To identify and compare clinical and neuroimaging predictors of primary lobar intracerebral hemorrhage (ICH) recurrence, assessing their relative contributions to recurrent ICH.
Subjects were ...consecutive survivors of primary ICH drawn from a single-center prospective cohort study. Baseline clinical, imaging, and laboratory data were collected. Survivors were followed prospectively for recurrent ICH and intercurrent aspirin and warfarin use, including duration of exposure. Cox proportional hazards models were used to identify predictors of recurrence stratified by ICH location, with aspirin and warfarin exposures as time-dependent variables adjusting for potential confounders.
A total of 104 primary lobar ICH survivors were enrolled. Recurrence of lobar ICH was associated with previous ICH before index event (hazard ratio HR 7.7, 95% confidence interval CI 1.4-15.7), number of lobar microbleeds (HR 2.93 with 2-4 microbleeds present, 95% CI 1.3-4.0; HR = 4.12 when >or=5 microbleeds present, 95% CI 1.6-9.3), and presence of CT-defined white matter hypodensity in the posterior region (HR 4.11, 95% CI 1.01-12.2). Although aspirin after ICH was not associated with lobar ICH recurrence in univariate analyses, in multivariate analyses adjusting for baseline clinical predictors, it independently increased the risk of ICH recurrence (HR 3.95, 95% CI 1.6-8.3, p = 0.021).
Recurrence of lobar ICH is associated with previous microbleeds or macrobleeds and posterior CT white matter hypodensity, which may be markers of severity for underlying cerebral amyloid angiopathy. Use of an antiplatelet agent following lobar ICH may also increase recurrence risk.
We assessed sex differences in stroke prevalence among individuals of midlife age (35 to 64 years) in the United States and determined factors predicting stroke.
Data from 1999 to 2004 (n = 17,061) ...from the National Health and Nutrition Examination Survey, a nationally representative sample of US adults, were used to assess sex differences in stroke prevalence and to identify independent predictors of stroke occurrence among middle-aged individuals.
Women aged 45 to 54 years had significantly higher odds of having experienced a stroke vs men of the same age (odds ratio OR 2.39, 95% CI 1.32 to 4.32). No other significant midlife stroke differences between sexes were noted. A higher stroke trend was seen in 45- to 54-year-old women vs 35- to 44-year-old women (OR 2.13, 95% CI 0.95 to 4.80, p = 0.067), but no difference was seen in stroke rates in 55- to 64-year-old women vs 45- to 54-year-old women (OR 1.40, 95% CI 0.6912 to 2.8229, p = 0.352). Independent predictors of stroke in women aged 45 to 54 years were coronary artery disease (OR 12.790, 95% CI 1.901 to 86.063, p = 0.009) and waist circumference (OR 1.543, 95% CI 1.002 to 2.376, p = 0.049). Several vascular risk factors including systolic blood pressure and total cholesterol levels increased at higher rates among women compared with men in each successively older cohort from 35 to 64 years.
A higher prevalence of stroke may exist among women aged 45 to 54 years compared with similarly aged men. This potential disparity could be due in part to inadequate stroke risk factor modification in women and is deserving of further study.
Soluble Fas (sFas) and soluble Fas ligand (sFasL) are associated with cellular dysfunction and death and are elevated in CSF from patients with HIV dementia (HIV-D). The authors investigated whether ...these markers correlated with dementia severity and course. sFas and sFasL were measured in 15 highly active antiretroviral therapy (HAART)-naïve HIV-D subjects, 30 HAART-naïve HIV+ controls, and 17 HIV-controls. HIV-D subjects had higher CSF sFas levels than controls. Subjects with moderate/severe dementia had higher CSF sFas levels than those with mild dementia. CSF sFas trended lower in those with progressive dementia.
