Cerebral infarction in diabetes: Clinical pattern, stroke subtypes,and predictors of in-hospital mortality

Background: To compare the characteristics and prognostic features of ischemic stroke in patients with diabetes and without diabetes, and to determine the independent predictors of in-hospital mortality in people with diabetes and ischemic stroke.Methods: Diabetes was diagnosed in 393 (21.3%) of 1,840 consecutive patients with cerebral infarction included in a prospective stroke registry over a 12-year period. Demographic characteristics, cardiovascular risk factors, clinical events, stroke subtypes, neuroimaging data, and outcome in ischemic stroke patients with and without diabetes were compared. Predictors of in-hospital mortality in diabetic patients with ischemic stroke were assessed by multivariate analysis. Results: People with diabetes compared to people without diabetes presented more frequently atherothrombotic stroke (41.2% vs 27%) and lacunar infarction (35.1% vs 23.9%) (P < 0.01). The in-hospital mortality in ischemic stroke patients with diabetes was 12.5% and 14.6% in those without (P = NS). Ischemic heart disease, hyperlipidemia, subacute onset, 85 years old or more, atherothrombotic and lacunar infarcts, and thalamic topography were independently associated with ischemic stroke in patients with diabetes, whereas predictors of in-hospital mortality included the patient's age, decreased consciousness, chronic nephropathy, congestive heart failure and atrial fibrillation. Conclusion: Ischemic stroke in people with diabetes showed a different clinical pattern from those without diabetes, with atherothrombotic stroke and lacunar infarcts being more frequent. Clinical factors indicative of the severity of ischemic stroke available at onset have a predominant influence upon in-hospital mortality and may help clinicians to assess prognosis more accurately.

Estudio comparativo de dos estrategias para el tratamiento del dolor durante la ablación de fibrilación auricular: analgesia frente a sedación

Antecedentes: Las aplicaciones de radiofrecuencia durante la ablación de la fibrilación auricular (FA) producen dolor y ansiedad. El tratamiento habitual se basa en la administración de analgésicos y sedación. La sedación intensa puede producir inestabilidad hemodinámica y desaturaciones.Objetivos: Comparar la incidencia de desaturaciones en relación a la utilización de dos protocolos distintos de tratamiento del dolor durante la ablación de FA. Uno de los protocolos está basado en la sedación con propofol (protocolo 1) y el otro en la analgesia intensa (protocolo 2).Resultados: Hemos analizado los datos de recogidos durante el procedimiento en un grupo de 43 pacientes tratados según el protocolo 1 y otro grupo de 43 pacientes tratados según el protocolo 2. Las variables analizadas han sido: la desaturación máxima, la dosis media de propofol y la dosis media de fentanilo. Las dosis de propofol necesarias en los pacientes del protocolo 1 han sido mayores que con el protocolo 2 (2,4±1,4mg/kg vs 1,7±0,5 mg/kg; p=0,005). La dosis de fentanilo en los pacientes del protocolo 1 han sido menores que en los del protocolo 2 (35,4±17,3mg vs 51,1±18,6mg vs; p<0,001). El 83,65% de los pacientes del protocolo 2 se mantuvo por encima del 94% de saturación frente al 58,1% de pacientes del protocolo 1. Conclusiones: Con el tratamiento basado en la analgesia para los procedimientos de ablación de FA se consigue que una menor proporción de pacientes tengan desaturaciones.

Multislice CT for assessing in-stent dimensions after left main coronary artery stenting: a comparison with three dimensional intravascular ultrasound

