The influence of initial stroke severity on mortality, overall functional outcome and in-hospital placement at 90 days following acute ischemic stroke: A tertiary hospital stroke register study.

BACKGROUND AND PURPOSE: Epidemiological studies on the extent of the interaction and/or influence of stroke severity on clinical outcomes are important. The aim of the present study was to investigate the putative (and degree of) impact of initial stroke severity in predicting the overall functional outcome, in-hospital placement, and mortality in acute ischemic stroke (AIS) in comparison with age, admission to the stroke unit and thrombolytic treatment. MATERIALS AND METHODS: The John Hunter Hospital acute stroke register was used to collect a retrospective cohort of AIS patients being assessed for reperfusion therapy and admitted between January 2006 and December 2013. Univariate and multivariate logistic regression and receiver operating characteristics analyses were used to assess associations with functional outcome, in-hospital placement, and mortality at 90 days. RESULTS: 608 AIS patients with complete datasets were included in the study. On univariate analysis, initial stroke severity showed the strongest independent association to the risk of death within 90 days (Odds ratio (OR) =1.15; P < 0.001; 95% confidence interval (CI) = [1.11, 1.18]); age was a less significant independent influence (OR = 1.02; P = 0.049; 95% CI = [1.00, 1.03]). Multivariate logistic regression analysis demonstrated that initial stroke severity independently predicted the 90 day mortality (OR = 1.16; 95% CI = [1.12, 1.2]; P < 0.0001) and unfavorable outcome (OR = 1.16; 95% CI = [1.13, 1.2]; P < 0.0001). Higher National Institute of Health Stroke Scale at admission was significantly associated with longer in-hospital placement (P < 0.0001). CONCLUSIONS: In this acute stroke cohort, initial stroke severity had a major impact on the likelihood of death following an AIS and appears to be the dominant influence on the overall stroke outcome and in-hospital placement.

An International Survey of Veterinary Students to Assess Their Use of Online Learning Resources.

Today's veterinary students have access to a wide range of online resources that support self-directed learning. To develop a benchmark of current global student practice in e-learning, this study measured self-reported access to, and use of, these resources by students internationally. An online survey was designed and promoted via veterinary student mailing lists and international organizations, resulting in 1,070 responses. Analysis of survey data indicated that students now use online resources in a wide range of ways to support their learning. Students reported that access to online veterinary learning resources was now integral to their studies. Almost all students reported using open educational resources (OERs). Ownership of smartphones was widespread, and the majority of respondents agreed that the use of mobile devices, or m-learning, was essential. Social media were highlighted as important for collaborating with peers and sharing knowledge. Constraints to e-learning principally related to poor or absent Internet access and limited institutional provision of computer facilities. There was significant geographical variation, with students from less developed countries disadvantaged by limited access to technology and networks. In conclusion, the survey provides an international benchmark on the range and diversity in terms of access to, and use of, online learning resources by veterinary students globally. It also highlights the inequalities of access among students in different parts of the world.

The ipsilesional upper limb can be affected following stroke.

OBJECTIVE: Neurological dysfunction commonly occurs in the upper limb contralateral to the hemisphere of the brain in which stroke occurs; however, the impact of stroke on function of the ipsilesional upper limb is not well understood. This study aims to systematically review the literature relating to the function of the ipsilesional upper limb following stroke and answer the following research question: Is the ipsilesional upper limb affected by stroke? DATA SOURCE: A systematic review was carried out in Medline, Embase, and PubMed. REVIEW METHODS: All studies investigating the ipsilesional upper limb following stroke were included and analysed for important characteristics. Outcomes were extracted and summarised. Results. This review captured 27 articles that met the inclusion criteria. All studies provided evidence that the ipsilesional upper limb can be affected following stroke. CONCLUSION: These findings demonstrate that clinicians should consider ipsilesional upper limb deficits in rehabilitation and address this reduced functional capacity. Furthermore, the ipsilesional upper limb should not be used as a "control" measure of recovery for the contralateral upper limb.

Granulocyte colony stimulating factor expands hematopoietic stem cells within the central but not endosteal bone marrow region.

