Early recurrent ischemic stroke in stroke patients undergoing intravenous thrombolysis

BACKGROUND: We assessed the incidence of early recurrent ischemic stroke in stroke patients treated with intravenous tissue-type plasminogen activator (tPA) and the temporal pattern of its occurrence compared with symptomatic intracranial hemorrhage (ICH). METHODS AND RESULTS: Prospectively collected, population-based data for 341 consecutive acute stroke patients (62% men; mean age, 66 years) treated with tPA according to the National Institute of Neurological Disorders and Stroke study protocol at 8 medical centers in Switzerland (3 academic and 5 community) between January 2001 and November 2004 were retrospectively analyzed. The primary outcome measure was neurological deterioration > or = 4 points on the National Institutes of Health Stroke Scale occurring within 24 hours of tPA treatment and caused either by recurrent ischemic stroke (defined as the occurrence of new neurological symptoms suggesting involvement of initially unaffected vascular territories and evidence of corresponding ischemic lesions on cranial computed tomography scans, in the absence of ICH) or by ICH. Early recurrent ischemic stroke was diagnosed in 2 patients (0.59%; 95% confidence interval, 0.07% to 2.10%) and symptomatic ICH in 15 patients (4.40%; 95% confidence interval, 2.48% to 7.15%). Both recurrent ischemic strokes occurred during thrombolysis, whereas symptomatic ICHs occurred 2 to 22 hours after termination of tPA infusion. CONCLUSIONS: Recurrent ischemic stroke is a rare cause of early neurological deterioration in acute stroke patients undergoing intravenous thrombolysis, with a different temporal pattern compared with that of symptomatic ICH.

Efalizumab-associated papular psoriasis

BACKGROUND: Efalizumab is a human anti-CD11a monoclonal antibody used in the treatment of patients with moderate to severe plaque psoriasis. Some of the patients develop new papular lesions during treatment, which are predominantly located in the flexural regions. OBSERVATION: Four patients with recalcitrant psoriasis undergoing treatment with efalizumab presented with erythematous, partly scaly papules and small plaques on previously unaffected areas after 4 to 10 weeks of efalizumab therapy. Tissue sections of biopsy specimens were stained with hematoxylin-eosin, and immunohistochemical staining was performed using monoclonal antibodies against CD3, CD4, CD8, T-cell-restricted intracellular antigen 1, granzyme B, neutrophil elastase, CD68, CD1a, CD11c, HLA-DR, CD25, CD20, and CD56. Histopathological and immunohistochemical examination of the lesions showed features consistent with psoriasis and activation of various leukocyte subtypes including T cells, dendritic cells, macrophages, and neutrophils. CONCLUSIONS: Papular eruptions appearing during efalizumab therapy represent new psoriatic lesions and could be referred to as efalizumab-associated papular psoriasis (EAPP). They usually do not necessitate termination of efalizumab therapy and may optionally be treated with topical corticosteroids. Dermatologists should be aware of these lesions and inform their patients accordingly.

Transcriptional silencing of nonsense codon-containing immunoglobulin micro genes requires translation of its mRNA

Eukaryotes have evolved quality control mechanisms that prevent the expression of genes in which the protein coding potential is crippled by the presence of a premature translation-termination codon (PTC). In addition to nonsense-mediated mRNA decay (NMD), a well documented posttranscriptional consequence of the presence of a PTC in an mRNA, we recently reported the transcriptional silencing of PTC-containing immunoglobulin (Ig) mu and gamma minigenes when they are stably integrated into the genome of HeLa cells. Here we demonstrate that this transcriptional silencing of PTC-containing Ig-mu constructs requires active translation of the cognate mRNA, as it is not observed under conditions where translation of the PTC-containing mRNA is inhibited through an iron-responsive element in the 5'-untranslated region. Furthermore, RNA interference-mediated depletion of the essential NMD factor Upf1 not only abolishes NMD but also reduces the extent of nonsense-mediated transcriptional gene silencing (NMTGS). Collectively, our data indicate that NMTGS and NMD are linked, relying on the same mechanism for PTC recognition, and that the NMTGS pathway branches from the NMD pathway at a step after Upf1 function.