Objective: To evaluate the agreement between multislice CT (MSCT) and intravascular ultrasound (IVUS) to assess the in-stent lumen diameters and lumen areas of left main coronary artery (LMCA) stents. Design: Prospective, observational single centre study. Setting: A single tertiary referral centre. Patients: Consecutive patients with LMCA stenting excluding patients with atrial fibrillation and chronic renal failure. Interventions: MSCT and IVUS imaging at 912 months follow-up were performed for all patients. Main outcome measures: Agreement between MSCT and IVUS minimum luminal area (MLA) and minimum luminal diameter (MLD). A receiver operating characteristic (ROC) curve was plotted to find the MSCT cut-off point to diagnose binary restenosis equivalent to 6 mm2 by IVUS. Results: 52 patients were analysed. PassingBablok regression analysis obtained a β coefficient of 0.786 (0.586 to 1.071) for MLA and 1.250 (0.936 to 1.667) for MLD, ruling out proportional bias. The α coefficient was −3.588 (−8.686 to −0.178) for MLA and −1.713 (−3.583 to −0.257) for MLD, indicating an underestimation trend of MSCT. The ROC curve identified an MLA ≤4.7 mm2 as the best threshold to assess in-stent restenosis by MSCT. Conclusions: Agreement between MSCT and IVUS to assess in-stent MLA and MLD for LMCA stenting is good. An MLA of 4.7 mm2 by MSCT is the best threshold to assess binary restenosis. MSCT imaging can be considered in selected patients to assess LMCA in-stent restenosis

Multislice CT for assessing in-stent dimensions after left main coronary artery stenting: a comparison with three dimensional intravascular ultrasound

Objective: To evaluate the agreement between multislice CT (MSCT) and intravascular ultrasound (IVUS) to assess the in-stent lumen diameters and lumen areas of left main coronary artery (LMCA) stents. Design: Prospective, observational single centre study. Setting: A single tertiary referral centre. Patients: Consecutive patients with LMCA stenting excluding patients with atrial fibrillation and chronic renal failure. Interventions: MSCT and IVUS imaging at 9-12 months follow-up were performed for all patients. Main outcome measures: Agreement between MSCT and IVUS minimum luminal area (MLA) and minimum luminal diameter (MLD). A receiver operating characteristic (ROC) curve was plotted to find the MSCT cut-off point to diagnose binary restenosis equivalent to 6 mm2 by IVUS. Results: 52 patients were analysed. Passing-Bablok regression analysis obtained a β coefficient of 0.786 (0.586 to 1.071) for MLA and 1.250 (0.936 to 1.667) for MLD, ruling out proportional bias. The α coefficient was −3.588 (−8.686 to −0.178) for MLA and −1.713 (−3.583 to −0.257) for MLD, indicating an underestimation trend of MSCT. The ROC curve identified an MLA ≤4.7 mm2 as the best threshold to assess in-stent restenosis by MSCT. Conclusions: Agreement between MSCT and IVUS to assess in-stent MLA and MLD for LMCA stenting is good. An MLA of 4.7 mm2 by MSCT is the best threshold to assess binary restenosis. MSCT imaging can be considered in selected patients to assess LMCA in-stent restenosis

Construction and validation of a scoring system for the selection of high-quality data in a Spanish population primary care database (SIDIAP)

Background Computerised databases of primary care clinical records are widely used for epidemiological research. In Catalonia, the InformationSystem for the Development of Research in Primary Care (SIDIAP) aims to promote the development of research based on high-quality validated data from primary care electronic medical records. Objective The purpose of this study is to create and validate a scoring system (Registry Quality Score, RQS) that will enable all primary care practices (PCPs) to be selected as providers of researchusable data based on the completeness of their registers. Methods Diseases that were likely to be representative of common diagnoses seen in primary care were selected for RQS calculations. The observed/ expected cases ratio was calculated for each disease. Once we had obtained an estimated value for this ratio for each of the selected conditions we added up the ratios calculated for each condition to obtain a final RQS. Rate comparisons between observed and published prevalences of diseases not included in the RQS calculations (atrial fibrillation, diabetes, obesity, schizophrenia, stroke, urinary incontinenceand Crohn’s disease) were used to set the RQS cutoff which will enable researchers to select PCPs with research-usable data. Results Apart from Crohn’s disease, all prevalences were the same as those published from the RQS fourth quintile (60th percentile) onwards. This RQS cut-off provided a total population of 1 936 443 (39.6% of the total SIDIAP population). Conclusions SIDIAP is highly representative of the population of Catalonia in terms of geographical, age and sex distributions. We report the usefulness of rate comparison as a valid method to establish research-usable data within primary care electronic medical records

