Increased plasma fibrinogen predicts one-year mortality in patients with acute ischemic stroke

BACKGROUND AND PURPOSE: Increased plasma fibrinogen is a risk factor for vascular diseases related to atherosclerosis. Its long-term predictive value in stroke survivors is not established. We conducted this study to establish the significance of hyperfibrinogenemia as the possible predictor of 30-day and one-year mortality in patients with acute ischemic stroke. METHODS: We studied 900 unselected patients with ischemic stroke admitted to the hospital within 24 h after onset of symptoms. We noted demographic data, risk factors for stroke, neurological deficit and disturbances of consciousness on admission. We measured plasma concentration of fibrinogen and the body temperature on day 1 and registered vital status at 1, 3, 6 and 12 months after stroke. RESULTS: Mean concentration of plasma fibrinogen was 2.9 g/L and 25.2% of patients had increased plasma concentration of fibrinogen (i.e. > or = 3.5 g/L) on day 1. Patients with hyperfibrinogenemia were more likely to die after 1, 3, 6 and 12 months than those with normal plasma fibrinogen (21.1% vs. 15.6%, 36.4% vs. 24.6%, 42.6% vs. 27.3%, 45.7% vs. 31.2%, respectively; P < 0.001 for the last three differences). Hyperfibrinogenemia did not predict short-term case-fatality, but increased concentration of plasma fibrinogen was an independent predictor of one-year case-fatality (P = 0.013; OR: 1.69 (95% CI 1.12-2.55)). Other independent predictors of one-year case-fatality were: neurological deficit on admission, age, white blood cell count, and body temperature on day 1. CONCLUSIONS: Increased concentration of plasma fibrinogen shortly after ischemic stroke independently increases risk of death within one year after stroke.     

Alternative methods of treatment used by multiple sclerosis patients in Poland

BACKGROUND AND PURPOSE: Despite the great progress that has been made in medicine, treatment of many chronic diseases, including multiple sclerosis (MS), remains hardly effective. It has been reported that more and more MS patients worldwide are using alternative methods (AM). The aim of the present study is to evaluate this phenomenon in the Polish MS population. MATERIALS AND METHODS: To obtain more data about use of AM in Poland we distributed questionnaires among 210 MS patients treated in 3 hospitals in different regions of our country: Warsaw, Gdansk and Pila. RESULTS: 210 patients (136 females and 74 males) took part in the study. 68.5% (144 of 210 questioned) declared use of AM now or in the past. The most popular (56%) was Oenothera seed oil, followed by vitamins (49%), and the third most common was massage (34%). There were no significant demographic differences between users and non-users. Neither disease duration nor disability had any impact on the decision to use AM. CONCLUSIONS: The phenomenon of use of AM by MS patients is not fully understood, but it seems that limited access to so-called immunomodulators, e.g. interferon-b or glatiramer acetate, and limited long-term efficacy are reasons why patients seek other therapies.     

The microsurgical treatment of the supratentorial arteriovenous malformations. Part I--early and late results

BACKGROUND AND PURPOSE: The aim of this study was an analysis of early and late results of the microsurgical treatment of arteriovenous malformations (AVM) located supratentorially and factors that may influence the outcome. MATERIAL AND METHODS: 88 consecutive patients operated on in the years 1983-2000 for supratentorial AVM located were included in a retrospective analysis. All patients underwent microsurgical selective removal of AVM without prior embolization. The outcome was assessed on the day of discharge according to the Glasgow Outcome Scale (GOS) and at least 6 months after surgery according to the Karnofsky Scale (KS). RESULTS: A satisfactory outcome (GR+MD in GOS) was achieved in 92%. A severe deficit appeared in 4.5% and 3 (3.4%) patients died. The only factor influencing satisfactory outcome was low grade of AVM (I-II) in the Spetzler-Martin scale (p<0.0001). Factors influencing the excellent outcome (GR in GOS) are: size of AVM<3 cm (p=0.02), non-eloquent location (p=0.001) and exclusively superficial venous drainage (p=0.04). There was no case of deterioration in the late period. In 3/4 of patients discharged with deficit, a significant improvement was observed: a mild deficit withdrew in 13 of 17, and a severe deficit withdrew in 3 of 4. A satisfactory outcome in final assessment (KS>70%) was achieved in 95.5%, severe disabling deficit (KS 50%) remained in 1.1%. CONCLUSIONS: Results of the surgical treatment of AVM are satisfactory, especially in I and II grade of the Spetzler-Martin scale. In these cases microsurgical removal should be the method of choice, because immediately after treatment the risk of further hemorrhage is eliminated. Postoperative deficits withdraw during weeks or months in most cases and the final satisfactory result was achieved in 95% of patients.     

Comparison of two treadmill training programs on walking ability and endothelial function in intermittent claudication

Background

In this randomized trial we compared two treadmill trainings, based on exercises performed to moderate claudication pain vs pain-free training, with respect to their effects on walking ability and endothelial function.

Methods

A total of sixty patients with stable intermittent claudication were randomized to the pain-free treadmill training (repetitive intervals to onset of claudication pain) or moderate treadmill training (repetitive intervals to moderate claudication pain). In both groups exercises were performed 3 times a week for 3 months. Changes in flow mediated dilatation (FMD) and treadmill walking performance as well as plasma levels of C-reactive protein (hs-CRP) and fibrinogen were assessed before and after the program.

