CT interpretation by ASPECTS in hyperacute ischemic stroke predicting functional outcomes

Purpose

To determine whether the Alberta Stroke Program Early CT Scores (ASPECTS) can predict posttreatment functional outcomes in hyperacute stroke patients who receive recombinant tissue-type plasminogen activator (rt-PA) treatment within 4.5 h.

Materials and methods

We studied 162 patients treated with rt-PA within 4.5 h of clinical onset. Of those, 29 patients (17.90 %) received rt-PA treatment between 3 and 4.5 h. Systematic CT scoring with the ASPECTS method was done. The primary outcome was the correlations between ASPECTS and the functional status at 3 months follow-up using the modified Rankin Scale.

Results

Clinical variables between those who received rt-PA treatment before and after 3 h were mostly comparable except the proportion of male gender. There were 116 patients (71.60 %) who were classified as independent. Time to receive CT scan or rt-PA treatment was not significantly associated with patients’ functional status. Baseline NIHSS and ASPECTS scores were significant factors associated with dependent status or death at 3 months after rt-PA treatment. The adjusted odds ratios were 1.133 [95 % confidence interval (CI), 1.047–1.226] and 0.844 (95 % CI, 0.720–0.990), respectively.

Conclusion

The ASPECTS predicts the functional status of acute stroke patients who received rt-PA treatment within the 4.5-h golden period.     

Clinical factors predictive of PCR positive in pandemic H1N1 2009 influenza virus infection

Please cite this paper as: Phungoen et al. (2011) Clinical factors predictive of PCR positive in pandemic H1N1 2009 influenza virus infection. Influenza and Other Respiratory Viruses 5(6), e558–e562. Objective Pandemic H1N1 2009 influenza virus (H1N1) has been spreading globally. Clinical features might be predictive and may be different among countries. Even though the PCR test is a confirmatory test for this viral infection, it is expensive and limited in most Thai health care facilities. We studied predictive factors of PCR positive in H1N1 suspected patients. Methods Consecutive patients who had influenza‐like illness less than seven days and had been tested for H1N1 by the real‐time PCR method between May and July 2009 were enrolled. Clinical data was collected and compared between those who had positive and negative PCR tests. Results There were 6494 patients had flu‐like symptoms. Of those, 166 patients were done PCR test and 75 patients (45·18%) had positive PCR test. There were four predictors for positive PCR test including history of contact with confirmed H1N1 patients, headache, body temperature, and coryza with the adjusted odds ratio (95% confidence interval) of 2·84 (1·09–7·40), 6·25 (1·42–27·49), 1·69 (1·08–2·66), and 0·31 (0·12–0·79), respectively. Conclusions Clinical factors can be both suggestive and protective factors for H1N1 infection. These factors may be helpful in clinical practice to assess the possibility of the H1N1 infection in people who are at risk; particularly in resource‐limited health care facilities.     

New phenolic compounds from Dendrobium capillipes and Dendrobium secundum

Phytochemical investigation of the stem of Dendrobium capillipes resulted in the isolation of a new flavonol glycoside namely quercetin-3-O-α-l-rhamnopyranosyl-(1?→?2)-β-d-xylopyranoside, along with seven known phenolic compounds which included two flavonol glycosides and five bibenzyls. From the stem of Dendrobium secundum, a new compound named 5-hydroxy-3,4,3',4',5'-pentamethoxybibenzyl was characterized, together with two known bibenzyls and three glycosidic flavonoids. Some of the isolated bibenzyls showed cytotoxicity against KB, NCI-H187, and MCF-7 cancer cells, whereas all of the glycosidic flavonoids were devoid of activity.     

Simulation of the effect of airway disease on respiratory airways

Airway disease such as tumours and asthma lead to lung injuries. Therefore, a better understanding of airway mechanics parameters is very important to avoid lung injuries in patients undergoing mechanical ventilation for treatment of respiratory problems in intensive-care medicine as well as pulmonary medicine. The objective of this study was to investigate the role of airway diseases such as asthma and tumours on airway mechanics parameters using coupled fluid-solid computational analysis. The results obtained indicate that both tumours and asthma greatly affect the airway mechanics parameters (airflow velocity increased by about 15% and the strains increased by about 40%). Strain results of this study highlight significant changes in levels of airway parameters, which may translate into higher health risk associated with airway tumours and the asthmatic airways. These results combined with optimization suggest that it is possible to develop mechanical ventilation protocols to avoid lung injuries in patients.     

A new phenanthrenequinone from Dendrobium draconis

A number of Dendrobium species (Orchidaceae) have been used as health foods. In Thailand, the tea prepared from the stems of Dendrobium draconis Rchb.f. (Orchidaceae) has been used as a blood tonic. Our phytochemical investigation of this plant led to the isolation of a new compound namely 5-methoxy-7-hydroxy-9,10-dihydro-1,4-phenanthrenequinone, along with four known stilbenoids including hircinol, gigantol, batatasin III, and 7-methoxy-9,10-dihydrophenanthrene-2,4,5-triol. The structures of these compounds were determined through extensive spectroscopic studies, including (1)H and (13)C NMR, DEPT, COSY, NOESY, HMQC, HMBC, ESI-MS, and HR-ESI-MS experiments. In the DPPH-free radical assay, these stilbene derivatives showed appreciable antioxidant activity.     