Granulocyte colony stimulating factor (G-CSF) is clinically well established for the mobilization of hematopoietic stem cells (HSC). Extensive data on the underlying mechanism of G-CSF induced mobilization is available; however, little is known regarding the functional effect of G-CSF on HSC within the bone marrow (BM). In this study we analyzed the proportion and number of murine HSC in the endosteal and central bone marrow regions after 4 days of G-CSF administration. We demonstrate that the number of HSC, defined as CD150(+)CD48(-)LSK cells (LSKSLAM cells), increased within the central BM region in response to G-CSF, but not within the endosteal BM region. In addition the level of CD150 and CD48 expression also increased on cells isolated from both regions. We further showed that G-CSF mobilized proportionally fewer LSKSLAM compared to LSK cells, mobilized LSKSLAM had colony forming potential and the presence of these cells can be used as a measure for mobilization efficiency. Together we provide evidence that HSC in the BM respond differently to G-CSF and this is dependent on their location. These findings will be valuable in developing new agents which specifically mobilize HSC from the endosteal BM region, which we have previously demonstrated to have significantly greater hematopoietic potential compared to their phenotypically identical counterparts located in other regions of the BM.

Phenotypically identical hemopoietic stem cells isolated from different regions of bone marrow have different biologic potential.

Hemopoietic stem cells (HSCs) reside within a specified area of the bone marrow (BM) cavity called a "niche" that modulates HSC quiescence, proliferation, differentiation, and migration. Our previous studies have identified the endosteal BM region as the site for the HSC niche and demonstrated that hemopoietic stem and progenitor populations (HSPCs, LSK) isolated from different BM regions exhibit significantly different hemopoietic potential. In this study, we have analyzed subpopulations of LSK cells isolated from different regions of the BM and showed that CD150(+)CD48(-)LSK HSCs within the endosteal BM region have superior proliferative capacity and homing efficiency compared with CD150(+)CD48(-)LSK HSCs isolated from the central BM. Furthermore, we show, for the first time, that a subset of CD150(+)CD48(+)LSK progenitor cells, previously defined as B-lymphoid primed hemopoietic cells, are capable of multilineage reconstitution, however, only when isolated from the endosteal region. In addition, we provide evidence for an unrecognized role of CD48 in HSC homing. Together, our data provide strong evidence that highly purified HSCs show functional differences depending on their origin within the BM and that the most primitive HSCs reside within the endosteal BM region.

[A case of minocycline-induced eosinophilic pneumonia presenting with multiple white eosinophilic plaques in the tracheobronchial mucosa].

A 45-year-old man was admitted with a severe dry cough and fever. He had been given 100 mg/day of minocycline and other drugs for 9 days to treat hematopyuria. Chest X-ray film showed multiple nodular shadows with diffuse reticular shadows. After all the drugs were discontinued, the fever and the shadows improved, but the severe dry cough persisted. The day 4 bronchofiberscopic findings included multiple white plaques in the tracheobronchial mucosa. Punch biopsy specimens obtained from the white plaques revealed severe eosinophil infiltration, and the eosinophil count in the bronchoalveolar lavage fluid had increased (differential count 23%). After three days of 125 mg/day of methylprednisolone sodium succinate injection therapy, the severe cough, the X-ray shadows and the white plaques disappeared. With a positive result in the lymphocyte migration inhibition test, the patient's condition was diagnosed as minocycline-induced eosinophilic pneumonia.

[Pulmonary mucormycosis caused by Cunninghamella bertholletiae in a non-immunocompromised woman].

A 74-year-old woman was admitted for further examination because of an abnormal nodular shadow and thickening of the bronchovascular bundle in the left upper lobe on chest radiography and CT. The findings from a transbronchial biopsy specimen were not conclusive. A thoracoscopic lung biopsy specimen revealed a fungal infection, and partial resection of S1 + 2 of the left upper lobe was carried out. In the dilated bronchus, mucus of high viscosity was seen. Lymphocytes and plasma cells had infiltrated into the bronchioles and alveoli. Fungus was cultured from the mucus, and the morphological characteristics showed Cunninghamella bertholletiae. Pulmonary mucormycosis caused by C. bertholletiae in a non-immunocompromised person is very rare. Furthermore, this patient also had a wheeze, eosinophilia, elevation of the serum IgE level, and was positive for specific IgE to Mucor. We therefore consider that this case was an incomplete type of allergic bronchopulmonary fungusis (ABPF).

