Summary Background Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular ...territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in treatment response after BAO. Methods The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO between November 1, 2002, and October 1, 2007. Stroke severity at time of treatment was dichotomised as severe (coma, locked-in state, or tetraplegia) or mild to moderate (any deficit that was less than severe). Outcome was assessed at 1 month. Poor outcome was defined as a modified Rankin scale score of 4 or 5, or death. Patients were divided into three groups according to the treatment they received: antithrombotic treatment only (AT), which comprised antiplatelet drugs or systemic anticoagulation; primary intravenous thrombolysis (IVT), including subsequent intra-arterial thrombolysis; or intra-arterial therapy (IAT), which comprised thrombolysis, mechanical thrombectomy, stenting, or a combination of these approaches. Risk ratios (RR) for treatment effects were adjusted for age, the severity of neurological deficits at the time of treatment, time to treatment, prodromal minor stroke, location of the occlusion, and diabetes. Findings 619 patients were entered in the registry. 27 patients were excluded from the analyses because they did not receive AT, IVT, or IAT, and all had a poor outcome. Of the 592 patients who were analysed, 183 were treated with only AT, 121 with IVT, and 288 with IAT. Overall, 402 (68%) of the analysed patients had a poor outcome. No statistically significant superiority was found for any treatment strategy. Compared with outcome after AT, patients with a mild-to-moderate deficit (n=245) had about the same risk of poor outcome after IVT (adjusted RR 0·94, 95% CI 0·60–1·45) or after IAT (adjusted RR 1·29, 0·97–1·72) but had a worse outcome after IAT compared with IVT (adjusted RR 1·49, 1·00–2·23). Compared with AT, patients with a severe deficit (n=347) had a lower risk of poor outcome after IVT (adjusted RR 0·88, 0·76–1·01) or IAT (adjusted RR 0·94, 0·86–1·02), whereas outcomes were similar after treatment with IAT or IVT (adjusted RR 1·06, 0·91–1·22). Interpretation Most patients in the BASICS registry received IAT. Our results do not support unequivocal superiority of IAT over IVT, and the efficacy of IAT versus IVT in patients with an acute BAO needs to be assessed in a randomised controlled trial. Funding Department of Neurology, University Medical Center Utrecht.
Geometry of Banach Spaces Müller, P. F. X; Schachermayer, W
02/1991, Letnik:
v.Series Number 158
eBook
This volume reflects the progress made in many branches of recent research in Banach space theory. It is based on a conference attended by most of the leading figures in the area, and is intended to ...illustrate the interplay of Banach space theory with harmonic analysis, probability, complex function theory and finite dimensional convexity theory. The papers consist of a selection of surveys and original research papers. Research workers in functional and complex analysis will find much here to interest them.
The nucleus-nucleus Lie`ge intranuclear-cascade+percolation+evaporation model has been applied to the
12C+
197Au data measured by the INDRA-ALADIN collaboration at GSI. After the intranuclear cascade ...stage, the data are better reproduced when using the Statistical Multiframentation Model as afterburner. Further checks of the model are done on data from the EOS and KAOS collaborations.
Several chemically substituted flavins are investigated in the oxidized and the reduced state by 13C and 15N NMR techniques. The dependence on the polarity of the solvent and on the concentration is ...studied. In combination with already published results, a semiempirical theory is developed to interpret the chemical shifts in terms of the solution structure of flavins. Where possible, the results are compared with crystallographic and light absorption data. In contrast to common ideas, the solution structure of the oxidized state is not fully coplanar, but the N(10) atom is situated out of plane to a certain degree. Polarizing the flavin by hydrogen bonds in a high dielectric medium moves the N(10) atom into the molecular plane, and the flavin molecule becomes coplanar. In the coplanar molecule, pi electrons are delocalized from the N(10) atom mainly to O(2 alpha) and O(4 alpha). The NMR results show that the solution structure of reduced flavin is mainly governed by sterical hindrance and hydrogen bonds. The findings are in contrast to commonly accepted ideas that reduced flavin is strongly bent. In an apolar solvent, the reduced neutral isoalloxazine is only slightly bent. The formation of hydrogen bonds in a protic solvent of a high dielectric constant decreases the bend. The N(10) atom is now almost fully sp2 hybridized, and the N(5) atom has an endocyclic angle of 115-117 degrees, indicating its predominant sp2 character. The results have several important implications for flavin catalysis.
Several flavin model compounds in the reduced state have been investigated by 13C NMR techniques. The NMR spectra were recorded in dependence of temperature, in the range of 30 to -100 degrees C. The ...results show that the activation barrier for the ring inversion ("butterfly" motion) is too low to be observed directly. In order to be able to detect the barrier of the ring inversion, it was coupled with a side-chain rotation. In this way, the intrinsic barrier for the ring inversion is increased by the barrier of the side-chain rotation, which allowed detection of the former barrier. It is shown that the intrinsic barrier for the ring inversion is less than 20 kJ/mol. Moreover, it is shown that previous results of Tauscher et al. Tauscher, L., Ghisla, S., & Hemmerich, P. (1973) Helv. Chim. Acta 56, 630-649 are incorrect and nitrogen inversion is not observed. Symmetry arguments in the dynamic processes are discussed. From the low activation barrier for the ring inversion, it can be concluded that the conformation of the reduced flavin can be easily influenced upon binding to apoflavoproteins. This aspect might be of importance in the regulation of the function of the flavin prosthetic group in biological systems.
