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BACKGROUND The primary symptoms of Restless Legs Syndrome (RLS) are circadian-dependent, leading to increased activity or decreased rest, especially at night. The primary pathology in RLS is brain iron insufficiency despite normal systemic iron stores. Natural variances in brain and peripheral iron concentrations across recombinant inbred (RI) murine strains provide a biological model of RLS. The question is whether these RI mice strains show a behavioral analog to circadian-dependent clinical phenotype of RLS. METHODS The home cage activity of eight female RI strains was measured over a 72-h period. The ratio of the average activity in the last 2 h of the active period relative to that in the total 12-h active period (late active period activity ratio, LAPAR) was the primary outcome variable. The relation of average LAPAR scores to measures of ventral midbrain (VMB) iron was evaluated across strains in this study. RESULTS RI strain 40 (LAPAR = 1.28) and RI strain 21 (LAPAR = 1.02) were the only strains to show an increased activity in the last part of the active period. ANOVA showed the increased activity was significantly greater during the last 2 h compared to the preceding 10 h of the active phase only for the RI strain 40. Average LAPAR across the eight strains did not significantly correlate with the VMB iron content (r = -0.27, p less then 0.10) but did correlate with changes in VMB iron with iron deficiency (r = 0.71, p less then 0.05) and diurnal change in VMB iron (r = 0.65, p less then 0.05). CONCLUSION The female RI strain 40 mice exhibited a distinct end-of-active-period behavior analogous to circadian-dependent clinical phenotype of RLS. Wilson's disease betides due to mutation in ATP-7B that leads to snagging in copper transport by the hepatic lysosomes resulted in the deposition of copper in the brain, liver, kidney or skeletal system. Luzindole concentration The symptoms are jaundice, edema in legs, ascites, Kayser-Fleischer rings, dysarthria, dysphagia, ataxia, dyskinesia, and muscle spasticity. Current therapeutic modalities for the management of Wilson's disease include zinc, trientine, penicillamine and ammonium tetrathiomolybdate. A 12 year old child diagnosed with Wilson's disease came with complaints of inability to speak, difficulty in swallowing and generalized stiffness for 6 months. His investigations showed SGPT 43 U/L, Ceruloplasmin 0.03 g/L, urine copper level 225.03 μg per 24 h, a chronic parenchymal disease in the liver and splenomegaly. According to Ayurveda, this case of generalized stiffness with hepatomegaly and splenomegaly was correlated with Agnimandya at the Dhatu level that led to Vatavyadhi, Yakrutodara, and Plihodara. The treatment mentioned for Vatavyadhi is Snehana (oleation), MruduSwedana (mild sudation), Anuvasana Basti (oil enema) and for Yakrutodara and Plihodara is Niruha Basti (Decoction Enema) and Anuvasana Basti (oil enema). The case was treated with Abhyanga, Swedana, Basti and oral medication. After treatment, the symptoms were reduced and he was able to extend both lower limbs completely. His urinary copper level came to normal (47.01 μg per 24 h), so, it can be concluded that the Ayurvedic approach and diet modifications in such patients may help in providing supportive care and improving the quality of life. An excessive temperature rise during bone drilling processes can result in osteonecrosis or impairment of the osteogenic potential. However, the effect of geometric parameters of the surgical drill bit, drilling process parameters, and the bone type on the temperature rise have not been fully investigated. In this study, thermocouples are introduced to measure the temperature rise, and three experimental designs are utilized separately to investigate the temperature rise with respect to each parameter, identify the effect of important drill geometric parameters and their interaction on the temperature rise, and develop a quadratic model of the temperature rise with respect to process parameters. The results show that the temperature rise can be significantly affected by geometric parameters of the surgical drill bit, drilling process parameters, and the bone type. The effects of the point angle and the interaction between the web thickness and the helix angle on the temperature rise are very significant. The quadratic regression equation obtained using response surface methodology can provide accurate predictions under a wide range of drilling process conditions, and the optimized drilling process parameters are in good agreement with the experimental results. This paper poses a problem for traditional phylogenetics The identity of organisms that reproduce through fission can be understood in several different ways. This prompts questions about how to differentiate parent organisms from their offspring, making vertical gene transfer unclear. Differentiating between parents and offspring stems from what I call the identity problem. How the problem is resolved has implications for phylogenetic groupings. If the identity of a particular asexual organism persists through fission, the vertical lineage on a phylogenetic tree will split differently than if the identity of an organism does not survive the fission process. BACKGROUND In Denmark 15%-20% of stroke victims die within the first year. Simple and valid tools are needed to assess patients' risk of dying. The aim of this study was to identify potential predictors of 1-year mortality in stroke victims and construct a simple and valid prediction model. METHODS Data were collected retrospectively from a cohort of 1031 stroke victims admitted over a period of 18 months at Nordsjællands Hospital, Denmark. Follow-up was 1 year after symptom onset. Multiple logistic regression analysis with backwards selection was used to identify predictors and construction