Pulse wave analysis measurements: important, underestimated and undervalued parameters in cardiovascular health problems.

Background: Central aortic stiffness is established as a reliable measure of cardiovascular disease. While pulse wave velocity (PWV) analysis measures arterial distensibility, risk profile of cardiovascular diseases can be expanded with following pulse wave analysis measurements: central aortic systolic blood pressure (CABPS), central aortic pulse pressure (CAPP), central aortic reflection magnitude (CARM), central aortic augmented pressure (CAAP) and central aortic augmentation index (CAAIx). The aim of this study is to evaluate the clinical usefulness and importance of pulse wave analysis measurements in specific cardiovascular conditions and diseases, both in term of diagnosis and therapeutic monitoring. Methods: One thousand sixty-six subjects were included. According to age bracket, four cohorts were investigated-healthy subjects (NL), hypertensive patients (HP), ischemic heart disease (IHD) and valvular heart disease (VHD) patients. Arterial stiffness was analyzed through Sphygmocor XCEL Central Blood Pressure Measurement System and Sphygmocor XCEL PWV Measurement System. Furthermore we observed the pulse wave analysis measurements of 14 patients with diagnose of ADHD who were referred by a child psychiatrist, in order to investigate the initiation of methylphenidate treatment. Results: Statistically significant differences were found between NL and HP cohorts, across almost all age brackets, regarding pulse wave analysis measurements. In the risk stratification of arterial stiffness hypertension and especially central aortic blood pressure systolic (CABPS) seems a determining factor. Pulse wave analysis measurements for IHD and VHD cohort comparisons with NL counterparts, revealed non- statistically significant variations. Elevated CAAP, CAAIx and CARM within the youngest age group (0-10 years) in attention-deficit-hyperactivity-disorder (ADHD) patients warrant attention. Conclusions: Following such investigations, CABPS appears as a robust predominant factor in problems of arterial stiffness. Pulse wave analysis and PWV are important parameters in the evaluation and monitoring of arterial hypertension and cardiovascular diseases. There is a hypothesis that CAAP could be an important and even decisive parameter in the diagnosis of ADHD. Further investigation needed.

Mothers' Knowledge of Childhood Neurodevelopmental Disorders: Indian Perspective.

Objectives This study aims to assess the knowledge of childhood neurodevelopmental disorders (CNDDs) among mothers of children younger than 5 years and to promote awareness through health education to promote early identification. Methods Quantitative approach, a descriptive survey in nature research design, was used. A total of 173 mothers who contented the inclusion conditions were chosen as sample on the basis of purposive sampling. The research study was done at the selected Primary Health Centre, Bengaluru, Karnataka. The tabulations were measured and construed based on the objectives of the study by using descriptive and inferential statistics. Results The findings showed that most of the mothers have insufficient knowledge (mean and standard deviation: 3.02 ± 2.75) and there is no substantial relationship found between mothers' knowledge on CNDD and their demographic variables except their occupation and majority of the mothers communicated that they needed further facts toward CNDD. Conclusion The government and nongovernmental organizations can take initiations to conduct health education programs toward childhood developmental delays and disorders for the general public including mothers and community health workers.

Conversion of Co Nanoparticles to CoS in Metal-Organic Framework-Derived Porous Carbon during Cycling Facilitates Na2S Reactivity in a Na-S Battery.

Room-temperature sodium-sulfur batteries have attracted wide interest due to their high energy density and high natural abundance. Polysulfide dissolution and irreversible Na2S conversion are challenges to achieving high battery performance. Herein, we utilize a metal-organic framework-derived Co-containing nitrogen-doped porous carbon (CoNC) as a catalytic sulfur cathode host. A concentrated sodium electrolyte based on sodium bis(fluorosulfonyl)imide, dimethoxyethane, and bis(2,2,2-trifluoroethyl) ether is used to mitigate polysulfide dissolution. We tune the amount of Co present in the CoNC carbon host by acid washing. Significant improvement in reversible sulfur conversion and capacity retention is observed with a higher Co content in CoNC, with 600 mAh g-1 and 77% capacity retention for CoNC and 261 mAh g-1 and 56% capacity retention for acid-washed CoNC at cycle 50 at 80 mAh g-1. Post-mortem X-ray photoelectron spectroscopy, transmission electron microscopy, and selected area electron diffraction suggest that CoS is formed during cycling in place of Co nanoparticles and CoN4 sites. Raman spectroscopy suggests that CoS exhibits a catalytic effect on the oxidation of Na2S. Our findings provide insights into understanding the role Co-based catalysts play in sulfur batteries.