Effectiveness of chlamydia screening: systematic review

BACKGROUND: Screening programmes are promoted to control transmission of and prevent female reproductive tract morbidity caused by genital chlamydia. The objective of this study was to examine the effectiveness of register-based and opportunistic chlamydia screening interventions. METHODS: We searched seven electronic databases (Cinahl, Cochrane Controlled Trials Register, DARE, Embase, Medline, PsycINFO and SIGLE) without language restrictions from January 1990 to October 2007 and reference lists of retrieved articles to identify studies published before 1990. We included studies examining primary outcomes (pelvic inflammatory disease, ectopic pregnancy, infertility, adverse pregnancy outcomes, neonatal infection, chlamydia prevalence) and harms of chlamydia screening in men and non-pregnant and pregnant women. We extracted data in duplicate and synthesized the data narratively or used random effects meta-analysis, where appropriate. RESULTS: We included six systematic reviews, five randomized trials, one non-randomized comparative study and one time trend study. Five reviews recommended screening of women at high risk of chlamydia. Two randomized trials found that register-based screening of women at high risk of chlamydia and of female and male high school students reduced the incidence of pelvic inflammatory disease in women at 1 year. Methodological inadequacies could have overestimated the observed benefits. One randomized trial showed that opportunistic screening in women undergoing surgical termination of pregnancy reduced post-abortal rates of pelvic inflammatory disease compared with no screening. We found no randomized trials showing a benefit of opportunistic screening in other populations, no trial examining the effects of more than one screening round and no trials examining the harms of chlamydia screening. CONCLUSION: There is an absence of evidence supporting opportunistic chlamydia screening in the general population younger than 25 years, the most commonly recommended approach. Equipoise remains, so high-quality randomized trials of multiple rounds of screening with biological outcome measures are still needed to determine the balance of benefits and harms of chlamydia screening.

Recurrent voluminous sector collapses at Volcán Barú, Panama

Two volcanic debris avalanche deposits (VDADs), both attributed to sector collapse at Volcán Barú, Panama, have been identified after an investigation of deposits that covered more than a thousand square kilometers. The younger Barriles Deposit is constrained by two radiocarbon ages that are ~9 ka; the older Caisán Deposit is at or beyond the radiocarbon range, >43,500 ybp. The total runout length of the Caisán Deposit was ~50 km and it covers 1190 km2. The Barriles Deposit extended to about 45 km and covered an area of 966 km2, overlapping most of the Caisán. The VDADs are blanketed by pyroclastic deposits and contain a predominance of andesitic material likely representing volcanic dome rock which accumulated above the active vent at Barú before collapsing. Despite heavy vegetation in the field area, over 4000 individual hummocks were digitized from aerial photography. Statistical analysis of hummock locations and geometries depict flow patterns of highly- fragmented material reflecting the effects of underlying topography and also help to define the limit of Barriles’ shorter termination. Barriles and Caisán are primarily unconfined, subaerial volcanic deposits that are among the world’s most voluminous. Calculated through two different geospatial processes, thickness values from field measurements and inferences yield volumes >30 km23 for both deposits. VDADs of comparable scale come from Mount Shasta, USA; Socompa, Chile/Argentina; and Shiveluch, Russia. Currently, the modern edifice is 200-400m lower than the pre-collapse Barriles and Caisán summits and only 16-25% of the former edifice has been replaced since the last failure.

Mechanical modeling of Intraneural Ganglion Cyst

Intraneural Ganglion Cyst is a 200 year old mystery related to nerve injury which is yet to be solved. Current treatments for the above problem are relatively simple procedures related to removal of cystic contents from the nerve. However, these treatments may result into neuropathic pain and recurrence of the cyst. The articular theory proposed by Spinner et al., (Spinner et al. 2003) takes into consideration the neurological deficit in Common Peroneal Nerve (CPN) branch of the sciatic nerve and affirms that in addition to the above treatments, ligation of articular branch results into foolproof eradication of the deficit. Mechanical Modeling of the Affected Nerve Cross Section will reinforce the articular theory (Spinner et al. 2003). As the cyst propagates, it compresses the neighboring fascicles and the nerve cross section appears like a signet ring. Hence, in order to mechanically model the affected nerve cross section; computational methods capable of modeling excessively large deformations are required. Traditional FEM produces distorted elements while modeling such deformations, resulting into inaccuracies and premature termination of the analysis. The methods described in this Master’s Thesis are effective enough to be able to simulate such deformations. The results obtained from the model adequately resemble the MRI image obtained at the same location and shows an appearance of a signet ring. This Master’s Thesis describes the neurological deficit in brief followed by detail explanation of the advanced computational methods used to simulate this problem. Finally, qualitative results show the resemblance of mechanical model to MRI images of the Nerve Cross Section at the same location validating the capability of these methods to study this neurological deficit.

