Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR)

<p><b>Background and Purpose:</b> The optimal management of blood pressure (BP) in acute stroke remains unclear. For ischemic stroke treated with intravenous thrombolysis, current guidelines suggest pharmacological intervention if systolic BP exceeds 180 mm Hg. We determined retrospectively the association of BP and antihypertensive therapy with clinical outcomes after stroke thrombolysis.</p> <p><b>Methods:</b> The SITS thrombolysis register prospectively recorded 11 080 treatments from 2002 to 2006. BP values were recorded at baseline, 2 hours, and 24 hours after thrombolysis. Outcomes were symptomatic (National Institutes of Health Stroke Scale score deterioration ≥4) intracerebral hemorrhage Type 2, mortality, and independence at (modified Rankin Score 0 to 2) 3 months. Patients were categorized by history of hypertension and antihypertensive therapy within 7 days after thrombolysis: Group 1, hypertensive treated with antihypertensives (n=5612); Group 2, hypertensive withholding antihypertensives (n=1573); Group 3, without history of hypertension treated with antihypertensives (n=995); and Group 4, without history of hypertension not treated with antihypertensives (n=2632). For 268 (2.4%) patients, these data were missing. Average systolic BP 2 to 24 hours after thrombolysis was categorized by 10-mm Hg intervals with 100 to 140 used as a reference.</p> <p><b>Results:</b> In multivariable analysis, high systolic BP 2 to 24 hours after thrombolysis as a continuous variable was associated with worse outcome (P<0.001) and as a categorical variable had a linear association with symptomatic hemorrhage and a U-shaped association with mortality and independence with systolic BP 141 to 150 mm Hg associated with most favorable outcomes. OR (95% CI) from multivariable analysis showed no difference in symptomatic hemorrhage (1.09 [0.83 to 1.51]; P=0.58) and independence (1.03 [0.93 to 1.10]; P=0.80) but lower mortality (0.82 [0.73 to 0.92]; P=0.0007) for Group 1 compared with Group 4. Group 2 had a higher symptomatic hemorrhage (1.86 [1.34 to 2.68]; P=0.0004) and mortality (1.62 [1.41 to 1.85]; P<0.0001) and lower independence (0.89 [0.80 to 0.99]; P=0.04) compared with Group 4. Group 3 had similar results as Group 1.</p> <p><b>Conclusions:</b> There is a strong association of high systolic BP after thrombolysis with poor outcome. Withholding antihypertensive therapy up to 7 days in patients with a history of hypertension was associated with worse outcome, whereas initiation of antihypertensive therapy in newly recognized moderate hypertension was associated with a favorable outcome.</p&gt

Diabetic retinopathy, diabetic macular edema, and cardiovascular risk: the importance of a long-term perspective and a multidisciplinary approach to optimal intravitreal therapy

Diabetic retinopathy (DR), diabetic macular edema (DME), and cardiovascular disease (CVD) resulting from vascular damage from persistently elevated blood glucose levels are among the serious secondary pathologies associated with long-standing diabetes mellitus. The established link between DR and CVD suggests the need for appropriate and early management of patients with diabetes to minimize CV risk. This is of particular importance in patients with recent, or a history of, major CV events. Early management of DR is a complex task that requires comprehensive evaluation and a multidisciplinary approach to manage complications, risk factors, and interactions between different aspects of the disease. Anti-vascular endothelial growth factor (VEGF) agents have become an important therapeutic modality in ophthalmology. However, their use is contraindicated in patients with DR and/or DME with a CV event in the previous 3 months. In patients with DME, corticosteroids target the multifaceted inflammatory pathways involved in the pathogenesis of DR, with a broader spectrum of action than anti-VEGF agents. In this context, recent guidelines suggest the use of corticosteroids, and in particular dexamethasone intravitreal implant, as a well-tolerated and efficacious first-line treatment in patients with high CV risk, such as a history of or recent major CV events. This review focuses on the subset of diabetic patients with a prior CV event, DR, and DME and discusses the need for a holistic approach in evaluating the optimal therapeutic choice for the care of the individual patient, supported by real-world clinical experience on long-term dexamethasone intravitreal implant therapy

Epigenetic inactivation and aberrant transcription of CSMD1 in squamous cell carcinoma cell lines

