Age-dependent differences in demographics, risk factors, co-morbidity, etiology, management, and clinical outcome of acute ischemic stroke

Background : Comparisons between younger and older stroke patients including comorbidities are limited. Methods : Prospective data of consecutive patients with first ever acute ischemic stroke were compared between younger (≤ 45 years) and older patients (> 45 years). Results : Among 1004 patients, 137 (14 %) were ≤ 45 years. Younger patients were more commonly female (57 % versus 34 %; p < 0.0001), had a lower frequency of diabetes (1 % versus 15 %; p < 0.0001), hypercholesterolemia (26 % versus 56 %; p < 0.0001), hypertension (19 % versus 65 %; p < 0.0001), coronary heart disease (14 % versus 40 %; p < 0.0001), and a lower mean Charlson co-morbidity index (CCI), (0.18 versus 0.84; p < 0.0001). Tobacco use was more prevalent in the young (39 % versus 26 %; P < 0.0001). Large artery disease (2 % versus 21 %; p < 0.0001), small artery disease (3 % versus 12 %; p = 0.0019) and atrial fibrillation (1 % versus 17 %; p = 0.001) were less common in young patients, while other etiologies (31 % versus 9 %; p < 0.0001), patent foramen ovale or atrial septal defect (44 % versus 26 %; p < 0.0001), and cervical artery dissection (26 % versus 7 %; p < 0.0001) were more frequent. A favorable outcome (mRS 0 or 1) was more common (57.4 % versus 46.9 %; p = 0.023), and mortality (5.1 % versus 12 %; p = 0.009) was lower in the young. After regression analysis, there was no independent association between age and outcome (p = 0.206) or mortality (p = 0.073). Baseline NIHSS score (p < 0.0001), diabetes (p = 0.041), and CCI (p = 0.002) independently predicted an unfavorable outcome. Conclusions : Younger patients were more likely to be female, had different risk factors and etiologies and fewer co-morbidities. There was no independent association between age and clinical outcome or mortalit

Postoperative assessment after AVR and TAVI

Background and aims : Severe aortic stenosis (AS) has been normally treated with surgical aortic valve replacement (AVR) whereas recently, transcatheter aortic valve implantation (TAVI) has been introduced as a minimally invasive operation for patients with high surgical risk and frailty. In this study, we have evaluated postoperative physical function and nutrition intake in the patients following AVR and TAVI. Methods : This prospective observational study involved 9 patients with surgical aortic valve replacement (AVR) and 7 patients with transcatheter aortic valve implantation (TAVI). Body composition was measured one day prior surgery, postoperative day (POD) 1, POD 3, POD 5 and POD 7. Hand grip strength, calf circumference and gait speed were measured one day before surgery and on the day of discharge. Results : Skeletal muscle was significantly decreased in AVR patients at postoperative day 3 and 7, while there was no change in TAVI patients. Patients with TAVI showed higher dietary intake after surgery compared to patients with AVR, and they maintained hand grip strength and calf circumference at discharge. Conclusions : In elderly patients with AS, TAVI can improve post-operative recovery maintaining nutritional status and physical function even

Does Autologous Chondrocyte Implantation Provide Better Outcomes Than Microfracture in the Repair of Articular Knee Defects?

OBJECTIVE: The objectives of this selective EBM review is to determine whether or not Autologous Chondrocyte Implantation is more effective than microfracture in the repair of articular knee defects. STUDY DESIGN: Review of three English language primary studies published in 2009 and 2010. DATA SOURCES: Randomized controlled trials comparing Autologous Chondrocyte Implantation and Microfracture found using PubMed, MedLine and Cochrane Database. OUTCOMES MEASURED: Clinical outcome measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary measure of outcome was evaluated using the KOOS questionnaire with subdomains of ADL’s, pain, symptoms, stiffness and quality of life. KOOS data was compared between treatment groups for patients with symptom onset less than 2 years vs more than 2 years and less or more than 3 years. Serial MRI scans were scored using Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) system. A rehabilitation protocol was implemented where components were evaluated pre surgery and at 6, 9, 12 and 24 months post surgery. Patients are followed up 8-12, 22-26, 50-54 weeks post operatively for efficacy and safety evaluations. RESULTS: Three randomized controlled trials were included in this review. The study by Basad indicated ACI as having significantly more effective outcomes over 2 years compared to microfracture. Saris’ study provided similar conclusions, offering improved outcomes with ACI after 36 months. However, Van Assche’s study had similar overall functional outcomes for both ACI and MF. CONCLUSIONS: Based on findings upon analysis of three RCT’s, Autologous chondrocyte implantation provides significant improvement in articular knee defects allowing improved function, mobilitiy and activity as compared to that of microfracture

Influence of ultra-low dose Aprotinin on thoracic surgical operations: a prospective randomized trial

