Long-Term Outcomes in Patients With Spontaneous Cerebellar Hemorrhage: An International Cohort Study.

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) in the cerebellum has a poor short-term prognosis, whereas data on the long-term case fatality and recurrent vascular events are sparse. Herewith, we aimed to assess the long-term case fatality and recurrence rate of vascular events after a first cerebellar ICH. METHODS: In this international cohort study, we included patients from 10 hospitals (the United States and Europe from 1997 to 2017) aged ≥18 years with a first spontaneous cerebellar ICH who were discharged alive. Data on long-term case fatality and recurrence of vascular events (recurrent ICH [supratentoria or infratentorial], ischemic stroke, myocardial infarction, or major vascular surgery) were collected for survival analysis and absolute event rate calculation. RESULTS: We included 405 patients with cerebellar ICH (mean age [SD], 72 [13] years, 49% female). The median survival time was 67 months (interquartile range, 23-100 months), with a cumulative survival rate of 34% at 10-year follow-up (median follow-up time per center ranged: 15-80 months). In the 347 patients with data on vascular events 92 events occurred in 78 patients, after initial cerebellar ICH: 31 (8.9%) patients had a recurrent ICH (absolute event rate, 1.8 per 100 patient-years [95% CI, 1.2-2.6]), 39 (11%) had an ischemic stroke (absolute event rate, 2.3 [95% CI, 1.6-3.2]), 13 (3.7%) had a myocardial infarction (absolute event rate, 0.8 [95% CI, 0.4-1.3]), and 5 (1.4%) underwent major vascular surgery (absolute event rate, 0.3 [95% CI, 0.1-0.7]). The median time to a first vascular event during follow-up was 27 months (interquartile range, 8.7-50 months), with a cumulative hazard of 47% at 10 years. CONCLUSIONS: The long-term prognosis of patients who survive a first spontaneous cerebellar ICH is poor and comparable to that of patients who survive a first supratentorial ICH. Further identification of patients at high risk of vascular events following the initial cerebellar ICH is needed. Including patients with cerebellar ICH in randomized controlled trials on secondary prevention of patients with ICH is warranted.

The effect of nano-silica and silica fume on the sodium carbonate-activated slag system containing air pollution control residues.

The utilization of municipal solid waste incineration residues in alkali-activated granulated ground blast furnace slag (GGBFS) has garnered substantial interest for its potential in sustainable solid waste management and achieving a low-carbon footprint. However, incorporating these residues often leads to the deterioration of mechanical properties. This study revealed the role of silica fume (SF) and nano-silica (NS) derived from olivine within a sodium carbonate-activated GGBFS system incorporating air pollution control (APC) residues. The dosage of silica additives and APC residues ranges from 0 - 6 wt% and 0-15 wt%, respectively. The mechanical properties, reaction kinetics, phase composition, microstructure and carbonation resistance of the blended binder were investigated. Results indicated that SF slightly improved the early compressive strength with the formation of C-(A)-S-H gel (Ca/Si = 1.47, Al/Si = 0.23), hemicarboaluminate and hydrotalcite; reactive NS retarded the activation of GGBFS and inhibited the formation of hemicarboaluminate and hydrotalcite, while promoting the formation of C-A-S-H gel (Ca/Si = 1.01, Al/Si = 0.23), resulting in an impressive 80.3 % enhancement in compressive strength. Notably, NS-modified samples exhibited decreased carbonation resistance due to increased porosity and C-(A)-S-H gels that are vulnerable to carbonation. Conversely, 2 % SF addition decreased the diffusion rate of CO2, and APC residues improved the carbonation resistance by facilitating the formation of C-(A)-S-H gel with a higher Ca/Si ratio. This study provided an alternative management practice for APC residues with favorable early strength development and offered new insights into using silica additives to enhance waste-combined alkali-activated materials.

The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort.

Introduction: The 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke. Methods: The BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40-69 years, recruited between 2006-2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline. Results: The BCS (median: 12; IQR:11-14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (95%CI: 40-72%) lower risk of dementia among participants aged <50. Among those aged 50-59, the figure was 32% (95%CI: 20-42%) and 8% (95%CI: 2-14%) for those aged >59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged <50, 52% (95%CI, 47-56%) among those aged 50-59, and 33% (95%CI, 29-37%) among those aged >59. Discussion: The BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide.

