Effect of hyperthermia on prognosis after acute ischemic stroke

<p><b>Background and Purpose:</b> Experimental studies have shown that hyperthermia is a determinant of poor outcome after ischemic stroke. Clinical studies evaluating the effect of temperature on poststroke outcome have, however, been limited by small sample sizes. We sought to evaluate the effect of temperature and timing of hyperthermia on outcome after ischemic stroke.</p> <p><b>Methods:</b> Data of 5305 patients in acute stroke trials from the Virtual International Stroke Trials Archive (VISTA) data set were analyzed. Data for temperatures at baseline, eighth, 24th, 48th, and 72nd hours, and seventh day were assessed in relation to outcome (poor versus good) based on the modified Rankin Scale at 3 months. Hyperthermia was defined as temperature >37.2°C and poor outcome as 90-day modified Rankin Scale >2. Hazard ratios with 95% CIs were reported for hyperthermia in relation to the outcome. Logistic regression models, in relation to hyperthermia, were fitted for a set of preselected covariates at different time points to identify predictors/determinants of hyperthermia.</p> <p><b>Results:</b> The average age of patients was 68.0±11.9 years, 2380 (44.9%) were females, and 42.3% (2233) received thrombolysis using recombinant tissue plasminogen activator. After adjustment, hyperthermia was a statistically significant predictor of poor outcome. The hazard ratios (95% CI) for poor outcome in relation to hyperthermia at different time points were: baseline 1.2 (1.0 to 1.4), eighth hour 1.7 (1.2 to 2.2), 24th hour 1.5 (1.2 to 1.9), 48th hour 2.0 (1.5 to 2.6), 72nd hour 2.2 (1.7 to 2.9), and seventh day 2.7 (2.0 to 3.8). Gender, stroke severity (National Institutes of Health Stroke Scale score >16), white blood cell count, and antibiotic use were significantly associated with hyperthermia (P≤0.01).</p> <p><b>Conclusions:</b> Hyperthermia, in acute ischemic stroke, is associated with a poor clinical outcome. The later the hyperthermia occurs within the first week, the worse the prognosis. Severity of stroke and inflammation are important determinants of hyperthermia after ischemic stroke. In patients with acute ischemic stroke, aggressive measures to prevent and treat hyperthermia could improve the clinical outcomes.</p&gt

Identification of Genes involved in Iron Metabolism in Rhizobium leguminosarum ATCC 14479 Genome through the use of In-silico Analysis

The complete genomic sequence of Rhizobium leguminosarum ATCC 14479 has been determined. Its genome size is 7,935,223 base-pairs of DNA (bp). This multipartite genome contains 5 distinct replicons: a chromosome of 4,883,137 bp and four mega-plasmids of size 1,234,209 bp, 415,988 bp, 771,583 bp, and 630,306 bp. In silico (literally: on computer) analysis was done on the complete genome to detect genes relating to iron metabolism by bacteria. Seven iron-related operons and genes were found: nodulation genes, the Tol operon, the hmuPSTUV operon, iron response regulator genes, the cycHJKL operon, genes for bacterial cyclic glucans, and vicibactin genes

Integrating Islamic Cultural Identity Preservation in the Urban Fabric of the United States

The post-displacement phase of Islamic migrants in the urban fabric of the United States as a democratic country creates a bicultural identity. Muslims have been concerned about their identity preservation in the United States and integrating in the surrounding host community. This paper concentrates on what type of solution I can contribute, as an architect, to help in integrating Muslim population specially migrants at the post-displacement phase in the urban fabric of the United States. How can an architect help Muslim religious commonality connect in the larger United States Context? How do religious cultural buildings preserve and integrate an Islamic cultural Identity in the general cultural context of the United States? In addition, how do public spaces located in urban fabrics serve the integration process of Islamic culture with the surrounding cultural norms in order to be identified and well accepted by the community? In order to understand displaced minorities needs and concerns interviews are conducted. A brief explanation and analysis of the main Islamic lifestyle and ancient cities planning is also an important methodology in order to understand the effectiveness of Islamic cultural buildings at the United States in the identity preservation process. Inspired by my own personal experience I will explore and compare three case studies: Saudi Arabia – a strict Islamic country, Sudan – a moderate Islamic country, and Columbus, Ohio – a western urban society in the United States that is a non-Islamic democratic country. An empirical study will compare these three case studies through the lens of democracy, diversity and religion to explore how the Islamic Culture has been reformed and how religious minorities are preserving their own identities. My proposed methodology in order to find a solution, as an architect, is to create a loose public space where all different cultures connect and engage

