Background Leukoaraiosis (LA) is closely associated with cognitive deficits. The association between LA and cognitive disorders, such as mild cognitive impairment (MCI) and dementia, after initial ...stroke has not been systematically studied. In this study, we sought to identify whether LA contributes to the occurrence of certain type of cognitive disorders after initial stroke. Methods Data from our Stroke Registry were examined, and 5-year follow-up data for LA and cognitive disorders were analyzed. We performed Kaplan–Meier analysis and log-rank test to assess the predictive value of LA for risk of cognitive decline and the Cox proportional hazards model to test the risk factors studied as independent determinants of cognitive impairment. Results The frequency of patients with normal cognitive function decreased significantly at 5 years compared with initial stroke (78% vs 70%; odds ratio, 1.51; 95% confidence interval, 1.41-1.62). Of 8784 patients, 1659 (19%) had dementia and 964 (11%) had MCI at the final analysis. After 5 years of follow-up, survival analysis showed that all patients with LA had an increased probability of MCI compared with those without LA ( P < .0001). Patients with LA had an increased chance of dementia compared with those without LA ( P < .0001) at the end of follow-up. Cognitive decline probability was significantly higher in patients with severe LA compared with those with mild/moderate LA ( P < .0001). Cox regression analyses showed that recurrence of stroke (hazard ratio HR, 3.92 95% CI, 3.26-4.72), hypertension (HR, 1.11 95% CI, 1.0-1.22), LA (HR, 1.15 95% CI, 1.05-1.25), age (HR, 1.05 95% CI, 1.04-1.06), hypercholesterolemia (HR, .86 95% CI, .77-.95), higher LDL cholesterol (HR, 1.21 95% CI, 1.11-1.32), lower HDL cholesterol (HR, .90 95% CI, .83-.98), coronary heart disease (HR, .85 95% CI, .77-.94), and National Institutes of Health Stroke Scale score at admission (HR, .77 95% CI, .72-.82) were also significantly associated with cognitive impairments. Conclusions Our findings suggest that patients with LA may be at risk of developing new cognitive impairments at long-term period after initial stroke. The evaluation of the concomitant risk factors, besides providing insights about the possible mechanisms behind the cognitive dysfunction present in LA, may be of help for the prevention of cognitive impairments.
The purpose of this study was to determine the variety and prevalence of renal and non-renal abnormalities detected on multidetector computed tomography (MDCT) that precluded patients from donating a ...kidney.
Institutional review board approval was obtained and the requirement for informed consent was waived. A retrospective, single-centre review of 701 patients (444 female, 257 male; age range 18-86 years; mean age 43.2±11.9 years) that underwent renal donor protocol MDCT was conducted. A systematic review of the CT report, records from multidisciplinary renal transplantation rounds, and electronic medical records was performed to determine which patients were approved or declined as live renal donors. If declined as a donor, CT-identified reasons were categorized as abnormalities of renal vasculature, renal parenchyma, collecting system, or extra-renal.
A total of 81 patients were excluded as renal donors on the basis of CT findings. Abnormalities of the collecting system accounted for the most frequent cause of exclusion (n=41), with asymptomatic renal calculi being detected in 39 patients. Complex vascular anatomy and vascular abnormalities resulted in the exclusion of 29 patients. Supernumerary arteries and early arterial branching resulted in the exclusion of 20 patients, while renal vein anomalies leading to exclusion were uncommon (n=2). Abnormalities of renal parenchyma resulted in the exclusion of nine patients. Three patients were diagnosed with autosomal dominant polycystic kidney disease, two patients had renal cell carcinoma, and two patients had areas of cortical scarring. A complex cystic lesion requiring surveillance imaging was encountered in one patient and a large area of renal infarction related to prior adrenalectomy was demonstrated in one patient. Extra-renal abnormalities leading to exclusion were limited to two patients with pulmonary nodules.
MDCT plays a critical role in the preoperative assessment of potential renal donors by identifying contraindications to donor nephrectomy and providing accurate vascular mapping. This study is anticipated to be informative for those involved in the workup of potential living renal donors by quantifying the incidence and reasons for donor exclusion identified on CT.