Improving Cell Resistance and Cycle Life with Solvate-Coated Thiophosphate Solid Electrolytes in Lithium Batteries.

Solid electrolytes (SEs) have become a practical option for lithium ion and lithium metal batteries because of their improved safety over commercially available ionic liquids. The most promising of the SEs are the thiophosphates, whose excellent ionic conductivities at room temperature are comparable to those of commercially utilized ionic liquids. Hybrid solid-liquid electrolytes exhibit higher ionic conductivities than their bare SE counterparts because of decreased grain boundary resistance, enhanced interfacial contact with electrodes, and decreased degradation at the interface. In this study, we add lithium bis(trifluoromethane sulfonyl)imide and a highly fluorinated ether solvate electrolyte to the surface of Li7P3S11 (LPS) and Li10GeP2S12 (LGPS) pellets and evaluate their overall cell resistance in Li-Li symmetric cells relative to their bare Li/SE/Li counterparts. Time-resolved electrochemical impedance spectroscopy shows an order of magnitude lower cell resistance for LGPS-solvate than for bare LGPS. In contrast, the LPS-solvate system exhibits a higher cell resistance than bare LPS. Scanning electron microscopy and energy dispersive X-ray spectroscopy show that LGPS allows for the total permeation of the solvate into the bulk SE. Although LPS has smaller grain sizes and higher porosity, it has a higher solubility in 1,1,2,2-tetrafluoroethyl 2,2,3,3-tetrafluoropropyl ether (TTE), which results in an LPS-TTE interlayer on the surface of the pellet, thereby increasing overall cell resistance. Cyclic voltammetry of the bare and hybrid SE cells shows an order of magnitude higher current density for the LGPS-solvate cell over the bare LGPS. Bare LPS shorts after two cycles, whereas the LPS-solvate cell does not short within the timeframe of the experiment (100 cycles). This study suggests that solvates can be used to improve the cell resistance and current density of SEs by altering the grain boundary structures and the interphase between electrode and electrolyte.

Intracerebral hemorrhage in cocaine users.

BACKGROUND AND PURPOSE: Cocaine is a cause of intracerebral hemorrhage (ICH), but there are no large studies that have characterized the location, pathology, and outcome of patients with cocaine-associated ICH. METHODS: We performed a retrospective analysis of all patients admitted to our stroke service from 2004 to 2007 who had nontraumatic ICH and urine drug screens positive for cocaine and compared them with similar patients who had negative drug screens for cocaine. RESULTS: We identified 45 patients with cocaine-associated ICH and 105 patients with cocaine-negative ICH. There were no significant differences in age or gender, but there was a significantly higher incidence of black patients in the cocaine-positive group. Cocaine-associated ICH patients had higher admission blood pressures, significantly more subcortical hemorrhages, and higher rates of intraventricular hemorrhage compared to patients with cocaine-negative ICH. Cocaine-positive patients had worse functional outcome, defined as modified Rankin Scale score >3 at the time of discharge (OR, 4.90; 95% CI, 2.19-10.97), and were less likely to be discharged home or to inpatient rehabilitation. Patients with cocaine-associated ICH were nearly 3-times more likely to die during their acute hospitalization when compared to cocaine-negative patients. CONCLUSION: Recent cocaine ingestion is associated with hemorrhages that occur more frequently in subcortical locations, have a higher risk of intraventricular hemorrhage, and have a poor prognosis compared to patients with cocaine-negative, spontaneous ICH.

