Hyperintense vessel sign on fluid-attenuated inversion recovery MR imaging is reduced by gadolinium

The HVS on FLAIR imaging is a useful marker of acute ischemic stroke. We investigated whether prior administration of gadolinium-based contrast hindered detection of this sign on images from subjects with acute nonlacunar ischemic stroke <4.5 hours after onset. Both blinded and comparative unblinded analyses showed significantly reduced HVS detection on postcontrast images. We suggest that assessment for this sign should be performed on images acquired prior to contrast administration

Use of diffusion and perfusion magnetic resonance imaging as a tool in acute stroke clinical trials

In light of the slow progress in developing effective therapies for ischemic stroke, magnetic resonance imaging techniques have emerged as new tools in stroke clinical trials. Rapid imaging with magnetic resonance imaging, diffusion weighted imaging, perfusion imaging and angiography are being incorporated into phase II and phase III stroke trials to optimize patient selection based on positive imaging diagnosis of the ischemic pathophysiology specifically related to a drug's mechanism of action and as a direct biomarker of the effect of a treatment's effect on the brain

The Mechanisms of Tourism Management in Achieving Sustainable Development Goals (SDGS): The Case of Phulomlo and Connected Areas, Thailand

Sustainable tourism has been a mainstream issue of concern, with the 2030 Agenda for Sustainable Development released in 2015. This agenda acknowledged 17 Sustainable Development Goals (SDGs) that contain a blueprint of urgent action for peace and prosperity for the people and the planet. This paper focuses on the mechanisms of tourism management that work toward achieving the SDGs. There are two mechanisms, a supportive mechanism and an operational mechanism, that address the question of how to achieve the SDGs by employing tourism as a tool, the Phulomlo of Thailand was selected as a case study. Data were collected from local stakeholders through semi-structured interviews, focus group discussions, and documentation. The results show that there is a concrete operational mechanismat the local level. However, to attain growth toward sustainability, more thorough promotion of supportive mechanisms should be considered, with a more explicit strategy to facilitate improvement in achieving the SDGs in all areas connected to Phulomlo.   Suggestions to enhance the achievement of SDGs in the case of Phulomlo and the connected areas are proposed, as it is important to formulate a practical strategy to accomplish the SDGs via the local network. Furthermore, additional features comprising of consistency in practice, coherence of policies at the national and local level, and collaboration among tourism stakeholders should also be considered

Dose escalation of desmoteplase for acute ischemic stroke (DEDAS): evidence of safety and efficacy 3 to 9 hours after stroke onset

<p><b>Background and Purpose:</b> Desmoteplase is a novel plasminogen activator with favorable features in vitro compared with available agents. This study evaluated safety and efficacy of intravenous (IV) desmoteplase in patients with perfusion/diffusion mismatch on MRI 3 to 9 hours after onset of acute ischemic stroke.</p> <p><b>Methods:</b> DEDAS was a placebo-controlled, double-blind, randomized, dose-escalation study investigating doses of 90 μg/kg and 125 μg/kg desmoteplase. Eligibility criteria included baseline National Institute of Health Stroke Scale (NIHSS) scores of 4 to 20 and MRI evidence of perfusion/diffusion mismatch. The safety end point was the rate of symptomatic intracranial hemorrhage. Primary efficacy co-end points were MRI reperfusion 4 to 8 hours after treatment and good clinical outcome at 90 days. The primary analyses were intent-to-treat. Before unblinding, a target population, excluding patients violating specific MRI criteria, was defined.</p> <p><b>Results:</b> Thirty-seven patients were randomized and received treatment (intent-to-treat; placebo: n=8; 90 μg/kg: n=14; 125 μg/kg: n=15). No symptomatic intracranial hemorrhage occurred. Reperfusion was achieved in 37.5% (95% CI [8.5; 75.5]) of placebo patients, 18.2% (2.3; 51.8) of patients treated with 90 μg/kg desmoteplase, and 53.3% (26.6; 78.7) of patients treated with 125 μg/kg desmoteplase. Good clinical outcome at 90 days occurred in 25.0% (3.2; 65.1) treated with placebo, 28.6% (8.4; 58.1) treated with 90 μg/kg desmoteplase and 60.0% (32.3; 83.7) treated with 125 μg/kg desmoteplase. In the target population (n=25), the difference compared with placebo increased and was statistically significant for good clinical outcome with 125 μg/kg desmoteplase (P=0.022).</p> <p><b>Conclusions:</b> Treatment with IV desmoteplase 3 to 9 hours after ischemic stroke onset appears safe. At a dose of 125 μg/kg desmoteplase appeared to improve clinical outcome, especially in patients fulfilling all MRI criteria. The results of DEDAS generally support the results of its predecessor study, Desmoteplase in Acute Ischemic Stroke (DIAS).</p&gt