Hypersensitivity pneumonitis associated with home ultrasonic humidifiers.

We describe five patients with hypersensitivity pneumonitis (HP) that was related to using home ultrasonic humidifiers. All patients had micronodular infiltrates on their chest radiograph, and their lung biopsy specimens revealed alveolitis with or without epithelioid cell granulomas. Challenge tests were performed on two patients with the humidifier water and three patients using the humidifier. All patients tested exhibited a positive response. Tests for precipitating antibodies against an extract of the humidifier water gave strongly positive reactions in all patients tested. Precipitins to Cephalosporium acremonium and Candida albicans were also present in all cases, whereas precipitins to thermophilic actinomycetes were not detected. Although cultures of the water grew a variety of fungal and bacterial organisms, thermophilic actinomycetes could not be detected. These findings suggest that thermophilic organisms may not be the causative antigens of HP associated with ultrasonic humidifiers. All five patients had an increase in the bronchoalveolar lavage (BAL) lymphocytes that were predominantly CD4+ lymphocytes. The T helper cell count (CD4) to suppressor T cell count (CD8) ratio was significantly higher than that observed in summer-type HP, and lower than that observed in bird fancier's lung, indicating that the phenotypes of the BAL lymphocytes may vary with the type of HP.

[Two cases of acute eosinophilic pneumonia with precipitating antibody against Trichosporon cutaneum and Trichoderma viride].

Two cases of acute eosinophilic pneumonia are described. The patients presented with an acute febrile illness, dry cough, severe hypoxemia and diffuse pulmonary infiltrates. Total cell count and the number of eosinophils were increased in bronchoalveolar lavage fluid. The TBLB specimen showed eosinophilic infiltration of alveolar walls and spaces. Precipitating antibodies against Trichosporon cutaneum and Trichoderma viride were noted in the patients' sera, and environmental provocation tests gave positive results. The clinical features of acute eosinophilic pneumonia resemble those of summer type hypersensitivity pneumonitis. From these results, we consider that there is a certain degree of overlap between the two diseases.

[Two cases of hypersensitivity pneumonitis due to contamination of an ultrasonic humidifier].

Two cases of hypersensitivity pneumonitis due to contamination of ultrasonic-humidifier were reported. The first case, a 64-year-old man, developed fever and dyspnea on exertion in January 1986. He was hospitalized for 18 days and received antibiotics for presumptive bacterial pneumonia. Half a day after discharge, those symptoms recurred. On readmission, fine crackles were heard at the left lung base, and chest X-ray film showed ground glass shadows all over the lung fields. Bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) were performed on the next day after readmission. TBLB specimen revealed lymphocyte alveolitis, granulomatous tissue and infiltration of polymorphonuclear neutrophils (PMN) in alveoli. Differential cell count of the BAL fluid showed not only lymphocytosis (38.2%) but also increased PMNs (44.2%). In the second BAL performed 18 days later, the value of PMNs demonstrated a dramatic decrease. Environmental challenge tests revealed that his hypersensitivity pneumonitis was caused by an ultrasonic humidifier in his bed room. Immunological examinations showed positive Arthus type skin reaction and serum precipitin against Aspergillus fumigatus. Inhalation challenge with A. fumigatus produced cough and dyspnea with a decrease of 10 Torr in PaO2. These data suggest that A. fumigatus may be the causative antigen in this case. The second case, a 64-year-old man who had used ultrasonic humidifier in his living room, was admitted for 8 weeks with an illness characterized by cough, low fever and general malaise on 22 January 1987. Examination revealed fine crackles on both lung bases. Chest X-ray film demonstrated diffuse nodular shadows. The TBLB specimen showed lymphocytic alveolitis and bronchiolitis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of glucocorticoid on lung tissue and bronchus-associated lymphoid tissue of experimental granulomatous lung].