Intravenous tissue plasminogen activator in patients with cocaine-associated acute ischemic stroke.

BACKGROUND AND PURPOSE: The safety of thrombolytic therapy in patients with cocaine-associated acute ischemic stroke (CIS) is unknown. METHODS: We conducted a retrospective review of patients with CIS who presented to our stroke center. Thrombolytic treatment was compared between cocaine-positive (n=29) and cocaine-negative (n=75) patients. We also compared patients with CIS treated with tissue plasminogen activator versus those who did not receive tissue plasminogen activator (n=58). Safety outcomes were determined by the incidence of symptomatic intracerebral hemorrhage, in-hospital mortality, and modified Rankin Scale at hospital discharge. RESULTS: There were no complications in tissue plasminogen activator-treated patients with CIS. Cocaine-positive and cocaine-negative treated patients had similar stroke severity and safety outcomes. Patients with CIS treated with tissue plasminogen activator had more severe strokes on baseline National Institutes of Health Stroke Scale but similar safety outcomes compared with nontreated patients with CIS. CONCLUSIONS: Thrombolytic therapy for CIS appears to be safe in this small study. Further research is needed to more definitively assess safety and efficacy of tissue plasminogen activator for CIS.

Methodological quality of animal studies of neuroprotective agents currently in phase II/III acute ischemic stroke trials.

BACKGROUND AND PURPOSE: Numerous neuroprotective agents have proven effective in animal stroke studies, but every drug has failed to achieve its primary outcome when brought forward to clinical trials. We analyzed the quality and adequacy of animal studies supporting the efficacy of NXY-059 and other neuroprotective agents that are currently being investigated in phase II/III trials. METHODS: We conducted a systematic search of all neuroprotective drugs in Phase II or III trials and collected data from animal studies of focal cerebral ischemia testing agents systemically administered within 24 hours of occlusion. The methodological rigor of each individual study was evaluated using 5 criteria derived from the STAIR guidelines. The adequacy of the preclinical "package" for each drug was then evaluated by combining the results of all studies for each drug to determine which of a further 5 STAIR criteria were met before moving forward from animal to human studies. RESULTS: Our search yielded 13 agents of which 10 had published data in peer-reviewed journals. There is substantial within-drug variability in the quality of preclinical studies as well as substantial variation in the completeness of the collective preclinical literature for different drugs. There has been little or no improvement in the quality of animal studies since NXY-059, and current agents have not been subjected to a more complete preclinical evaluation. CONCLUSIONS: There is significant heterogeneity in the quality of animal testing for neuroprotective agents in stroke. Drugs in the post-SAINT era have not been subjected to more thorough preclinical evaluation.

Efficacy of 4D-CT preoperative localization in 2 patients with MEN 2A.

Multiple endocrine neoplasia type 2A (MEN2A) is an autosomal dominant syndrome that is associated with hyperparathyroidism in 20% to 30% of adult gene carriers. The appropriate surgical management of these patients remains in question. Approaches to this disease range from selective gland resection to a subtotal parathyroidectomy with or without autotransplantation. Despite surgical intervention, disease recurrence is problematic. Surgical management of patients found to have recurrence relies on localizing the anatomic location of the hyperfunctional gland(s). The primary imaging modality for localization of hyperfunctioning parathyroid glands is technetium 99m sestamibi single photon emission computed tomography (SPECT). Although sestamibi imaging has a sensitivity of 60% to 90%, specific anatomic detail is not always present by this imaging modality. Four-dimensional computed tomography (4D-CT) scans allow localization of ectopic parathyroid glands and autotransplanted parathyroid tissue, and they provide the anatomic detail necessary for decisions about appropriate surgical management. Another benefit of the 4D-CT scan is that enhancement characteristics, which are determined by contrast opacification of the hyperfunctional parathyroid tissue over 4 phases of the scan, correlate with metabolic activity. We recommend the use of 4D-CT scanning because of its capacity to identify hyperfunctional parathyroid glands and to provide anatomic information important in preoperative planning.