The effects of soil moisture, field-scale toposequential position, and slope on yields in irrigated upland rice fields in Flores, Comayagua, Honduras

Rice (Oryza sativa L.) is an important cash crop in Honduras because of the rice lobby’s size, willingness to protest, and ability to negotiate favorable price guarantees on a year-to-year basis. Despite the availability of inexpensive irrigation in the study area in Flores, La Villa de San Antonio, Comayagua, the rice farmers do not cultivate the crop using prescribed methods such as land leveling, puddling, and water conservation structures. Soil moisture (Volumetric Water Content) was measured using a soil moisture probe after the termination of the first irrigation within the tillering/vegetative, panicle emergence/flowering, post-flowering/pre-maturation and maturation stages. Yield data was obtained by harvesting on 1 m2 plots in each soil moisture testing site. Data was analyzed to find the influence of toposequential position along transects, slope, soil moisture, and farmers on yields. The results showed that toposequential position was more important than slope and soil moisture on yields. Soil moisture was not a significant predictor of rice yields. Irrigation politics, precipitation, and land tenure were proposed as the major explanatory variables for this result.

MODULARITY BASED FUZZY COMMUNITY DETECTION IN SOCIAL NETWORKS

Fuzzy community detection is to identify fuzzy communities in a network, which are groups of vertices in the network such that the membership of a vertex in one community is in [0,1] and that the sum of memberships of vertices in all communities equals to 1. Fuzzy communities are pervasive in social networks, but only a few works have been done for fuzzy community detection. Recently, a one-step forward extension of Newman’s Modularity, the most popular quality function for disjoint community detection, results into the Generalized Modularity (GM) that demonstrates good performance in finding well-known fuzzy communities. Thus, GMis chosen as the quality function in our research. We first propose a generalized fuzzy t-norm modularity to investigate the effect of different fuzzy intersection operators on fuzzy community detection, since the introduction of a fuzzy intersection operation is made feasible by GM. The experimental results show that the Yager operator with a proper parameter value performs better than the product operator in revealing community structure. Then, we focus on how to find optimal fuzzy communities in a network by directly maximizing GM, which we call it Fuzzy Modularity Maximization (FMM) problem. The effort on FMM problem results into the major contribution of this thesis, an efficient and effective GM-based fuzzy community detection method that could automatically discover a fuzzy partition of a network when it is appropriate, which is much better than fuzzy partitions found by existing fuzzy community detection methods, and a crisp partition of a network when appropriate, which is competitive with partitions resulted from the best disjoint community detections up to now. We address FMM problem by iteratively solving a sub-problem called One-Step Modularity Maximization (OSMM). We present two approaches for solving this iterative procedure: a tree-based global optimizer called Find Best Leaf Node (FBLN) and a heuristic-based local optimizer. The OSMM problem is based on a simplified quadratic knapsack problem that can be solved in linear time; thus, a solution of OSMM can be found in linear time. Since the OSMM algorithm is called within FBLN recursively and the structure of the search tree is non-deterministic, we can see that the FMM/FBLN algorithm runs in a time complexity of at least O (n2). So, we also propose several highly efficient and very effective heuristic algorithms namely FMM/H algorithms. We compared our proposed FMM/H algorithms with two state-of-the-art community detection methods, modified MULTICUT Spectral Fuzzy c-Means (MSFCM) and Genetic Algorithm with a Local Search strategy (GALS), on 10 real-world data sets. The experimental results suggest that the H2 variant of FMM/H is the best performing version. The H2 algorithm is very competitive with GALS in producing maximum modularity partitions and performs much better than MSFCM. On all the 10 data sets, H2 is also 2-3 orders of magnitude faster than GALS. Furthermore, by adopting a simply modified version of the H2 algorithm as a mutation operator, we designed a genetic algorithm for fuzzy community detection, namely GAFCD, where elite selection and early termination are applied. The crossover operator is designed to make GAFCD converge fast and to enhance GAFCD’s ability of jumping out of local minimums. Experimental results on all the data sets show that GAFCD uncovers better community structure than GALS.

