Comparing the efficacy and safety of direct oral anticoagulants with vitamin K antagonist in cerebral venous thrombosis

Cerebral venous thrombosis (CVT) causes significant disability and mortality. Current guidelines for CVT management support the initial use of unfractionated heparin or low molecular weight heparin followed by longer-term oral vitamin K antagonist (VKA). There has been increasing, albeit limited, evidence for the use of direct oral anticoagulants (DOAC) as an alternative to VKA. We performed a systematic review and meta-analysis of studies that compared the safety and efficacy of DOACs to VKA in treating CVT. A comprehensive literature search was carried out in Medline, Embase and Cochrane Stroke Group Trials Register using a suitable keyword/MeSH term search strategy. All studies published in English comparing outcomes of patients with CVT treated with DOAC or VKA were included. In total, 6 studies (5 observational studies and 1 randomized clinical trial) comprising 412 patients (age range 16-83 years) were analyzed. DOAC was used in 151 patients, while 261 received VKA. The follow-up period was 3-11 months. The efficacy of DOACs was comparable with VKA in terms of partial or full thrombus recanalization (RR 1.02, 95% CI 0.89-1.16) and excellent functional recovery with modified Rankin scale < 2 (RR 1.02, 95% CI 0.93-1.13). Patients treated with DOAC developed lower major bleeding events when compared to VKA, although this did not reach statistical significance (RR 0.44, 95% CI 0.12-1.59). We provide preliminary evidence to support DOAC as effective and safe alternatives to VKA in CVT treatment. We await the results of upcoming randomized trials to further support our results and validate the use of DOAC.

Recommending Inequality? Patterns of US Healthcare Providers' HPV Vaccine Recommendations

Purpose: Infrequent provider recommendations continue to be a key barrier to human papillomavirus (HPV) vaccination, including among adolescents at higher risk for future HPV cancers. To inform future provider- training programs, our study sought to synthesize the findings of existing studies of disparities in provider recommendation of HPV vaccination among adolescents. Methods: We conducted a systematic review of studies that quantitatively assessed the prevalence of provider recommendation of HPV vaccination among US parents of adolescents aged 9–17. We excluded studies that were not empirical, not peer-reviewed, or collected data before 2012. Following PRISMA guidelines, two independent coders extracted and screened 3,158 unique titles and abstracts from multiple databases. Next, two independent coders reviewed the full text of eligible studies, systematically collecting data using a standardized abstraction form. We resolved coding disagreements via discussion with the whole team. Results: Fifty-four of 252 reviewed studies met eligibility criteria, including 33 studies of parents and 21 studies of providers. Parental report of receiving a provider recommendation for HPV vaccination ranged from 22% to 78%. These studies most often assessed disparities by adolescents' sex, with almost all finding that provider recommendations were less common for boys vs. girls. Most studies of provider reports confirmed disparate recommendations by sex. Fewer studies stratified recommendation disparities by income or race/ethnicity; these studies found that recommendations were less common among lower-income households, but reported mixed findings by race/ethnicity. Geographic assessments found variation across states and urbanicity, with recommendations being lower including in some Southern states and in rural areas. Conclusion: Findings suggest differences in provider recommendation by sex, household income, geography, and possibly race/ethnicity, in spite of national guidelines for routine HPV vaccination. National efforts to improve provider communication about HPV vaccination should focus on improving recommendation consistency, especially for populations such as lower-income and rural adolescents who are at higher risk for future HPV cancers.

The association between serum prolactin levels and interleukin-6 and systemic lupus erythematosus activity