A neutrino with energy of \(\sim\)290 TeV, IceCube-170922A, was detected in coincidence with the BL Lac object TXS~0506+056 during enhanced gamma-ray activity, with chance coincidence being rejected ...at \(\sim 3\sigma\) level. We monitored the object in the very-high-energy (VHE) band with the MAGIC telescopes for \(\sim\)41 hours from 1.3 to 40.4 days after the neutrino detection. Day-timescale variability is clearly resolved. We interpret the quasi-simultaneous neutrino and broadband electromagnetic observations with a novel one-zone lepto-hadronic model, based on interactions of electrons and protons co-accelerated in the jet with external photons originating from a slow-moving plasma sheath surrounding the faster jet spine. We can reproduce the multiwavelength spectra of TXS 0506+056 with neutrino rate and energy compatible with IceCube-170922A, and with plausible values for the jet power of \(\sim 10^{45} - 4 \times 10^{46} {\rm erg \ s^{-1}}\). The steep spectrum observed by MAGIC is concordant with internal \(\gamma\gamma\) absorption above a few tens of GeV entailed by photohadronic production of a \(\sim\)290 TeV neutrino, corroborating a genuine connection between the multi-messenger signals. In contrast to previous predictions of predominantly hadronic emission from neutrino sources, the gamma-rays can be mostly ascribed to inverse Compton up-scattering of external photons by accelerated electrons. The X-ray and VHE bands provide crucial constraints on the emission from both accelerated electrons and protons. We infer that the maximum energy of protons in the jet co-moving frame can be in the range \(\sim 10^{14}\) to \(10^{18}\) eV.
Rheumatoid arthritis (RA) is a debilitating, chronic multisystem disease with an unknown etiology. Recent findings indicate that increased oxidative stress and/or defective antioxidant status ...contribute to the etiology of RA. The present study was undertaken to examine the oxidant and antioxidant systems in patients with RA and healthy controls.
Twenty two patients with RA and 20 healthy volunteers were included in the study. Levels of malondialdehyde (MDA) and antioxidant vitamins (A, E, C) in serum samples were determined by high performance liquid chromatography (HPLC). Spectrophotometric methods were used to determine activity levels of antioxidant enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), in erythrocytes.
MDA levels in patients with RA were found to be significantly (P<0.005) higher than controls whereas levels of vitamins A, E, C and activities of GSH-Px, SOD were lower in the patients compared to controls (P<0.005 for SOD and antioxidant vitamins; P<0.05 for GSH-Px).
There was an increased oxidative stress and a low antioxidant status in patients with RA. These changes are probably due to efforts for reducing lipid peroxidation and hence to lower tissue damage.
To evaluate the efficacy of contrast-enhanced power Doppler sonography in the differential diagnosis of breast lesions after a mammography-gray scale sonography combination.
Sixty-eight patients with ...69 breast masses underwent power Doppler sonography before and after intravenous injection of a contrast agent. The lesions were diagnosed as "highly suggestive of malignancy" (category 5; n = 32), "suspicious" (category 4; n = 21), and "probably benign" (category 3; n = 16) by mammography and gray scale sonography, modeled on the American College of Radiology Breast Imaging Reporting and Data System classification. Power Doppler findings did not affect patient treatment. The authors subjectively evaluated the estimated area of vascularity, degree of enhancement following contrast agent administration, morphologic features, and distribution of vessels within the lesions.
The final diagnoses were malignant in 28 lesions and benign in 41. Significant enhancement after contrast agent injection was detected in both the malignant and benign groups. Only 2 criteria, estimated area of vascularity and degree of enhancement following contrast agent administration, proved to be significant diagnostic determinants for contrast-enhanced power Doppler sonography (P < .001; interobserver agreements, 74.4 and 77.8, respectively). Contrast-enhanced power Doppler sonography provided a higher specificity, positive predictive value, and negative predictive value than power Doppler sonography but a lower sensitivity and negative predictive value than mammography-gray scale sonography. Only in the category 4 lesions could the combination of mammography-gray scale sonography and contrast-enhanced power Doppler sonography accomplish a higher specificity (71%) and positive predictive value (70%) than mammography-gray scale sonography (39% and 53%, respectively).
Power Doppler and contrast-enhanced power Doppler sonography cannot be recommended as confirmatory tests in Breast Imaging Reporting and Data System category 3 and category 5 lesions. Although contrast-enhanced power Doppler sonography may help reduce unnecessary biopsies in Breast Imaging Reporting and Data System category 4 lesions, recommendation of its use has many drawbacks, such as imperfectly established criteria, lack of absolute certainty, and high cost.
Highlights • The restriction in cervical range of motion may be a pain generator in patients with Chiari type 1 malformation • Posterior fossa decompression with or without patch duraplasty could ...affect cervical range of motion and cervical lordosis in severe cases of tonsillar herniation • In cases of grade 3 Chiari type 1 malformation, the addition of patch duraplasty to posterior fossa decompression may provide a benefit by restoring cervical range of motion while preserving cervical lordosis and stability.
