Early statin therapy in patients with acute intracerebral hemorrhage without prior statin use.

BACKGROUND AND PURPOSE: Statin therapy is beneficial for primary and secondary prevention of ischaemic stroke, but its influence in patients with intracerebral hemorrhage (ICH) is unclear. An assessment was made of the effect of early statin therapy on patients with acute ICH. METHODS: Taiwan's National Health Insurance Research Database was screened for patients without prior statin therapy admitted from January to December 2008 for newly diagnosed ICH. Patients taking statins during hospitalization or within 3 months post-discharge were the early statin group (n = 749); patients who were not were the control group (n = 7583). The study end-points were recurrent ICH and all-cause mortality during follow-up. RESULTS: All eligible patients were followed up until 31 December 2010. During the follow-up, 69 (9.2%) patients in the early statin group and 677 (8.9%) control group patients had recurrent ICH. Cox proportional hazards analyses showed that early statin use did not increase the risk of recurrent ICH (adjusted hazard ratio 1.044; 95% confidence interval 0.812-1.341). During the same period, 90 (12.0%) of the early statin group and 1519 (20.0%) control group patients died. All-cause mortality was lower in the early statin group (adjusted hazard ratio 0.742; 95% confidence interval 0.598-0.919) than in the control group. Matched propensity score analyses were consistent with findings in Cox proportional hazards analyses. CONCLUSIONS: Early statin group patients with acute ICH did not have a higher recurrent risk of ICH and might have lower all-cause mortality during follow-up. It is concluded that statin therapy might be beneficial for patients with ICH.

Impact of early statin therapy in patients with ischemic stroke or transient ischemic attack.

BACKGROUND: Statin therapy has demonstrated benefits in ischemic stroke patients. However, little is known about whether the timing of statin initiation affects clinical outcomes. The possible association of statin use and cerebral hemorrhage is also a concern for early statin therapy after stroke. The objective of this study was to evaluate the efficacy and safety of the initiation timing of statins in acute ischemic stroke. METHODS: A cohort study was performed using 5-year National Health Insurance Research Database in Taiwan. Patients without prior statin therapy admitted for their new ischemic stroke or transient ischemic attack (TIA) were enrolled. Patients were recognized as inhospital use group (2019 patients, statin initiation during hospitalization), intermediate use group (2266 patients, statin initiation within 1 year after discharge) or late use group (2958 patients, statin initiation 1 year later after discharge). The study endpoint was the composite outcome of ischemic stroke, TIA, hemorrhagic stroke, or acute coronary event. RESULTS: As compared with inhospital use, patients with late use had a 49% increased risk (adjusted HR: 1.49, 95% CI: 1.26-1.76) of composite endpoint. In contrast, patients with intermediate use had similar risk of endpoint as those with inhospital use. The risk of cerebral hemorrhage was similar in patients receiving inhospital, intermediate, or late statin treatment. CONCLUSIONS: In acute ischemic stroke, patients receiving late statin treatment carried a poorer clinical outcome than those with earlier statin initiation. Inhospital statin use after an acute ischemic stroke did not increase the risk of cerebral hemorrhage.

Effect of statin treatment on three-month outcomes in patients with stroke-associated infection: a prospective cohort study.

BACKGROUND AND PURPOSE: Infection is a major medical problem in patients with acute stroke. Recent evidences suggest that statins reduce infection-associated complications. The purpose of this study was to examine the influence of statin treatment on mortality and functional outcomes in patients with stroke-associated infection. METHODS: In this prospective observational cohort study, 514 patients with acute ischaemic stroke or transient ischaemic attack (mean age, 74 ± 11 years; men, 48%) with infection occurring in the first 7 days after admission were included. We examined the effect of in-hospital statin treatment on mortality and favorable functional outcome (modified Rankin Scale score ≤2) at 3 months follow-up. RESULTS: Infection occurred at 0.93 ± 1.49 days after admission. All patients had not received statin treatment prior to admission, and 121 patients (24%) received statin at 1.71 ± 1.28 days after admission. Follow-up at 3 months was completed for 511 patients (99%). National Institutes of Health Stroke Scale score and Charlson index were the most important independent predictors of mortality and functional outcome. Univariate [hazard ratio (HR), 0.82; 95% confidence intervals (CI), 0.47-1.42] and multivariate (HR, 1.68; 95% CI, 0.79-3.56) Cox regression analysis showed that statin did not significantly decrease the morality. In propensity analysis, statin treatment still had no significant association with mortality (HR, 1.54; 95% CI, 0.68-3.47) in the multivariate analyses after adjusting for age, sex, and propensity score. CONCLUSIONS: Statin use was not associated with a better functional outcome or survival in patients with stroke-associated infection.

Low-loss propagation in Cr4+:YAG double-clad crystal fiber fabricated by sapphire tube assisted CDLHPG technique.

