plasminogen activator (IV rt-PA) include symptomatic intracerebral hemorrhage (SICH) and early recurrent ischemic stroke. We observed a number of cases of acute deterioration due to recurrent ischemic events.</p> <p><b>Methods:</b> We undertook a single-center, retrospective analysis of consecutive acute stroke patients treated with IV rt-PA between January 2006 and December 2008 to define the incidence of early neurologic deterioration (>= 4-point drop on the National Institutes of Health Stroke Scale within 72 hours) and its mechanism. Deterioration was attributed to SICH when associated with a PH1 or PH2 hemorrhage on postdeterioration computed tomography scans, to recurrent ischemic stroke when there was clinical and radiologic evidence of a new territorial infarction or new vessel occlusion, and otherwise to evolution of the incident stroke.</p> <p><b>Results:</b> Of 228 consecutive IV rt-PA-treated patients, 34 (15%) developed early neurologic deterioration, 18 (8%) secondary to incident strokes 10 (4.4%) due to SICH, and 6 (2.6%) due to early recurrent ischemic events, which were significantly associated with atrial fibrillation (present in 5 of 6 patients; 4 paroxysmal, 1 permanent). In 4 patients, sudden clinical deterioration developed during or shortly after IV rt-PA infusion, and in 2, deterioration developed 3 days later. All died 2 days to 2 weeks later. The single case without atrial fibrillation had a recurrent, contralateral, middle cerebral artery stroke during IV rt-PA infusion and multiple high-signal emboli detected by transcranial Doppler. Early recurrent ischemic stroke accounted for 5 of 12 (42%) cases of early neurologic deterioration in patients with atrial fibrillation.</p> <p><b>Conclusion:</b> In this single-center series, the incidence of early recurrent ischemic stroke after IV rt-PA was 2.6% and was associated with previous atrial fibrillation.</p&gt

Randomized trial comparing proactive, high-dose versus reactive, low-dose intravenous iron supplementation in hemodialysis (PIVOTAL) : Study design and baseline data

Background: Intravenous (IV) iron supplementation is a standard maintenance treatment for hemodialysis (HD) patients, but the optimum dosing regimen is unknown. Methods: PIVOTAL (Proactive IV irOn Therapy in hemodiALysis patients) is a multicenter, open-label, blinded endpoint, randomized controlled (PROBE) trial. Incident HD adults with a serum ferritin 700 μg/L and/or TSAT ≥40%) or a reactive, low-dose IV iron arm (iron sucrose administered if ferritin <200 μg/L or TSAT < 20%). We hypothesized that proactive, high-dose IV iron would be noninferior to reactive, low-dose IV iron for the primary outcome of first occurrence of nonfatal myocardial infarction (MI), nonfatal stroke, hospitalization for heart failure or death from any cause. If noninferiority is confirmed with a noninferiority limit of 1.25 for the hazard ratio of the proactive strategy relative to the reactive strategy, a test for superiority will be carried out. Secondary outcomes include infection-related endpoints, ESA dose requirements, and quality-of-life measures. As an event-driven trial, the study will continue until at least 631 primary outcome events have accrued, but the expected duration of follow-up is 2-4 years. Results: Of the 2,589 patients screened across 50 UK sites, 2,141 (83%) were randomized. At baseline, 65.3% were male, the median age was 65 years, and 79% were white. According to eligibility criteria, all patients were on ESA at screening. Prior stroke and MI were present in 8 and 9% of the cohort, respectively, and 44% of patients had diabetes at baseline. Baseline data for the randomized cohort were generally concordant with recent data from the UK Renal Registry. Conclusions: PIVOTAL will provide important information about the optimum dosing of IV iron in HD patients representative of usual clinical practice. Trial Registration: EudraCT number: 2013-002267-25.Peer reviewedFinal Published versio

Static and Dynamic Magnetism in Underdoped Superconductor BaFe1.92_{1.92}Co0.08_{0.08}As2_2