Method and Apparatus for Characterizing Microscale Formability of Thin Sheet Materials

A method of predicting sheet formability at a microscale level includes the steps of providing a grid pattern on a test sheet, bulging the test sheet to a hemispherical shape until a crack is initiated on the surface of the test sheet, detecting the initiation of the crack, acquiring two images of the surface adjacent to the crack and calculating surface strains on the test sheet

Method and Apparatus for Characterizing Microscale Formability of Thin Sheet Materials

A method of predicting sheet formability at a microscale level includes the steps of providing a grid pattern on a test sheet, bulging the test sheet to a hemispherical shape until a crack is initiated on the surface of the test sheet, detecting the initiation of the crack, acquiring two images of the surface adjacent to the crack and calculating surface strains on the test sheet

Grief Reactions of Bereaved Spouses in Ilorin Metropolis, Kwara State, Nigeria

Spousal death is one of the most traumatic events that can occur in marital experience and most times, engenders different reactions. The paper investigated the grief reactions of bereaved spouses in Ilorin metropolis, Kwara State. A total of 395 bereaved spouses were selected using a purposive sampling technique. Data were collected from the respondents using an instrument titled "Grief Reaction of Bereaved Spouses Questionnaire" (GRBSQ). The research questions raised were answered with percentages while the hypotheses generated were analysed using t-test statistics and three-way Analysis of Variance (ANOVA) at 0.05 alpha level. The findings of the study indicated that (90.6%) of bereaved spouses in Kwara state have positive grief reactions, while 37 (9.4%) have negative grief reactions. The study further revealed significant differences in the grief reactions of bereaved spouses in Ilorin metropolis based on age at bereavement, nature of death and length of years of loss. Based on these findings, recommendations were made on the desirability of establishing counselling centres in governmental and non-governmental organisations aside from the conventional ones in schools and hospitals. The study also stresses the need for bereaved spouses to be exposed to grief counselling to help them adjust better to their bereavement and educated on the adverse effect of complicated grief as a result of poor adjustment

NXY-059 for the treatment of acute stroke: pooled analysis of the SAINT I and II trials

<p><b>Background and Purpose:</b> In animal models of acute ischemic stroke (AIS), the free radical-trapping agent NXY-059 showed promise as a neuroprotectant. SAINT I and II were randomized, placebo-controlled, double-blind trials to investigate the efficacy of NXY-059 in patients with AIS.</p> <p><b>Methods:</b> Patients with AIS received an infusion of intravenous NXY-059 or placebo within 6 hours from the onset of stroke symptoms. A pooled individual patient analysis was prespecified to assess the overall efficacy and to examine subgroups. The primary end point was the distribution of disability scores measured on the modified Rankin scale (mRS) at 90 days. Neurologic and activities of daily living scores were investigated as secondary end points. We also evaluated whether treatment with NXY-059 would reduce alteplase-related intracranial hemorrhages. Finally, we evaluated possible predictors of good or poor outcome.</p> <p><b>Results:</b> An intent-to-treat efficacy analysis was based on 5028 patients. Baseline parameters and prognostic factors were well balanced between treatment groups. The distribution of scores on the mRS was not different in the group treated with NXY-059 (n = 2438) compared with the placebo group (n = 2456): odds ratio for limiting disability = 1.02; 95% CI, 0.92 to 1.13 (P = 0.682, Cochran-Mantel-Haenszel test). Comparisons at each level of the mRS confirmed an absence of benefit. There was no evidence of efficacy in prespecified subgroups or from the secondary outcome analyses. Mortality was equal in the 2 groups (16.7% vs 16.5%), and adverse event rates were similar. Among patients treated with alteplase, there was no decrease in rates of symptomatic or asymptomatic hemorrhage associated with NXY-059 treatment versus placebo. Subgroup analyses identified National Institutes of Health Stroke Scale score, age, markers of inflammation, blood glucose, and right-sided infarct as predictors of poor outcome.</p> <p><b>Conclusions:</b> NXY-059 is ineffective for treatment of AIS within 6 hours of symptom onset. This is also true for subgroups and the prevention of alteplase-associated hemorrhage.</p&gt