Results

Fifty-two patients completed the training program. Post-training maximal walking time was prolonged by 100% (p < 0.001) vs 98% (p < 0.001), and pain-free walking time by 120% (p < 0.001) vs 93% (p < 0.001) in the moderate training group as compared to the pain-free training group, respectively. FMD increased by 56% (p < 0.001) in the moderate training group and by 36% (p < 0.01) in the pain-free training group. No significant changes in the levels of hs-CRP and fibrinogen were seen after treadmill program in either group.

Conclusions

Both pain-free treadmill training and the moderate treadmill training have similar efficacy on walking ability in patients with claudication. The improvement of post-training FMD indicates systemic effect of both treadmill programs on endothelial function. Both programs appear to be safe therapeutic modes, since none of them escalates the inflammation. Pain-free treadmill training seems useful and effective therapeutic option for patients with claudication.     

Physicochemical Characteristics of Sunitinib Malate and its Process-Related Impurities

In this article, details of crystal and molecular structures of sunitinib malate (SUM), an anticancer therapeutic, and its key synthetic intermediate are presented. Both these compounds were also characterized spectroscopically and thermally. SUM crystallizes in the monoclinic P2₁ space group with two molecules in the asymmetric part of the unit cell, whereas the intermediate crystallises in the triclinic P-1 space group with four independent molecules in the asymmetric unit. The three-dimensional structure of SUM consists of two different layers of molecules. The first one is built of the malic anions, whereas the other layer consists of more hydrophobic sunitinib molecules. This layer is formed by two types of molecules creating a herring bond-like pattern with pairs of neighboring cations forming the V-shape arrangement of molecules. The V-shaped pairs of molecules form ribbons by fitting into two neighboring V shapes. The characteristic V-shape assemble of the moieties is hold together with three C-H…F weak interactions. Besides, process-related impurities of SUM were identified and their structures confirmed by separate synthesis. These impurities were fully characterized by spectroscopic and crystallographic methods as well as by differential scanning calorimetry and thermogravimetric analysis. The H-, ¹³C-, and ¹⁵N-nuclear magnetic resonance signals were fully assigned structurally and the resulting structures were confirmed by Fourier-transformed infrared spectroscopy. It was the herein elaborated synthesis of impurity-free SUM that allowed for growing of its single crystals suitable for X-ray crystallographic studies. Comparison of the powder X-ray diffraction pattern for SUM with that derived from single-crystal X-ray crystallographic analysis indicated that SUM formed the polymorph I crystal phase, which is also encountered in its pharmaceutical formulation. © 2012 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 102:706–716, 2013     

Synthesis and Biological Evaluation of Novel 1,2,3‐Triazolonucleotides

A general procedure for the preparation of 1,2,3‐triazole analogs of nucleosides from diethyl 2‐azidoethoxymethyl‐ and 2‐azidoethoxyethylphosphonates was elaborated. The application of microwave irradiation shortened the reaction time to 10 min in comparison to ca. 48 h when 1,3‐dipolar cycloadditions were performed under standard conditions. All compounds were evaluated in vitro for inhibitory activity against a broad variety of DNA and RNA viruses. None of the compounds were antivirally active at subtoxic concentrations. Compound 17k exhibited moderate inhibitory effects on the proliferation of human T‐lymphocyte cells (IC₅₀ = 64 µM for CEM).     

Influence of the Undercut Anchor Head Angle on the Propagation of the Failure Zone of the Rock Medium—Part II

Problems concerning the influence of the geometric parameters of an undercutting anchor on the range of the failure zone of rock medium during the pulling out of the anchor constitute one of the aspects that arouse the interest of authors due to attempts to use undercutting anchors in the process of rock lump separation. This method is considered an alternative to the existing methods of separation, especially in special cases of mining technologies. This article presents the results of numerical investigations into the effect of changes in the head geometry that occur as a result of wear on the conical part of the undercutting anchor and the extent of failure of the rock medium during its pulling out. This is an extension of considerations presented in previous work, where special attention was paid to the influence of potential errors in anchor installation, leading to changes in head geometry and, consequently, to changes in the extent of the failure zone of the rock medium. As a result, significant changes in the volume of the detached rock masses are observed. This study shows that the increasing surface friction of the stripping anchor head leads to a decrease in the angle of the undercutting head. As a result, the extent of the failure zone measured on the free rock surface increases, the value of the angle of the failure cone at the initial stage of the stripping decreases, and the deformation of rock in the plane perpendicular to the anchor axis increases.     

Research into the Disintegration of Abrasive Materials in the Abrasive Water Jet Machining Process

The size and distribution of abrasive particles have a significant influence on the effectiveness of the cutting process by the high-speed abrasive water jet (AWJ). This paper deals with the disintegration intensity of abrasive materials in AWJ cutting during the creation of the abrasive jet. An evaluation of the abrasive materials was performed after forming in the cutting head was carried out and grain distribution was evaluated using the geometric and logarithmic Folk and Ward method. The influence of the abrasive concentration of abrasive materials such as alluvial garnet, recycled garnet, corundum, and olivine on grain distribution was studied. A recovery analysis was also carried out and the recycling coefficient was determined for each abrasive material tested.