Intracerebral hemorrhage (ICH), which constitutes 10 to 15% of all strokes and affects approximately 65,000 people each year in the United States, has the highest mortality rate of all stroke ...subtypes. Hypertension, cerebral amyloid angiopathy, and anticoagulation underlie the majority of cases of ICH. Warfarin not only increases the risk but also increases the severity of ICH by causing hematoma expansion. With the advent of gradient-echo magnetic resonance imaging, patients with underlying cerebral amyloid angiopathy or hypertensive vasculopathy can be identified, and measures can be taken to prevent ICH. Initiating an antihypertensive regimen in a patient with nonlobar microbleeds suggestive of hypertensive vasculopathy, and withholding warfarin in patients with lobar microbleeds suggestive of cerebral amyloid angiopathy, are emerging prevention strategies. Although a treatment for cerebral amyloid angiopathy does not exist, agents targeting beta-amyloid metabolism and bioactivity are promising candidates. Strategies for preventing warfarin-associated hemorrhage include strict monitoring of anticoagulation levels and using agents such as direct thrombin inhibitors. The future of ICH management lies in therapies targeted at the pathophysiological steps in ICH. Potential treatments include glutamate receptor antagonists for preventing glutamate excitotoxicity, matrix metalloproteinase and thrombin inhibitors for preventing perihematomal edema, and recombinant activated factor VII for preventing hematomal expansion.
Building codes commonly accept inelastic deformations that inevitably occur due to seismic excursions in structures. To control the damage, limits on the inelastic deformations have been established. ...Standard passive energy dissipation systems have been used to reduce the damage, generally with some effectiveness. The damped rigid substructure (DRS) passive damping system, proposed in this article, geometrically amplifies the damper displacements and exerts a re-centering force, leading to effective discharge of the seismic energy to the extent that structural damage can be prevented. This is achieved using common damped and undamped diagonals arranged per implementation and design principles introduced in this article. The DRS system can considerably reduce material consumption and construction costs, leading to more sustainable structures when seismic forces govern the design. It can also benefit from the usage of high-strength materials to enhance its re-centering mechanism. The system is adaptable to the architectural needs and can be used for all categories of importance and height variation, made of steel or concrete.
There are stark inequities in stroke incidence, prevalence, acute care, rehabilitation, risk factor control, and outcomes. To address these inequities, it is critical to engage communities in ...identifying priorities and designing, implementing, and disseminating interventions. This issue of
features health equity themed lectures delivered during the International Stroke Conference and Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving meetings in 2021 as well as articles covering issues of disparities and diversity in stroke. Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, received the 2021 William Feinberg Award Lecture for his lifetime achievements in seeking global and local solutions to cerebrovascular health inequities. The second annual Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving symposium, which took place the day before the International Stroke Conference in February 2021, focused on community-engaged research for reducing inequities in stroke. Phil Gorelick, MD was awarded the Edgar J. Kenton III Award for his lifetime achievements in using community engagement strategies to recruit and retain Black participants in observational studies and clinical trials. Walter Koroshetz, MD, Director of the National Institute of Neurological Disorders and Stroke delivered the keynote lecture on stroke inequities and Richard Benson, MD, PhD, Director of the Office of Global Health and Health Disparities at National Institute of Neurological Disorders and Stroke, gave a lecture focused on National Institute of Neurological Disorders and Stroke efforts to address inequities. Nichols et al highlighted approaches of community-based participatory research to address stroke inequities. Verma et al showcased digital health innovations to reduce inequities in stroke. Das et al showed that the proportion of underrepresented in medicine vascular neurology fellows has lowered over the past decade and authors provided a road map for enhancing the diversity in vascular neurology. Clearly, to overcome inequities, multipronged strategies are required, from broadening representation among vascular neurology faculty to partnering with communities to conduct research with meaningful impact.
