Textural Analysis of the Hyperdense Artery Sign in Patients with Acute Ischemic Stroke Predicts the Outcome of Thrombectomy.

Textural analysis is pivotal in augmenting the diagnosis and outcomes of endovascular procedures for stroke patients. Due to the detection of changes imperceptible to the human eye, this type of analysis can potentially aid in deciding the optimal type of endovascular treatment. We included 40 patients who suffered from acute ischemic stroke caused by large vessel occlusion, and calculated 130 different textural features based on the non-enhanced CT scan using an open-source software (3D Slicer). Using chi-squared and Mann-Whitney tests and receiver operating characteristics analysis, we identified a total of 21 different textural parameters capable of predicting the outcome of thrombectomy (quantified as the mTICI score), with variable sensitivity (50-97.9%) and specificity (64.6-99.4%) rates. In conclusion, CT-based radiomics features are potential factors that can predict the outcome of thrombectomy in patients suffering from acute ischemic stroke, aiding in the decision between aspiration, mechanical, or combined thrombectomy procedure.

Chemical Stimulation of Heterocyte Differentiation by the Feather Moss Hylocomium splendens: a Potential New Step in Plant-Cyanobacteria Symbioses.

Cyanobacteria associated with mosses play a key role in the nitrogen (N) cycle in unpolluted ecosystems. Mosses have been found to release molecules that induce morphophysiological changes in epiphytic cyanobionts. Nevertheless, the extent of moss influence on these microorganisms remains unknown. To evaluate how mosses or their metabolites influence N2 fixation rates by cyanobacteria, we assessed the nitrogenase activity, heterocyte frequency and biomass of a cyanobacterial strain isolated from the feather moss Hylocomium splendens and a non-symbiotic strain when they were either growing by themselves, together with H. splendens or exposed to H. splendens water, acetone, ethanol, or isopropanol extracts. The same cyanobacterial strains were added to another moss (Taxiphyllum barbieri) and a liverwort (Monosolenium tenerum) to assess if these bryophytes affect N2 fixation differently. Although no significant increases in nitrogenase activity by the cyanobacteria were observed when in contact with H. splendens shoots, both the symbiotic and non-symbiotic cyanobacteria increased nitrogenase activity as well as heterocyte frequency significantly upon exposure to H. splendens ethanol extracts. Contact with T. barbieri shoots, on the other hand, did lead to increases in nitrogenase activity, indicating low host-specificity to cyanobacterial activity. These findings suggest that H. splendens produces heterocyte-differentiating factors (HDFs) that are capable of stimulating cyanobacterial N2 fixation regardless of symbiotic competency. Based on previous knowledge about the chemical ecology and dynamics of moss-cyanobacteria interactions, we speculate that HDF expression by the host takes place in a hypothetical new step occurring after plant colonization and the repression of hormogonia.

Solar-mediated degradation of linezolid and tedizolid under simulated environmental conditions: Kinetics, transformation and toxicity.

Linezolid (LIN) and Tedizolid (TED) are representatives of oxazolidinone antibiotics of last resort with a strong efficacy against gram-positive bacteria. This study focused on their solar-mediated degradation to understand better their fate in aquatic environment, for the realistic concentrations in the range of 1 µg/L. Results showed that both antibiotics (ABs) are degradable by simulated sunlight (1 kW/m2), with half-lives of 32 and 93 h in ultrapure water, for LIN and TED, respectively. LIN showed similar photolytic behaviour in pure solution and in surface water, whereas sunlight enhanced the degradation of LIN in pure solutions, but not in surface water. Structure elucidation by liquid chromatography coupled to high resolution mass spectrometry provided information about seven transformation products for LIN and five for TED. The morpholinyl-ring was identified as the target site for most transformation reactions of LIN. TED was prone to oxidation and cleavage of the oxazolidinone ring. Results of a growth inhibition test on Bacillus subtilis exposed to UV light showed antibacterial efficacy of transformation products of LIN and no significant efficacy of degradation products of TED for the concentration range of 100 µg/L-10 mg/L of parent compounds. Photolytically treated solutions of the ABs maintained their inhibitory effect on the bioluminescence of Aliivibrio fischeri.

Pre-hospital rescue times and interventions in severe trauma in Germany and the Netherlands: a matched-pairs analysis.

