Adult Stroke Screening Tool in Childhood Ischemic Stroke

Investigators from Nationwide Children's Hospital, Columbus, OH performed a retrospective study to determine whether the application of an adult stroke scale could discriminate between children with acute arterial ischemic stroke (AIS) and other causes of acute neurologic deficits

A new proof of the Bianchi type IX attractor theorem

We consider the dynamics towards the initial singularity of Bianchi type IX vacuum and orthogonal perfect fluid models with a linear equation of state. The `Bianchi type IX attractor theorem' states that the past asymptotic behavior of generic type IX solutions is governed by Bianchi type I and II vacuum states (Mixmaster attractor). We give a comparatively short and self-contained new proof of this theorem. The proof we give is interesting in itself, but more importantly it illustrates and emphasizes that type IX is special, and to some extent misleading when one considers the broader context of generic models without symmetries.Comment: 26 pages, 5 figure

Matter and dynamics in closed cosmologies

To systematically analyze the dynamical implications of the matter content in cosmology, we generalize earlier dynamical systems approaches so that perfect fluids with a general barotropic equation of state can be treated. We focus on locally rotationally symmetric Bianchi type IX and Kantowski-Sachs orthogonal perfect fluid models, since such models exhibit a particularly rich dynamical structure and also illustrate typical features of more general cases. For these models, we recast Einstein's field equations into a regular system on a compact state space, which is the basis for our analysis. We prove that models expand from a singularity and recollapse to a singularity when the perfect fluid satisfies the strong energy condition. When the matter source admits Einstein's static model, we present a comprehensive dynamical description, which includes asymptotic behavior, of models in the neighborhood of the Einstein model; these results make earlier claims about ``homoclinic phenomena and chaos'' highly questionable. We also discuss aspects of the global asymptotic dynamics, in particular, we give criteria for the collapse to a singularity, and we describe when models expand forever to a state of infinite dilution; possible initial and final states are analyzed. Numerical investigations complement the analytical results.Comment: 23 pages, 24 figures (compressed), LaTe

Suppression of acute proinflammatory cytokine and chemokine upregulation by post-injury administration of a novel small molecule improves long-term neurologic outcome in a mouse model of traumatic brain injury

<p>Abstract</p> <p>Background</p> <p>Traumatic brain injury (TBI) with its associated morbidity is a major area of unmet medical need that lacks effective therapies. TBI initiates a neuroinflammatory cascade characterized by activation of astrocytes and microglia, and increased production of immune mediators including proinflammatory cytokines and chemokines. This inflammatory response contributes both to the acute pathologic processes following TBI including cerebral edema, in addition to longer-term neuronal damage and cognitive impairment. However, activated glia also play a neuroprotective and reparative role in recovery from injury. Thus, potential therapeutic strategies targeting the neuroinflammatory cascade must use careful dosing considerations, such as amount of drug and timing of administration post injury, in order not to interfere with the reparative contribution of activated glia.</p> <p>Methods</p> <p>We tested the hypothesis that attenuation of the acute increase in proinflammatory cytokines and chemokines following TBI would decrease neurologic injury and improve functional neurologic outcome. We used the small molecule experimental therapeutic, Minozac (Mzc), to suppress TBI-induced up-regulation of glial activation and proinflammatory cytokines back towards basal levels. Mzc was administered in a clinically relevant time window post-injury in a murine closed-skull, cortical impact model of TBI. Mzc effects on the acute increase in brain cytokine and chemokine levels were measured as well as the effect on neuronal injury and neurobehavioral function.</p> <p>Results</p> <p>Administration of Mzc (5 mg/kg) at 3 h and 9 h post-TBI attenuates the acute increase in proinflammatory cytokine and chemokine levels, reduces astrocyte activation, and the longer term neurologic injury, and neurobehavioral deficits measured by Y maze performance over a 28-day recovery period. Mzc-treated animals also have no significant increase in brain water content (edema), a major cause of the neurologic morbidity associated with TBI.</p> <p>Conclusion</p> <p>These results support the hypothesis that proinflammatory cytokines contribute to a glial activation cycle that produces neuronal dysfunction or injury following TBI. The improvement in long-term functional neurologic outcome following suppression of cytokine upregulation in a clinically relevant therapeutic window indicates that selective targeting of neuroinflammation may lead to novel therapies for the major neurologic morbidities resulting from head injury, and indicates the potential of Mzc as a future therapeutic for TBI.</p