Cr4+:YAG double-clad crystal fiber with an uniform 10-microm core was fabricated by using a sapphire tube as a heat capacitor to stabilize the power fluctuation of the CO2 laser in the co-drawing laser-heated pedestal growth system. The uniformity of the fiber core showed a factor of 3 improvement compared to that without the use of sapphire tube. The variation of the core diameter is within the +/-1.35-degree adiabatic criterion and has a autocorrelation length of 1.7 mm. The measured propagation loss is only 0.02 dB/cm. The sapphire tube also reduces the vertical temperature gradient during the crystal fiber growth process so the 10-microm crystal core exhibits a smooth perimeter. The sapphire tube assisted system can be applied to the growth of many other optical crystal materials.

Double-clad Cr4+:YAG crystal fiber amplifier.

A novel double-clad Cr4+:YAG crystal fiber is demonstrated by use of a codrawing laser-heated pedestal growth method. Up to 10 dB of gross gain at a wavelength of 1.52 microm is achieved at a pump power of 0.83 W, which, to our knowledge, is the first Cr4+-doped fiber amplifier in the optical fiber communication band.

Ultradistal and distal forearm bone mineral density in postmenopausal women.

OBJECTIVES: A cross-sectional study was conducted to evaluate bone mineral density of the forearm in older women. METHODS: Eight hundred and thirty-two women who had received a routine distal forearm bone mineral density screening measurement were included. Data were collected on age, age at menopause, duration of menopause, body height, body weight, and duration of hormone replacement therapy. RESULTS: After menopause the incidence of osteoporosis increased markedly with age, from 5.8% in the distal site and 3.9% in the ultradistal site less than 5 years after menopause to 61.1% and 44.4%, respectively, 25 years or later after menopause. Hormone replacement therapy markedly reduced the incidence of osteoporosis. CONCLUSIONS: After menopause, the incidence of osteoporosis in the forearm increased markedly with years. Women with higher body weight had higher forearm bone mineral density, and postmenopausal hormone replacement therapy prevented bone loss in the forearm.

Acute respiratory distress syndrome in a woman with heroin and methamphetamine misuse.

Methamphetamine, heroin, and cannabis are three of the most commonly misused drugs in Asia. In Taiwan, cases of misuse of methamphetamine have been increasing. In this paper, we report the case of a 23-year-old woman who had a 10-year history of smoking methamphetamine and intermittent use of heroin for 3 to 4 years. She developed pulmonary toxic effects associated with misuse of heroin and methamphetamine. She was brought to the emergency room because of consciousness disturbance and acute respiratory failure. Her symptoms of rapid progression of refractory hypoxemia, ill-defined densities over both lung fields, and normal pulmonary artery wedge pressure were consistent with acute respiratory distress syndrome. Rapid resolution of infiltrations and improvement of oxygenation were observed after mechanical ventilation with positive end-expiratory pressure support and oxygen therapy. She was discharged on the fifteenth hospital day without any sequela except for mild exertional dyspnea.

Functional mutation in the promoter region of thrombomodulin gene in relation to carotid atherosclerosis.

Thrombomodulin is an important endothelial anticoagulant protein that decreases thrombin activity and activates protein C. Our recent study has shown that the G-33A promoter mutation of thrombomodulin gene is associated with coronary artery disease. This study was conducted to determine whether the G-33A mutation in the promoter region of thrombomodulin gene is a genetic risk factor for ischemic stroke or carotid atherosclerosis. The functional significance of this mutation was also evaluated. We recruited 333 patients (mean age 64 years, 59% male) with ischemic stroke and 257 age- and sex-matched controls. In all study participants, carotid atherosclerosis was assessed by Duplex scanning, and thrombomodulin G-33A promoter mutation was detected by single-strand conformation polymorphism. Luciferase reporter gene assay was used to assess the influence of this mutation on thrombomodulin promoter activity. There was no significant difference in the thrombomodulin G-33A mutation frequency (GA+AA genotypes) between the stroke and the control groups (18.3 vs. 24. 1%, P=0.105). The G-33A mutation frequency was also similar between the study participants with and without carotid atherosclerosis (22.2 vs. 19.8%, P=0.550). When only younger subjects (age

Chronic focal encephalitis (Rasmussen's syndrome) in an adult.

Chronic focal encephalitis in adults is rare. Here we report a case of chronic focal encephalitis with epilepsy in a man. A 53-year-old man was admitted to our hospital because of right-sided focal seizures and epilepticus partialis continua. Brain imaging studies demonstrated progressive, focal, left cerebral atrophy. Prominent degenerative changes including neuronal loss and astrocytic gliosis were found on brain biopsy. Although the characteristics were typical of Rasmussen's encephalitis, unlike chronic focal encephalitis in children, his seizures were easily controlled by traditional antiepileptic therapy.