A geometric probabilistic approach to random packing of hard disks in a plane.

In this paper, the random packing fraction of hard disks in a plane is analyzed, following a geometric probabilistic approach. First, the random close packing (RCP) of equally sized disks is modelled. Subsequently, following the same methodology, a simple, statistical geometric model is proposed for the random loose packing (RLP) of monodisperse disks. This very basic derivation of RLP leads to a packing value (≈0.66) that is in very good agreement with values that have been obtained previously for 2D disk packings. The present geometrical model also enables a closed-form expression for the contact (coordination) number as a function of the packing density at different states of compaction. These predictions are thoroughly compared with empirical and simulation results, among others the Rényi parking model, yielding good agreement.

Emission rates of bio-based building materials, a method description for qualifying and quantifying VOC emissions.

Biobased insulation materials offer opportunities to use vapor-open building constructions. Such constructions allow direct interaction between the biobased material and the indoor environment. This interaction raises questions about indoor air quality concerning volatile organic compounds (VOCs). This study presents results for the VOC emissions from biobased materials. It consists of two parts: 1) qualification of VOC emissions (compounds) from several biobased and non-biobased building materials, and 2) quantification of VOC emissions (emission rate) from expanded cork (biobased), particle board (semi-biobased), and EPS insulation. By quantifying the emission rate, the exposure to the released VOC emissions at room temperature in a standardized room can be compared to health limit requirements. Gas chromatography and mass spectroscopy (GC-MS) is used to derive the individual VOC emissions and the Total Volatile Organic Compounds (TVOC) from these materials. For qualification, two different sampling techniques are used in which temperature is introduced as a variable to investigate its effect on the type of compounds emitted. For quantification, the toluene equivalent approach is compared to the group equivalent approach. From the analyses it is concluded that temperature has an effect on the type of VOC compounds emitted from (biobased) materials. Results from the quantification indicate that expanded cork and particle board emit no harmful substances at a level that can affect human health. For EPS insulation, elevated levels of benzene were found to exceed healthy limits. The toluene equivalent approach for quantifying the emission, generally, underestimates the rate as compared to the more accurate group equivalent approach.

Characterization and Classification of Spatial White Matter Tract Alteration Patterns in Glioma Patients Using Magnetic Resonance Tractography: A Systematic Review and Meta-Analysis.

INTRODUCTION: Magnetic resonance (MR) tractography can be used to study the spatial relations between gliomas and white matter (WM) tracts. Various spatial patterns of WM tract alterations have been described in the literature. We reviewed classification systems of these patterns, and investigated whether low-grade gliomas (LGGs) and high-grade gliomas (HGGs) demonstrate distinct spatial WM tract alteration patterns. METHODS: We conducted a systematic review and meta-analysis to summarize the evidence regarding MR tractography studies that investigated spatial WM tract alteration patterns in glioma patients. RESULTS: Eleven studies were included. Overall, four spatial WM tract alteration patterns were reported in the current literature: displacement, infiltration, disruption/destruction and edematous. There was a considerable heterogeneity in the operational definitions of these terms. In a subset of studies, sufficient homogeneity in the classification systems was found to analyze pooled results for the displacement and infiltration patterns. Our meta-analyses suggested that LGGs displaced WM tracts significantly more often than HGGs (n = 259 patients, RR: 1.79, 95% CI [1.14, 2.79], I2 = 51%). No significant differences between LGGs and HGGs were found for WM tract infiltration (n = 196 patients, RR: 1.19, 95% CI [0.95, 1.50], I2 = 4%). CONCLUSIONS: The low number of included studies and their considerable methodological heterogeneity emphasize the need for a more uniform classification system to study spatial WM tract alteration patterns using MR tractography. This review provides a first step towards such a classification system, by showing that the current literature is inconclusive and that the ability of fractional anisotropy (FA) to define spatial WM tract alteration patterns should be critically evaluated. We found variations in spatial WM tract alteration patterns between LGGs and HGGs, when specifically examining displacement and infiltration in a subset of the included studies.

