A scoring tool to predict mortality and dependency after cerebral venous thrombosis

BACKGROUND

We developed a prognostic score to predict dependency and death after cerebral venous thrombosis (CVT) to identify patients for targeted therapy in future clinical trials..

METHODS

We used data from the International CVT Consortium. We excluded patients with pre-existent functional dependency. We used logistic regression to predict poor outcome (modified Rankin Scale 3-6) at 6 months and Cox regression to predict 30-day and 1-year all-cause mortality. Potential predictors derived from previous studies were selected with backward stepwise selection. Coefficients were shrunken using Ridge regression to adjust for optimism in internal validation.

RESULTS

Of 1454 patients with CVT, the cumulative number of deaths was 44 (3%) and 70 (5%) for 30 days and 1 year, respectively. Of 1126 patients evaluated regarding functional outcome, 137 (12%) were dependent or dead at 6 months. From the retained predictors for both models, we derived the SI₂ NCAL₂ C score utilizing the following components: absence of female Sex-specific risk factor, Intracerebral hemorrhage, Infection of the central nervous system, Neurologic focal deficits, Coma, Age, lower Level of hemoglobin (g/L), higher Level of glucose (mmol/L) at admission, and Cancer. C-statistics were 0.80 (95%CI 0.75-0.84), 0.84 (95%CI 0.80-0.88) and 0.84 (95%CI 0.80-0.88) for the poor outcome, 30 days and 1 year mortality model, respectively. Calibration plots indicated good model fit between predicted and observed values. The SI₂ NCAL₂ C score calculator is freely available at www.cerebralvenousthrombosis.com.

CONCLUSIONS

The SI₂ NCAL₂ C score shows adequate performance for estimating individual risk of mortality and dependency after CVT but external validation of the score is warranted.

Persistence of phylogeographic footprints helps to understand cryptic diversity detected in two marine amphipods widespread in the Mediterranean basin

Amphipods of the genus Gammarus are a vital component of macrozoobenthic communities in European inland and coastal, marine and brackish waters of the Mediterranean and the Black Sea. Exceptional levels of cryptic diversity have been revealed for several widespread freshwater Gammarus species in Europe. No comprehensive assessment has yet been made for brackishwater counterparts, such as Gammarus aequicauda and G. insensibilis, which are among the most widely dispersed members of the so-called "G. locusta group" in the Mediterranean and in the Black Sea. Here we probe the diversity of these morphospecies examining the partitioning of mtDNA and nDNA across multiple populations along their distribution range and discuss it within the regional paleogeographic framework. We gathered molecular data from a collection of 166 individuals of G. aequicauda and G. insensibilis from 47 locations along their distribution range in the Mediterranean including the Black Sea. They were amplified for both mitochondrial COI and 16S rRNA as well as the nuclear 28S rRNA. All five MOTU delimitation methods (ABGD, BIN, bPTP, GMYC single and multiple threshold models) applied revealed deep divergence between Black Sea and Mediterranean populations in both G. aequicauda and G. insensibilis. There were eight distinct MOTUs delimited for G. aequicauda (6-18% K2P) and 4 MOTUs for G. insensibilis (4-14% K2P). No sympatric MOTUs were detected throughout their distribution range. Multimarker time-calibrated phylogeny indicated that divergence of both G. aequicauda and G. insensibilis species complexes started already in the late Oligocene/early Miocene with the split between clades inhabiting eastern and western part of the Mediterranean occurring in both species at the similar time. Our results indicate a high cryptic diversity within Mediterranean brackishwater Gammarus, similar to that observed for freshwater counterparts. Moreover, the phylogenetic history combined with the current geographic distribution indicate that the evolution of both studied Gammarus morphogroups has been strongly connected with the geological events in the Mediterranean Basin and it reflect the turbulent history of the area.

Large-scale meta-analysis of interleukin-1 beta and interleukin-1 receptor antagonist polymorphisms on risk of radiographic hip and knee osteoarthritis and severity of knee osteoarthritis

OBJECTIVE

To clarify the role of common genetic variation in the Interleukin-1β (IL1B) and Interleukin-1R antagonist (IL1RN) genes on risk of knee and hip osteoarthritis (OA) and severity of knee OA by means of large-scale meta-analyses.

METHODS

We searched PubMed for articles assessing the role of IL1B and IL1RN polymorphisms/haplotypes on the risk of hip and/or knee OA. Novel data were included from eight unpublished studies. Meta-analyses were performed using fixed- and random-effects models with a total of 3595 hip OA and 5013 knee OA cases, and 6559 and 9132 controls respectively. The role of ILRN haplotypes on radiographic severity of knee OA was tested in 1918 cases with Kellgren-Lawrence (K/L) 1 or 2 compared to 199 cases with K/L 3 or 4.

