A predictive value of hyponatremia for poor outcome and cerebral infarction in high-grade aneurysmal subarachnoid haemorrhage patients

BACKGROUND

The clinical significance of hyponatremia has not been investigated in high-grade aneurysmal subarachnoid haemorrhage (aSAH) patients. Thus, we assessed the predictive value of hyponatremia for poor outcome or cerebral infarction in high grade patients (the World Federation of Neurological Surgeons Scale (WFNS) grade 4 or 5) after aSAH.

METHODS

Patients with WFNS grade 4 or 5 after aSAH were selected into this study between January 2005 and January 2008. In the same period, patients with WFNS grade 1, 2 or 3 after aSAH (low grade) were also chosen into this study. Hyponatremia was determined with serum sodium measurements obtained within 9 days after aSAH. Prognosis of patients was estimated with Glasgow Outcome Scale at 3 months. The relationship between hyponatremia and poor outcome and association of hyponatremia and cerebral infarction were analysed, respectively.

RESULTS

A total of 124 high-grade patients were included in this study. Of those, 78 patients developed hyponatremia. Hyponatremia developed in 32.3% of cases between days 1 and 3 after aSAH, and 30.6% developed hyponatremia after 3 days post-aSAH. Multivariable analysis revealed that hyponatremia was not correlated with poor outcome in high-grade aSAH patients. Furthermore, only late-onset hyponatremia was correlated with cerebral infarction in these patients. Meanwhile, there was no significant correlation between hyponatremia and poor outcome or cerebral infarction in 259 low-grade aSAH patients.

CONCLUSIONS

Hyponatremia does not predict poor outcome in all-grade aSAH patients. However, late-onset hyponatremia in high-grade aSAH patients is associated with cerebral infarction. Therefore, the appropriate management of hyponatremia could be beneficial in those patients.

Level crossings and zero-field splitting in the {Cr8}-cubane spin cluster studied using inelastic neutron scattering and magnetization

Inelastic neutron scattering (INS) in variable magnetic field and high-field magnetization measurements in the millikelvin temperature range were performed to gain insight into the low-energy magnetic excitation spectrum and the field-induced level crossings in the molecular spin cluster {Cr(8)}-cubane. These complementary techniques provide consistent estimates of the lowest level-crossing field. The overall features of the experimental data are explained using an isotropic Heisenberg model, based on three distinct exchange interactions linking the eight Cr(III) paramagnetic centers (spins s = 3/2), that is supplemented with a relatively large molecular magnetic anisotropy term for the lowest S = 1 multiplet. It is noted that the existence of the anisotropy is clearly evident from the magnetic field dependence of the excitations in the INS measurements, while the magnetization measurements are not sensitive to its effects.

Atypical teratoid/rhabdoid tumors in adult patients: CT and MR imaging features

Primary AT/RT is a rare highly malignant tumor of the CNS, usually occurring in children younger than 5 years of age. The objective of this study was to characterize the CT and MR imaging findings in a series of 5 adult patients with pathologically proved AT/RT. All 5 AT/RTs were supratentorial. In 2 patients who underwent nonenhanced CT, the tumors appeared isoattenuated, and 1 of the 2 tumors contained calcifications. Solid portions of the tumors on MR imaging were isointense on T1-weighted, T2-weighted, and FLAIR images, and 1 case showed restricted diffusion on DWI. The tumors also demonstrated a bandlike rim of strong enhancement surrounding a central cystic area on contrast-enhanced T1-weighted imaging. One tumor was associated with destruction of the calvaria. Although AT/RTs can have nonspecific findings, the tumors in our series were large and isointense on T1-weighted, T2-weighted, and FLAIR images with central necrosis and prominent rim enhancement.

Ferromagnetically coupled Shastry-Sutherland quantum spin singlets in (CuCl)LaNb₂O₇

A thorough crystal structure determination at very low temperature of (CuCl)LaNb₂O₇, originally proposed as a spin-1/2 square-lattice antiferromagnet, is reported thanks to the use of single-crystal x-ray diffraction and powder neutron diffraction. State-of-the-art calculations (maximum entropy method) reveal that (CuCl)LaNb₂O₇ is orthorhombic with Pbam symmetry. First-principles calculations demonstrate that the dominant magnetic interactions are antiferromagnetic between fourth nearest neighbors with a Cu-Cl-Cl-Cu exchange path, which lead to the formation of spin singlets. The two strongest interactions between the singlets are ferromagnetic, which makes (CuCl)LaNb₂O₇ the first system of ferromagnetically coupled Shastry-Sutherland quantum spin singlets.