Topical cream-based oxyresveratrol in the treatment of cutaneous HSV-1 infection in mice

Anti-herpes simplex virus (HSV) activities of oxyresveratrol in vitro and topical administration in cutaneous HSV-1 infection in mice were examined. The inhibitory concentrations for 50% plaque formation (IC₅₀) of oxyresveratrol against HSV-1 clinical isolates and HSV-2 clinical isolates were 20.9-29.5 and 22.2-27.5 μg/ml, respectively. In topical administration in cutaneous HSV-1 infection in mice, 2.5%, 5%, 10% and 20% oxyresveratrol in cream vehicle applied three times daily for 7 days after infection were evaluated and 10% and 20% oxyresveratrol cream were significantly effective in delaying the development of skin lesions and protection from death (P < 0.01). The concentration of 10% oxyresveratrol in cream was significantly more effective than that of 30% oxyresveratrol in vaseline applied three times daily (P < 0.01). Oxyresveratrol cream at 20% was as effective as 5% ACV cream applied three times daily (P < 0.01). Both 10% and 20% oxyresveratrol cream were as effective as that of 5% ACV cream applied two times daily (P > 0.05). Therapeutic efficacy of oxyresveratrol in cream vehicle was dose-dependent and the maximum efficacy observed on day 6 after infection was shown at 10% oxyresveratrol in cream applied three times daily. The frequency of application of 10% oxyresveratrol cream at three, four and five times daily was as effective as that of 5% ACV cream applied five times daily (P > 0.05). These results demonstrated that topical administration of oxyresveratrol in novel cream vehicle reduced the concentration of oxyresveratrol to 10% and was suitable for cutaneous HSV infection.     

Risk score predictive of mortality in status epilepticus according to a national database

Status epilepticus (SE) is a serious neurologic condition with high morbidity and mortality rates. This study aimed to develop and validate a risk score that is predictive of mortality in patients with SE using clinical factors without electrocardiography. The inclusion criteria of this study were all patients diagnosed with SE and treated between 2005 and 2015. We retrospectively searched for eligible patients using the International Classification of Diseases, Tenth Revision (ICD‐10) code for SE (G41) in the national Universal Health Coverage database. The outcome was death at discharge or within 30 days after discharge. Factors‐associated death was analyzed using stepwise logistic regression analysis. Risk scores were developed based on the final logistic regression model. The final model was also validated. There were 10 924 patients used for model development and 10 808 used for model validation. The formula to determine the risk score for SE mortality was 5 × shock + 4 × age over 60 years old + 3.5 × heart diseases + 3 × acute renal failure + 3 × septicemia + 2.5 × central nervous system infection + 2.5 × age 41‐60 years old + 2 × cancer + 2 × chronic renal failure + 1.5 × age 21‐40 years old + 1 × pneumonia + 1 × respiratory failure + 1 × anemia. The risk scores of greater than 4 indicated risk for mortality with a sensitivity of 78.20% and specificity of 75.38%. The area under the receiver‐operating characteristic (ROC) curve for death in the final model was 83.59%. The area under the ROC curve for the model validation group was 83.52%. SE patients who had a risk score of 4 or more were at high risk for death. Physicians should be aware of the high mortality rate in these particular patients.     

Optimization of 3D Printing Technology for Fabrication of Dental Crown Prototype Using Plastic Powder and Zirconia Materials

This research was aimed at developing a dental prototype from 3D printing technology using a synthetic filament of polylactic acid (PLA) and zirconium dioxide (ZrO₂) with glycerol and silane coupling agent as a binder. A face-centered central composite design was used to study the effects of the filament extrusion parameters and the 3D printing parameters. Tensile and compressive testing was conducted to determine the stress-strain relationship of the filaments. The yield strength, elongation percentage and Young’s modulus were also calculated. Results showed the melting temperature of 193 °C, ZrO₂ ratio of 17 wt.% and 25 rpm screw speed contributed to the highest ultimate tensile strength of the synthetic filament. A Nozzle temperature of 210 °C and an infill density of 100% had the most effect on the ultimate compressive strength whilst the printing speed had no significant effects. Differential scanning calorimetry (DSC) was used to study the thermal properties and percentage of crystallinity of PLA filaments. The addition of glycerol and a silane coupling agent increased the tensile strength and filament size. The ZrO₂ particles induced the crystallization of the PLA matrix. A higher crystallization was also obtained from the annealing treatment resulting in the greater thermal resistance performance of the dental crown prototype.