Increased Risk of Ischemic Stroke during Sleep in Apneic Patients.

BACKGROUND AND PURPOSE:The literature indicates that obstructive sleep apnea (OSA) increases the risk of ischemic stroke. However, the causal relationship between OSA and ischemic stroke is not well established. This study examined whether preexisting OSA symptoms affect the onset of acute ischemic stroke. METHODS:We investigated consecutive patients who were admitted with acute ischemic stroke, using a standardized protocol including the Berlin Questionnaire on symptoms of OSA prior to stroke. The collected stroke data included the time of the stroke onset, risk factors, and etiologic subtypes. The association between preceding OSA symptoms and wake-up stroke (WUS) was assessed using multivariate logistic regression analysis. RESULTS:We identified 260 subjects with acute ischemic strokes with a definite onset time, of which 25.8% were WUS. The presence of preexisting witnessed or self-recognized sleep apnea was the only risk factor for WUS (adjusted odds ratio=2.055, 95% confidence interval=1.035-4.083, p=0.040). CONCLUSIONS:Preexisting symptoms suggestive of OSA were associated with the occurrence of WUS. This suggests that OSA contributes to ischemic stroke not only as a predisposing risk factor but also as a triggering factor. Treating OSA might therefore be beneficial in preventing stroke, particularly that occurring during sleep

The Race to Invest: What Is the Driving Cause of the European Union\u27s Increased Involvement in Latin America?

This article analyzes the rhetoric of members of the European Parliament (MEPs) and high-level EU leaders who speak about the EU’s role in Latin America and the role of China in the region. To what extent are MEPs and other EU officials concerned about Chinese expansion and is China the reason why the EU seeks increased collaboration with Latin American partners? Our paper documents who in the EU is advocating for increased ties with Latin American countries, why they are doing so, and whether the influence of China is inducing rhetorical changes in EU foreign policy. Findings suggest that while China is a perceived threat to EU influence in Latin America, the EU also pursues partnerships with Latin America due to its own economic concerns and because of its attention to democracy, shared cultures, and historical ties that bind the two regions together

Safety classification of herbal medicine use among hypertensive patients: a systematic review and meta-analysis

BackgroundThe use of herbal medicines (HMs) for the treatment of hypertension (HTN) is increasing globally, but research on the potential adverse effects and safety of HMs in HTN patients is limited. Therefore, this systematic review and meta-analysis aim to determine the global prevalence of HM usage among HTN patients and assess the safety of identified herbs based on current scientific evidence.MethodsThe PubMed/MEDLINE, EMBASE (Ovid), and Cumulated Index to Nursing and Allied Health Literature (CINAHL) databases were searched for cross-sectional studies on the use of HM among HTN patients. Our review includes studies published in English up to the year 2023. After extracting and appraising the data from the studies, a meta-analysis was conducted using the Stata version 16.0 to estimate the pooled prevalence of HM use in patients with HTN (PROSPERO: CRD42023405537). The safety classification of the identified HM was done based on the existing scientific literature.ResultsThis study analyzed 37 cross-sectional studies from 21 countries and found that 37.8% of HTN patients used HM to manage their health. The prevalence of HM use varied significantly based on publication year and geographical region. Among the 71 identified herbs, Allium sativum L., Hibiscus sabdariffa L., and Olea europaea L. were the most commonly used. However, four herbs were identified as contraindicated, 50 herbs required caution, and only 11 herbs were considered safe for use.ConclusionThe study highlights the potential risks of toxicities and adverse effects associated with HM use in the treatment of HTN. Ensuring patient safety involves using safe HMs in appropriate doses and avoiding contraindicated HMs. Future research should focus on identifying commonly used herbs, especially in resource-limited countries with poor HTN management, and additional clinical research is required to assess the toxicity and safety of commonly used HMs

Subclinical Cervical Osteochondroma Presenting as Brown-Sequard Syndrome after Trivial Neck Trauma

Osteochondroma is a rare condition in the spine that may be indolent due to its slow growth. The authors present a case of 32-year-old man with subclinical osteochondroma in the cervical spine presenting as Brown-Sequard syndrome after trivial neck trauma. After resection of the tumor through hemilaminectomy, his symptoms were improved with mild residual sequelae

Neurotoxic Manifestations of an Overdose Intrathecal Injection of Gadopentetate Dimeglumine

The intravenous administration of gadopentetate dimeglumine (GD) is relatively safe and rarely causes systemic toxicity in the course of routine imaging studies. However, the general safety of intrathecal GD has not been established. We report a very rare case of an overdose intrathecal GD injection presenting with neurotoxic manifestations, including a decreased level of consciousness, global aphasia, rigidity, and visual disturbance