Characterization of a Coal Fly Ash-Cement Slurry by the Absolute Foam Index

This dissertation established a standard foam index: the absolute foam index test. This test characterized a wide range of coal fly ash by the absolute volume of air-entraining admixture (AEA) necessary to produce a 15-second metastable foam in a coal fly ash-cement slurry in a specified time. The absolute foam index test was used to characterize fly ash samples having loss on ignition (LOI) values that ranged from 0.17 to 23.3 %wt. The absolute foam index characterized the fly ash samples by absolute volume of AEA, defined as the amount of undiluted AEA solution added to obtain a 15-minute endpoint signified by 15-second metastable foam. Results were compared from several foam index test time trials that used different initial test concentrations to reach termination at selected times. Based on the coefficient of variation (CV), a 15-minute endpoint, with limits of 12 to 18 minutes was chosen. Various initial test concentrations were used to accomplish consistent contact times and concentration gradients for the 15-minute test endpoint for the fly ash samples. A set of four standard concentrations for the absolute foam index test were defined by regression analyses and a procedure simplifying the test process. The set of standard concentrations for the absolute foam index test was determined by analyzing experimental results of 80 tests on coal fly ashes with loss on ignition (LOI) values ranging from 0.39 to 23.3 wt.%. A regression analysis informed selection of four concentrations (2, 6, 10, and 15 vol.% AEA) that are expected to accommodate fly ashes with 0.39 to 23.3 wt.% LOI, depending on the AEA type. Higher concentrations should be used for high-LOI fly ash when necessary. A procedure developed using these standard concentrations is expected to require only 1-3 trials to meet specified endpoint criteria for most fly ashes. The AEA solution concentration that achieved the metastable foam in the foam index test was compared to the AEA equilibrium concentration obtained from the direct adsorption isotherm test with the same fly ash. The results showed that the AEA concentration that satisfied the absolute foam index test was much less than the equilibrium concentration. This indicated that the absolute foam index test was not at or near equilibrium. Rather, it was a dynamic test where the time of the test played an important role in the results. Even though the absolute foam index was not an equilibrium condition, a correlation was made between the absolute foam index and adsorption isotherms. Equilibrium isotherm equations obtained from direct isotherm tests were used to calculate the equilibrium concentrations and capacities of fly ash from 0.17 to 10.5% LOI. The results showed that the calculated fly ash capacity was much less than capacities obtained from isotherm tests that were conducted with higher initial concentrations. This indicated that the absolute foam index was not equilibrium. Rather, the test is dynamic where the time of the test played an important role in the results. Even though the absolute foam index was not an equilibrium condition, a correlation was made between the absolute foam index and adsorption isotherms for fly ash of 0.17 to 10.5% LOI. Several batches of mortars were mixed for the same fly ash type increasing only the AEA concentration (dosage) in each subsequent batch. Mortar air test results for each batch showed for each increase in AEA concentration, air contents increased until a point where the next increase in AEA concentration resulted in no increase in air content. This was maximum air content that could be achieved by the particular mortar system; the system reached its air capacity at the saturation limit. This concentration of AEA was compared to the critical micelle concentration (CMC) for the AEA and the absolute foam index.

[Artificial intravascular oxygenation (IVOX). Application to the treatment of postoperative respiratory failure]

Very recently, the concept of artificial intracorporeal oxygenation of blood for patients suffering from respiratory failure has been introduced into clinical practice through development of a totally implantable intravascular oxygenator (IVOX). We report on the use of such a device in a patient who developed severe respiratory insufficiency secondary to prolonged hypovolaemic shock and pneumonia following successful repair of a ruptured abdominal aortic aneurysm in September, 1990. Postoperatively, severe hypoxaemia occurred (AaDO2 548-602 torr) despite extensive mechanical ventilatory support. There was no obvious chance to overcome this situation by conventional therapeutic measures and the decision was made to institute IVOX therapy. Hypoxaemia was resolved immediately and both FiO2 and tidal volume could be reduced within hours. The patient's respiratory condition continued to improve over the next days leading to termination of IVOX therapy after 71 hours. However, the necessity of long-term ventilatory support secondary to recurrent pneumonia and sepsis, multiple abdominal reoperations for ischemic colitis and retroperitoneal abscess prolonged his recovery. He was discharged from the hospital after four months and is alive and well now 14 months after his operation. He is the first long-term survivor after IVOX therapy in Europe. IVOX may be successfully used in selected patients while the indications and it's potential role in the therapy of severe respiratory failure still need to be defined.

Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure

BACKGROUND: Psychological distress, poor disease-specific quality of life (QoL), and reduction in vagally mediated early heart rate recovery (HRR) after exercise, all previously predicted morbidity and mortality in patients with chronic heart failure (CHF). We hypothesized lower HRR with greater psychological distress and poorer QoL in CHF. DESIGN: All assessments were made at the beginning of a comprehensive cardiac outpatient rehabilitation intervention program. METHODS: Fifty-six CHF patients (mean 58+/-12 years, 84% men) completed the Hospital Anxiety and Depression Scale and the Minnesota Living With Heart Failure Questionnaire. HRR was determined as the difference between HR at the end of exercise and 1 min after exercise termination (HRR-1). RESULTS: Elevated levels of anxiety symptoms (P=0.005) as well as decreased levels of the Minnesota Living With Heart Failure Questionnaire total (P = 0.025), physical (P=0.026), and emotional (P=0.017) QoL were independently associated with blunted HRR-1. Anxiety, total, physical, and emotional QoL explained 11.4, 8, 7.8, and 9.0%, respectively, of the variance after controlling for covariates. Depressed mood was not associated with HRR-1 (P=0.20). CONCLUSION: Increased psychological distress with regard to elevated anxiety symptoms and impaired QoL were independent correlates of reduced HRR-1 in patients with CHF. Reduced vagal tone might explain part of the adverse clinical outcome previously observed in CHF patients in relation to psychological distress and poor disease-specific QoL.

The cranial bone window model: studying angiogenesis of primary and secondary bone tumors by intravital microscopy

The successful treatment of primary and secondary bone tumors in a huge number of cases remains one of the major unsolved challenges in modern medicine. Malignant primary bone tumor growth predominantly occurs in younger people, whereas older people predominantly suffer from secondary bone tumors since up to 85% of the most frequently occurring malignant solid tumors, such as lung, mammary, and prostate carcinomas, metastasize into the bone. It is well known that a tumor's course may be altered by its surrounding tissue. For this reason, reported here is the protocol for the surgical preparation of a cranial bone window in mice as well as the method to implant tumors in this bone window for further investigations of angiogenesis and other microcirculatory parameters in orthotopically growing primary or secondary bone tumors using intravital microscopy. Intravital microscopy represents an internationally accepted and sophisticated experimental method to study angiogenesis, microcirculation, and many other parameters in a wide variety of neoplastic and nonneoplastic tissues. Since most physiologic and pathophysiologic processes are active and dynamic events, one of the major strengths of chronic animal models using intravital microscopy is the possibility of monitoring the regions of interest in vivo continuously up to several weeks with high spatial and temporal resolution. In addition, after the termination of experiments, tissue samples can be excised easily and further examined by various in vitro methods such as histology, immunohistochemistry, and molecular biology.

Dextran sulfate modulates MAP kinase signaling and reduces endothelial injury in a rat aortic clamping model

