Factors influencing emergency delays in acute stroke management.

Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay. Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated. Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01). Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account.

Influence of socioeconomic factors on delays, management and outcome amongst patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

The outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is strongly affected by time delays. In this study, we sought to identify the impact of specific socioeconomic factors on time delays, subsequent STEMI management and outcomes in STEMI patients undergoing pPCI, who came from a well-defined region of the French part of Switzerland. A total of 402 consecutive patients undergoing pPCI for STEMI in a large tertiary hospital were retrospectively studied. Symptom-to-first-medical-contact time was analysed for the following socioeconomic factors: level of education, origin and marital status. Main exclusion criteria were: time delay beyond 12 hours, previous treatment with fibrinolytic agents or patients immediately referred for coronary artery bypass graft surgery. Therefore, 222 patients were finally included. At 1 year, there was no difference in mortality between the different socioeconomic groups. Furthermore, there was no difference in management characteristics between them. Symptom-to-first-medical-contact time was significantly longer for patients with a low level of education, Swiss citizens and unmarried patients, with median differences of 23 minutes, 18 minutes and 13 minutes, respectively (p <0.05). Nevertheless, no difference was found regarding in-hospital management and clinical outcome. This study demonstrates that symptom-to-first-medical-contact time is longer amongst people with a lower educational level, Swiss citizens and unmarried people. Because of the low mortality rate in general, these differences in delays did not affect clinical outcomes. Still, tertiary prevention measures should particularly focus on these vulnerable populations.

Dysregulated ADAM10-Mediated Processing of APP during a Critical Time Window Leads to Synaptic Deficits in Fragile X Syndrome.

The Fragile X mental retardation protein (FMRP) regulates neuronal RNA metabolism, and its absence or mutations leads to the Fragile X syndrome (FXS). The β-amyloid precursor protein (APP) is involved in Alzheimer's disease, plays a role in synapse formation, and is upregulated in intellectual disabilities. Here, we show that during mouse synaptogenesis and in human FXS fibroblasts, a dual dysregulation of APP and the α-secretase ADAM10 leads to the production of an excess of soluble APPα (sAPPα). In FXS, sAPPα signals through the metabotropic receptor that, activating the MAP kinase pathway, leads to synaptic and behavioral deficits. Modulation of ADAM10 activity in FXS reduces sAPPα levels, restoring translational control, synaptic morphology, and behavioral plasticity. Thus, proper control of ADAM10-mediated APP processing during a specific developmental postnatal stage is crucial for healthy spine formation and function(s). Downregulation of ADAM10 activity at synapses may be an effective strategy for ameliorating FXS phenotypes.

Factors affecting regional SMEs progression to Digital Business Ecosystems

SMEs are widely recognized as an important driving force of economic growth, yet, their uptake of ICT is still very low. Tosupport SMEs ICT adoption and to foster regional development, in 2000, the Lisbon Strategy on the Information Society andKnowledge-based economy created a vision for 2010 towards the creation of the European Digital Business Ecosystems(DBE). This paper is positioned within that context and reports upon a project involving 6000 SMEs whose aim was tosupport ICT adoption and to encourage SME networks through the creation of a Regional Business Portal. The papere xplores factors affecting the regional SMEs participating in the DBE. An in-depth longitudinal case study approach was adopted and multiple sources of evidence were used. Many factors affecting SMEs progression to DBE were identified:including people and organization, environmental, diffusion networks, technological, regional and time factors