PURPOSE: The aim of this study was to compare the pre-hospital treatment of major trauma patients with similar injury patterns in Germany and the Netherlands. PATIENTS AND METHODS: This matched-pairs analysis is based on the TraumaRegister DGU®. The authors compared major trauma patients (ISS ≥ 16) from 2009 to 2015 treated in Dutch and German Level 1 trauma centers (TC). Endpoints were the pre-hospital times and interventions performed until hospital admission. Additional endpoints included hospital mortality, 24-h mortality and standardized mortality ratio (SMR) which was calculated using the Revised Injury Severity Classification, version II (RISC II). Patients were matched by age, gender, injury pattern, vital status on-scene and involvement into a traffic accident. Three subgroups were formed according to the mode of transportation and level of care provided during transport: Ambulance/Physician, Helicopter/Physician and Ambulance/Emergency Medical Technician. RESULTS: Patients were matched into 1094 pairs. German patients arrived at the TC after a mean pre-hospital time of 65.6 (± 29.6) min while Dutch patients arrived after 61.4 (± 28.7) min. Pre-hospital intubation rate was slightly higher in the Netherlands (44.1% GER vs 50.5% NL). Chest tubes were placed in 3.0% of German patients and 8.3% of Dutch patients. 63.5% of the German patients received analgesia/sedation which was below the rate of Dutch patients (71.1%). The hospital mortality was for 17.6% for German patients and 19.8% for Dutch patients. The SMR was about 1.0 for both groups. CONCLUSION: Multiple differences and some similarities in the treatment of major trauma patients with similar injury patterns were found but no clinically relevant differences in the chosen outcome parameters could be observed.

Photolysis of four ß­lactam antibiotics under simulated environmental conditions: Degradation, transformation products and antibacterial activity.

߭Lactam antibiotics are among the most widely used antibiotics in human medicine and their effects on the aquatic environment - concerning bacterial resistance - are controversially discussed. This study focused on the photolysis of the four ߭lactam antibiotics - amoxicillin, ampicillin, penicillin V and piperacillin - under simulated environmental conditions. It was observed that all investigated ߭lactam antibiotics are photolytically degradable by simulated sunlight (1 kW/m2) with half-lives between 3.2 and 7.0 h. Structure elucidation of transformation products performed with liquid chromatography coupled to high resolution mass spectrometry showed that the hydrolysis of the ߭lactam ring is the primary transformation reaction, followed by the elimination of carboxylic and dimethyl thiazolidine carboxylic acid. Growth inhibition tests on Bacillus subtilis showed the loss of bactericide activity of irradiated solutions of amoxicillin, ampicillin and piperacillin, suggesting the transformation of the ߭lactam ring is responsible for the antibiotic effect. In contrast, the solutions of penicillin V did not show any decline of the antibacterial activity after photolytic degradation, probably due to the formation of still active epimers.

Pre-hospital rescue times and actions in severe trauma. A comparison between two trauma systems: Germany and the Netherlands.

INTRODUCTION: The aim of this study was to compare the effect of national pre-hospital rescue strategies on the status of severely injured patients at the time of admission to a Trauma Center (TC) in Germany or the Netherlands. PATIENTS AND METHODS: This retrospective database analysis based on the TraumaRegister DGU(®) (TR-DGU) of the German Trauma Society compares the pre-hospital trauma system of Germany with three Trauma Centers (TCs) from the Netherlands. It comprises trauma patients from 2009 to 2012 admitted to a Level I TC, all patients aged 16-80 years primarily admitted with an ISS ≥ 16 and data available for mode of transport, pre-hospital measures and total pre-hospital time. Additionally three subgroups were formed by mode of transportation and involved personnel: Ambulance/Physician, Helicopter/Physician, Ambulance/EMT. Primary endpoint is the patient's status at the time of admission to the trauma room. Secondary endpoint is hospital mortality. RESULTS: A total of 12,168 patients met the inclusion criteria. Major differences in the injury patterns, pre-hospital rescue time, transport strategy and actions are documented. The mean ISS in the German overall group was 28.6 ± 12.2 compared to 27.4 ± 12.8 in the Dutch overall group. In the subgroups the highest injury severity with 29.8 ± 12.7 for German patients and 31.0 ± 14.6 for Dutch patients was found in the Helicopter/Physician subgroups and the lowest in patients transported by ambulance under emergency medical technician (EMT) care i.e. 24.2 ± 8.9 for German patients and 23.6 ± 10.3 for Dutch patients. The mean total pre-hospital time for patients admitted to Dutch TCs of 53.8 ± 28.7 min was 15.1 min shorter than for patients transported to German TCs 68.7 ± 28.6 min. The overall mean pre-hospital volume replacement of 1103 ± 821 ml for German patients was about twice as high as for Dutch patients (541 ± 700 ml). In physician led subgroups in the Netherlands higher rates of intubation, catecholamine administration and chest tubes are recorded. The basic vital signs from on-scene to hospital admission did not show relevant changes. Additional parameters available in the trauma room revealed a lower mean Base Excess (BE) for Dutch patients and a diminished mean prothrombin ratio for German patients. No reliable evidence was found that differences in the mortality analysis resulted from different national pre-hospital strategy. CONCLUSIONS: Many differences in the national pre-hospital strategy were demonstrated but the effect on patient's status at the time of admission to trauma room remains unclear. A follow-up study, which mitigates the now known injury patterns has to be initiated to further substantiate the findings of this study.