Over the time, instrument transportability has become more and more important, especially in Cultural Heritage, as often artworks cannot be moved from their site, either because of the size or due to ...problems with permission issues, or simply because moving them to a laboratory is physically impossible, as e.g. in the case of mural paintings. For this reason, the INFN-CHNet, the network for Cultural Heritage studies of the Italian National Institute of Nuclear Physics (INFN), has developed an XRF scanner for in situ analyses. The instrument is the result of a wide collaboration, where different units of the network have been developing the diverse parts, then merged in a single system. The XRF scanner has been designed to be a
four-season
and
green
instrument. The control/acquisition/analysis software has been fully developed by our group, using only open-source software. Other strong points of the system are easiness of use, high portability, good performances and ultra-low radiation dispersion, which allows us to use even when the public can be present. It can run both with mains or on batteries, in the latter case with a maximum runtime longer than 10 h. It has a very low cost, when compared to commercial systems with equivalent performances, and easily replaceable components, which makes it accessible for a much wider portion of the interested community. The system has been thought and designed as an open system, suitable for further development/improvements, that can result interesting for non-conventional XRF analysis. The CHNet XRF scanner has proved to be really very well suited for applications in the Cultural Heritage field, as testified by the many recent applications. This paper describes the present version of our instrument and reports on the tests performed to characterise its main features.
Graphical abstract
Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through ...antagonism of PAR-1.
We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage.
At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval CI, 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001).
Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.).
The authors report a case of spontaneous dissection of both carotid arteries, followed by spontaneous dissection of the left anterior descending coronary artery after a few days. No major ...abnormalities of collagen production were found. This case may be underlain by a dysplasia of common precursors of the carotid and coronary walls.
Dementia after first stroke Censori, B; Manara, O; Agostinis, C ...
Stroke (1970),
07/1996, Volume:
27, Issue:
7
Journal Article
Peer reviewed
Cognitive deficits may significantly worsen the quality of life after stroke. Our aim was to determine the frequency of dementia in a consecutive series of previously nondemented patients between the ...ages of 40 and 79 years at 3 months after a first ischemic stroke.
All patients admitted to our department during an 18-month period who met the above criteria were visited and tested and underwent a CT scan 3 months after their stroke. Dementia was diagnosed according to criteria of the National Institute of Neurological Disorders and Stroke and AIREN, but cases with aphasia were not excluded.
Of 304 patients admitted for stroke, 146 were eligible for study. Eleven refused to participate, 25 were dead at 3 months, and 110 were tested. Fifteen patients were demented (13.6%; 95% confidence interval CI, 7.8% to 21.5%), and six had severe isolated aphasia, neglect, or memory deficit (5.4%). Excluding patients with aphasia, 5.0% of cases showed dementia (95% CI, 1.6% to 11.3%). The frequency of dementia was 24.6% (95% CI, 14.5% to 37.3%), considering only patients with supratentorial lesions and with residual deficits of elementary functions (paresis, sensory deficits) at the time of examination. Demented patients had significantly more diabetes (P<.029), atrial fibrillation (P=.032), aphasia at entry (P<.001), large middle cerebral artery infarctions (P=.001), and a more severe neurological deficit at entry (P=.003) and at 3 months (P=.001). At CT scan, demented patients had a larger mean volume of the recent lesion (P<.001) and more lesions in the frontal lobe (P=.041). An exploratory multivariate analysis selected age between 60 and 69 years (odds ratio OR, 45.8; 95% CI, 2.9 to 726.0), diabetes (OR 59.4; 95% CI, 4.3 to 821.0), aphasia (OR, 14.8; 95% CI, 2.0 to 111.0), a large middle cerebral artery infarction (OR, 30.0; 95% CI, 2.7 to 334.0), and lesions of the frontal lobe (OR, 9.8; 95% CI, 1.3 to 72.8) as significant independent correlates of poststroke dementia.
Dementia is relatively frequent after a clinical first stroke in persons younger than 80 years, and aphasia is very often associated with poststroke dementia. If aphasic patients are not considered, it may be necessary to screen a very large number of subjects to collect an adequate sample of demented cases.
To determine the direct costs of hospital care of acute ischemic stroke in a large Italian hospital, and to identify the main components of such costs.
Cost containment in stroke care requires an ...up-to-date assessment of expenditures in the different areas of stroke management. However, costs may vary among countries because of different health system organizations.
All patients with ischemic stroke admitted during 1996 were considered. Total cost was the sum of a daily component, reflecting personnel wages and general care, and an ancillary component, reflecting mostly investigations and treatments. The real costs were used, not fixed charges.
We included 245 patients, with a mean length of stay (LOS) of 13.1+/-7.0 days, and an in-hospital case fatality rate of 8.2%. The mean total cost per patient was 5,087,000+/-2,536,000 Italian Lira (LIT; $3,289+/-$1,640), with a mean cost per day of 388,000 LIT ($251). Approximately 80% of total costs were due to the daily component and 20% to the ancillary component. A multiple linear regression model of length of stay, which determines the daily cost, showed that the Rankin score at entry, the clinical syndrome type, and the destination at discharge independently contributed to LOS. A second linear regression model showed that younger age and longer LOS significantly increased ancillary costs.
The containment of hospital costs of ischemic stroke may be achieved mostly through measures that reduce LOS, such as effective treatments and a quicker deployment.
We sought to detect prognostic factors related to functional outcome during the first 6 hours after a first-ever stroke in the carotid artery territory.
