Updates on the Morphometric Characterization of Indian Pangolin (Manis crassicaudata) in Sri Lanka

An accurate morphological description and analysis based on reliable data are unavailable for the geographically isolated population of M. crassicaudata in Sri Lanka. This study provides the most updated morphological description of M. crassicaudata with special reference to body measurements directly obtained from 27 specimens collected island-wide. Morphological parameters were recorded under three age classes that were defined based on their body weight (BW) and total body length (TBL); juvenile (BW: 7.3 kg TBL: >101 cm) and gender to reveal sexual dimorphism based on morphometric parameters. The TBL of adult males ranged between 137 and 177 cm while body weight ranged between 20.4 and 48.8 kg. The average count of body scales was 511 ± 21. The body scales were found arranged in 13 longitudinal rows with the highest number of scales observed on the vertebral scale row (16 ± 1). Three major scale morphs were identified; broad rhombic scales, elongated kite-shaped scales, and folded shaped scales. Broad rhombic shaped scales was the dominant scale type (80.49%) on the body (405 ± 7). The tail-length to body-length ratio of an Indian pangolin was 0.87. The tail length of an Indian pangolin is a reliable predictor of the TBL and has potential implications in quick field data gathering

Baseline factors associated with early and late death in intracerebral haemorrhage survivors

Background and purpose: The aim of this study was to determine whether early and late death are associated with different baseline factors in intracerebral haemorrhage (ICH) survivors. Methods: This was a secondary analysis of the multicentre prospective observational CROMIS‐2 ICH study. Death was defined as ‘early’ if occurring within 6 months of study entry and ‘late’ if occurring after this time point. Results: In our cohort (n = 1094), there were 306 deaths (per 100 patient‐years: absolute event rate, 11.7; 95% confidence intervals, 10.5–13.1); 156 were ‘early’ and 150 ‘late’. In multivariable analyses, early death was independently associated with age [per year increase; hazard ratio (HR), 1.05, P = 0.003], history of hypertension (HR, 1.89, P = 0.038), pre‐event modified Rankin scale score (per point increase; HR, 1.41, P < 0.0001), admission National Institutes of Health Stroke Scale score (per point increase; HR, 1.11, P < 0.0001) and haemorrhage volume >60 mL (HR, 4.08, P < 0.0001). Late death showed independent associations with age (per year increase; HR, 1.04, P = 0.003), pre‐event modified Rankin scale score (per point increase; HR, 1.42, P = 0.001), prior anticoagulant use (HR, 2.13, P = 0.028) and the presence of intraventricular extension (HR, 1.73, P = 0.033) in multivariable analyses. In further analyses where time was treated as continuous (rather than dichotomized), the HR of previous cerebral ischaemic events increased with time, whereas HRs for Glasgow Coma Scale score, National Institutes of Health Stroke Scale score and ICH volume decreased over time. Conclusions: We provide new evidence that not all baseline factors associated with early mortality after ICH are associated with mortality after 6 months and that the effects of baseline variables change over time. Our findings could help design better prognostic scores for later death after ICH

Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial

Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy. Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388. Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16, p<0·0001). Interpretation: Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice

Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA

Post-stroke dementia is common but has heterogenous mechanisms that are not fully understood, particularly in patients with atrial fibrillation (AF)-related ischaemic stroke or TIA. We investigated the relationship between MRI small-vessel disease markers (including a composite cerebral amyloid angiopathy, CAA, score) and cognitive trajectory over 12 months. We included patients from the CROMIS-2 AF study without pre-existing cognitive impairment and with Montreal Cognitive Assessment (MoCA) data. Cognitive impairment was defined as MoCA < 26. We defined “reverters” as patients with an “acute” MoCA (immediately after the index event) score < 26, who then improved by ≥ 2 points at 12 months. In our cohort (n = 114), 12-month MoCA improved overall relative to acute performance (mean difference 1.69 points, 95% CI 1.03–2.36, p < 0.00001). 12-month cognitive impairment was associated with increasing CAA score (per-point increase, adjusted OR 4.09, 95% CI 1.36–12.33, p = 0.012). Of those with abnormal acute MoCA score (n = 66), 59.1% (n = 39) were “reverters”. Non-reversion was associated with centrum semi-ovale perivascular spaces (per-grade increase, unadjusted OR 1.83, 95% CI 1.06–3.15, p = 0.03), cerebral microbleeds (unadjusted OR 10.86, 95% CI 1.22–96.34, p = 0.03), and (negatively) with multiple ischaemic lesions at baseline (unadjusted OR 0.11, 95% CI 0.02–0.90, p = 0.04), as well as composite small-vessel disease (per-point increase, unadjusted OR 2.91, 95% CI 1.23–6.88, p = 0.015) and CAA (per-point increase, unadjusted OR 6.71, 95% CI 2.10–21.50, p = 0.001) scores. In AF-related acute ischaemic stroke or TIA, cerebral small-vessel disease is associated both with cognitive performance at 12 months and failure to improve over this period

Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial

Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy.Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388.Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16,

Higher energy triplet-pair states in polyenes and their role in intramolecular singlet fission