Acute Shunt Malfunction after Cesarean Section Delivery: A Case Report

Shunt malfunctions that require surgical intervention during pregnancy and the postpartum period are rare. Furthermore, no study has reported on an acute shunt malfunction immediately after cesarean section. Here, we describe the case of a 32-yr-old woman who became drowsy 12 hr after cesarean section delivery of her second child. She had a ventriculoperitoneal shunt placed to treat hydrocephalus associated with meningitis at 26 yr of age. Marked ventriculomegaly was seen on brain computed tomography and her consciousness recovered temporarily after aspirating cerebrospinal fluid from the flushing device. At surgery, the distal catheter tip was plugged by a blood clot. We believe that the blood spilled over during the cesarean section. The clogged catheter end was simply cut off and the remaining catheter was repositioned in the peritoneal cavity. Her consciousness recovered fully

CSAI analysis of non-crimp fabric cross-ply laminate manufactured through wet compression molding process

The main purpose of the present work is to demonstrate mechanical performance of a wet-compression-molding (WCM) composite product through conventional compressive-strength-after-impact (CSAI) analysis. Biaxial non-crimp fabric (NCF) is utilized to manufacture laminated composite panels. Specimens are cut from the panels and tested to characterize fundamental mechanical properties of the NCF composite. The volume fractions of fibers and voids are also measured to evaluate the quality of the WCM product. Impact tests are carried out to examine impact resistance of the composite structure. Numerous impact characteristics at various energy levels are quantitatively measured. Internal failure patterns and damage extent are revealed via X-ray CT. Compression tests on the impacted plates are followed to evaluate structural integrity and damage tolerance (SIDT). 3D DIC technique is employed and distinct buckling responses dependent on impact energy levels are successfully visualized. Experimental results are showing a promising potential of the WCM process as one of the alternatives to the conventional autoclave-based fabrication method

Left Ventricular Dysfunction in Outpatients with Frequent Ventricular Premature Complexes

Frequent ventricular premature complexes (VPCs) and VPC QRS duration are risk factors for left ventricular (LV) dysfunction. To determine which clinical characteristics and electrocardiographic features are associated with LV dysfunction (ejection fraction, We identified 412 consecutive outpatients (mean age, 54.7 ± 16.8 yr; 227 women [55.1%]) who were diagnosed with frequent VPCs and had no structural heart disease from January 2010 through December 2017. Available transthoracic echocardiograms and 24-hour Holter monitoring data were evaluated to correlate the occurrence of VPCs and symptoms. Typical VPC-related symptoms (palpitations or dropped beats) were observed in 251 patients (61.1%). Electrocardiograms revealed VPCs with a left bundle branch block–like morphology in 327 patients (79.5%) and VPCs with an inferior axis in 353 (85.8%). Twenty-six patients (6.3%) were diagnosed with VPC-related LV dysfunction. The mean VPC burden did not differ significantly by LV functional status (11.06% ± 10.13% [normal] vs 14.41% ± 13.30% [impaired]; P=0.211). Patients with impaired LV function were more often men (P=0.027), had no typical VPC-related symptoms (P=0.006), and had significantly longer VPC QRS durations (mean, 157 ms vs 139 ms; P \u3c0.01). Our findings suggest that male sex, absence of typical VPC-related symptoms, and a VPC QRS duration \u3e157 ms are associated with LV dysfunction in patients with frequent VPCs, findings that may be useful in predicting such dysfunction

Efficacy of Tandem High-Dose Chemotherapy and Autologous Stem Cell Rescue in Patients Over 1 Year of Age with Stage 4 Neuroblastoma: The Korean Society of Pediatric Hematology-Oncology Experience Over 6 Years (2000-2005)

The efficacy of tandem high-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) was investigated in patients with high-risk neuroblastoma. Patients over 1 yr of age who were newly diagnosed with stage 4 neuroblastoma from January 2000 to December 2005 were enrolled in The Korean Society of Pediatric Hematology-Oncology registry. All patients who were assigned to receive HDCT/ASCR at diagnosis were retrospectively analyzed to investigate the efficacy of single or tandem HDCT/ASCR. Seventy and 71 patients were assigned to receive single or tandem HDCT/ASCR at diagnosis. Fifty-seven and 59 patients in the single or tandem HDCT group underwent single or tandem HDCT/ASCR as scheduled. Twenty-four and 38 patients in the single or tandem HDCT group remained event free with a median follow-up of 56 (24-88) months. When the survival rate was analyzed according to intent-to-treat at diagnosis, the probability of the 5-yr event-free survival±95% confidence intervals was higher in the tandem HDCT group than in the single HDCT group (51.2±12.4% vs. 31.3±11.5%, P=0.030). The results of the present study demonstrate that the tandem HDCT/ASCR strategy is significantly better than the single HDCT/ASCR strategy for improved survival in the treatment of high-risk neuroblastoma patients