OBJECTIVE: Mitogen-activated protein kinases (MAPKs), including JNK, p38, and ERK1/2, noticeably influence ischemia/reperfusion injury (IRI). The complement inhibitor dextran sulfate (DXS) associates with damaged endothelium denudated of its heparan sulfate proteoglycan (HSPG) layer. Other glycosaminoglycan analogs are known to influence MAPK signaling. Hypothetically therefore, targeted intravascular cytoprotection by DXS may function in part through influencing MAPK activation to reduce IRI-induced damage of the vasculature. METHODS: IRI of the infrarenal aorta of male Wistar rats was induced by 90 minutes clamping followed by 120 minutes reperfusion. DXS (5 mg/mL) or physiologic saline (NaCl controls) was infused locally into the ischemic aortic segment immediately prior to reperfusion. Ninety minutes ischemia-only and heparinase infusion (maximal damage) experiments, as well as native rat aorta, served as controls. Aortas were excised following termination of the experiments for further analysis. RESULTS: DXS significantly inhibited IRI-induced JNK and ERK1/2 activation (P = .043; P =.005) without influencing the p38 pathway (P =.110). Reduced aortic injury, with significant inhibition of apoptosis (P = .032 for DXS vs NaCl), correlated with decreased nuclear factor kappaB translocation within the aortic wall. DXS treatment clearly reduced C1q, C4b/c, C3b/c, and C9 complement deposition, whilst preserving endothelial cell integrity and reducing reperfusion-induced HSPG shedding. Protection was associated with binding of fluorescein labeled DXS to ischemically damaged tissue. CONCLUSIONS: Local application of DXS into ischemic vasculature immediately prior to reperfusion reduces complement deposition and preserves endothelial integrity, partially through modulating activation of MAPKs and may offer a new approach to tackle IRI in vascular surgical procedures. CLINICAL RELEVANCE: The purpose of the present study was to determine the role of dextran sulfate (DXS), a glycosaminoglycan analog and complement inhibitor, in modulating intracellular MAPK signaling pathways, reducing complement activation and ultimately attenuating ischemia/reperfusion injury (IRI) in a rat aortic-clamping model, in part a surrogate model to study the microvasculature. The study shows a role for DXS in ameliorating endothelial injury by reducing IRI-mediated damage and intravascular, local inflammation in the affected aortic segment. DXS may be envisaged as an endothelial protectant in vascular injury, such as occurs during vascular surgical procedures.

The Southern Hemisphere at glacial terminations: insights from the Dome C ice core

The many different proxy records from the European Project for Ice Coring in Antarctica (EPICA) Dome C ice core allow for the first time a comparison of nine glacial terminations in great detail. Despite the fact that all terminations cover the transition from a glacial maximum into an interglacial, there are large differences between single terminations. For some terminations, Antarctic temperature increased only moderately, while for others, the amplitude of change at the termination was much larger. For the different terminations, the rate of change in temperature is more similar than the magnitude or duration of change. These temperature changes were accompanied by vast changes in dust and sea salt deposition all over Antarctica. Here we investigate the phasing between a South American dust proxy (non-sea-salt calcium flux, nssCa2+), a sea ice proxy (sea salt sodium flux, ssNa+) and a proxy for Antarctic temperature (deuterium, δD). In particular, we look into whether a similar sequence of events applies to all terminations, despite their different characteristics. All proxies are derived from the EPICA Dome C ice core, resulting in a relative dating uncertainty between the proxies of less than 20 years. At the start of the terminations, the temperature (δD) increase and dust (nssCa2+ flux) decrease start synchronously. The sea ice proxy (ssNa+ flux), however, only changes once the temperature has reached a particular threshold, approximately 5°C below present day temperatures (corresponding to a δD value of −420‰). This reflects to a large extent the limited sensitivity of the sea ice proxy during very cold periods with large sea ice extent. At terminations where this threshold is not reached (TVI, TVIII), ssNa+ flux shows no changes. Above this threshold, the sea ice proxy is closely coupled to the Antarctic temperature, and interglacial levels are reached at the same time for both ssNa+ and δD. On the other hand, once another threshold at approximately 2°C below present day temperature is passed (corresponding to a δD value of −402‰), nssCa2+ flux has reached interglacial levels and does not change any more, despite further warming. This threshold behaviour most likely results from a combination of changes to the threshold friction velocity for dust entrainment and to the distribution of surface wind speeds in the dust source region.

A Primer on ACTA What Europeans Should Fear about the Anti-Counterfeiting Trade Agreement

The European Commission recently published the first official draft of the Anti-Counterfeiting Trade Agreement (ACTA). The article describes the institutional background of the negotiations on ACTA and its relationship to the existing legal framework. The civil enforcement provisions and the Internet chapter are compared with the international and European instruments in the field. For the most part, ACTA will not oblige EU member states to enact rules that go beyond the already established European standards. But stricter rules could be implemented regarding injunctions against non-infringing intermediaries, strict liability rules for damages, and ex parte measures in preliminary proceedings. According to the published draft, the termination of user accounts in the case of repeated intellectual property infringement will not be mandatory for member ACTA states.