Species resolved analysis of the expansion of hydroxyapatite laser ablation plumes

The plume generated by ablation of hydroxyapatite targets under ArF excimer laser irradiation has been investigated by means of fast intensified CCD-imaging and optical emission spectroscopy. Results have shown that the plume splits into two plasma clouds as it expands. Time and spatial resolved spectra have revealed that under the experiment conditions emission is mostly due to calcium neutral atoms and calcium oxide molecular radicals. Imaging of the plume with the aid of bandpass filters has demonstrated that the emissive species in the larger and faster plasma cloud are calcium neutral atoms, whereas in the smaller and slower one they are calcium oxide molecular radicals

Characterization of hydroxyapatite laser ablation plumes by fast intensified CCD-imaging

ArF excimer laser pulses (193 nm, 20 ns, 150 mJ) have been focused on a hydroxyapatite (HA) target in similar conditions to those normally used for thin film deposition. Fast intensified CCD images of HA laser ablation plumes have been taken in vacuum and under different water vapor pressures ranging from 0.01 mbar to 1 mbar. Images of HA ablation in vacuum have shown a plume freely expanding at a constant velocity of 2.3 106 cm/s. HA ablation under a water vapor pressure of 0.01 mbar has revealed an expansion behavior very similar to that of ablation in vacuum. Images taken under a water vapor pressure of 0.1 mbar have shown the formation of a shock structure in the plume. Finally, HA ablation under a water vapor pressure of 1 mbar has revealed the development of some irregularities in the shape of the plume.

Evidence of chemical reactions in the hydroxyapatite laser ablation plume with a water atmosphere

The expansion dynamics of the ablation plume generated by KrF laser irradiation of hydroxyapatite targets in a 0.1 mbar water atmosphere has been studied by fast intensified charge coupled device imaging with the aid of optical bandpass filters. The aim of the filters is to isolate the emission of a single species, which allows separate analysis of its expansion. Images obtained without a filter revealed two emissive components in the plume, which expand at different velocities for delay times of up to 1.1 ¿s. The dynamics of the first component is similar to that of a spherical shock wave, whereas the second component, smaller than the first, expands at constant velocity. Images obtained through a 520 nm filter show that the luminous intensity distribution and evolution of emissive atomic calcium is almost identical to those of the first component of the total emission and that there is no contribution from this species to the emission from the second component of the plume. The analysis through a 780 nm filter reveals that atomic oxygen partially diffuses into the water atmosphere and that there is a contribution from this species to the emission from the second component. The last species studied here, calcium oxide, was analyzed by means of a 600 nm filter. The images revealed an intensity pattern more complex than those from the atomic species. Calcium oxide also contributes to the emission from the second component. Finally, all the experiments were repeated in a Ne atmosphere. Comparison of the images revealed chemical reactions between the first component of the plume and the water atmosphere.

Selective ablation of photovoltaic materials with UV laser sources for monolithic interconnection of devices based on a-Si:H

Lasers are essential tools for cell isolation and monolithic interconnection in thin-film-silicon photovoltaic technologies. Laser ablation of transparent conductive oxides (TCOs), amorphous silicon structures and back contact removal are standard processes in industry for monolithic device interconnection. However, material ablation with minimum debris and small heat affected zone is one of the main difficulty is to achieve, to reduce costs and to improve device efficiency. In this paper we present recent results in laser ablation of photovoltaic materials using excimer and UV wavelengths of diode-pumped solid-state (DPSS) laser sources. We discuss results concerning UV ablation of different TCO and thin-film silicon (a-Si:H and nc-Si:H), focussing our study on ablation threshold measurements and process-quality assessment using advanced optical microscopy techniques. In that way we show the advantages of using UV wavelengths for minimizing the characteristic material thermal affection of laser irradiation in the ns regime at higher wavelengths. Additionally we include preliminary results of selective ablation of film on film structures irradiating from the film side (direct writing configuration) including the problem of selective ablation of ZnO films on a-Si:H layers. In that way we demonstrate the potential use of UV wavelengths of fully commercial laser sources as an alternative to standard backscribing process in device fabrication.