Additional outcomes and subgroup analyses of NXY-059 for acute ischemic stroke in the SAINT I trial

<p><b>Background and Purpose:</b> NXY-059 is a free radical-trapping neuroprotectant demonstrated to reduce disability from ischemic stroke. We conducted analyses on additional end points and sensitivity analyses to confirm our findings.</p> <p><b>Methods:</b> We randomized 1722 patients with acute ischemic stroke to a 72-hour infusion of placebo or intravenous NXY-059 within 6 hours of stroke onset. The primary outcome was disability at 90 days, as measured by the modified Rankin Scale (mRS), a 6-point scale ranging from 0 (no residual symptoms) to 5 (bed-bound, requiring constant care). Additional and exploratory analyses included mRS at 7 and 30 days; subgroup interactions with final mRS; assessments of activities of daily living by Barthel index; and National Institutes of Health Stroke Scale (NIHSS) neurological scores at 7 and 90 days.</p> <p><b>Results:</b> NXY-059 significantly improved the distribution of the mRS disability score compared with placebo at 7, 30, and 90 days (Cochran-Mantel-Haenszel test P=0.002, 0.004, 0.038, respectively; 90-day common odds ratio 1.20; 95% CI, 1.01 to 1.42). The benefit was not attributable to any specific baseline characteristic, stratification variable or subgroup interaction. Neurological scores were improved at 7 days (odds ratio [OR], 1.46; 95% CI, 1.13, 1.89; P=0.003) and the Barthel index was improved at 7 and 30 days (OR, 1.55; 95% CI, 1.22, 1.98; P<0.0001; OR, 1.27; 95% CI, 1.01, 1.59; P=0.02).</p> <p><b>Conclusions:</b> NXY-059 within 6 hours of acute ischemic stroke significantly reduced disability. Benefit on neurological scores and activities of daily living was detectable early but not significant at 90 days; however, our trial was underpowered to measure effects on the neurological examination. The benefit on disability is not confounded by interactions and is supported by other outcome measures.</p&gt

Revealing hidden information in osteoblast’s mechanotransduction through analysis of time patterns of critical events

Background Mechanotransduction in bone cells plays a pivotal role in osteoblast differentiation and bone remodelling. Mechanotransduction provides the link between modulation of the extracellular matrix by mechanical load and intracellular activity. By controlling the balance between the intracellular and extracellular domains, mechanotransduction determines the optimum functionality of skeletal dynamics. Failure of this relationship was suggested to contribute to bone-related diseases such as osteoporosis. Results A hybrid mechanical and agent-based model (Mech-ABM), simulating mechanotransduction in a single osteoblast under external mechanical perturbations, was utilised to simulate and examine modulation of the activation dynamics of molecules within mechanotransduction on the cellular response to mechanical stimulation. The number of molecules and their fluctuations have been analysed in terms of recurrences of critical events. A numerical approach has been developed to invert subordination processes and to extract the direction processes from the molecular signals in order to derive the distribution of recurring events. These predict that there are large fluctuations enclosing information hidden in the noise which is beyond the dynamic variations of molecular baselines. Moreover, studying the system under different mechanical load regimes and altered dynamics of feedback loops, illustrate that the waiting time distributions of each molecule are a signature of the system’s state. Conclusions The behaviours of the molecular waiting times change with the changing of mechanical load regimes and altered dynamics of feedback loops, presenting the same variation of patterns for similar interacting molecules and identifying specific alterations for key molecules in mechanotransduction. This methodology could be used to provide a new tool to identify potent molecular candidates to modulate mechanotransduction, hence accelerate drug discovery towards therapeutic targets for bone mass upregulation

Digitizing radiology films using flat-bed scanner and produce a multimedia digital teaching file in musculoskeletal radiology

Digital images have been long established in radiology department. Despite this, most radiology teaching films has been film-based. The drawback of this conventional system is that it consumed space, only one user can use at any one time and expensive. Analogue radiology films were digitized using flatbed scanner with transparency adaptor and digital camera. Digital-based teaching files using personal computer (PC) should be encouraged as this will reduce space for storing, can be distributed without much cost, inexpensive, many users can use at the same time and others can use even though at different place using the internet. The teaching file was prepared using HyperText Mark-up Language (HTML) as this can be used using any web browser. It is now available in University Sains Malaysia, Kelantan Campus Branch (USMKCK) intranet