Chicken anemia virus : an understanding of the in-vitro host response over time

Chicken anemia virus (CAV) is an economically important virus affecting the chicken meat and egg industry. CAV is characterized by anemia, lymphoid depletion, and immunosuppression. Microarrays were used to investigate the response of MDCC-MSB1 cells (MSB1) to infection with CAV at 24 and 48 h post-infection (hpi). The major genes responding to CAV infection include genes involved in inflammation, apoptosis, and antiviral activity. Several cytokines were differentially regulated at either 24 or 48 hpi, including interleukin 2 (IL-2), interleukin receptors IL-1R, IL-22R, IL-18R, and IL-7R, and interferon-α (IFN-α). While there were many genes differentially regulated in this experiment, only two genes were common to both time points, suggesting a dramatic change in gene expression over the two time points studied. The present study is the first microarray experiment to investigate CAV, and we identified a number of key pathways involved in viral infection. Overall, there were more genes upregulated at 24 hpi than at 48 hpi, including genes involved in cytokine signaling, apoptosis, and antiviral activity. The two time points were vastly different in their gene expression patterns, in that at 24 hpi there were many genes involved in the response to infection, whereas at 48 hpi there were many genes associated with apoptosis and immunosuppression.

CPITN: time and cost estimates for periodontal prevention and treatment procedures.

The aim of this study was to estimate the necessary time and cost for periodontal prevention and treatment in a working population from sugar and alcohol refineries in Araraquara, SP, Brazil. A stratified sample of 528 employees aged 18-64 from administrative, industrial and agricultural staffs was examined by one examiner, previously trained, according to the community periodontal index of treatment needs (CPITN). The time required for procedures and the cost was extrapolated to the total worker population. The results showed that the estimated time required for periodontal prevention/treatment was 4527 hours. Of this time, 1783 hours were required for oral hygiene instruction, 2531 for scaling, 151 for surgery and 62 for maintenance. The cost would be US $17,655 for hiring a dentist for 8 hours/day to provide oral hygiene instruction, scaling, surgery and maintenance. However, the cost would be US $9,028 for hiring a dentist for 4 hours/day to provide surgery and maintenance and a dental hygienist for 8 hours/day to provide scaling and oral hygiene instruction. Taking into account epidemiologic, technical and economic aspects, the decision relating to manpower should be this second option.

Calcium hydroxide root canal dressing. Histopathological evaluation of periapical repair at different time periods.

The objective of this study was to evaluate periapical and apical repair using calcium hydroxide root canal dressings for different lengths of times in teeth with induced chronic periapical lesions. A total of 61 root canals of maxillary and mandibular premolars from 4 dogs were used. After mechanical preparation of the root canals using the crown-down technique, and 5.25% NaOCl as irrigating solution, the apical foramen was enlarged in all cases. A calcium hydroxide root canal dressing was applied. The control group did not receive a root canal dressing. The animals were killed at 7, 15 or 30 days. After histological preparation, serial sections were stained with hematoxylin-eosin and Mallory's trichrome. The best histopathological results occurred at 15 and 30 days, and the worst results occurred at 7 days and in the control group.

Factors affecting somatic cell counts and their relations with milk and milk constituent yield in buffaloes

Data concerning daily milk yield (MY), percentage of milk fat (%F), protein (%P), lactose (%LT), and total solids (%TS), and somatic cell counts (SCC) for a herd of 222 Murrah buffalo reared in the state of São Paulo, Brazil, were collected monthly from 1997 to 2000 in order to study the factors affecting SCC and their relation to milk production and constituents during lactation. SCC decreased in the second month of lactation and increased thereafter, up to the ninth month of lactation. The interaction of month of lactation x order of calving was significant. Mean MY observed during the first month of lactation was 6.87 kg, which increased to 7.65 kg during the second month, and then decreased until the ninth month of lactation (3.83 kg). During the different months of lactation, %F, %P, %LT, and %TS ranged from 6.28 to 8.38%, 4.05 to 4.59%, 4.96 to 5.34%, and 16.94 to 18.55%, respectively. Calving year, calving order, and order of month of lactation significantly affected MY, %F, %P, %LT, and %TS. The regression coefficients of transformed SCC on MY and %LT were negative and significant during all months of lactation, showing that milk and lactose yield decreased with increased transformed SCC, causing losses to buffalo milk producers.