Based on the recent evidence of association between hyperprolactinemia and systemic lupus erythematosus disease activity (SLEDAI), a study was conducted to analyze the association of hyperprolactinemia with lupus nephritis disease activity. In this cross-sectional study, the analysis was conducted on SLE patients who visited the University Kebangsaan Malaysia Medical Centre (UKMMC) Nephrology Clinic from August 2015 till February 2016. The disease activity was measured using the SLEDAI score, with more than 4 indicating active lupus nephritis. Basal resting prolactin level was analyzed in 43 patients with lupus nephritis, in 27.9% of them had raised serum prolactin. The median of serum prolactin level at 0 minutes was 19.91 ng/mL (IQR: 15.95-22.65 ng/ mL) for active lupus nephritis, which was significantly higher compared to the median of serum prolactin level of 14.34 ng/mL (IQR: 11.09-18.70 ng/mL) for patients in remission (p=0.014). The serum prolactin level positively correlated with SLEDAI (rhos: 0.449, p=0.003) and the UPCI level in lupus nephritis patients (rhos: 0.241, p=0.032). The results were reproduced when the serum prolactin was repeated after 30 minutes. However, the serum prolactin levels at 0 minutes were higher than those taken after 30 minutes (p=0.001). An assessment of serum IL-6 levels found that the active lupus nephritis patients had a higher median level of 65.91 pg/ mL (IQR: 21.96-146.14 pg/mL) compared to the in-remission level of 15.84 pg/mL (IQR: 8.38-92.84 pg/mL), (p=0.039). Further correlation analysis revealed that there was no statistical correlation between the interleukin (IL)-6 levels with serum prolactin, SLEDAI and other lupus nephritis parameters. An ROC curve analysis of serum prolactin at 0 minutes and serum prolactin after 30 minutes and IL-6 levels for prediction of SLE disease activity provided the cutoff value of serum prolactin at 0 minutes, which was 14.63 ng/mL with a sensitivity of 91.7% and specificity of 58.1% and AUC of 0.74 (p=0.015). This study concurred with the previous findings that stated that hyperprolactinemia is prevalent in SLE patients and correlated with clinical disease activity and UPCI level. The baseline of the fasting serum prolactin level was found to be a sensitive biomarker for the evaluation of lupus nephritis disease activity.

The Role of Topographic Collaterals in Predicting Functional Outcome after Thrombolysis in Anterior Circulation Ischemic Stroke

BACKGROUND

The Alberta Stroke Program Early CT (ASPECTS) leptomeningeal collaterals score on CT-angiography helps in prognosticating functional outcome in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis. We evaluated whether a simplified topological ASPECTS collaterals scoring could serve as a rapid biomarker for early prediction in thrombolyzed AIS patients.

METHODS

Consecutive patients from 2010 to 2014 with anterior circulation AIS treated with intravenous thrombolysis were included. The primary outcome was good functional outcome (modified Rankin scale score 0-1 at 3-months). Collaterals were scored according to the extent of contrast opacification in arteries distal to the acute occlusion. Prognostic value of individual ASPECTS leptomeningeal collateral regions was determined by multivariate logistic regression.

RESULTS

A total of 283 patients were included (mean National Institutes of Health Stroke Scale [NIHSS] score 19.0 ± 6.3 points). Using multivariate logistic regression, good M5 region (parietal)-collaterals (OR 2.62, 95%CI 1.215-5.682, P = .014), younger age (OR .97 per year, 95%CI .943-.990, P = .006), nondiabetics (OR .44, 95%CI .224-.889, P = .021), and lower NIHSS (OR .89 per point, 95%CI .842-.935, P < .001) were independently associated with good functional outcome. The receiver operating characteristic curve showed NIHSS as a good predictor of functional outcome (area under the curve .718, 95%CI .656-.780, P < .001). However, a better predictive value was achieved when M5 collateral score was added to the NIHSS (area under the curve .752, 95%CI .694-.809, P < .001).

CONCLUSIONS

Good collaterals in the M5 region are associated with good functional outcome. Addition of this simple neuroimaging tool to the pretreatment NIHSS may serve as a reliable biomarker for prognosis.

Fabrication and electrochemical properties of hemisphere structured 3D Li(Li0.2Mn0.54Co0.13Ni0.13)O2 cathode thin film for all-solid-state lithium battery

The Li[Li0.2Mn0.54Ni0.13Co0.13]O2 cathode thin films were deposited on planar, hemisphere, linked hemisphere, and isolated hemisphere structured Pt current collector thin films to investigate the effect of 3-dimensional (3-D) structure for the electrochemical properties of active cathode thin films. The films of linked hemisphere structure shows the highest initial discharge capacity of 140 microA h/cm2-microm which is better than those of planar (62 microA h/cm2-microm), hemisphere (94.6 microA h/cm2-microm), and isolated hemisphere (135 microA h/cm2-microm) films due to increase of surface area for cathode thin films. Linked hemisphere shows the biggest capacity and the best retention rate because 6 nanobridges of each hemisphere bring strong connection.