of a prediction model. The model was validated using cross validation with 10,000 repeated random splits of the dataset. Area under the receiver operating characteristic curve (AUC) and Brier score were used as measures of validity. RESULTS Within the first year 186 patients died (18.0%) and 4 (0.4%) were lost to follow-up. Age (OR 1.08), gender (OR 2.19), stroke severity (OR 1.03), Early Warning Score (OR 1.17), Performance Status (ECOG) (OR 1.94), Body Mass Index (OR 0.91), the Charlton's Comorbidity Index (OR 1.17), and urinary problems (OR 2.55) were found to be independent predictors of 1-year mortality. A model including age, stroke severity, Early Warning Score, and Performance Status was found to be valid (AUC 86.5 %, Brier Score 9.03). CONCLUSIONS A model including only 4 clinical variables available shortly after admission was able to predict the 1-year mortality risk of patients with acute ischemic and haemorrhagic stroke. BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) is present in 20% to 35% of acute ischemic stroke patients and may increase the risk of poor functional outcome or death. We aimed to determine whether CKD was associated with worse outcome in stroke patients treated with endovascular thrombectomy (EVT). DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Consecutive EVT patients were identified from a prospective registry and dichotomized into patients with and without CKD, defined as an eGFR of less than 60 mL/min/1.73m2. The primary outcome was 3-month mortality following EVT. Secondary outcomes included symptomatic intracerebral hemorrhage (defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study), early neurological recovery (defined as change in National Institutes of Health Stroke Scale [NIHSS] score of ≥8 at 24 hours or an NIHSS of 0-1 at 24 hours) and functional independence (defined as a modified Rankin Scale [mRS] score of 0, 1 or 2) at 3 months. RESULTS 378 EVT patients (223 men; mean ± SD age 65 ± 15 years) were included. The median (IQR) admission eGFR was 71 (58-89) mL/min/1.73 m² and 117 (31%) patients had CKD. Multiple logistic regression adjusted for potential confounders demonstrated that CKD was a significant predictor of lower rates of functional independence (OR = .54, 95% CI, .31 to .90, P = .02), higher mRS scores (common OR = 1.78, 95% CI, 1.14 to 2.81, P = .01), and increased mortality (OR = 2.19, 95% CI, 1.16 to 4.12, P = .01). There was no association between CKD and early neurological recovery (OR = .92, 95% CI, .55 to 1.49, P = .71) or symptomatic intracerebral hemorrhage (OR = 1.18, 95% CI, .38 to 3.69, P = .77). CONCLUSIONS CKD was a significant predictor of worse functional outcome and mortality in stroke patients treated with EVT. The presence of CKD should not preclude patients from proceeding to EVT, but may help with prognostication and improve shared decision-making between patients, families and physicians. BACKGROUND AND PURPOSE Cognitive impairment occurs in 20%-40% of stroke patients and is a predictor of long-term morbidity and mortality. In this study, we aim to determine the association between poststroke cognitive impairment and stroke recurrence risk, in patients with anterior versus posterior circulation intracranial stenosis. METHODS This is a post-hoc analysis of the Stenting and Aggressive Medical Therapy for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. The primary predictor was poststroke cognitive function measured by Montreal Cognitive Assessment (MOCA) at 3-6 months and the primary outcome was recurrent ischemic stroke. We used univariate and multivariable cox-regression models to determine the associations between MOCA at 3-6 months and recurrent stroke. RESULTS Of the 451 patients enrolled in SAMMPRIS, 393 patients met the inclusion criteria. The mean age of the sample (in years) was 59.5 ± 11.3, 62.6% (246 of 393) were men. Fifty patients (12.7%) had recurrent ischemic stroke during a mean follow up of 2.7 years. The 3-6 month MOCA score was performed on 351 patients. In prespecified multivariable models, there was an association between 3 and 6 month MOCA and recurrent stroke (hazard ratio [HR] per point increase .93 95% confidence interval [CI] .88-.99, P = .040). This effect was present in anterior circulation stenosis (adjusted HR per point increase .92 95% CI .85-0.99, P = .022) but not in posterior circulation artery stenosis (adjusted HR per point increase 1.00 95% .86-1.16, P = .983). CONCLUSIONS Overall, we found weak associations and trends between MoCA at 3-6 months and stroke recurrence but more notable and stronger associations in certain subgroups. Since our study is underpowered, larger studies are needed to validate our findings and determine the mechanism(s) behind this association. INTRODUCTION The significance of microembolic signals (MES) detected by transcranial Doppler ultrasound emboli monitoring (TCD-e) in patients supported with left ventricular assist devices (LVAD) remains unclear. We aimed to investigate the relationship between cerebral microembolization detected by TCD-e and acute ischemic events in LVAD patients. METHODS We reviewed consecutive patients with acute ischemic stroke or transient ischemic attack (TIA) in a prospectively collected database of LVAD patients. TCD-e exams consisted of monitoring the middle cerebral arteries for microembolic signals (MES) over 30 minutes. RESULTS Of 515 persons with LVAD, 41 TCD-e studies were performed in 35 patients with acute ischemic stroke or transient ischemic attack (TIA) in a median of 1 day (Interquartile range [IQR] 0-2) after the event. MES were present in 15 (44%) TCD-e studies with a median MES count of 4 (IQR 2-15.5). Bloodstream infections were more common in patients with MES (38% versus 8%, P = .039). There were trends for lower international normalized ratio (1.
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