Oligodendrogliomas tend to infiltrate the frontal aslant tract, whereas astrocytomas tend to displace it.

INTRODUCTION: MR-tractography is increasingly used in neurosurgical practice to evaluate the anatomical relationships between glioma and nearby subcortical tracts. In some patients, the subcortical tracts seem displaced by the glioma, while in other patients, the subcortical tracts seem infiltrated without displacement. At this point, it is unknown whether these different patterns are related to tumor type. The aim of this exploratory study was to investigate whether tumor type is related to the spatial tractography pattern of the frontal aslant tract (FAT) in low-grade gliomas (LGGs). METHODS: In 64 IDH-mutated LGG patients, the FAT was generated using a pipeline for automatic tractography. In 41 patients, the glioma adjoined the FAT, and four blinded reviewers independently assessed the following two dichotomous categories (yes/no): (i) glioma displaces the tract, and (ii) glioma infiltrates the tract. RESULTS: Fisher's exact tests demonstrated strong and significant positive associations between displacement and astrocytomas (p = .002, φ = .497) and infiltration and oligodendrogliomas (p = .004, φ = .484). The interobserver agreement was good for both categories: (i) κ = 0.76 and (ii) κ = 0.71. CONCLUSION: High sensitivity but low specificity for displacement in astrocytomas demonstrates that in the case of an astrocytoma, the tract is most likely displaced, but that displacement in itself is not necessarily predictive for astrocytomas, as oligodendrogliomas may both infiltrate and displace a tract. Overall, these results demonstrate that oligodendrogliomas tend to infiltrate the nearby subcortical tract, whereas astrocytomas only tend to displace it.

Quantitative analysis and phase assemblage of basic oxygen furnace slag hydration.

Basic oxygen furnace (BOF) slag from steelmaking could be applied as a binder in building materials, reducing the CO2 footprint and solid waste, which is relevant for industrial waste management and circular economy. However, its use is mostly restricted because its hydraulic activity is poorly understood. The BOF slag was hydrated in this study, and its reaction products were systematically characterized using XRD, QXRD, and SEM/EDX-based phase mapping. Internal consistency checks of the data were performed between the analytical techniques. The results revealed that the composition of the amorphous hydration products could be identified and quantified, and the main hydration products were hydrogarnets and C-S-H gel. An extended milling process significantly improved the reactivity, and all the major slag phases, including wüstite, participated in the reaction. Brownmillerite formed hydrogarnets during the first 7 days of hydration. The new hydration products contributed to the immobilization of vanadium and chromium. Particle size played an important role in the amount of C2S reacting, the composition of the hydrogarnets and C-S-H gel, their proportions, and the immobilization capacity. Based on the findings, an overall hydration reaction was developed.

V and Cr substitution in dicalcium silicate under oxidizing and reducing conditions - Synthesis, reactivity, and leaching behavior studies.

Dicalcium silicate (C2S) is known to incorporate potentially hazardous metals (Cr and V) in a belite-rich cementitious system. The effect of the electrovalence nature of V and Cr on C2S polymorphs' (α´, ß, γ) stability under oxidizing and reducing conditions as well as their reactivity are systematically investigated via analyzing oxidation states, phase composition, bonding system, and microstructure as well as oxide composition quantitively. It is shown that C2S can incorporate Cr (VI) and V(V) consequently leading to stabilization of α´, ß-C2S. Instead, Cr (II, III) and V < (V) tend not to substitute in C2S. Despite reactive polymorphs (α´, ß-C2S) stability due to Cr (VI) and V(V) incorporation, the early age (48-72 h) C2S reactivity is drastically reduced due to Cr (VI) and V (V) incorporation. Moreover, one batch leaching test revealed that the V (V) leaching is inversely proportional to aqueous Ca2+ ion at pH > 12 while Cr leaching is sensitive to its oxidation state, and dissolution of C2S. Even though C2S can incorporate Cr (VI) and V (V) ions, the final leaching is governed by the immobilization potential of C-S-H gel, pH as well as types of calcium chromate and vanadate complexes.