[The changes of right ventricular function in the course of COPD induced cor pulmonale]

A study on pulmonary hemodynamics, radionuclide right ventricular ejection fraction and blood gas analysis in 62 cases of COPD induced cor pulmonale at different stages showed the following results: 1. In early stage of cor pulmonale, stroke volume could not increase after exercise, it proved that cardiac reserve has been reduced; 2. With the progression of the disease, cardiac stroke volume reduced but cardiac output increased gradually, it could be considered as the evolutionary characteristic of cardiac function in chronic cor pulmonale; 3. The right ventricular stroke work was normal and could increase with the rise of after-load, reflecting the relatively effective functional compensation; 4. In acute exacerbation of cor pulmonale, the cardiac failure should be attributed to hyperdynamic type with hypervolemia; 5. Correlation analyses suggested that cardiac output decreased along with the increase of right ventricular afterload only in acute exacerbation of late cor pulmonale; PaO2 and PaCO2 have only slight influence on right ventricular function.

Appearance of exogenous epidermal growth factor in liver, bile, and intestinal lumen of suckling rats

This study was performed to investigate the distribution and the degradation of IV administered [125I]rat epidermal growth factor (rEGF) in the liver and gastrointestinal tract of suckling rats. The bile duct of anesthetized rats was cannulated, and [125I]rEGF was injected (with or without 2500-fold excess unlabeled rEGF) into the femoral vein. After 5, 30, 60, and 120 minutes, the radioactivity in the liver, stomach, small intestine, blood, kidney, bile, and luminal contents of the stomach and small intestine was measured. The extracted radioactivity was then analyzed by immunoaffinity chromatography and binding to EGF-specific receptors. High levels of radioactivity were found in the liver (57% of total administered) and small intestine (10%) at 5 minutes, which gradually decreased. On the contrary, radioactivity secreted in the bile and luminal contents of the small intestine increased with time. The radioactivity in the bile represented 2.4% and 4.5% of the total administered at 60 and 120 minutes, respectively. During the first 60 minutes, more than 90% of the radioactivity in the liver, small intestine, bile, and intestinal contents was immunoreactive. Thirty-four to seventy percent of the radio-activity in the bile and liver and 20%-41% of radioactivity in the small intestinal wall and contents were capable of binding to EGF-specific receptors. Radioactivity detected in the liver, bile, small intestine, and intestinal contents was profoundly reduced by the coinjection excess of unlabeled EGF. These studies show that IV administered [125I]rEGF is rapidly taken up by the liver and the gastrointestinal tract and secreted into the bile and intestinal luminal contents of suckling rats in form(s) capable of binding to anti-EGF antibody and EGF-specific receptors. The uptake and secretion by the liver and the small intestine appear to be receptor mediated.

Trenbolone alters the responsiveness of skeletal muscle satellite cells to fibroblast growth factor and insulin-like growth factor I

The potential role of satellite cells in mediating the effect of trenbolone [17 beta-hydroxyestra-4,9-11-trien-3-one (TBOH)] on skeletal muscle hypertrophy was examined. Young female Sprague-Dawley rats received TBOH injections daily for 2 weeks; growth, body composition, and the composition of selected muscles were assessed. Treated rats grew more rapidly and deposited less body lipid and more protein. The semimembranosus muscle from treated rats was larger and had approximately 60% more DNA per muscle than muscles from control rats. The addition of trenbolone directly to the medium of cultured satellite cells did not stimulate cell proliferation, nor did it augment the stimulatory response of these cells to fibroblast growth factor (FGF) or insulin-like growth factor I (IGF-I). In contrast, satellite cells cultured from TBOH-treated rats exhibited greater proliferative responses to FGF and IGF-I than satellite cells from control rats. In addition, serum from TBOH-treated rats stimulated greater cell proliferation in satellite cell cultures than serum from control rats. These experiments suggest that one possible mechanism responsible for the ability of TBOH to stimulate skeletal muscle hypertrophy may be through enhanced proliferation and differentiation of satellite cells as a result of the increased sensitivity of these cells to IGF-I and FGF.