Abstract Introduction The arterial blood gas measurement process is a painful and invasive procedure, often uncomfortable for both the patient and the physician. Because the patient-related factors ...that determine the difficulty of the process cannot be controlled, the physician-related factors and blood gas measurement techniques are a modifiable area of improvement that ought to be considered. Many hospitals use insulin syringes or syringes washed with heparin for the purpose of blood gas measurement because they do not have blood gas–specific syringes. In this prospective cross-sectional study, we aimed to compare safety-engineered blood gas syringes and conventional heparinized syringes used during the arterial blood gas extraction process in terms of ease of operation, the physician-patient satisfaction, laboratory appropriateness, and complications. Methods Our study included patients whose arterial blood gas needed to be measured in the emergency department and who agreed to participate in the study. Patients were randomly divided into 2 groups. The arterial blood gas of the patients from the first group was measured by using conventional heparinized syringes, whereas safety-engineered blood gas syringes were used to measure the arterial blood gas of the patients from the second group. The groups were compared in terms of demographic data, the number of attempts, the physician and patient satisfaction, early and late-term complications, and laboratory appropriateness of the taken sample. Results A total of 550 patients were included in our study in a 2-month study period. There were no significant differences between patients in terms of sex, age, weight, height, body mass index, and wrist circumference. In addition, the number of attempts ( P = .489), patients' pain level during the procedure ( P = .145), and the degree of difficulty of the procedure according to the patient ( P = .109) and physician ( P = .554) were not significantly different between the groups. After arterial blood gas extraction procedure, 115 patients (20.9%) developed complications. In the conventional heparinized syringe group, the complication rate (n = 69; 25.1%) was significantly higher compared with the group that used safety-engineered blood gas syringes (n = 46; 16%; P = .0211). Localized pain, which is one of the most common early complications, was more frequent in the conventional heparinized syringe group (19.3%). Complications in women ( P = .003) and local pain ( P = .01) developed lesser in the second group that used safety-engineered blood gas syringes, and the patient-physician satisfaction was higher in that group, as well. In the evaluation 48 hours after the procedure, the ratios of infection and local hematoma were higher in the conventional heparinized syringe group ( P = .0213 and P < .0001). Conclusion In this study, we did not find any significant differences between the conventional heparinized syringes and safety-engineered blood gas syringes in terms of ease of operation, physician and patient satisfaction, and appropriateness of the taken sample. However, patients whose arterial blood gas was extracted by using safety-engineered blood gas syringes felt less pain and experienced fewer infections and hematomas at their puncture site.
A search for tau neutrino induced showers with the MAGIC telescopes is presented. The MAGIC telescopes located at an altitude of 2200 m a.s.l. in the Canary Island of La Palma, can point towards the ...horizon or a few degrees below across an azimuthal range of about 80 degrees. This provides a possibility to search for air showers induced by tau leptons arising from interactions of tau neutrinos in the Earth crust or the surrounding ocean. In this paper we show how such air showers can be discriminated from the background of very inclined hadronic showers by using Monte Carlo simulations. Taking into account the orography of the site, the point source acceptance and the event rates expected have been calculated for a sample of generic neutrino fluxes from photo-hadronic interactions in AGNs. The analysis of about 30 hours of data taken towards the sealeads to a 90\% C.L. point source limit for tau neutrinos in the energy range from \(1.0 \times 10^{15}\) eV to \(3.0 \times 10^{18}\) eV of about \(E_{\nu_{\tau}}^{2}\times \phi (E_{\nu_{\tau}}) < 2.0 \times 10^{-4}\) GeV cm\(^{-2}\) s\(^{-1}\) for an assumed power-law neutrino spectrum with spectral index \(\gamma\)=-2. However, with 300 hours and in case of an optimistic neutrino flare model, limits of the level down to \(E_{\nu_{\tau}}^{2}\times \phi (E_{\nu_{\tau}}) < 8.4 \times 10^{-6}\) GeV cm\(^{-2}\) s\(^{-1}\) can be expected.
Abstract Objective The aim of the study was to compare anti-HLA antibodies examined as panel-reactive antibody (PRA) in kidney transplant candidates with chronic renal failure (CRF) with the use of 2 ...methods: Flow-PRA and Luminex-PRA. Methods CRF patients displaying class I PRA (n = 34) and/or class II PRA (n = 41) were tested by the 2 different methods from April 2012 to September 2012, using antigen-coated beads. Results Eleven (32.3%) 34 patients tested for class I PRA were female and 23 (67.7%) male; 17 (41.5%) 41 patients tested for class II PRA were female and 24 (58.5%) male. Only 2 patients were preemptive, the others had been subjected to dialysis. The concordance ratio of class I PRA test results between Flow-PRA and Luminex PRA was 67.6%. Whereas 13 samples (38.2%) were positive by Flow-PRA, 22 (64.7%) were positive by Luminex-PRA. Two of the 3 patients not previously immunized were found to be positive only by Luminex PRA; 1 was noted to be positive only by Flow-PRA. Regarding class II PRA screening, the concordance between Flow-PRA and Luminex PRA was 70.7%. Whereas 14 (34.1%) samples were positive for Flow-PRA; 24 (58.5%) were positive for Luminex-PRA. The 2 patients not previously immunized were positive only in Luminex PRA. Conclusions We speculated that the reason for the low concordance ratios was due to the use of sera that had been previously found to be indeterminate in PRA tests. We also speculated that the low concordance ratios were due to the coating procedure for the beads, which may cause changes in antigenic epitopes and decrease concordance between Flow-PRA and Luminex-PRA.
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