Modified cellulose nanofibers aerogels as a novel air filters; Synthesis and performance evaluation.

Nanofilters made with high adsorption freeze-dried modified cellulose nanofiber (CNF) aerogel were produced. The modification was made using functional groups containing phthalimide, and then their ability to adsorb particulate matter (PM) was evaluated and compared with the control filter (HEPA). The results showed that the highest adsorption of PM2.5 (99.95%) belonged to the nanofilters made of 1.5% phthalimide-modified CNF aerogel, and the lowest adsorption (76.66%) was related to the control samples. Moreover, based on the results, the nanofilter produced from freeze-dried phthalimide-modified CNF aerogel showed high filtration efficiency as well as excellent resistance to temperature and humidity. This modification enables the filter to operate in different environmental conditions, especially for particles less than 0.1 µm that are mainly responsible for reducing air quality, human health, air visibility, and climate change. In conclusion, we developed an environmentally friendly biodegradable nanofilter capable of high-performance filtration functions and structural stability in different environmental conditions.

Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage.

Background and Purpose: The computed tomography angiography spot sign is associated with hematoma expansion, case fatality, and poor functional outcome in spontaneous supratentorial intracerebral hemorrhage (ICH). However, no data are available on the spot sign in spontaneous cerebellar ICH. Methods: We investigated consecutive patients with spontaneous cerebellar ICH at 3 academic hospitals between 2002 and 2017. We determined patient characteristics, hematoma expansion (>33% or 6 mL), rate of expansion, discharge and 90-day case fatality, and functional outcome. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6. Associations were tested using univariable and multivariable logistic regression. Results: Three hundred fifty-eight patients presented with cerebellar ICH, of whom 181 (51%) underwent a computed tomography angiography. Of these 181 patients, 121 (67%) were treated conservatively of which 15 (12%) had a spot sign. Patients with a spot sign treated conservatively presented with larger hematoma volumes (median [interquartile range]: 26 [7­41] versus 6 [2­13], P=0.001) and higher speed of expansion (median [interquartile range]: 15 [24­3] mL/h versus 1 [5­0] mL/h, P=0.034). In multivariable analysis, presence of the spot sign was independently associated with death at 90 days (odds ratio, 7.6 [95% CI, 1.6­88], P=0.037). With respect to surgically treated patients (n=60, [33%]), 14 (23%) patients who underwent hematoma evacuation had a spot sign. In these 60 patients, patients with a spot sign were older (73.5 [9.2] versus 66.6 [15.4], P=0.047) and more likely to be female (71% versus 37%, P=0.033). In a multivariable analysis, the spot sign was independently associated with death at 90 days (odds ratio, 2.1 [95% CI, 1.1­4.3], P=0.033). Conclusions: In patients with spontaneous cerebellar ICH treated conservatively, the spot sign is associated with speed of hematoma expansion, case fatality, and poor functional outcome. In surgically treated patients, the spot sign is associated with 90-day case fatality.

Secondary Hematoma Evacuation and Outcome After Initial Conservative Approach for Patients with Cerebellar Hematoma Larger than 3 cm.

BACKGROUND: In patients with spontaneous cerebellar intracerebral hemorrhage (ICH) guidelines advocate evacuation when the hematoma diameter is > 3 cm. We studied outcome in patients with cerebellar ICH > 3 cm who did not undergo immediate hematoma evacuation. METHODS: We included consecutive patients with cerebellar ICH > 3 cm at two academic hospitals between 2008 and 2017. Patients who died < 24 h (h) were excluded because of probable confounding by indication. We determined patient characteristics, hematoma volumes, EVD placement, secondary hematoma evacuation, in-hospital and 3-month case-fatality, and functional outcome. RESULTS: Of 130 patients with cerebellar ICH, 98 (77%) had a hematoma > 3 cm of whom 22 (23%) died < 24 h and 28 (29%) underwent hematoma evacuation < 24 h. Thus, 48 patients were initially treated conservatively (mean age 70 ± 13, 24 (50%) female). Of these 48 patients, 7 (15%) underwent secondary hematoma evacuation > 24 h, of whom 1 (14%) had received an EVD < 24 h. Five others also received an EVD < 24 h without subsequent hematoma evacuation. Of the 41 patients without secondary hematoma evacuation, 11 (28%) died and 20 (51%) had a favorable outcome (mRS of 0-3) at 3 months. The 7 patients who underwent secondary hematoma evacuation had a decrease in GCS score of at least two points prior to surgery; two (29%) had deceased at 3 months; and 5 (71%) had a good functional outcome (mRS 0-3). CONCLUSIONS: While cerebellar ICH > 3 cm is often considered an indication for immediate hematoma evacuation, there may be a subgroup of patients in whom surgery can be safely deferred. Further data are needed to assess the optimal timing and indications of surgical treatment in these patients.