Economic Returns to Travel and Hospitality Businesses in Hot Spring Attraction Areas in The Upper Northern Provinces of Thailand

The main objective of this present study was to examine economic returns to tourism business in hot springs attraction areas in the upper northern provinces of Thailand. Data were collected from 30 entrepreneurs and managers in tourism business. The instrument for data collection was a business financial information interview form. Data were analyzed through financial analyses. Results indicated that business types had an effect on economic returns. The spa businesses had the average net present value (NPV) of 5,742,440.81 baht, the internal rate of return (IRR) of 128.95%, benefit-cost ratio(B/C) of 1.53 times and payback period (PB) of 1.61 years. The food and beverage businesses had the average NPV of 495,455.35 baht, IRR of 62.21% , B/C of 1.34 times and PB of 1.97 years. The accommodation businesses had NPV of 9,739,357.81, IRR of 56.53% , B/C of 2.00 and PB of 1.85. The CBT has NPV of 2,312,388.42, IRR of 86.17%, B/C of 2.15 times and PB of 1.87 years. The other business had NPV of 4,241,483.16 baht, IRR of 75.68%, B/C of 1.69 times and PB of 1.92 years. Also, findings indicated that the top three economic returns for travel and hospitality businesses were spa business (S45), CBT tourism business (T46), and Food and beverage business (F46), respectively

การศึกษาพฤติกรรมและทัศนคติของนักท่องเที่ยวต่อการพัฒนาแหล่งท่องเที่ยวจังหวัดปราจีนบุรี

This research aims to explore tourists’ behavior and attitude toward a development of tourist Landmark of Prachinburi province. This quantitative research used questionnaire as a tool in collecting data through random interview questions, asking 400 respondents. The participants were randomly selected from Thai tourists whom travelling in area of the province. Under the main purpose, this research investigated the potential tourist behavior and their personal status that caused impact in tourist landmark in Prachinburi. The analysis was performed using frequency and percentage method. The tourists attitude toward the development of tourist landmark in Prachinburi, has been analyzed by means and standard deviation. The outcome of the study shows that most of the tourists were female age 21 – 30, with Bachelor degree, employed by private sectors and having the range of salary between 15,000 – 25,000 baht per month, living in Bangkok and the nearby provinces. They were spending the day with family, travelling by car. The tourists have received information from on-line and media. They were visiting Khoayai National Park, Choapraya-Abhaibhubejhr Hospital, and Naraesuan the Great Shrine for their recreation. The attitude toward development of tourist Landmarks of Prachinburi related to tourist landmarks and the guidepost, it was point out their opinion toward the development of route conditions and roadside as rated high. However, other aspects required to be developed were moderated. Therefore, the province should aim to develop other aspects of tourist landmark to be able to serve more visitors too

The water quality assessment and biodiversity of phytoplankton in Phayao Lake, Phayao Province, Thailand