From (pi,0) magnetic order to superconductivity with (pi,pi) magnetic resonance in Fe(1.02)Te(1-x)Se(x)

The iron chalcogenide Fe(1+y)(Te(1-x)Se(x)) is structurally the simplest of the Fe-based superconductors. Although the Fermi surface is similar to iron pnictides, the parent compound Fe(1+y)Te exhibits antiferromagnetic order with an in-plane magnetic wave vector (pi,0) (ref. 6). This contrasts the pnictide parent compounds where the magnetic order has an in-plane magnetic wave vector (pi,pi) that connects hole and electron parts of the Fermi surface. Despite these differences, both the pnictide and chalcogenide Fe superconductors exhibit a superconducting spin resonance around (pi,pi) (refs 9, 10, 11). A central question in this burgeoning field is therefore how (pi,pi) superconductivity can emerge from a (pi,0) magnetic instability. Here, we report that the magnetic soft mode evolving from the (pi,0)-type magnetic long-range order is associated with weak charge carrier localization. Bulk superconductivity occurs as magnetic correlations at (pi,0) are suppressed and the mode at (pi, pi) becomes dominant for x>0.29. Our results suggest a common magnetic origin for superconductivity in iron chalcogenide and pnictide superconductors.

Impact of concurrent macrovascular co-morbidities on healthcare utilization in patients with type 2 diabetes in Europe: a matched study

AIM

To examine and to quantify the impact of concurrent macrovascular co-morbidities (MVC) on healthcare resource utilization among patients with type 2 diabetes mellitus (T2DM) in Europe.

METHODS

This is a matched cohort study based on the Real-Life Effectiveness and Care Patterns of Diabetes Management study, a multicentre, observational study with retrospective medical chart reviews of T2DM patients in Spain, France, UK, Norway, Finland, Germany and Poland. Included patients were aged > or =30 years at time of diagnosis of T2DM who added a sulfonylurea or a PPARgamma agonist to failing metformin monotherapy (index date) and had concurrent MVC (cases). A control cohort with T2DM but without concurrent MVC was identified using 1:1 propensity score matching. Logit models were used to identify the relationship between concurrent MVC and the likelihood of emergency room admission, receiving medical/surgical procedures, and hospitalization during the study period after controlling for baseline demographics, clinical information and baseline treatment. Negative binomial models were used to predict the number of office visits and length of hospital stay per year attributable to the concurrent MVC.

RESULTS

Relative to controls, patients with MVC were significantly more likely to have emergency department admissions [odds ratio (OR) 2.69; 95% CI: 1.56-4.65], receiving medical/surgical procedures (OR 2.57; 95% CI: 1.56-4.21) and hospitalizations (OR 2.58; 95% CI: 1.64-4.07) after controlling for other predictors. Similarly, MVC were associated with 1.49 additional office visits per year (p = 0.036) and 0.32 days of hospital stay per year (p = 0.023).

CONCLUSIONS

Within a seven-country European sample, this study showed that T2DM patients with MVC were more likely to use healthcare resources compared with T2DM patients without MVC.

Nutrition support with glutamine dipeptide in patients undergoing liver transplantation

AIM

The effect of total parenteral nutrition (TPN) support supplemented with alanyl-glutamine (Ala-Gln) dipeptide was investigated in a randomized, controlled clinical trial.

METHODS

Sixty-five patients with the diagnosis of end-stage liver disease or hepatic cellular carcinoma admitted for orthotopic liver transplantation were randomly divided into 3 groups: diet group (n = 21), TPN group (n = 22), and Gln group (n = 22). Patients in the TPN and Gln groups received isocaloric and isonitrogenous TPN for 7 days. Venous heparin blood samples were obtained for assay on days 2 and 9 after surgery; we performed routine pathologic tests.