RESULTS

The meta-analysis of six published studies retrieved from the literature search and eight unpublished studies showed no evidence of association between common genetic variation in the IL1B or IL1RN genes and risk of hip OA or knee OA (P>0.05 for rs16944, rs1143634, rs419598 and haplotype C-G-C (rs1143634, rs16944 and rs419598) previously implicated in risk of hip OA). The C-T-A haplotype formed by rs419598, rs315952 and rs9005, previously implicated in radiographic severity of knee OA, was associated with reduced severity of knee OA (odds ratio (OR)=0.71 95%CI 0.56-0.91; P=0.006, I(2)=74%), and achieved borderline statistical significance in a random-effects model (OR=0.61 95%CI 0.35-1.06 P=0.08).

CONCLUSION

Common genetic variation in the Interleukin-1 region is not associated with prevalence of hip or knee OA but our data suggest that IL1RN might have a role in severity of knee OA.

Immobilization of Candida rugosa lipase on glass beads for enantioselective hydrolysis of racemic naproxen methyl ester

Candida rugosa lipase (CRL) was immobilized on glutaraldehyde-activated aminopropyl glass beads by using covalent binding method or sol-gel encapsulation procedure and improved considerably by fluoride-catalyzed hydrolysis of mixtures of RSi(OCH3)3 and Si(OCH3)4. The catalytic properties of the immobilized lipases were evaluated into model reactions, i.e. the hydrolysis of p-nitrophenylpalmitate (p-NPP). It has been observed that the percent activity yield of the encapsulated lipase was 166.9, which is 5.5 times higher than that of the covalently immobilized lipase. The enantioselective hydrolysis of racemic Naproxen methyl ester by immobilized lipase was studied in aqueous buffer solution/isooctane reaction system and it was noticed that particularly, the glass beads based encapsulated lipases had higher conversion and enantioselectivity compared to covalently immobilized lipase. In short, the study confirms an excellent enantioselectivity (E>400) for the encapsulated lipase with an ee value of 98% for S-Naproxen.

Evaluation of soil properties and flora under afforestation and natural forest in semi-arid climate of central Anatolia

Arid and semi-add climates and antropojen effects have caused rapid deterioration of the natural resources in the watershed. The main objectives of the study were to determine the correlation between soil properties and flora and to examine some soil properties and floristic composition under natural forest and afforestration. The topographical, geological and stand viewing maps of the watershed belong to 1955 and 2006 years were eximaned in the study. According to this study the 14.5% rate of black pine forest in 1955 increased to 35.8% in 2006. Degraded forest, degraded black pine and agricultural area decreased respectively to 5.7, 1.8 and 15.8% in 51 years. The richest families in the research area were Asteraceae, Fabaceae, Lamiaceae, Poaceae, Brassicaceae, Caryophyllaceae, Scrophulariaceae, Boraginaceae, Apiaceae and Rosaceae. The rate of the richest families was 71.75% in the total species, the remaining 22 families were scattered to 28.25% in proportion of species.

Tumour necrosis factor alpha -308G/A gene polymorphism: lack of association with knee osteoarthritis in a Turkish population

OBJECTIVE

To study the association between TNFalpha-308 G/A polymorphism and susceptibility to and severity of knee osteoarthritis in a Turkish population.

METHODS

Genomic DNA was obtained from 151 patients with knee osteoarthritis and 84 ethnically matched healthy controls. Polymerase chain reaction-restriction fragment length analysis was used to identify G/A polymorphism at position -308 in the promoter region. Genotype distributions and allelic frequencies of TNFalpha-308 G/A polymorphism were compared between osteoarthritis patients and controls. Thereafter, this association was investigated between patients and controls of the same sex. In addition, the standard Kellgren-Lawrence grading score and the Turkish version of the Western Ontario and McMaster Universities Osteoarthritis Index were used to assess the radiological and functional severity of the disease and their relationship with the TNFalpha-308 gene polymorphism was investigated.

RESULTS

Genotype distribution and allelic frequencies of -308 G/A polymorphism in the TNFalpha gene did not differ significantly between patients with knee osteoarthritis and controls (p>0.05). Moreover, there were no significant differences between patients and controls of the same sex (p>0.05). In addition, no association was observed between the radiological and functional severity of the disease and TNFalpha-308 G/A polymorphism (p>0.05).

CONCLUSION

These findings suggest that the examined polymorphism in the TNFalpha gene does not contribute to susceptibility to or severity of knee osteoarthritis in the Turkish population.

Synthesis of beta-cyclodextrin and starch based polymers for sorption of azo dyes from aqueous solutions

Three beta-cyclodextrin (polymers 1-3) and a starch-based (polymer 4) polymers were synthesized using hexamethylene diisocyanate (HMDI) as a cross-linking agent in dry dimethylformamide and used as a sorbent for the removal of some selected azo dyes from aqueous solutions. The cross-linked polymers were characterized by Fourier transform infrared spectroscopy, thermogravimetric and differential scanning calorimetric analysis. Results of sorption showed that cyclodextrin and starch based polymers can be effectively used as a sorbent for the removal of anionic azo dyes. The Influence of the amide groups and the chemical structure of azo dyes are also studied. Results of sorption experiments showed that these adsorbent exhibited high sorption capacities toward Direct Violent 51 (80% for polymer 1, 69% for polymer 2, 70% for polymer 3 and 78% for polymer 4). The sorption capacity of dyes on the polymers was dependent on the presence of sulfonate groups of the anionic dyes. In order to explain the results an adsorption mechanism mainly physical adsorption and interactions such as hydrogen bonding, ion-exchange due to the nature of the polymer network and the formation of an inclusion complex due to the beta-CD molecules through host-guest interaction is proposed.

