Models containing age and NIHSS predict recovery of ambulation and upper limb function six months after stroke : an observational study

Questions What is the incidence of recovery of ambulation and upper limb function six months after stroke? Can measures such as age and the National Institutes of Health Stroke Scale (NIHSS) be used to develop models to predict the recovery of ambulation and upper limb function? Design Prospective cohort study. Participants Consecutive sample of 200 people with stroke admitted to a Sydney Hospital. Outcome measures Ambulation was measured with item 5 of the Motor Assessment Scale (MAS); patients scoring ≥ 3 could ambulate independently. Upper limb function was measured with items 7 and 8 of the MAS; patients scoring ≥ 5 could move a cup across the table and feed themselves with a spoonful of liquid with the hemiplegic arm. Results Of the 114 stroke survivors who were unable to ambulate initially, 80 (70%) achieved independent ambulation at six months. Of the 51 stroke survivors who could not move a cup across the table initially, 21 (41%) achieved the upper limb task at six months. Of the 56 stroke survivors who were unable to feed themselves initially, 25 (45%) could feed themselves at six months. Models containing age and severity of stroke (measured with NIHSS) predicted recovery of ambulation and ability to move a cup across the table, whilst a model containing severity of stroke predicted ability to feed oneself. All prediction models showed good discrimination (AUC 0.73 to 0.84). Conclusion More than two-thirds of people after stroke recovered independent ambulation and less than half recovered upper limb function at six months. Models using age and NIHSS can predict independent ambulation and upper limb function but these prediction models now require external validation before use in clinical practice

Desmoid Tumor Treated with Polychemotherapy Followed by Imatinib: A Case Report and Review of the Literature

Desmoid tumors, also known as aggressive fibromatosis, are tumors of intermediate dignity, which grow slowly but are locally aggressive. These tumors do not metastasize but can be potentially life threatening when infiltrating vital structures. The therapy strategy consists of surgery, radiation and systemic therapy with non-steroidal anti-inflammatory drugs, antiestrogen compounds and cytotoxic chemotherapy. We report on a 40-year-old male patient with advanced fibromatosis of the neck who has been treated with 7 cycles of polychemotherapy (adriablastin, ifosfamide and dacarbazine) followed by targeted therapy with imatinib. Tumor response was evaluated clinically and by magnetic resonance imaging. The tumor decreased significantly after the first cycle of chemotherapy and tumor-related symptoms declined. The response continued after switching to targeted therapy with imatinib, which is currently ongoing. The best treatment for this rare tumor remains under discussion. Doxorubicin and dacarbazine are frequently used agents. We included ifosfamide in our therapy, which is standard in the treatment of soft tissue tumors. The tyrosine kinase inhibitor imatinib seems to offer new possibilities and is currently investigated in randomized trials. We conclude that combination chemotherapy including doxorubicin, ifosfamide and dacarbazine in the treatment of aggressive fibromatosis should be considered for patients suffering from unresectable, advanced disease and clinical symptoms which require a rapid response to therapy

Vapor-Liquid Equilibrium of Ionic Liquid 7-Methyl-1,5,7-triazabicyclo[4.4.0]dec-5-enium Acetate and Its Mixtures with Water

Ionic liquids have the potential to be used for extracting valuable chemicals from raw materials. These processes often involve water, and after extraction, the water or other chemicals must be removed from the ionic liquid, so it can be reused. To help in designing such processes, we present data on the vapor-liquid equilibrium of the system containing protic ionic liquid 7-methyl-1,5,7-triazabicyclo [ 4.4.0 ] dec-5-enium acetate, water, acetic acid, and 7-methyl-1,5,7-triazabicyclo [4.4.0] dec-5-ene. Earlier studies have only focused on mixtures of water and an ionic liquid with a stoichiometric ratio of the ions. Here, we also investigated mixtures containing an excess of the acid or base component because in real systems with protic ionic liquids, the amount of acid and base in the mixture can vary. We modeled the data using both the ePC-SAFT and NRTL models, and we compared the performance of different modeling strategies. We also experimentally determined the vapor composition for a few of the samples, but none of the modeling strategies tested could accurately predict the concentration of the acid and base components in the vapor phase.Peer reviewe

Recycling of Superbase-Based Ionic Liquid Solvents for the Production of Textile-Grade Regenerated Cellulose Fibers in the Lyocell Process