Valorization of bottom ash fines by surface functionalization to reduce leaching of harmful contaminants.

This paper focuses on the functionalization of heterogeneous and highly contaminated waste material, namely bottom ashes (BA) with a particle size ≤ 125 µm that cannot be recycled with conventional treatments. The main goal of this study is to modify this waste into a valuable material that can be used in various applications, especially in the building sector. The complex mineralogical nature of this material was investigated with quantitative XRD, which confirms the presence of crystalline and amorphous phases such as silicates, carbonates, metallic oxides and amorphous glass. A hydrophobic modification was performed by using a fluorosilane grafting agent that utilizes the reactive surface sites of these minerals to form silanol bonds. Results showed that the 2.5% (m/m) of silane made the BA hydrophobic. Moreover, a thorough characterization showed that fluorosilane was well-grafted at the surface of the BA, with more than 60% of the fluorosilane chemisorbed on the surface. Additionally, the hydrophobic modification led to a significant decrease of the leaching of the contaminants (Cr, Cu, Mo and Sb) from the BA particles. Following this methodology, fine fraction of BA could be eventually used as a building material, preventing the landfill of this toxic waste.

A promising process to modify cellulose nanofibers for carbon dioxide (CO2) adsorption.

A novel process of using phthalimide to modify cellulose nanofibers (CNF) for CO2 adsorption was studied. The effectiveness of the modification was confirmed by ATR-IR. Phthalimide incorporation onto CNF was confirmed with the characteristic peaks of NH2, C-N, and ester bonding COO- was observable. The XPS analyses confirmed the presence of N1s peak in Ph-CNF, meaning that the hydroxyl groups reacted with the amino groups (NH2) of phthalimide on the CNF surface. Based on the results, surface modification and addition of phthalimide increased the specific surface area, but also decreased the overall porosity, size of pores and volume of pores. When the temperature, humidity, pressure, and airflow rate increased, the CO2 adsorption significantly increased. The CO2 adsorption of phthalimide-modified CNF was confirmed by ATR-IR spectroscopy as the characteristic peaks of HCO3-,NH3+ and ester bonding NCOO- were visible on the spectra.

Associations of Radiographic Cerebral Small Vessel Disease with Acute Intracerebral Hemorrhage Volume, Hematoma Expansion, and Intraventricular Hemorrhage.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the impact of radiographic cerebral small vessel disease (CSVD) on the severity of acute intracerebral hemorrhage (ICH) as measured by: ICH volume, hematoma expansion, and extension of intraventricular hemorrhage (IVH). METHODS: CSVD was determined on baseline computed tomography (CT) scans of patients from the Ethnic and Racial Variations of Intracerebral Hemorrhage study through the extent of leukoaraiosis and cerebral atrophy using visual rating scales. The associations of leukoaraiosis and atrophy with ICH volume, hematoma expansion, IVH presence, and severity of IVH were tested using multivariable regression models. Secondary analyses were stratified by hemorrhage location. Bonferroni correction was applied to correct for multiple testing. RESULTS: A total of 2579 patients (mean age 61.7 years, 59% male) met inclusion criteria. Median ICH volume was 10.5 (Interquartile range [IQR] 4.0-25.3) mL. IVH was detected in 971 patients (38%). Neither leukoaraiosis nor atrophy was associated with hematoma expansion. Increasing grades of leukoaraiosis were associated with increased risk of IVH in a dose-dependent manner, while cerebral atrophy was inversely associated with IVH (both P for trend < 0.001). Increasing grades of global atrophy were dose-dependently associated with lower ICH volumes (ß (95% Confidence Interval [CI]) - 0.30[- 0.46, - 0.14], - 0.33[- 0.49, - 0.17], - 0.40[- 0.60, - 0.20], and - 0.54[- 0.76, - 0.32], for grades 1, 2, 3 and 4 compared to 0; all P < 0.001). The associations of leukoaraiosis with ICH volume were consistent with those of atrophy, albeit not meeting statistical significance. CONCLUSIONS: Leukoaraiosis and cerebral atrophy appear to have opposing associations with ICH severity. Cerebral atrophy correlates with smaller ICH volume and decreased risk and severity of IVH, while leukoaraiosis is associated with increased risk of IVH. Whether these observations reflect overlapping or divergent underlying mechanisms requires further study.