Effects of storage time on incubating egg gas pressure, thyroid hormones, and corticosterone levels in embryos and on their hatching parameters

Incubating eggs (1,800 total) produced by a commercial flock of Cobb broiler breeders were used to determine the effects of storage duration (3 and 18 d) on gas partial pressure, thyroid hormones, and hatching parameters. Partial pressure of oxygen (pO2) and carbon dioxide (pCO2) were measured on d 18 and at internal pipping (IP) during incubation. Blood samples were collected for determination of triiodothyronine (T3), thyroxine (T4), and corticosterone concentrations in the embryos at IP and in newly hatched chicks. From 464 to 510 h of incubation, eggs were checked individually every 2 h to determine the timing and duration of IP, external pipping (EP), and total hatching time. At 18 d of incubation and at IP, pCO2 was greater in air cell of eggs stored for 3 d compared to those stored for 18 d (P < 0.05), but pO2 was greater in eggs stored for 18 d. At IP, T3 and corticosterone levels were higher in plasma of the embryos of eggs stored for 3 d compared to those stored for 18 d, but it was the reverse in newly hatched chicks (P < 0.05). Embryos from eggs stored for 18 d required more time to complete IP compared to embryos of eggs stored for only 3 d (P < 0.05), whereas the duration of EP was not affected by storage. The overall longer incubation was, however, not only due to prolonged IP but also to later occurrence of IP. It was concluded that prolonged IP as a result of long storage may be related to the late increase in corticosterone level, which may be a necessary stimulus for higher T 3/T4 ratio, late increase in pCO2 level, and decrease in pO2. The effect of long storage was a delay in hatching and a continuous increase in T3 due to higher corticosterone levels between IP and hatching, which may be an indication of the more stressful event of hatching of embryos from eggs stored longer. Differences in pCO2, pO2, T3, T4, and corticosterone levels in the incubating eggs may be manifestations of these changes culminating in altered hatching parameters and consequently differences in chick quality and growth potentials.

Oxygen uptake kinetics and time to exhaustion in cycling and running: A comparison between trained and untrained subjects

The objective of the present study was to compare pulmonary gas exchange kinetics (VO 2 kinetics) and time to exhaustion (Tlim) between trained and untrained individuals during severe exercise performed on a cycle ergometer and treadmill. Eleven untrained males in running (UR) and cycling (UC), nine endurance cyclists (EC), and seven endurance runners (ER) were submitted to the following tests on separate days: (i) incremental test for determination of maximal oxygen uptake (VO 2max) and the intensity associated with the achievement of VO 2max (IVO 2max) on a mechanical braked cycle ergometer (EC and UC) and on a treadmill (ER and UR); (ii) all-out exercise bout performed at IVO 2max to determine the time to exhaustion at IVO 2max (Tlim) and the time constant of oxygen uptake kinetics (τ). The τ was significantly faster in trained group, both in cycling (EC = 28.2 ± 4.7 s; UC = 63.8 ± 25.0 s) and in running (ER = 28.5 ± 8.5 s; UR = 59.3 ± 12.0 s). Tlim of untrained was significantly lower in cycling (EC = 384.4 ± 66.6 s vs. UC; 311.1 ± 105.7 s) and higher in running (ER = 309.2 ± 176.6 s vs. UR = 439.8 ± 104.2 s). We conclude that the VO 2 kinetic response at the onset of severe exercise, carried out at the same relative intensity is sensitive to endurance training, irrespective of the exercise type. The endurance training seems to differently influence Tlim during exercise at IVO 2max in running and cycling. © 2003 Taylor & Francis Ltd.