We report neutron scattering measurements on single crystals of BaFe$_{1.92}$Co$_{0.08}$As$_2$. The magnetic Bragg peak intensity is reduced by 6 % upon cooling through T$_C$. The spin dynamics exhibit a gap of 8 meV with anisotropic three-dimensional (3d) interactions. Below T$_C$ additional intensity appears at an energy of $\sim$4.5(0.5) meV similar to previous observations of a spin resonance in other Fe-based superconductors. No further gapping of the spin excitations is observed below T$_C$ for energies down to 2 meV. These observations suggest the redistribution of spectral weight from the magnetic Bragg position to a spin resonance demonstrating the direct competition between static magnetic order and superconductivity.Comment: 4 pages, 4 figure

Ionospheric response to the corotating interaction region-driven geomagnetic storm of October 2002

Unlike the geomagnetic storms produced by coronal mass ejections (CMEs), the storms generated by corotating interaction regions (CIRs) are not manifested by dramatic enhancements of the ring current. The CIR-driven storms are however capable of producing other phenomena typical for the magnetic storms such as relativistic particle acceleration, enhanced magnetospheric convection and ionospheric heating. This paper examines ionospheric plasma anomalies produced by a CIR-driven storm in the middle- and high-latitude ionosphere with a specific focus on the polar cap region. The moderate magnetic storm which took place on 14–17 October 2002 has been used as an example of the CIR-driven event. Four-dimensional tomographic reconstructions of the ionospheric plasma density using measurements of the total electron content along ray paths of GPS signals allow us to reveal the large-scale structure of storm-induced ionospheric anomalies. The tomographic reconstructions are compared with the data obtained by digital ionosonde located at Eureka station near the geomagnetic north pole. The morphology and dynamics of the observed ionospheric anomalies is compared qualitatively to the ionospheric anomalies produced by major CME-driven storms. It is demonstrated that the CIR-driven storm of October 2002 was able to produce ionospheric anomalies comparable to those produced by CME-driven storms of much greater Dst magnitude. This study represents an important step in linking the tomographic GPS reconstructions with the data from ground-based network of digital ionosondes

Intermediates of Metabolism: From Bystanders to Signalling Molecules

British Heart Foundation Fellowship FS/12/38/2964

Effects of synchronous music on treadmill running among elite triathletes

This is the post-print version of the final paper published in Journal of Science and Medicine in Sport. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2011 Elsevier B.V.Objectives: Music can provide ergogenic, psychological, and psychophysical benefits during physical activity, especially when movements are performed synchronously with music. The present study developed the train of research on synchronous music and extended it to elite athletes. Design: Repeated-measures laboratory experiment. Method: Elite triathletes (n = 11) ran in time to self-selected motivational music, a neutral equivalent and a no-music control during submaximal and exhaustive treadmill running. Measured variables were time-to-exhaustion, mood responses, feeling states, RPE, blood lactate concentration, oxygen consumption and running economy. Results: Time-to-exhaustion was 18.1% and 19.7% longer, respectively, when running in time to motivational and neutral music, compared to no music. Mood responses and feeling states were more positive with motivational music compared to either neutral music or no music. RPE was lowest for neutral music and highest for the no-music control. Blood lactate concentrations were lowest for motivational music. Oxygen consumption was lower with music by 1.0%–2.7%. Both music conditions were associated with better running economy than the no-music control. Conclusions: Although neutral music did not produce the same level of psychological benefits as motivational music, it proved equally beneficial in terms of time-to-exhaustion and oxygen consumption. In functional terms, the motivational qualities of music may be less important than the prominence of its beat and the degree to which participants are able to synchronise their movements to its tempo. Music provided ergogenic, psychological and physiological benefits in a laboratory study and its judicious use during triathlon training should be considered.QAS Centre of Excellence for Applied Sport Science Researc