The goals of this evaluation of Phayao Lake were to evaluate the physical, chemical, and biological water quality, to determine the phytoplankton biodiversity, and to examine the relationship between biodiversity and water quality. Seven stations gathered samples for six months, from September 2020 to February 2021. Twice a month, samples were collected from each location. The results identified eight divisions, fifty-nine genera, and eighty-nine species. The most prevalent division of phytoplankton was Chlorophyta (45%), composed of 40 species. Coelomoron sp. was the most dominant species, with 732 ± 252 individuals L-1. The ranges for the Shannon – Wiener index, the evenness index, the richness index, and the index of similarity were 0.210 to 3.101, 0.151 to 0.985, 0.481 to 6.487, and 40.00 to 76.11, respectively. Based on the relationship between water quality variables and phytoplankton and utilizing statistical data analyzed using canonical correspondence analysis, phytoplankton was categorized into seven types, each of which was linked to an increase in dissolved oxygen levels. Although community-use water was classed as having medium to low nutrient levels, the average water quality in terms of dissolved oxygen (DO), biological oxygen demand (BOD), conductivity, nitrate concentrations, and phosphorus was classified as having medium to high nutrient levels. Because aquatic organisms use the area surrounding Phayao Lake as a nursery and breeding site, it has been. It will continue to be an important source of food for the community. Aquatic animals use the area surrounding Phayao Lake as a nursery and breeding ground; hence, this area is and will continue to be an important food source for the local community. Long-term monitoring determines the annual phytoplankton succession and identifies the progression of anomalous events, as recommended by the policy recommendations.Sitthisak Pinmongkhonkul (Department of Biology, School of Science, University of Phayao), Rattapoom Prommana (Department of Environmental Science, School of Environmental Science, University of Phayao), Thatchakorn Khamkhunmuang (Department of Biology, Faculty of Science, Chiang Mai University), Shalinee Singkurt (Department of Biology, School of Science, University of Phayao), Akepawee Sukcharoen (Department of Biology, School of Science, University of Phayao), Warach Madhyamapurush (Department of Tourism and Hotel Management, School of Business and Communication Arts, University of Phayao)Includes bibliographical references

Cerebral Infarct/Intracranial Cerebrovascular Disease

Imaging goals for intracranial cerebral vascular disease are (1) to assess the degree of parenchymal injury and identify intraparenchymal hemorrhage; (2) to determine if there are areas of altered perfusion that may be at risk for future injury; and (3) to assess the intracranial arteries (patency as well as direction of flow). This unit describes a Basic Protocol that can be used to evaluate stable patients with acute, subacute, or chronic cerebrovascular symptoms. An Alternate Protocol is also given for cases of hyperacute strokes or cerebrovascular symptoms in an unstable patient.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145411/1/cpmia0101.pd

Mucocèle appendiculaire : à propos d’un cas observé à Lubumbashi

La mucocèle appendiculaire est une entité pathologique rare, mais potentiellement dangereuse, elle se  présente sous différentes formes cliniques. Nous rapportons ici un cas d'une patiente âgée de 49 ans sans antécédents chirurgicaux chez qui nous avons découvert d'une façon fortuite cette affection. La clinique était celle d'un syndrome appendiculaire aigu patent et elle révélait une masse dans la fosse iliaque droite. Les  examens de laboratoire ont montré une hyperleucocytose et une vitesse de sédimentation augmentée.  L'échographie a démontré une masse kystique péricaecal. La patiente a subi une appendicectomie avec  cæcectomie partielle et la pièce opératoire appendiculaire mesurait 153 mm de longueur et 64 mm de  diamètre. L'analyse anatomopathologique de celle-ci a confirmé le diagnostic de mucocèle appendiculaire sans cellules de malignité. Les suites opératoires ont été simples et la patiente est sortie au cinquième jour  postopératoire.Key words: Mucocèle appendiculaire, Tumeur mucosécrétante appendiculaire, Appendicite, Lubumbash