There are stark inequities in stroke incidence, prevalence, care, and outcomes. This issue of
features manuscripts from the third annual HEADS-UP (Health Equity and Actionable Disparities in Stroke: ...Understanding and Problem-Solving) symposium, which took place the day before the International Stroke Conference in February 2022. The 2022 HEADS-UP symposium focused on clinical trials to address stroke inequities. The 2022 Edgar J. Kenton III award was awarded to Moira Kapral. In Kenton Award Lecture-Stroke Disparities Research: Learning from the Past, Planning for the Future, Kapral details 10 key considerations for researchers interested in addressing inequities in stroke. These considerations provide an insightful, evidence-based roadmap for the future of stroke inequities research. In the article, Care Transition Interventions to Improve Stroke Outcomes, Reeves et al highlight barriers faced by historically disenfranchised populations navigating transitions in the stroke continuum of care; summarize clinical trials aimed at enhancing transitions in care, particularly in historically marginalized populations; and stress the importance of co-designing future interventions with patient populations to address inequities. In Telehealth Trials to Enhance Health Equity for Patients With Stroke, Sharrief et al detail how telehealth interventions have the potential to address inequities if they are implemented in a thoughtful manner, addressing the potential factors than can exacerbate a digital divide. Finally, in Polypill Programs to Prevent Stroke and Cut Costs in Low Income Countries: From Clinical Efficacy to Implementation, Sarfo et al review the evidence for polypill strategies in primary and secondary cardiovascular disease prevention in low- and middle-income countries, who bear the majority of the worldwide burden of stroke.
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•MFI zeolite has the highest adsorption of RSH in the pressure range of 0–0.005 kPa.•In the 0–0.005 kPa, the effect of Di is dominant on RSH adsorption.•FAU zeolite has the highest ...adsorption of RSH in the pressure range of 0–100 kPa.•In the 0–100 kPa, the effect of accessible volume is main on RSH adsorption.
Selective removal of ethyl mercaptan from natural gas is presently challenge in the gas industry. Nanoporous zeolite frameworks with different topologies have been known as the most appropriate compounds for the adsorption of ethyl mercaptan. Grand Canonical Monte Carlo (GCMC) simulation has been employed to predict the adsorption and separation properties of mixtures containing ethyl mercaptan under difficult experimental conditions. The adsorption isotherms of ethyl mercaptan in pure form and mixtures with methane on purely siliceous zeolites including BEA, FAU, LTL, MFI, and MOR have been obtained at the temperature of 298 K over the pressure range of 0–100 kPa. The results show that the adsorption capacity is a function of the pore diameter of zeolites. FAU has appeared as an adsorbent with high adsorption capacity. In contrast, it has shown considerably lower adsorption affinity for methane in comparison with ethyl mercaptan, confirming the competitive adsorption between them. Therefore, FAU could be the promising candidate for industrial desulfurization of natural gas. The effects of temperature, pressure, initial bulk concentration, and pore structure have been examined. Distribution snapshots displays the preferred positions of zeolites for the adsorption of sulfur species.
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•Performance of BEA, FAU, LTL, MFI, and MOR in the capture of COS were compared.•MFI with optimum pore size and shape has high adsorption capacity of COS.•The effect of Di is dominant ...on COS adsorption.•Sips and Langmuir models explain the behavior of the adsorbed COS on the zeolites.
The economic and environmental challenge for the oil and gas industries is to eliminate carbonyl sulfide (COS) from natural gas selectively. This compound can lead to corrosion and environmental damage, even when it is present in small amounts. The zeolites have been known as the appropriate adsorbent for COS. Grand Canonical Monte Carlo (GCMC) simulation has been used to explore the suitability of zeolite frameworks with different topologies on the adsorption and separation properties of mixtures containing industrial concentrations of COS in order to overcome the experimental tests that are difficult to handle. The adsorption isotherms for pure COS and COS/methane mixture on purely siliceous zeolites such as BEA, FAU, LTL, MFI, and MOR have been recorded at 298 K within a pressure range of 0–100 kPa. MFI zeolite, with its high adsorption capacity and isosteric heat, has been identified as the most suitable candidate for COS adsorption due to its ideal pore size and shape. Examining the density distribution snapshots reveals the preferred locations of zeolites for the COS adsorption. The findings could be systematically used in various case studies, thereby providing insights into selecting the best zeolitic nanostructure for the industrial removal processes of COS.
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