BACKGROUND: The p23.2 region of human chromosome 8 is frequently deleted in several types of epithelial cancer and those deletions appear to be associated with poor prognosis. Cub and Sushi Multiple Domains 1 (CSMD1) was positionally cloned as a candidate for the 8p23 suppressor but point mutations in this gene are rare relative to the frequency of allelic loss. In an effort to identify alternative mechanisms of inactivation, we have characterized CSMD1 expression and epigenetic modifications in head and neck squamous cell carcinoma cell lines. RESULTS: Only one of the 20 cell lines examined appears to express a structurally normal CSMD1 transcript. The rest express transcripts which either lack internal exons, terminate abnormally or initiate at cryptic promoters. None of these truncated transcripts is predicted to encode a functional CSMD1 protein. Cell lines that express little or no CSMD1 RNA exhibit DNA methylation of a specific region of the CpG island surrounding CSMD1's first exon. CONCLUSION: Correlating methylation patterns and expression suggests that it is modification of the genomic DNA preceding the first exon that is associated with gene silencing and that methylation of CpG dinucleotides further 3' does not contribute to inactivation of the gene. Taken together, the cell line data suggest that epigenetic silencing and aberrant splicing rather than point mutations may be contributing to the reduction in CSMD1 expression in squamous cancers. These mechanisms can now serve as a focus for further analysis of primary squamous cancers

Effectiveness of a Parent-Child Home Numeracy Intervention on Urban Catholic School First Grade Students

Catholic social teaching affirms the primary role of parents in their children’s education, as well as the importance of forging a positive home-school partnership. The purpose of this article is to provide empirical evidence for further cultivating a collaborative, home-school relationship aimed at improving the mathematics performance of Catholic school first grade students by training parents as providers of at-home numeracy support. The participants included 60 parents (29 Black; 2 Asian; 1 Latino; 26 White; and 2 other) from two urban, Catholic schools. Parents randomly assigned to the experimental group received numeracy training and materials and then, implemented a 15-week home numeracy intervention. Results revealed that students in the treatment group or those who received the parent-child home numeracy intervention made large and statistically significant gains in their mathematics achievement, measured by a standardized test, as compared to the control group. Keywords Parental involvement, mathematics achievement, urban education, Catholic education Efficacité d\u27une intervention parent-enfant pour le calcul à la maison sur les enfants de cours préparatoire dans des écoles catholiques urbaines. La doctrine sociale catholique affirme le rôle premier des parents dans l\u27éducation de leurs enfants, de même que l\u27importance de nouer une relation positive entre l\u27école et la maison. Cet article vise à donner une preuve empirique en vue de cultiver davantage une relation positive entre l\u27école et la maison, afin d\u27améliorer les résultats en mathématiques des élèves de cours préparatoire des écoles catholiques en formant les parents pour qu\u27ils puissent les aider en calcul à la maison. Les parents comptaient 60 participants (29 noirs, 2 asiatiques, 1 hispanique, 26 blancs et 2 autres) dans deux écoles catholiques urbaines. Les parents affectés au groupe expérimental de manière aléatoire ont reçu une formation au calcul et des documents, et ont ensuite mis en œuvre une intervention de 15 semaines de calcul à la maison. Les résultats ont montré que les élèves dans le groupe de traitement ou ceux qui ont bénéficié de l\u27intervention parent-enfant de calcul à la maison ont obtenu des gains importants et statistiquement significatifs dans leurs résultats en mathématiques, mesurés par un test standard, comparé au groupe de contrôle. Mots-clés : implication des parents, réussite en mathématiques, éducation urbaine, éducation catholique Efectividad de una intervención de matemáticas padre-hijo en el hogar, en estudiantes de primer curso de escuelas urbanas católicas La enseñanza social católica afirma el principal papel de los padres en la educación de sus hijos, así como la importancia de forjar una relación positiva hogar-escuela. El objetivo de este artículo es proveer evidencia empírica que cultive aún más una relación hogar-escuela colaborativa y mejorar los resultados de los estudiantes de primer curso de escuelas católicas en las matemáticas al entrenarse a los padres en tanto que proveedores de apoyo de matemáticas en casa. Los participantes incluyeron a 60 padres (29 negros, 2 asiáticos, 1 latino, 26 blancos y 2 de otros grupos) de dos escuelas católicas urbanas. Los padres asignados al azar al grupo experimental, recibieron entrenamiento matemático y materiales por lo que se implementó una intervención de matemáticas de 15 semanas. Los resultados revelaron que los estudiantes en el grupo de tratamiento o los que recibieron la intervención de matemáticas padre-hijo en el hogar mejoraron significativa y estadísticamente en sus logros matemáticos, medidos por un test estandarizado, en comparación con el grupo de control. Palabras clave Involucración de los padres, logros matemáticos, educación urbana, educación católic