<p>Abstract</p> <p>Background</p> <p>The blood saving effect of aprotinin has been well documented in cardiac surgery. In thoracic surgery, very few recent studies, using rather high doses of aprotinin, have shown a similar result. In a randomized prospective trial, we have tested the influence of aprotinin using an ultra-low dose drug regime.</p> <p>Methods</p> <p>Fifty-nine patients, mean age 58 ± 13.25 years (mean ± SD) undergoing general thoracic procedures were randomized into placebo (Group A) and treatment group (Group B). The group B (n = 29) received 500.000 IU of aprotinin after induction to anesthesia and a repeat dose immediately after chest closure. A detailed protocol with several laboratory parameters was recorded. Patients were transfused when perioperative Ht was less than 26%.</p> <p>Results</p> <p>The two groups were similar in terms of age, gender, diagnosis, pathology, co-morbidity and operations performed. The mean drainage of the first and second postoperative day in group B was significantly reduced (412.6 ± 199.2 vs. 764.3 ± 213.9 ml, p < 0.000, and 248.3 ± 178.5 vs. 455.0 ± 274.6, p < 0.001). Similarly, the need for fresh frozen plasma transfusion was lower in group B, p < 0.035. Both the operation time and the hospital stay were also less for group B but without reaching statistical significance (84.6 ± 35.2 vs 101.2 ± 52.45 min. and 5.8 ± 1.6 vs 7.2 ± 3.6 days respectively, p < 0.064). The overall transfusion rate did not differ significantly. No side effects of aprotinin were noted.</p> <p>Conclusion</p> <p>The perioperative ultra-low dose aprotinin administration was associated with a reduction of total blood losses and blood product requirements. We therefore consider the use of aprotinin safe and effective in major thoracic surgery.</p

GM 13. Neonatal weakness and its sequels in tropical crossbred calves

Neonatal morbidity and mortality cause significant economic and genetic losses in cattle. This study analyzed aspects associated with weakness in newborn crossbred calves. They were analyzed in 675 yearling crossbred calves with 9 genotypes of milk and meat races. The calves were evaluated clinically between birth and 24 h. The data were collected from 1990-1994 in a commercial dual-purpose farm in Mene Grande, Zulia State, Venezuela. The effect of sire breed on weakness occurrence and seasonal effects on the occurrence of pathological conditions and weakness were analyzed using Chi-Squares. Analyzed variables were: perinatal clinical condition (PCC) in levels good (G), affected (A) and bad (B); perinatal pathologies (PP) (weakness=W; diarrhea=D, omphalitis=O and blindness=B); and perinatal mortality (PM) Effect of sire breed (SB) on the occurrence of W and season of birth (S) on CCP, PP and occurrence of DB. CCP was distributed in G (78.81 %), A (18.22 %) and B (1.32 %). W (87.87 %) were the greater exponent of PP, followed of D (6.81 %)), O (4.54%) and B (0.75%). PM was 0.43 %. Neonatal weakness was associated (P&lt;.001) with sire breed, but not with season of birth, being Jersey (35.70 %), Holstein (26.10 %), red Brahman (25.60 %), Swiss Brown (18.40 %) and Limousin (16.60 %) the genotypes with greater incidence. And S was not associate with PCC nor a W, but it was associated (P&lt;.05) to the PP incidence. It is concluded that neonatal weakness must be reviewed like the main predisposing of morbidity and mortality and that its relation with genetic factors must be carefully analyzed

Antibiotic resistance in Escherichia coli in the female microbiota. Phylogenetic differences within the Escherichia coli.

Urinary tract infections (UTIs) are the most common infection in women. While UTIs are most frequently caused by E. coli, it can also reside within the urinary tract as a commensal member of the urinary microbiota. Prior genomic analysis of E. coli strains associated with UTIs and commensal strains have been conducted, looking at virulence factors and antibiotic resistance distinguishing the two. UTIs are commonly treated with an antibiotic. While E. coli strains can encode for antibiotic-resistance genes naturally, they can also acquire resistance because of prior antibiotic treatment. Dueto the community-acquired antibiotic resistance, there are less and less treatment options for UTIs. Recently we isolated and sequenced the genomes of 66 E. coli isolates from the bladder microbiota of women with UTIs, with urinary urgency incontinence, overactive bladder, and without LUTs. The efficacy of five commonly prescribed antibiotics on the growth of these strains was tested. Despite the presence of coding regions associated with antibiotic resistance, we found that UTI+ and UTI- strains exhibit similar sensitivities to these drugs. We also found that there is no difference within the UTI+ and UTI- strains in their placement in a phylogenetic tree based on their amino acid sequence

Persistent Neurobehavioral Traits in a Mouse Model of Prenatal Ethanol Exposure

Fetal Alcohol Spectrum Disorders (FASD) effect an estimated 2% of the population, causing a range of symptoms: from craniofacial defects to inhibited cortical growth (May, et al., 2009; Murawski, et al., 2015). Impaired medial forebrain function apparent in FASD is associated with lifelong cognitive behavioral deficits, but these consequences may be avoided with early diagnosis and intervention (Streissguth, et al., 2004). Our goal is to identify early neurobehavioral abnormalities that persist into adulthood that could potentially serve as early indicators for FASD. Mouse models of prenatal ethanol exposure were developed using a voluntary drinking paradigm that introduced a sweetened ethanol solution to pregnant dams. Impulsive behavior was observed during juvenile and adult testing, where ethanol-exposed mice displayed more risk-taking behavior in situations that induced inhibition in control mice. In contrast, ethanol-exposed mice were over-cautious in scenarios in which control mice experienced less anxiety. Ultimately, we observed what appears to be a persistent failure to accurately gauge and respond to environmental stimuli. This trait is analogous to impaired sensorimotor gating, or the unconscious cognitive ability to filter out irrelevant and attend relevant stimuli, a distinctive symptom of FASD. Future studies are needed to further establish early FASD markers applicable to humans