The effect of glucocorticoid on the immunological response in the delayed type hypersensitivity reaction of granulomatous disorders was investigated in order to elucidate the mechanism of glucocorticoid on the suppressive course of the reaction. Experimental pulmonary granuloma model in rats was induced by an intravenous injection of heat killed BCG, and the effects of methylprednisolone (MPSL) on the granulomatous lung tissue, bronchus associated lymphoid tissue (BALT) and the population of cells from bronchoalveolar lavage fluid (BALF) and peripheral blood were examined by the cytological and immunohistochemical methods. The pulmonary granulomatous reaction was reduced effectively by the administration of MPSL. A remarkable reduction of the number of Ia antigen positive alveolar macrophages (Ia+ A.M phi) and T lymphocytes in the granulomatous lung tissue and BALF was observed. T helper cells to non-helper cells (TH/TNH) ratio in BALF decreased remarkably. Furthermore, a reduction of Ia antigen positive macrophages (Ia+ M phi) and T cells was noted in the parafollicular area of BALT. These findings suggest that glucocorticoid may suppress the immunological activity of M phi and T cell through its inhibitory effect on the differentiation of Ia+ M phi and activated T cells, which result in the diminishment of pulmonary granulomatous reaction through the disorder of M phi - T cell interaction. On the other hand, lymphocytopenia with decreased TH/TNH ratios in peripheral blood was observed simultaneously with the reduction of the pulmonary granulomatous reaction. Thus, the mechanism of reduced pulmonary granulomatous reaction after MPSL administration may be not only due to local immunosuppression, but also to impaired systemic immune response. In addition, the disappearance of the germinal center and the reduction of surface IgM-positive cells in the follicular area of BALT occurred with the reduction of pulmonary granulomatous reaction. These results suggest that glucocorticoid also suppress the humoral immune responses in BALT during the course of delayed type hypersensitivity reaction.

[Luminol-amplified chemiluminescence evaluation of the microbicidal property of alveolar macrophages in response to drugs].

The present study was designed to evaluate the validity of luminol-dependent chemiluminescence (CL) to evaluate the microbicidal properties of alveolar macrophages (AM) in response to drugs. It was observed that production of CL is associated with H2O2 as well as O2-, 1O2, .OH. Furthermore, our data revealed that CL is dependent not only upon the extracellular release of these oxygen radicals, but also upon intracellular metabolic events, which thus allows a complete analytical study in any given state. It should also be noted from our data that the effect of antibacterial agents on CL was greatly affected by the source of the target cells. The defect of amplified CL in AM obtained from young rabbits might be attributable to immaturity of AM.

[Clinical aspects of sarcoidosis with autoantibodies].

Among 64 sarcoidosis cases, 6 cases with autoantibodies or autoimmune disorders are described. All 6 cases were females over 40 years old, and made up 24% of the original 25 patients over 40 years old. Rheumatoid factor was observed in 2 cases, anti-DNA antibody in 4 cases and anti-microsomal antibody in 2 cases. Four cases of sarcoidosis were associated with ITP or Hashimoto's disease or rheumatoid arthritis. The presence of these autoantibodies or autoimmune diseases seemed to correlate with continued disease activity of sarcoidosis. The analysis of the clinical features of sarcoidosis with coexistent autoimmune diseases may clarify immunologic processes involved in the pathogenesis of both disorders and also provide clues to understanding the relatively poor clinical outcome of longstanding sarcoidosis.

Rooting cofactor activity of plant phytoalexins.

The pterocarpinoid phytoalexins, glyceollin, pisatin, and phaseollin, stimulated adventitious root formation in a mung bean rooting bioassay only in the presence of indoleacetic acid (rooting cofactor activity). Relatively low (5 to 50 micrograms per milliliter) concentrations of the phytoalexins were effective. The phytoalexins also increased the numbers of root primordia formed, therefore suggesting that they interacted with an early process in root formation.