Hemorrhagic risk after intravenous thrombolysis for ischemic stroke in patients with cerebral microbleeds and white matter disease

Objectives: Aim of this study was to evaluate the association between cerebral microbleeds (CMBs) and white matter disease (WMD) with intracerebral hemorrhage (ICH) after intravenous thrombolysis (IVT) with rt-PA. We also evaluated whether CMBs characteristics and WMD burden correlate with symptomatic ICH and outcome. Methods: We included acute ischemic stroke (AIS) patients treated with IVT. The number and location of CMBs as well as severity of WMD were rated analyzing pre- or post-treatment MRI. Multivariable regression analysis was used to determine the impact of CMB and WMD on ICH subgroups and outcome measures. Results: 434 patients were included. CMBs were detected in 23.3% of them. ICH occurred in 34.7% of patients with CMBs. Independent predictors of parenchymal hemorrhage were the presence of CMBs (OR 2.724, 95% CI 1.360–5.464, p = 0.005) as well as cortical-subcortical stroke (OR 3.629, 95% CI 1.841–7.151, p < 0.001) and atherothrombotic stroke subtype (OR 3.381, 95% CI 1.335–8.566, p = 0.010). Either the presence, or number, and location of CMBs, as well as WMD, was not independently associated with the development of SICH. No independent association between the presence, number, or location of CMBs or WMD and outcome measures was observed. Conclusions: The results of our study suggest that the exclusion of eligible candidates to administration of IV rt-PA only on the basis of CMBs presence is not justified. The clinical decision should be weighed with a case-by-case approach. Additional data are needed to evaluate the benefit-risk profile of rt-PA in patients carrying numerous microbleeds

Pengaruh Variasi Panjang Pipa Masuk (Drive Pipe) dan Beban Katup Buang (Waste Valve) terhadap Efisiensi Pompa Hidram

Masyarakat yang bertempat tinggal jauh dari jangkauan sumber energi listrik terdapat kendala untuk memindahkan air dari tempat rendah ke tempat yang lebih tinggi. Untuk memompa air ke dalam rumah umumnya mereka menggunakan pompa sentrifugal. Jenis pompa ini membutuhkan energi listrik untuk mengoperasikannya, namun kadang-kadang listrik juga merupakan suatu masalah tersendiri bagi masyarakat. Salah satu cara yang dapat digunakan adalah dengan pompa hidram atau hydraulic ram yang energi atau tenaga penggeraknya berasal dari tekanan atau hantaman air yang masuk ke dalam pompa melalui pipa. Pompa hidrolik ram merupakan suatu solusi karena tidak membutuhkan energi listrik atau bahan bakar. Pompa jenis ini dapat bekerja terus menerus 24 jam sehari, harganya murah dan mudah dibuat Penelitian ini dilakukan untuk mengetahui efisiensi unjuk kerja pompa hidrolik ram dengan variasi panjang pipa masuk dan beban katub buang. Metode penelitian melalui perancangan instalasi pompa hidram dengan pengamatan pengaruh panjang pipa masuk (4 m, 6 m dan 8 m), dan pengamatan pengaruh beban katub buang (450 kg, 830 kg, dan 1220 kg) terhadap debit pompa hidram. Hasil penelitian menunjukkan bahwa efisiensi tertinggi pompa hidram adalah 36,19 % efisiensi D\u27Aubuission pada berat beban 450 gram dan panjang pipa masuk 4 m. Faktor panjang pipa masuk dan berat beban sangat berpengaruh terhadap debit pemompaan, debit buang, dan efisiensi pompa hidram

Peer Helping in an Intercollegiate Athletic Environment

Intercollegiate student-athletes face a variety of unique responsibilities and stressors. Balancing practice, training, traveling, and academics can be overwhelming. To assist student-athletes with these issues, the peer helper program called the Student Peer Athlete Network (SPAN) was developed. SPAN was designed to train specific student-athletes in peer helper skills so they, in turn, can assist other student-athletes who need support or assistance for certain personal, academic, or athletic concerns. Empowering student-athletes promotes a sense a self-responsibility and benefits the entire student-athlete population