[A comparison of respiratory muscle strength, pulmonary function tests and endurance in patients with early and late stage ankylosing spodylitis]

BACKGROUND

Ankylosing spondylitis (AS) is a multisystemic disease in which pulmonary function is altered owing mainly to the restriction of chest wall involvement. A restrictive ventilatory defect has been extensively reported. This has been suggested to be a consequence of reduced mobility of the thoracic cage. Respiratory function in AS shows a typical restrictive pattern but pulmonary compliance, diffusion capacity, and arterial blood gases are normal.

OBJECTIVE

The objective of the present study was to compare pulmonary function tests (PFT), respiratory muscle strength (MIP, MEP) and endurance (MVV) in early and late AS.

METHODS

A total of 35 patients (30 males, 5 females) took part, all of whom met the New York criteria for AS. Patients were divided into two groups for the comparison of early (disease duration <10 years, 20 patients) and late (disease duration >10 years, 15 patients) manifestations in pulmonary function tests, respiratory muscle strength and endurance, dyspnea score, chest expansion, and BASFI score. In addition, 21 healthy controls were compared with the AS patients. Measurement of chest expansion was performed in all subjects. Pulmonary function tests were performed by spirometry. Respiratory muscle strength was evaluated by a mouth pressure meter (MPM). Functional status was assessed by BASFI in all AS patients.

RESULTS

There was no significant difference in body mass index between the groups. The FVC and FEV(1) were significantly lower in late AS (p=0.003, p=0.03, restrictive ventilatory defect ). Chest expansion was significantly lower in late AS (p<0.05). There was no significant difference for MIP or MEP values between late AS, early AS and the controls (p>0.05). Endurance (MVV) was significantly lower in late AS patients (p=0.05). Although the BASFI and dyspnea scores were higher in late AS, they did not reach significant levels. In addition, age was negatively correlated with MIP and MEP in late AS (r=-0.733; p=0.02, r=-0.667; p=0.05).

CONCLUSION

This study demonstrates that FVC and FEV(1) (hallmarks of a restrictive pattern), MVV (endurance) and chest expansion are especially involved in long-standing AS. Therefore, improvement of the thoracic cage should be taken into consideration, especially in early AS. These patients should be encouraged to make regular respiratory exercises for preventing the limitation of chest expansion and also improving cardiopulmonary fitness and respiratory endurance.

Neurotization of the frontal muscle after scalp replantation: case report

A case of immediate replantation of an avulsed scalp by microvascular anastomosis is presented. Microvascular replantation of the scalp seems to offer significant social and psychological advantages over secondary reconstructive procedures. The significance of the case presented is the regaining of the motor neural function of the facial nerve after 38 months.

Free musculofasciocutaneous medial plantar flap for reconstruction of thenar defects

Functional reconstruction of thenar skin defects complicated by muscle loss is possible by transfer of a medial plantar flap with the underlying abductor hallucis muscle. Three patients with severe flexion-adduction contractures of the thumb due to gunshot injuries were reconstructed by using this musculofasciocutaneous flap. At surgery, after release of the skin contractures, all dysfunctional fibrotic muscles were excised. A medial plantar flap and the abductor hallucis muscle were dissected together; the motor branch of the abductor hallucis was preserved by intraneural dissection and sutured to the thenar motor branch of the median nerve. The muscle ends were sutured across the defects of the thenar muscles. All flaps survived without any loss at follow-up of 6-9 months. The flaps adapted to the thenar region completely by providing sufficient thenar bulk and a good skin colour match with palmar skin. Electromyography of the transferred muscle showed an interference pattern with an amplitude of about 200 mV in two cases and 100 mV in one case. Clinically, these findings were supported by voluntary opposition of the thumbs with good strength.

Kinetic Study of Ligand Exchange Reaction of Anions as Ligands on DAE-Sporopollenin

The specific rate coefficients and ligand sorption isotherms of Br and I- as ligands on diaminoethyl-sporopollenin were determined as a function of pH and temperature between 20 and 60&deg;C. The ligand exchange rates were measured just after the rapid mixing of the ligand solution with the resin suspension. The data have also been analyzed to obtain activation parameters DeltaG, DeltaH, and DeltaS for reaction in the corresponding mixture. A single ligand-exchange process was observed; the sorption of ligand increased with decreasing pH and hydrated radius of ligands and increasing temperature. A reaction mechanism which describe the ligand exchange reaction is proposed.