Compositional modelling and crushing behaviour of MSWI bottom ash material classes.

At present, in Europe, 18 million tonnes of MSWI Bottom Ash (BA) is annually stockpiled or used in low-grade applications (e.g. in road bases). Therefore, alternative applications, such as aggregate or as a cement component in concrete, are stimulated. Physical and chemical characteristics remaining after treatment, however, prevent its extensive application in building materials. Hence, knowledge is needed on the distinct properties of the material classes making up a heterogeneous BA, enabling the assessment of its characteristics and the resulting applicability. Furthermore, a user-friendly composition assessment procedure is necessary to evaluate the output of physical treatment processes. Crushing is a commonly applied treatment and its effect on the material classes comprising BA is still unknown. In this paper, the latter are identified and classified into slag, magnetic slag, glass, refractory, metals, and unburned material classes. The individual characteristics of each material class are identified and a suitable tracer for tracking these classes in heterogeneous samples is defined. Furthermore, a fast method to quantify the distribution of material classes based just on the oxide composition is developed and applied to approximate the changes in the configuration of BA through crushing. It is concluded that, although the jaw crushing of BA results in a more homogeneous distribution, beneficiation of material classes occurs and selective crushing is possible in order to improve the quality of the BA and therefore its subsequent application.

Chemical speciation, distribution and leaching behavior of chlorides from municipal solid waste incineration bottom ash.

Municipal solid waste incineration (MSWI) bottom ash is an environmentally harmful solid waste that cannot be recycled without pre-treatment. The chloride content in bottom ash (BA) is a major obstacle that restricts its application as secondary building materials. Here, the chemical speciation of the chlorides in BA is systematically studied with multiple analytical techniques, i.e., quantitative XRD, microanalysis and XPS. In addition to halite (NaCl), several chloride-rich minerals are present in BA. These phases are hydrous metal oxides, ettringite, decomposed hydration products (C4A3) and incineration slag with a chloride content of 3.2%, 1.4%, 2.1% and 1.3%, respectively. For the first time, the real-time leaching profiles of chloride (up to 80 h) from BA were obtained with a chloride-ion specific electrode to explain the leaching mechanism. In the initial stage of leaching, highly soluble alkali salts (NaCl) and physisorbed chlorides (especially those adsorbed on hydrous metal oxides) are released, which is controlled by diffusion. Later, the leaching is controlled by the solubility/reactivity of the chloride-containing phases, such as ettringite and incineration slag. The results show that the release of chloride is not only a diffusion-controlled process, as reported in the literature, but also a reaction-controlled phenomenon, during which the chloride-rich phases decompose and release chlorides that are associated with them via sorption/incorporation.

Impact of Cerebral Small Vessel Disease on Functional Recovery After Intracerebral Hemorrhage.