This article has a correction concerning the authors: We regret that there is an error with the author list in our original article. The authors Jussi Helminen, Paulus Hyväri, and Ilkka Kilpeläinen, all with the Department of Chemistry, University of Helsinki, P.O. Box 55, FI-00014 Helsinki, Finland, were mistakenly omitted. The author list should be as shown above in this Addition and Correction. DOI 10.1021/acssuschemeng.0c07773Ioncell is a Lyocell based technology for the production of manmade cellulose fibers. This technology exploits the intrinsic dissolution power of superbase-based ionic liquids (ILs) toward cellulose and the ability to form spinnable cellulose solutions. The regenerated fibers are produced via a dry-jet wet spinning process in which the cellulose filaments are stretched in an air gap before regenerating in an aqueous coagulation medium. For the commercialization of this process, it is essential to demonstrate the quantitative recovery of the solvent from the coagulation bath without impairing its solvation power. This study reports on the spinnability and recyclability of the IL 7-methyl-1,5,7-triazabicyclo[4.4.0]dec-5-enium acetate ([mTBDH][OAc]) over five cycles in comparison to 1,5-diaza-bicyclo[4.3.0]non-5-enium acetate ([DBNH][OAc]). The aqueous IL solutions were recovered from the coagulation bath by successive thermal treatments under reduced pressure. Accordingly, the recycled ILs were utilized to dissolve 13 wt % cellulose pulp in each cycle without the addition of make-up IL. While using [mTBDH][OAc], the pulp was completely dissolved and processed into easily spinnable cellulose solutions during all five cycles, whereas the ability to dissolve pulp was completely lost after the first recovery cycle when using [DBNH][OAc]. The composition of the recovered ILs and extent of side-products generated in the adopted process was analyzed in detail. This includes characterization of the rheological properties of the solutions as well as the macromolecular and mechanical properties of the regenerated fibers. In addition, we review the toxicity of both solvents using Vibrio fischeri bacteria. Finally, the spun fibers from all [mTBDH][OAc] spinning trials were combined to produce a demonstration dress (Paju), designed and sewn by Marimekko Design House in Finland.Peer reviewe

Molecular profiling of soft-tissue sarcomas with FoundationOne® Heme identifies potential targets for sarcoma therapy: a single-centre experience

Background: Molecular diagnosis has become an established tool in the characterisation of adult soft-tissue sarcomas (STS). FoundationOne ® Heme analyses somatic gene alterations in sarcomas via DNA and RNA-hotspot sequencing of tumour-associated genes. Methods: We evaluated FoundationOne ® Heme testing in 81 localised STS including 35 translocation-associated and 46 complex-karyotyped cases from a single institution. Results: Although FoundationOne ® Heme achieved broad patient coverage and identified at least five genetic alterations in each sample, the sensitivity for fusion detection was rather low, at 42.4%. Nevertheless, potential targets for STS treatment were detected using the FoundationOne ® Heme assay: complex-karyotyped sarcomas frequently displayed copy-number alterations of common tumour-suppressor genes, particularly deletions in TP53 , NF1 , ATRX , and CDKN2A . A subset of myxofibrosarcomas (MFS) was amplified for HGF ( n  = 3) and MET ( n  = 1). PIK3CA was mutated in 7/15 cases of myxoid liposarcoma (MLS; 46.7%). Epigenetic regulators (e.g. MLL2 and MLL3 ) were frequently mutated. Conclusions: In summary, FoundationOne ® Heme detected a broad range of genetic alterations and potential therapeutic targets in STS (e.g. HGF/MET in a subset of MFS, or PIK3CA in MLS). The assay’s sensitivity for fusion detection was low in our sample and needs to be re-evaluated in a larger cohort

UK experience of liver transplantation for erythropoietic protoporphyria

Erythropoietic protoporphyria (EPP) is characterised by excess production of free protoporphyrin from the bone marrow, most commonly due to deficiency of the enzyme ferrochelatase. Excess protoporphyrin gives rise to the cutaneous photosensitivity characteristic of the disease, and in a minority of patients leads to end-stage liver disease necessitating liver transplantation (LT). There is limited information regarding the timing, impact and long-term outcome of LT in such patients, thus we aimed to identify the indications and outcomes of all transplants performed for EPP in the UK using data from the UK Transplant Registry. Between 1987 and 2009, five patients underwent LT for EPP liver disease. Median follow-up was 60 months, and there were two deaths at 44 and 95 months from causes unrelated to liver disease. The remaining recipients are alive at 22.4 years, 61 months and 55 months after transplant. A high rate of postoperative biliary stricturing requiring multiple biliary interventions was observed. Recurrent EPP-liver disease occurred in 4/5 (80%) of patients but graft failure has not been observed. Given the role of biliary obstruction in inducing EPP-mediated liver damage, we suggest that consideration should be given for construction of a Roux loop at the time of transplant. Thus we demonstrate that although EPP liver transplant recipients have a good long-term survival, comparable to patients undergoing LT for other indications, biliary complications and disease recurrence are almost universal, and bone marrow transplantation should be considered where possible