RESULTS

Compared with the results on day 9 in the TPN group, there was a significant increase in the prognostic nutrition index and in prealbumin among the Gln group. Aspartate aminotransferase improved significantly by Gln treatment compared with traditional TPN support (P < .05). The pathologic results also showed Gln supplementation to reduce hepatic cell injury. A significant decrease in postoperative hospital stay was observed in the Gln group.

CONCLUSIONS

Posttransplant TPN support greatly improved protein metabolism and nutritional state of patients. TPN with Ala-Gln helped to improve synthetic function and to reduce the injury to a transplanted liver.

Dynamic scaling in the susceptibility of the spin-1/2 kagome lattice antiferromagnet herbertsmithite

The spin-1/2 kagome lattice antiferromagnet herbertsmithite, ZnCu(3)(OH)(6)Cl(2), is a candidate material for a quantum spin liquid ground state. We show that the magnetic response of this material displays an unusual scaling relation in both the bulk ac susceptibility and the low energy dynamic susceptibility as measured by inelastic neutron scattering. The quantity chiT(alpha) with alpha approximately 0.66 can be expressed as a universal function of H/T or omega/T. This scaling is discussed in relation to similar behavior seen in systems influenced by disorder or by the proximity to a quantum critical point.

A role of Miz-1 in Gfi-1-mediated transcriptional repression of CDKN1A

Zinc-finger (ZF) transcriptional repressor Gfi-1 plays an important role in hematopoiesis and inner ear development, and also functions as an oncoprotein that cooperates with c-Myc in lymphomagenesis. Gfi-1 represses transcription by directly binding to conserved sequences in the promoters of its target genes. CDKN1A encoding p21^Cip1 has been identified as a Gfi-1 target gene and shown to contain Gfi-1 binding sites in the upstream promoter region. We show here that Gfi-1 represses CDKN1A in a manner that is independent of its DNA binding activity. Gfi-1 interacts with POZ-ZF transcription factor Miz-1, originally shown to be a c-Myc interacting partner, and via Miz-1 binds to CDKN1A core promoter. Interestingly, Gfi-1 and c-Myc, through Miz-1, form a ternary complex on the CDKN1A promoter, and act in collaboration to repress CDKN1A. Gfi-1 knockdown results in enhanced levels of p21^Cip1 and attenuated cell proliferation. Notably, similar to c-Myc, the expression of Gfi-1 is downregulated by TGFβ and the level of Gfi-1 influences the response of cell to the cytostatic effect of TGFβ. Our data reveal an important mechanism by which Gfi-1 regulates cell proliferation and may also have implications for understanding the role of Gfi-1 in lymphomagenesis.

Insight into the dicrotic notch in photoplethysmographic pulses from the finger tip of young adults

This study aims to investigate arterial stiffness in selected young adults by non-invasively determining the characteristics of the photoplethysmographic dicrotic notch. A total of 15 volunteers participated in this study, divided into four groups by age and gender. Contour analysis was applied to analyse the photoplethysmographic dicrotic notch, including time-related and height-related parameters. The height of reflected wave, mirrored by the notch relative amplitude (NRA), was found to be significantly larger in the older group compared to the younger group (p = 0.016). The timing of the reflected wave, measured by three parameters, i.e. notch index (NI), notch latency (NL) and peak-to-notch latency (PTNL), significantly increased in the female group compared to the male group (all p < 0.02). The results confirm that arterial stiffness occurs in young adults, and demonstrate that a difference of arterial stiffness exists between young male and female. This study indicates that examining the characteristic notch of the PPG pulse could help in identifying differences of vascular activities.

Bronchogenic and Esophageal Cyst With Laryngeal Malformations in a Thoroughbred Foal

This report documents an unusual case of congenital foregut cyst with dysphagia and stridor in a Thoroughbred foal. Histologically, the bilocular cyst, near the junction of larynx and trachea, had an epithelial lining of bronchogenic and esophageal origin. Concomitant malformation of the laryngeal muscles and cartilage resulted in a combination of anomalies that have not been reported in the human or veterinary literature.

Neutron scattering investigations of the partially ordered pyrochlore Tb(2)Sn(2)O(7)

Neutron scattering measurements have been performed on polycrystalline Tb(2)Sn(2)O(7) at temperatures above and below that of the phase transition, T(N) = 0.87 K, to investigate further the spin dynamics in the magnetically ordered state. In particular, new neutron spin echo results are presented showing a dependence on Q in the dynamics. We show evidence of the coexistence of static ferromagnetism and dynamically fluctuating spins down to 30 mK and we make a comparison of this partially ordered system to the spin liquid Tb(2)Ti(2)O(7).