All patients with these characteristics seen ...during a 3-year period were included. Outcome was evaluated according to a modified Rankin scale. The following variables were examined at univariate analysis: sex, age, severity of deficit at entry and at day 7, level of consciousness at entry, time after symptom onset, history of smoking, history of hypertension, diabetes, myocardial infarction, atrial fibrillation, rheumatic heart disease, dilated cardiomyopathy, all potential cardioembolic sources, presence of a consistent lesion on computed tomography at entry and at days 5-9, and the size of such lesion.
All entry criteria were met by 172 patients. Age > or = 70 years, a Canadian Neurological Scale score < 6.5 at entry and at day 7, atrial fibrillation, presence of a potential cardioembolic source, and a "large" lesion (involving more than half the cerebral lobe) on computed tomography at days 5-9 were associated with a significantly worse outcome both at 30 days and at 6 months. After multivariate analysis, a Canadian Scale score < 6.5 at entry (p < 0.0001) and atrial fibrillation (p = 0.005) were associated with a significant handicap or death at 30 days, whereas only a Canadian Scale score < 6.5 (p < 0.0001) was associated with a worse prognosis at 6 months. An association of age > or = 70 years with a worse outcome at 6 months was of borderline significance (p = 0.054).
Some prognostic indicators are available during the first few hours after onset of a carotid ischemic stroke and may be useful in the stratification of patients in clinical trials. Severity of deficit is the most important indicator, whereas the presence of atrial fibrillation worsens the prognostic outlook with respect to early handicap but not mortality.
We describe the case of a large brain lesion whose computed tomography appearance and clinical evolution mimicked a herniating tumor. The patient progressed to coma within 6 days of hospitalization ...despite high-dose steroid treatment. Emergency excision of the lesion was carried out. Histological analysis showed massive demyelination, axon preservation and no tumor cells. No lesion recurrence was seen during a 55-month follow-up. Recognition of such lesions through magnetic resonance imaging or spectroscopy may spare unnecessary surgery or biopsy. However, our case shows that such lesions may still require resection in the face of a rapid clinical progression and poor response to medical treatment.
OBJECTIVES--To report experience of intra-arterial thrombolysis for acute stroke, performed with a microcatheter navigated into the intracranial circulation to impale the clot. METHODS--Patients were ...selected on the following criteria: (1) clinical examination suggesting a large vessel occlusion in stroke patients between 18 and 75 years; (2) no radiographic signs of large actual ischaemia on CT at admission; (3) angiographically documented occlusion of the middle cerebral artery (MCA) stem or of the basilar artery (BA), without occlusion of the ipsilateral extracranial internal carotid artery or of both the vertebral arteries; (4) end of the entire procedure within six hours of stroke. 12 patients with acute stroke were recruited, eight of whom had occlusion of the MCA stem and four of the BA. Urokinase was used as the thrombolytic agent. RESULTS--Complete recanalisation in six MCA stem and in two BA occurred, and partial recanalisation in two MCA stem and one BA. There was no recanalisation in one BA. A clinically silent haemorrhage occurred in two patients, and a parenchymal haematoma in one patient, all in MCA occlusions. At four months five patients achieved self sufficiency (four with MCA and one with BA occlusion). Six patients were dependent (three totally), and one died. CONCLUSIONS--The strict criteria of eligibility allowing the enrollment of very few patients and the procedure itself, requiring particular neuroradiological expertise, make this procedure not routine. Nevertheless, the approach can be considered a possible option for patients with acute ischaemic stroke.
We have undertaken a prospective study to measure anticardiolipin antibodies of IgG isotype within the first few hours of an acute non-hemorrhagic stroke.
We have collected blood samples at entry ...from one hundred patients (53 men and 47 women), mean age 67.4 years, referred within 6 h of a first-ever non-hemorrhagic stroke, and from an equal number of age- and gender-matched control patients.
IgG anticardiolipin antibodies were > or = 10 GPL in 26 patients and in 5 controls (p < 0.0001, X2 test). After logistic regression analysis, increase of IgG anticardiolipin antibodies remained independently associated with stroke (p = 0.0034), together with hypertension (p = 0.0009) and atrial fibrillation (p = 0.0238).
Our data suggest that the occurrence of elevation of IgG anticardiolipin antibodies in stroke patients should antedate stroke onset and might be a risk factor per se.
We have investigated the reliability of transcranial doppler compared with cerebral angiography in acute ischemic stroke in the middle cerebral artery territories. We studied 48 patients, 28 men and ...21 women, mean age 68.1 (range 54-75), observed within 5 h of the onset of ischemic stroke in the middle cerebral artery territory. Ultrasound evaluation (duplex scanner and transcranial doppler) and cerebral angiography were carried out in close sequence immediately after CT scan. CT was repeated by Day 7 to estimate the infarct size: 27/48 patients had intracranial arterial obstructions. An acoustic temporal "window" was not found in 6.25%. Transcranial doppler showed a sensitivity of 80.0% and a specificity of 90.0% compared with cerebral Angiography for patients with patent acoustic temporal "windows". Accuracy was 79.2%, when patients with no "windows" were included. With respect to intracranial internal carotid artery and middle cerebral artery mainstem, transcranial doppler showed a sensitivity of 95.0%, and a specificity of 92.0%. Including patients with no windows, accuracy was 87.5%.
Our data suggest that Transcranial Doppler can be reliably used to demonstrate intracranial internal carotid artery or middle cerebral artery mainstem obstructions in the acute phase of a brain infarction.
PDF