Background and Purpose- In this study, we aim to investigate the association of computed tomography-based markers of cerebral small vessel disease with functional outcome and recovery after intracerebral hemorrhage. Methods- Computed tomographic scans of patients in the ERICH study (Ethnic and Racial Variations of Intracerebral Hemorrhage) were evaluated for the extent of leukoaraiosis and cerebral atrophy using visual rating scales. Poor functional outcome was defined as a modified Rankin Scale (mRS) of ≥3. Multivariable logistic and linear regression models were used to explore the associations of cerebral small vessel disease imaging markers with poor functional outcome at discharge and, as a measure of recovery, change in mRS from discharge to 90 days poststroke. Results- After excluding in-hospital deaths, data from 2344 patients, 583 (24.9%) with good functional outcome (mRS of 0-2) at discharge and 1761 (75.1%) with poor functional outcome (mRS of 3-5) at discharge, were included. Increasing extent of leukoaraiosis (P for trend, 0.01) and only severe (grade 4) global atrophy (odds ratio, 2.02; 95% CI, 1.22-3.39, P=0.007) were independently associated with poor functional outcome at discharge. Mean (SD) mRS change from discharge to 90-day follow-up was 0.57 (1.18). Increasing extent of leukoaraiosis (P for trend, 0.002) and severe global atrophy (ß [SE], -0.23 [0.115]; P=0.045) were independently associated with less improvement in mRS from discharge to 90 days poststroke. Conclusions- In intracerebral hemorrhage survivors, the extent of cerebral small vessel disease at the time of intracerebral hemorrhage is associated with poor functional outcome at hospital discharge and impaired functional recovery from discharge to 90 days poststroke.

The immobilization of potentially toxic elements due to incineration and weathering of bottom ash fines.

Incineration bottom ash fines (≤ 125 µm) are known to contain potentially toxic elements (PTEs) and inorganic salts. The most abundant PTEs in the fines were Zn (0.5%), Cu (0.25%), Pb (0.12%), Mn (0.08%) and Cr (0.03%). The systematic quantification of the mineral phases and PTEs associated with them was performed with a multimethod approach using quantitative XRD, phase mapping with PhAse Recognition and Characterization (PARC) software and microprobe analysis. The mineral phases in the fines can be categorized as follows: 1) residual phases (e.g., quartz), 2) incineration phases (e.g., melilitic slag and iron oxides) and 3) quenching/weathering phases (e.g., calcite, ettringite, gypsum, hydrous Fe- and Al-oxides). Among the incineration phases, the melilitic slag was observed to contain Cr, Cu and Zn with 0.02%, 0.13% and 0.19%, respectively. In order of predominance, the weathering phases containing the most PTEs were: calcite < ettringite < hydrous Al-oxides < hydrous Fe-oxides. More than 70% of the phases in the BA fines were formed during incineration and weathering processes that explain the enrichment of PTEs in the smaller particles. During the one-batch leaching test, dissolution of weathering phases, especially ettringite, was observed (total mass loss: 7.2%).

In-depth mineralogical quantification of MSWI bottom ash phases and their association with potentially toxic elements.

Municipal solid waste incineration bottom ash fractions ≤4 mm are the most contaminated ones in terms of potentially toxic elements (PTEs). In order to estimate potential environmental impacts, it is important to understand the association of the PTEs with the mineral phases. Large area phase mapping (SEM/EDX) using "PhAse Recognition and Characterization - PARC" software in combination with quantitative X-ray powder diffraction has been used to characterize amorphous and crystalline BA phases for the first time. The results show that one of the main incineration products was melilite and an amorphous phase with a melilitic composition. The ratio of crystalline to amorphous melilite was 1:2. They formed an inhomogeneous layer around BA particles and contained a high percentage of the PTEs, i.e., Cu, Zn, Ni and Cr. Other major sources of PTEs (especially Ni and Cu) were iron oxides produced during incineration and the weathering products, such as calcite and ettringite (Cu and Zn). After extensive characterization of BA, a sequential extraction procedure (SEP) was performed, which exposed bottom ash to different chemical environments designed to dissolve specific phases and release their PTEs into solution. The extracted solutions and solid residues generated from the extraction procedure were analyzed to identify the association between PTEs and dissolved phases of BA. By combining SEP results with information obtained via large area phase mapping it is shown that SEP can be used for studying the association of PTEs with the phase that cannot be investigated with XRD/EDX, such as organic matter and Fe-Mn-hydrous oxides. Furthermore, according to SEP results a high percentage (40-80 wt%) of each investigated PTE can be considered immobile and not susceptible to leaching in the environment.