Spherically symmetric relativistic stellar structures

We investigate relativistic spherically symmetric static perfect fluid models in the framework of the theory of dynamical systems. The field equations are recast into a regular dynamical system on a 3-dimensional compact state space, thereby avoiding the non-regularity problems associated with the Tolman-Oppenheimer-Volkoff equation. The global picture of the solution space thus obtained is used to derive qualitative features and to prove theorems about mass-radius properties. The perfect fluids we discuss are described by barotropic equations of state that are asymptotically polytropic at low pressures and, for certain applications, asymptotically linear at high pressures. We employ dimensionless variables that are asymptotically homology invariant in the low pressure regime, and thus we generalize standard work on Newtonian polytropes to a relativistic setting and to a much larger class of equations of state. Our dynamical systems framework is particularly suited for numerical computations, as illustrated by several numerical examples, e.g., the ideal neutron gas and examples that involve phase transitions.Comment: 23 pages, 25 figures (compressed), LaTe

Rapid Fabrication of Flat Plate Cavity Phosphor Thermography Test Models for Shuttle Return-to-Flight Aero-Heating

Methods, materials and equipment are documented for fabricating flat plate test models at NASA Langley Research Center for Shuttle return-to-flight aeroheating experiments simulating open and closed cavity interactions in Langley s hypersonic 20-Inch Mach 6 air wind tunnel. Approximately 96 silica ceramic flat plate cavity phosphor thermography test models have been fabricated using these methods. On one model, an additional slot is machined through the back of the plate and into the cavity and vented into an evacuated plenum chamber to simulate a further opening in the cavity. After sintering ceramic to 2150 F, and mounting support hardware, a ceramic-based two-color thermographic phosphor coating is applied for global temperature and heat transfer measurements, with fiducial markings for image registration

Acute Neurologic Dysfunction in Critically Ill Children: The PODIUM Consensus Conference

CONTEXT Acute neurologic dysfunction is common in critically ill children and contributes to outcomes and end of life decision-making. OBJECTIVE To develop consensus criteria for neurologic dysfunction in critically ill children by evaluating the evidence supporting such criteria and their association with outcomes. DATA SOURCES Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020, by using a combination of medical subject heading terms and text words to define concepts of neurologic dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION Studies were included if the researchers evaluated critically ill children with neurologic injury, evaluated the performance characteristics of assessment and scoring tools to screen for neurologic dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies with an adult population or premature infants (≤36 weeks' gestational age), animal studies, reviews or commentaries, case series with sample size ≤10, and studies not published in English with an inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted from each study meeting inclusion criteria into a standard data extraction form by task force members. DATA SYNTHESIS The systematic review supported the following criteria for neurologic dysfunction as any 1 of the following: (1) Glasgow Coma Scale score ≤8; (2) Glasgow Coma Scale motor score ≤4; (3) Cornell Assessment of Pediatric Delirium score ≥9; or (4) electroencephalography revealing attenuation, suppression, or electrographic seizures. CONCLUSIONS We present consensus criteria for neurologic dysfunction in critically ill children

Common data elements for pediatric traumatic brain injury: Recommendations from the working group on demographics and clinical assessment

The Common Data Elements (CDEs) initiative is a National Institutes of Health (NIH) interagency effort to standardize naming, definitions, and data structure for clinical research variables. Comparisons of the results of clinical studies of neurological disorders have been hampered by variability in data coding, definitions, and procedures for sample collection. The CDE project objective is to enable comparison of future clinical trials results in major neurological disorders, including traumatic brain injury (TBI), stroke, multiple sclerosis, and epilepsy. As part of this effort, recommendations for CDEs for research on TBI were developed through a 2009 multi-agency initiative. Following the initial recommendations of the Working Group on Demographics and Clinical Assessment, a separate workgroup developed recommendations on the coding of clinical and demographic variables specific to pediatric TBI studies for subjects younger than 18 years. This article summarizes the selection of measures by the Pediatric TBI Demographics and Clinical Assessment Working Group. The variables are grouped into modules which are grouped into categories. For consistency with other CDE working groups, each variable was classified by priority (core, supplemental, and emerging). Templates were produced to summarize coding formats, guide selection of data points, and provide procedural recommendations. This proposed standardization, together with the products of the other pediatric TBI working groups in imaging, biomarkers, and outcome assessment, will facilitate multi-center studies, comparison of results across studies, and high-quality meta-analyses of individual patient data

Dynamics of Bianchi type I elastic spacetimes

We study the global dynamical behavior of spatially homogeneous solutions of the Einstein equations in Bianchi type I symmetry, where we use non-tilted elastic matter as an anisotropic matter model that naturally generalizes perfect fluids. Based on our dynamical systems formulation of the equations we are able to prove that (i) toward the future all solutions isotropize; (ii) toward the initial singularity all solutions display oscillatory behavior; solutions do not converge to Kasner solutions but oscillate between different Kasner states. This behavior is associated with energy condition violation as the singularity is approached.Comment: 28 pages, 11 figure