Predictive factors of functional independence after optimal reperfusion in anterior circulation ischaemic stroke with indication for intravenous thrombolysis plus mechanical thrombectomy.

BACKGROUND AND PURPOSE: Intravenous thrombolysis plus mechanical thrombectomy (IVT + MT) is the best current management of acute stroke due to large-vessel occlusion and results in optimal reperfusion for most patients. Nevertheless, some of these patients do not subsequently achieve functional independence. The aim was to identify baseline factors associated with 3-month independence after optimal reperfusion and to validate a prediction model. METHODS: All consecutive patients with intracranial anterior large-vessel occlusion, with indication for IVT + MT and achieving optimal reperfusion (defined as modified Treatment in Cerebral Ischaemia score 2b-3), from the THRACE trial and the ETIS registry, were included in order to identify a prediction model. The primary outcome was 3-month independence [modified Rankin Scale (mRS) score ≤ 2]. Multivariate inferences invoked forward logistic regression, multiple imputation and bootstrap resampling. Predictive performance was assessed by c-statistic. Model validation was conducted on patients from the ASTER trial. RESULTS: Amongst 139 patients (mean age 65.5 years; 54.3% female), predictors of 3-month mRS ≤ 2 (n = 82) were younger age [odds ratio 0.62 per 10-year increase; 95% confidence interval (CI) 0.53-0.72] and higher Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (odds ratio 1.65 per 1-point increase; 95% CI 1.47-1.86) with c-statistic 0.77. Model validation (n = 104/181 patients with 3-month mRS ≤ 2) demonstrated a moderate discrimination (c-statistic 0.74; 95% CI 0.66-0.81) combining age and ASPECTS. The validation model was improved by the adjunction of three candidate variables that were found to be predictors. Addition of baseline National Institutes of Health Stroke Scale (NIHSS) score, history of vascular risk factor and onset-to-reperfusion time significantly improved discrimination (c-statistic 0.85; 95% CI 0.83-0.87). CONCLUSIONS: After optimal reperfusion, younger age, higher ASPECTS, lower NIHSS score, shorter onset-to-reperfusion time and absence of vascular risk factor were predictive of independence and could help to guide patient management.

CALCULATION OF SKIN DOSE DUE TO BETA CONTAMINATION USING THE NEW QUANTITY OF THE ICRP 116: THE 'LOCAL SKIN DOSE'.

Values of the new protection quantity 'Local Skin Dose' LSD, introduced by the International Commission on Radiological Protection (ICRP) Publication 116, were calculated for 134 ß- or ß+ emitting radionuclides, using the Monte Carlo code MCNP6. Two types of source geometry are considered: a point source and disc-type surface contamination (the source is placed in contact with the skin). This new protection quantity is compared with the operational quantity H'(0.07,0°), leading us to conclude that, in accordance with the rules of the ICRP, the operational quantity over-estimates the protection quantity to a reasonable extent, except in very rare cases for very low average beta energies. Thus, with the new skin model described in ICRP 116, there are no longer any major differences between the operational quantities and protection quantities estimated with the skin model described in ICRP 74.

Solubilization and partial purification of S-adenosyl-L-homocysteine binding proteins from the rat brain.

Rat brain proteins presenting high-affinity binding of S-adenosyl-L-homocysteine were solubilized and purified. Extraction of binding protein was carried out in the presence of Triton X-100 and 1 M NaCl; this solubilized fraction exhibits similar kinetic properties than the membrane proteins. Purification was performed using affinity chromatography on S-adenosyl-L-homocysteine carboxyhexyl Sepharose 48 conjugate. The analysis of the affinity gel eluate by SDS-PAGE showed high purification ratios for two proteins exhibiting 54 and 68 kDa. Three activity peaks were separated when solubilized membrane proteins were submitted to isoelectric focusing; the activity peaks corresponded to proteins of pH1 6.0, 6.5, and 7.2. SDS-PAGE separation of proteins contained in each peak showed protein aggregation; a 54-kDa subunit was present in each aggregate. Solubilized membrane proteins were labeled by photoaffinity labeling with tritiated S-adenosyl-L-homocysteine; the 54- and 68-kDa proteins were found among the specifically labeled proteins. Finally, according to the previous data from the literature, the purified S-adenosyl-L-homocysteine binding proteins do not seem to be the same as adenosine receptors or phosphatidylethanolamine-N-methyltransferase.

[Solubilization of cerebral binding sites of S-adenosyl-L-homocysteine]. / Solubilisation des sites de fixation cérébraux de la S-adénosyl-L-homocystéine.

We describe the solubilization of S-adenosyl-L-homocysteine binding sites from rat brain membranes; Triton X100 could solubilize near 50% of the sites. The solubilized extract exhibited the same pH dependence as the membrane extract and had the same dissociation constant and the same sensibility to S-adenosyl-L-methionine and adenosine. The solubilized extract exhibited a methylase activity which accepted phosphatidylethanolamine as substrate.