Electromyographic fatigue threshold of the biceps brachii: The effect of endurance time

Muscle fatigue can be a limiting factor to determine index as the electromyographic fatigue threshold (EMGFT) due the alterations in motivation and disconfots. This way, the purpose of this study was to identify the right biceps brachii and left biceps brachii obtained from repetitive elbow flexions at each 10% of total time. Nine healthy subjects performed the exercise named biceps curl until exhaustion with 25%, 35%, and 45% of one repetition maximum, in three different days. EMG amplitude (root mean square - RMS) was obtained for concentric contractions during these load levels and correlated with time to determine the slope values for each load and them detemine the EMGFT. The EMGFT was obtained within of each 10% of total time and they were compared by analysis of variance. The results showed a progressive increase in RMS with time, for both muscles in all loads, characterizing the muscle fatigue process, and for the EMGFT values ware not found predominantly significant differences between the execution time, as well as between muscles (right biceps × left biceps). This protocol allowed to identify the EMGFT to both muscles during the biceps curl, which was similar at different percentage of total time, indicating the possibility to reduce the length of the contraction test without the need to maintain the contraction until exhaustion. Further studies are needed to evaluate the applicability of this method to determining the effects on performance.

Factors affecting the strength of denture repairs: Topics of interest

Fracture of dentures is a common clinical finding in daily prosthodontic practice, resulting in great inconvenience to both patient and dentist. A satisfactory repair should be cost-effective, simple to perform, and quick; it should also match the original color and not cause distortion to the existing denture. Different repair materials, surface designs, and mechanical and chemical surface treatments have been recommended in order to obtain stronger repairs. This article reviews some of the available literature with regard to the most important factors that may influence the strength of denture repairs. © 2007 by The American College of Prosthodontists.

Microhardness of glass ionomer cements indicated for the ART technique according to surface protection treatment and storage time

The aim of this study was to assess the microhardness of 5 glass ionomer cements (GIC) - Vidrion R (V, SS White), Fuji IX (F, GC Corp.), Magic Glass ART (MG, Vigodent), Maxxion R (MR, FGM) and ChemFlex (CF, Dentsply) - in the presence or absence of a surface protection treatment, and after different storage periods. For each GIC, 36 test specimens were made, divided into 3 groups according to the surface protection treatment applied - no protection, varnish or nail varnish. The specimens were stored in distilled water for 24 h, 7 and 30 days and the microhardness tests were performed at these times. The data obtained were submitted to the ANOVA for repeated measures and Tukey tests (α = 5%). The results revealed that the mean microhardness values of the GICs were, in decreasing order, as follows: F > CF = MR > MG > V; that surface protection was significant for MR, at 24 h, without protection (64.2 ± 3.6a), protected with GIC varnish (59.6 ± 3.4b) and protected with nail varnish (62.7 ± 2.8ab); for F, at 7 days, without protection (97.8 ± 3.7ab), protected with varnish (95.9 ± 3.2b) and protected with nail varnish (100.8 ± 3.4a); and at 30 days, for F, without protection (98.8 ± 2.6b), protected with varnish (103.3 ± 4.4a) and protected with nail varnish (101 ± 4.1ab) and, for V, without protection (46 ± 1.3b), protected with varnish (49.6 ± 1.7ab) and protected with nail varnish (51.1 ± 2.6a). The increase in storage time produced an increase in microhardness. It was concluded that the different GICs, surface protection treatments and storage times could alter the microhardness values.

Influence of concentration, time and method of application of citric acid and sodium citrate in root conditioning.

The aim of this study was to establish the parameters of concentration, time and mode of application of citric acid and sodium citrate in relation to root conditioning. A total of 495 samples were obtained and equally distributed among 11 groups (5 for testing different concentrations of citric acid, 5 for testing different concentrations of sodium citrate and 1 control group). After laboratorial processing, the samples were analyzed under scanning electron microscopy. A previously calibrated and blind examiner evaluated micrographs of the samples. Non-parametric statistical analysis was performed to analyze the data obtained. Brushing 25% citric acid for 3 min, promoted greater exposure of collagen fibers in comparison with the brushing of 1% citric acid for 1 minute and its topical application at 1% for 3 min. Sodium citrate exposed collagen fibers in a few number of samples. Despite the lack of statistical significance, better results for collagen exposure were obtained with brushing application of 25% citric acid for 3 min than with other application parameter. Sodium citrate produced a few number of samples with collagen exposure, so it is not indicated for root conditioning.