Probing extended polyene systems with energy in excess of the bright state (1^1B+u/S2) band edge generates triplets via singlet fission. This process is not thought to involve the 2^1A−g/S1 state, suggesting that other states play a role. Using density matrix renormalization group (DMRG) calculations of the Pariser-Parr-Pople-Peierls Hamiltonian, we investigate candidate states that could be involved in singlet fission. We find that the relaxed 1^1B−u and 3^1A−g singlet states and 1^5A−g quintet state lie below the S2 state. The 1^1B−u, 3^1Ag, and 1^5A−g states are all thought to have triplet-pair character, which is confirmed by our calculations of bond dimerization, spin-spin correlation, and wave function overlap with products of triplet states. We thus show that there is a family of singlet excitations (i.e., 2^1A−g, 1^1B−u, 3^1A−g,⋯), composed of both triplet-pair and electron-hole character, which are fundamentally the same excitation, but have different center-of-mass energies. The lowest energy member of this family, the 2^1A−g state, cannot undergo singlet fission. But higher-energy members (e.g., the 3^1A−g) state, owing to their increased kinetic energy and reduced electron-lattice relaxation, can undergo singlet fission for certain chain lengths

Photoexcited state dynamics and singlet fission in carotenoids

We describe our simulations of the excited state dynamics of the carotenoid neurosporene, following its photoexcitation into the “bright” (nominally 11Bu+) state. To account for the experimental and theoretical uncertainty in the relative energetic ordering of the nominal 11Bu+ and 21Ag– states at the Franck–Condon point, we consider two parameter sets. In both cases, there is ultrafast internal conversion from the “bright” state to a “dark” singlet triplet-pair state, i.e., to one member of the “2Ag” family of states. For one parameter set, internal conversion from the 11Bu+ to 21Ag– states occurs via the dark, intermediate 11Bu– state. In this case, there is a cross over of the 11Bu+ and 11Bu– diabatic energies within 5 fs and an associated avoided crossing of the S2 and S3 adiabatic energies. After the adiabatic evolution of the S2 state from predominately 11Bu+ character to predominately 11Bu– character, there is a slower nonadiabatic transition from S2 to S1, accompanied by an increase in the population of the 21Ag– state. For the other parameter set, the 21Ag– energy lies higher than the 11Bu+ energy at the Franck–Condon point. In this case, there is cross over of the 21Ag– and 11Bu+ energies and an avoided crossing of the S1 and S2 energies, as the S1 state evolves adiabatically from being of 11Bu+ character to 21Ag– character. We make a direct connection from our predictions to experimental observables by calculating the time-resolved excited state absorption. For the case of direct 11Bu+ to 21Ag– internal conversion, we show that the dominant transition at ca. 2 eV, being close to but lower in energy than the T1 to T1* transition, can be attributed to the 21Ag– component of S1. Moreover, we show that it is the charge-transfer exciton component of the 21Ag– state that is responsible for this transition (to a higher-lying exciton state), and not its triplet-pair component. These simulations are performed using the adaptive tDMRG method on the extended Hubbard model of π-conjugated electrons. The Ehrenfest equations of motion are used to simulate the coupled nuclei dynamics. We next discuss the microscopic mechanism of “bright” to “dark” state internal conversion and emphasize that this occurs via the exciton components of both states. Finally, we describe a mechanism relying on torsional relaxation whereby the strongly bound intrachain triplet-pairs of the “dark” state may undergo interchain exothermic dissociation

Therapeutic management of acute intracerebral haemorrhage

Intracerebral haemorrhage (ICH) is a stroke resulting from spontaneous rupture of an intracranial vessel and is associated with high early mortality and long-term morbidity rates. With the exception of dedicated stroke units or neurocritical care, no surgical or medical intervention has been proven to effectively improve outcome following ICH. Pharmacotherapeutic considerations include optimal blood pressure control and the choice of antihypertensive agents. Acute haematoma expansion represents the most obvious acute treatment target. The use of haemostatic agents may have a role in ICH management; although it appears improved patient selection may be required before the use of these agents can be demonstrated clinically. In patients with anticoagulant-associated ICH, a number of therapeutic agents may be used to urgently reverse the coagulopathy, although further clinical trials are required. Recurrent bleeding and future thrombo-embolic event rates in patients who require anticoagulation following ICH risks are difficult to determine accurately, although risk stratification data are emerging. This article reviews the pathophysiology, natural history and the evidence supporting present therapeutic management practices for ICH. The authors' practice based on best available evidence is provided

Singlet triplet-pair production and possible singlet-fission in carotenoids

Internal conversion from the photoexcited state to a correlated singlet triplet-pair state is believed to be the precursor of singlet fission in carotenoids. We present numerical simulations of this process using a π-electron model that fully accounts for electron–electron interactions and electron–nuclear coupling. The time-evolution of the electrons is determined rigorously using the time-dependent density matrix renormalization group method, while the nuclei are evolved via the Ehrenfest equations of motion. We apply this to zeaxanthin, a carotenoid chain with 18 fully conjugated carbon atoms. We show that the internal conversion of the primary photoexcited state, S2, to the singlet triplet-pair state occurs adiabatically via an avoided crossing within ∼50 fs with a yield of ∼60%. We further discuss whether this singlet triplet-pair state will undergo exothermic versus endothermic intra- or interchain singlet fission