Comparison of effective renal plasma flow (ERPF) and endogenous creatinine clearance (Ccr) in evaluation of the differential kidney function: an in vivo study.

Eleven patients with obstructive uropathy were inserted with a pigtail catheter either for urinary diversion, endopyelotomy or percutaneous nephrolithotomy. Differential kidney functions were obtained by single-sample technique with I-131 orthoiodohippurate (OIH) and separate endogenous creatinine clearance (Ccr). Good linear correlation was noted between effective renal plasma flow (ERPF) and Ccr (r = 0.84, p less than 0.005), but there was still some discrepancy between these two examinations, chiefly found in two severely obstructed kidneys. Determination of ERPF by I-131-OIH single-sample technique is a simple, rapid, inexpensive and relative accurate test to measure the differential kidney function. But if the ERPF is at extremely low level, further investigations such as sonography of kidney and separate endogenous creatinine clearance should be done to avoid unnecessary nephrectomy.

Clinical significance of serum type-III procollagen aminopropeptide in hepatitis B virus-related liver diseases.

Serum type-III procollagen aminopropeptide (PIIIP) has been considered a marker of hepatic fibrogenesis. In an attempt to evaluate the clinical significance of serum PIIIP in patients with hepatitis B virus (HBV)-related liver diseases, the levels of the peptide were measured in 66 healthy adults and 200 patients with HBV-related liver diseases. As compared with the healthy adults (12.3 +/- 3.1 ng/ml), the serum PIIIP levels were significantly elevated in patients with acute hepatitis (17.4 +/- 6.6 ng/ml), chronic persistent hepatitis (18.3 +/- 4.9 ng/ml), and inactive liver cirrhosis (22.1 +/- 7.1 ng/ml). The PIIIP levels in patients with chronic active hepatitis (CAH) (33.9 +/- 23.1 ng/ml) were the highest among HBV-related liver diseases and had a tendency to increase with the severity of CAH. Of the liver-diseased patients with serum PIIIP levels greater than 30 ng/ml, 91% had a recent episode of severe hepatocellular damage, whereas 56% of patients with greatly elevated serum liver aminotransferase levels had no associated high increase in serum PIIIP levels. Thus, we suggest that fibrogenesis in HBV-related liver diseases is initiated by severe hepatocellular damage, but liver damage can also take place without prominent hepatic fibrogenesis. Serum PIIIP may be a serum marker to predict the active fibrogenesis of HBV-related liver diseases.

Radionuclide diagnosis of intrahepatic lithiasis.

Hepatic lithiasis is a major disease in Asia, especially East Asia. Its clinical aspect and incidence have been reviewed. The radionuclide methods ranging from sequential scintigraphy through hepatic retention ratio determination to retention ratio image would be simple and innocuous techniques for screening and detecting this disease.

Combined passive and active immunization for interruption of perinatal transmission of hepatitis B virus in Taiwan.

We attempted a clinical trial to interrupt transmission of hepatitis B virus (HBV) infection from hepatitis B surface antigen (HBsAg) positive and hepatitis Be antigen (HBsAg) positive mothers to their infants in Taiwan. Screening of 5,595 pregnant women revealed that 856 (15.3%) were HBsAg positive. Three hundred and sixty-one (42.2%) of the HBsAg positive pregnant women were HBeAg positive. Infants born to HBsAg and HBeAg positive mothers were randomized into 3 groups to receive the HBV vaccine alone or combined with hepatitis B immune globulin (HBIG). HGV vaccine was given at 2, 6, and 10 weeks after birth. Group I received HBV vaccine alone while Group II received HBV vaccine in combination with HBIG at birth and group III received HBV vaccine plus HBIG at birth and again at one month old. Group IV constituted the control group when their parents refused vaccination. At 6 months of age, the HBV carrier rate was 23.7% (9/38) in Group I, 11.1% (4/36) in Group II, and 5.3% (2/38) in Group III infants. Compared with 90% of infants who became HBV carriers in the control group (Group IV), the efficacy of HBV vaccination in preventing HBV infection among these high risk infants at the 6th month was 73.7% in Group I, 87.7% in Group II, and 94.1% in Group III. The antibody to HBsAg (anti-HBs) positivity rate in sera of Group I, II, III infants at 6 months of age was 79.0%, 88.9% and 94.7%, respectively. These initial results indicate that combined passive and active immunization is efficacious in interrupting perinatal transmission of HBV infection.

Noise analysis in isolation of iodine using three energies.

The Poisson noise inherent in multispectral x-ray imaging systems is formulated to give the SNR under a limited exposure constraint. The SNR value is maximized with respect to the exposure partition among different x-ray energies. The study shows how to choose suitable spectra and the dose weights. The robustness of these dose weights is also demonstrated for systems of varying bone and tissue contents.