COVID-19 presenting as stroke

© 2020 Elsevier Inc. Objective: Acute stroke remains a medical emergency even during the COVID-19 pandemic. Most patients with COVID-19 infection present with constitutional and respiratory symptoms; while others present with atypical gastrointestinal, cardiovascular, or neurological manifestations. Here we present a series of four patients with COVID-19 that presented with acute stroke. Methods: We searched the hospital databases for patients that presented with acute stroke and concomitant features of suspected COVID-19 infection. All patients who had radiographic evidence of stroke and PCR-confirmed COVID-19 infection were included in the study. Patients admitted to the hospital with PCR- confirmed COVID-19 disease whose hospital course was complicated with acute stroke while inpatient were excluded from the study. Retrospective patient data were obtained from electronic medical records. Informed consent was obtained. Results: We identified four patients who presented with radiographic confirmation of acute stroke and PCR-confirmed SARS-CoV-2 infection. We elucidate the clinical characteristics, imaging findings, and the clinical course. Conclusions: Timely assessment and hyperacute treatment is the key to minimize mortality and morbidity of patients with acute stroke. Stroke teams should be wary of the fact that COVID-19 patients can present with cerebrovascular accidents and should dawn appropriate personal protective equipment in every suspected patient. Further studies are urgently needed to improve current understandings of neurological pathology in the setting of COVID-19 infection

Impact of Using Unedited CT-Based DIR-Propagated Autocontours on Online ART for Pancreatic SBRT

PURPOSE: To determine the dosimetric impact of using unedited autocontours in daily plan adaptation of patients with locally advanced pancreatic cancer (LAPC) treated with stereotactic body radiotherapy using tumor tracking. MATERIALS AND METHODS: The study included 98 daily CT scans of 35 LAPC patients. All scans were manually contoured (MAN), and included the PTV and main organs-at-risk (OAR): stomach, duodenum and bowel. Precision and MIM deformable image registration (DIR) methods followed by contour propagation were used to generate autocontour sets on the daily CT scans. Autocontours remained unedited, and were compared to MAN on the whole organs and at 3, 1 and 0.5 cm from the PTV. Manual and autocontoured OAR were used to generate daily plans using the VOLO™ optimizer, and were compared to non-adapted plans. Resulting planned doses were compared based on PTV coverage and OAR dose-constraints. RESULTS: Overall, both algorithms reported a high agreement between unclipped MAN and autocontours, but showed worse results when being evaluated on the clipped structures at 1 cm and 0.5 cm from the PTV. Replanning with unedited autocontours resulted in better OAR sparing than non-adapted plans for 95% and 84% plans optimized using Precision and MIM autocontours, respectively, and obeyed OAR constraints in 64% and 56% of replans. CONCLUSION: For the majority of fractions, manual correction of autocontours could be avoided or be limited to the region closest to the PTV. This practice could further reduce the overall timings of adaptive radiotherapy workflows for patients with LAPC

Paracetamol modulates biofilm formation in Staphylococcus aureus clonal complex 8 strains

Staphylococcus aureus biofilms are a major problem in modern healthcare due to their resistance to immune system defenses and antibiotic treatments. Certain analgesic agents are able to modulate S. aureus biofilm formation, but currently no evidence exists if paracetamol, often combined with antibiotic treatment, also has this effect. Therefore, we aimed to investigate if paracetamol can modulate S. aureus biofilm formation. Considering that certain regulatory pathways for biofilm formation and virulence factor production by S. aureus are linked, we further investigated the effect of paracetamol on immune modulator production. The in vitro biofilm mass of 21 S. aureus strains from 9 genetic backgrounds was measured in the presence of paracetamol. Based on biofilm mass quantity, we further investigated paracetamol-induced biofilm alterations using a bacterial viability assay combined with N-Acetylglucosamine staining. Isothermal microcalorimetry was used to monitor the effect of paracetamol on bacterial metabolism within biofilms and green fluorescent protein (GFP) promoter fusion technology for transcription of staphylococcal complement inhibitor (SCIN). Clinically relevant concentrations of paracetamol enhanced biofilm formation particularly among strains belonging to clonal complex 8 (CC8), but had minimal effect on S. aureus planktonic growth. The increase of biofilm mass can be attributed to the marked increase of N-Acetylglucosamine containing components of the extracellular matrix, presumably polysaccharide intercellular adhesion. Biofilms of RN6390A (CC8) showed a significant increase in the immune modulator SCIN transcription during co-incubation with low concentrations of paracetamol. Our data indicate that paracetamol can enhance biofilm formation. The clinical relevance needs to be further investigated.</p

Novel non-equilibrium critical behavior in unidirectionally coupled stochastic processes

Phase transitions from an active into an absorbing, inactive state are generically described by the critical exponents of directed percolation (DP), with upper critical dimension d_c = 4. In the framework of single-species reaction-diffusion systems, this universality class is realized by the combined processes A -> A + A, A + A -> A, and A -> \emptyset. We study a hierarchy of such DP processes for particle species A, B,..., unidirectionally coupled via the reactions A -> B, ... (with rates \mu_{AB}, ...). When the DP critical points at all levels coincide, multicritical behavior emerges, with density exponents \beta_i which are markedly reduced at each hierarchy level i >= 2. This scenario can be understood on the basis of the mean-field rate equations, which yield \beta_i = 1/2^{i-1} at the multicritical point. We then include fluctuations by using field-theoretic renormalization group techniques in d = 4-\epsilon dimensions. In the active phase, we calculate the fluctuation correction to the density exponent for the second hierarchy level, \beta_2 = 1/2 - \epsilon/8 + O(\epsilon^2). Monte Carlo simulations are then employed to determine the values for the new scaling exponents in dimensions d<= 3, including the critical initial slip exponent. Our theory is connected to certain classes of growth processes and to certain cellular automata, as well as to unidirectionally coupled pair annihilation processes. We also discuss some technical and conceptual problems of the loop expansion and their possible interpretation.Comment: 29 pages, 19 figures, revtex, 2 columns, revised Jan 1995: minor changes and additions; accepted for publication in Phys. Rev.

Teachers’ changing work and support needs from the perspectives of school leaders and newly qualified teachers in the Finnish context

Teachers operate amidst continuous societal changes that transform schools. In response, teachers must acquire wide-ranging professional competences to work in complex school situations while cooperating with numerous partners both within and outside the school. This study examines how teacher growth and the new demands of the teaching profession appear from the perspectives of school leaders and newly qualified teachers. The aim is to investigate in which professional competences new teachers require support at the beginning of their careers. After presenting various theoretical reflections, we analyse the empirical data of Finnish school leaders (N = 104) and new teachers (N = 145) using quantitative and qualitative methods. The results indicate that new teachers require support, for example, in order to provide holistic support for students’ learning and in working with partners, both within and outside the school community. The results provide important knowledge for the induction phase of teachers’ careers.Peer reviewe