Two-dimensional kagome correlations and field induced order in the ferromagnetic XY pyrochlore Yb2Ti2O7

Neutron scattering measurements show the ferromagnetic XY pyrochlore Yb2Ti2O7 to display strong quasi-two-dimensional (2D) spin correlations at low temperature, which give way to long range order (LRO) under the application of modest magnetic fields. Rods of scattering along 111 directions due to these 2D spin correlations imply a magnetic decomposition of the cubic pyrochlore system into decoupled kagome planes. A magnetic field of approximately 0.5 T applied along the [110] direction induces a transition to a 3D LRO state characterized by long-lived, dispersive spin waves. Our measurements map out a complex low temperature-field phase diagram for this exotic pyrochlore magnet.

Tunable (deltapi, deltapi)-type antiferromagnetic order in alpha-Fe(Te,Se) superconductors

The new alpha-Fe(Te,Se) superconductors share the common iron building block and ferminology with the LaFeAsO and BaFe(2)As(2) families of superconductors. In contrast with the predicted commensurate spin-density-wave order at the nesting wave vector (pi, 0), a completely different magnetic order with a composition tunable propagation vector (deltapi, deltapi) was determined for the parent compound Fe_{1+y}Te in this powder and single-crystal neutron diffraction study. The new antiferromagnetic order survives as a short-range one even in the highest T_{C} sample. An alternative to the prevailing nesting Fermi surface mechanism is required to understand the latest family of ferrous superconductors.

Itinerant spin excitations near the hidden order transition in URu(2)Si(2)

By means of neutron scattering we show that the high temperature precursor to the hidden order state of the heavy fermion superconductor URu(2)Si(2) exhibits heavily damped incommensurate paramagnons whose strong energy dispersion is very similar to that of the long-lived longitudinal f spin excitations that appear below T(0). This suggests that there is a strongly hybridized character to the itinerant excitations observed previously above the hidden order transition. Here we present evidence that the itinerant excitations, like those in chromium, are due to Fermi surface nesting of hole and electron pockets; hence the hidden order phase probably originates from a Fermi surface instability. We identify wavevectors that span nested regions of a f-d hybridized band calculation and that match the neutron spin crossover from incommensurate to commensurate on approach to the hidden order phase.

Inhibitions of vascular endothelial growth factor expression and foam cell formation by EGb 761, a special extract of Ginkgo biloba, in oxidatively modified low-density lipoprotein-induced human THP-1 monocytes cells

It has been reported that oxidatively modified low-density lipoprotein (Ox-LDL) involvement with vascular endothelial growth factor (VEGF) and foam cell formation play an important role in atherosclerosis (AS). Protective effects of Ginkgo biloba extract (EGb 761) have been identified for some cardiovascular and neurological disorders. The aim of this study was to investigate whether Ox-LDL regulates VEGF expression in human THP-1 monocytes, as well as the effect of EGb 761 on VEGF expression and the formation of foam cells. After exposure to Ox-LDL alone or in combination with EGb 761 for up to 48h, cell viability was measured using the MTT assay. VEGF protein content in the supernatant was analyzed by enzyme-linked immunosorbent assay (ELISA). VEGF mRNA was determined by real-time PCR. To determine the effect of EGb 761 on foam cell formation, an Ox-LDL-induced foam cell model was used. Ox-LDL inhibited the growth of THP-1 cells and EGb 761 increased the cell survival rate. Ox-LDL markedly increased VEGF expression in THP-1 cells in a time- and concentration-dependent manner, which was significantly suppressed by EGb 761. EGb 761 also inhibited monocyte/macrophage-derived foam cell formation. These results suggest that Ox-LDL is involved in the development of human AS through VEGF induction in monocytes, and that EGb 761 prevents in vitro atherogenesis, probably via downregulation of VEGF expression in monocytes and inhibition of monocyte/macrophage-derived foam cell formation. The findings suggest a mechanism for the in vivo anti-AS effect of EGb 761 and support its potential clinical use in AS.