Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke

Centralization of intravenous thrombolysis (IVT) for acute ischemic stroke in high-volume centers is believed to improve the door-to-needle times (DNT), but limited data support this assumption. We examined the association between DNT and IVT volume in a large Dutch province. We identified consecutive patients treated with IVT between January 2009 and 2013. Based on annualized IVT volume, hospitals were categorized as low-volume (≤ 24), medium-volume (25-49) or high-volume (≥ 50). In logistic regression analysis, low-volume hospitals were used as reference category. Of 17,332 stroke patients from 11 participating hospitals, 1962 received IVT (11.3 %). We excluded 140 patients because of unknown DNT (n = 86) or in-hospital stroke (n = 54). There were two low-volume (total 101 patients), five medium-volume (747 patients) and four high-volume hospitals (974 patients). Median DNT was shorter in high-volume hospitals (30 min) than in medium-volume (42 min, p < 0.001) and low-volume hospitals (38 min, p < 0.001). Patients admitted to high-volume hospitals had a higher chance of DNT < 30 min (adjusted OR 3.13, 95 % CI 1.70-5.75), lower risk of symptomatic intracerebral hemorrhage (adjusted OR 0.39, 95 % CI 0.16-0.92), and a lower mortality risk (adjusted OR 0.45, 95 % CI 0.21-1.01), compared to low-volume centers. There was no difference in DNT between low- and medium-volume hospitals. Onset-to-needle times (ONT) did not differ between the groups. Hospitals in this Dutch province generally achieved short DNTs. Despite this overall good performance, higher IVT volumes were associated with shorter DNTs and lower complication risks. The ONT was not associated with IVT volum

Silica nanoparticle: a potential new insecticide for beet armyworm, Spodoptera exigua Hubner (Lep.: Noctuidae) control

Application of pesticides for controlling crop pest produces deleterious effect on natural enemies, humans and the environment.  Therefore, the use of non-invasive and safe alternative methods is essential. Nanotechnology is a promising field of interdisciplinary research, and its practical applications into agriculture is receiving attention nowadays due to the potential benefits that nanomaterials (NMs) can guarantee pests management. In this study, potency of silica nanoparticle (SNPs) in  controlling the second larval instar of beet armyworm, Spodoptera exigua in laboratory and field condition, damage of pest and effect on total chlorophyll contents were evaluated. The LC50 and LT50 values of SNPs in three methods of application including dust spray, leaf dipping and solution spray were determined. The LC50 value of SNPs against 2nd larval stage after 24, 48 and 72 hours in dust spray, leaf dipping and solution spray were (660.40, 431.35, 893.10), (460.44, 833.31, 690.12) and (279.28, 565.59, 323.96) mg. L-1, respectively. The LT50 value of SNPs against 2nd larval stage of S. exigua by three methods showed that dust application can cause 50% mortality in shorter time in comparison to leaf dipping and solution spray methods. In field trail, the result of mortality and damage assessment showed that dust SNPs had significant differences with control treatment (P≤0.05). Total chlorophyll contents in dust SNPs treatment had no significant differences with control treatment (P≥0.05). In summary, it can be noted that SNPs could be a new alternative to chemical insecticides and could be used in dust spray without using water in the development of new natural insecticides in integrated pest management program

The Incidence of Cerebral Venous Thrombosis A Cross-Sectional Study

Background and Purpose-The purpose of this study was to determine the incidence of adult cerebral venous thrombosis. Methods-A retrospective cross-sectional study was conducted among all 19 hospitals located in 2 Dutch provinces serving 3.1 million people. Adult cerebral venous thrombosis cases diagnosed between January 1, 2008, and December 31, 2010, were identified using the Dutch financial coding system for hospital care and the International Classification of Diseases, 9th Revision. Medical records of potential patients were hand searched to identify cerebral venous thrombosis cases. The Dutch National Bureau for Statistics provided population figures of the 2 provinces during 2008 to 2010. Results-Among 9270 potential cases, we identified 147 patients diagnosed with cerebral venous thrombosis. Of these, 53 patients did not meet the inclusion criteria; therefore, 94 patients were included in the analysis. The overall incidence was 1.32 per 100 000 person-years (95% CI, 1.06-1.61). Among women between the ages of 31 and 50 years, the incidence was 2.78 (95% CI, 1.98-3.82). Conclusions-The incidence of cerebral venous thrombosis among adults is probably higher than previously believed. (Stroke. 2012; 43: 3375-3377.

Spinal anesthesia as a complication of brachial plexus block using the posterior approach

IMPLICATIONS: In this case report we describe a technique used to provide local analgesia for surgical procedures. Although this technique has a reduced risk of complications, we present a patient who experienced a life-threatening paralysis without loss of consciousness during an attempted brachial plexus block with a posterior approac

Cervical dystonia and genetic common variation in the dopamine pathway

<p>Cervical dystonia, a late onset focal dystonia, has a complex genetic background. Multiple lines of evidence point to a role for aberrant dopamine levels in dystonia. We assessed whether common variation within genes that regulate brain dopamine levels and in key genes of the dopamine metabolic pathway, modulate the risk for cervical dystonia. DNA was collected from 363 Dutch CD patients and a cohort of Dutch control individuals. Haplotype-tagging single nucleotide polymorphisms (SNPs) complemented with selected variants of functional importance in COMT, DAT, TH, MAO-A and -B, DDC and DBH were investigated. We tested the 143 markers in single-SNP, haplotype and epistasis analyses. We did not find an association with any of the selected 143 SNPs in these key dopamine genes. Our data shows that common variations in key genes of the dopamine pathway do not contribute to dystonia risk in the Dutch population. Possibly, risk alleles in this pathway may be rarer than detectable in this study, or might be located in downstream dopamine signaling pathway. Alternatively, found dopamine level changes are secondary to the dystonia disease processes. (C) 2012 Published by Elsevier Ltd.</p>

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Randomised controlled trial of escitalopram for cervical dystonia with dystonic jerks/tremor

Objective: Trials for additional or alternative treatments for cervical dystonia (CD) are scarce since the introduction of botulinum neurotoxin (BoNT). We performed the first trial to investigate whether dystonic jerks/tremor in patients with CD respond to the selective serotonin reuptake inhibitor (SSRI) escitalopram. Methods: In a randomised, double-blind, crossover trial, patients with CD received escitalopram and placebo for 6 weeks. Treatment with BoNT was continued, and scores on rating scales regarding dystonia, psychiatric symptoms and quality of life (QoL) were compared. Primary endpoint was the proportion of patients that improved at least one point on the Clinical Global Impression Scale for jerks/tremor scored by independent physicians with experience in movement disorders. Results: Fifty-threepatients were included. In the escitalopram period, 14/49 patients (29%) improved on severity of jerks/tremor versus 11/48 patients (23%) in the placebo period (P=0.77). There were no significant differences between baseline and after treatment with escitalopram or placebo on severity of dystonia or jerks/tremor. Psychiatric symptoms and QoL improved significantly in both periods compared with baseline. There were no significant differences between treatment with escitalopram and placebo for dystonia, psychiatric or QoL rating scales. During treatment with escitalopram, patients experienced slightly more adverse events, but no serious adverse events occurred. Conclusion: In this innovative trial, no add-on effect of escitalopram for treatment of CD with jerks was found on motor or psychiatric symptoms. However, we also did not find a reason to withhold patients treatment with SSRIs for depression and anxiety, which are common in dystonia