Antibiofilm potential of purified environmental bacteriophage preparations against early stage Pseudomonas aeruginosa biofilms.

AIMS: This paper presents the potential of environmentally sourced bacteriophages to affect the growth of clinical isolates of Pseudomonas aeruginosa biofilms, and assesses the respective plaque morphotypes presented by each bacteriophage, in vitro. METHODS AND RESULTS: Bacterial host strains were typed for their ability to produce the quorum sensing-controlled virulence factor pyocyanin, and then tested for bacteriophage susceptibility using the spot test method. The bacteriophages were co-administered with ciprofloxacin in order to determine whether the bacteriophages would demonstrate synergistic or antagonistic behaviour to the antibiotic in vitro. Results suggest a potential relationship between the bacteriophage plaque size and biofilm inhibition, where those producing smaller plaques appear to be more effective at reducing bacterial biofilm formation. CONCLUSIONS: This phenomenon may be explained by a high adsorption rate leading to the rapid formation of smaller plaques, and greater biofilm reduction associated with the loss of viable bacterial cells before the cells can adhere to the surface and form a biofilm. Results from the co-administration of bacteriophage and ciprofloxacin suggest that the two work synergistically to affect P. aeruginosa biofilms. SIGNIFICANCE AND IMPACT OF THE STUDY: The data indicate enhanced efficacy of ciprofloxacin by ≥50%. This could offer an alternative strategy for targeting antibiotic-resistant infections.

[Fine-needle aspiration (FNA) of the thyroid gland : Analysis of discrepancies between cytological and histological diagnoses]. / Feinnadelaspiration (FNA) der Schilddrüse : Analyse diskrepanter zytologischer und histologischer Diagnosen.

BACKGROUND: Diagnostic problems of thyroid cytology are frequently discussed, but relevance and causes of discrepant cytological and histological diagnoses are rarely studied in detail. OBJECTIVES: Investigation of causes and relevance of discrepant diagnoses. MATERIALS AND METHOD: The analysis includes 297 patients who had thyroid resection after prior fine needle aspiration (FNA) and is based on the cytological and histological reports. In special cases, cytological and histological specimens were re-examined. RESULTS: Malignant tumors were found in 45 patients (15.1 %). In 5 patients the cytological diagnosis was "false negative". Three of these 5 tumors were papillary carcinomas (PTC) of ≤10 mm, one an obviously nonmalignant papillary proliferation of the thyroidal epithelium and one a malignant lymphoma complicating autoimmune thyreoiditis (AIT). In 11 of the 35 patients with a FNA diagnosis "suspicious of malignancy" or "malignant," 1 AIT, 4 goiter nodules, and 6 adenomas were diagnosed histologically. However, since distinct nuclear atypia was found in three of five false positive diagnoses, there still remains doubt in their benignity. CONCLUSIONS: Carcinomas of ≤10 mm incidentally detected in the resected thyroid tissue may not be relevant to the patient and do not reduce the high negative predictive value of FNA. The final diagnosis on the resected tissue should include the cytological findings. Discrepant findings should be commented in the report to the clinician.

[Psychiatric aspects of rheumatoid arthritis: Review of literature]. / Les manifestations psychiatriques dans la polyarthrite rhumatoïde.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory degenerative disease whose symptoms are mainly joint with significant functional impact, resulting in a restriction of the activities of the patient and increasing the impact on mental well-being. Several studies have been conducted to explore psychiatric disorders comorbid with RA. OBJECTIVE: The objective of this review is to present the various psychiatric manifestations of RA reported in the medical literature. METHODS: A literature review was conducted using the Pubmed search with the following keywords: psychiatry, psychiatric manifestations, rheumatoid arthritis. Three hundred and sixty-one articles were reviewed for relevance and 47 references were selected. RESULTS: Among the major psychiatric disorders found in RA, the anxiety and depressive disorders are prevalent (13 to 48% of patients), as well as suicide, insomnia and tiredness. The impairment of quality of life is markedly after age 65. The association between RA and schizophrenia seems negative so that factors predisposing one is protective for the other. CONCLUSION: Comorbid psychiatric disorders with RA are prevalent and may increase the impairment of quality of life for patients. The detection and treatment of psychiatric disorders improve the care of patients with RA.

Robotic-assisted laparoscopic colposuspension for female stress urinary incontinence: a prospective series.

The suspension of use of sub-urethral mesh in the UK in 2018 has seen the resurgence of colposuspension in female SUI surgery. Open and laparoscopic colposuspension techniques are well recognised. We present data from 28 robotic-assisted laparoscopic colposuspension (RALCp) procedures, reporting on technique, safety and efficacy. Approval was obtained from the hospital New and Novel Procedures Committee. All patients had urodynamic assessment prior to surgery. Data was prospectively gathered and 24-h pad usage and Urinary Incontinence Short Form Questionnaire (ICIQ-UI-SF) scores were used to assess symptom severity and quality of life. PGII scores were used to assess patient satisfaction after the procedure. Paired T test analysis was conducted. Since May 2019, robotic colposuspension has been performed in 28 patients. The mean age and BMI were 49 and 27 (kg/m2), respectively, with a mean follow-up period of 12 months. 67.9% of patients had pure urodynamic SUI and 32.1% of patients had previous anti-SUI surgery. Average operating time was 127 min, blood loss 20 ml and length of stay 2 days. There was a significant 73% improvement in mean 24-h pad usage (p = 0.001) and an improvement in mean ICIQ-UI-SF scores from 18.1 to 9.4 (p = 0.0001). Day 1 mean pain score was 5/10. This is the largest series of its kind. Robotic colposuspension is safe and feasible with significant improvements seen in quality of life scores and number of pads used per day. It presents a minimally invasive treatment option in female SUI, however needs larger volume evaluation and longer follow-up for further evaluation.

Assessment of parent knowledge and perception towards the importance of child immunization in Sudair region, Saudi Arabia.

OBJECTIVE: According to WHO, global coverage of immunization was 86% in 2019, which dropped to 83% in 2020. The objective of this study is to assess parental knowledge and identify their perception towards the importance of child immunization. This study has also tried to determine the possible influencing factors for parental decision-making towards child immunization. PATIENTS AND METHODS: A community-based cross-sectional study was conducted in 2020 in Sudair region of Saudi Arabia. The study was done among parents residing in Sudair region, where the sample was randomly selected based on the household. The sample of 436 was taken using the population proportion formula. Data were collected and analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). Both the descriptive and inferential statistics were used to draw the results. RESULTS: In this study the three-fourth (77.1%) of respondents were female and the remaining were male (23%). The majority of the respondent's knowledge was reported to have some form of influence on their idea of immunization followed by Ministry of Health, family members, medical staff, social media and others. A significant association was seen between age, marital status, occupational status and parents' knowledge on the importance of immunization (thinking if all child immunization was important). Association was also seen between parents' perception that immunization causes serious side effects and the age of the respondents. CONCLUSIONS: The specific programs and bcc materials are needed to enhance the knowledge and perception of individuals regarding the need for complete immunization and also regarding the fact of vaccine-preventable diseases.

Mapping the movement for climate change and health in England: a descriptive review and theory of change analysis.

AIMS: There are a growing number of organisations working to address the connections between climate change and health. This article introduces the concept of 'theories of change' - the methodology by which organisations or movements hope to bring about social change - and applies it to the current climate change and health movement in England. Through movement mapping, the article describes and offers reflections on the climate change and health ecosystems in England. METHODS: Organisations working on climate change and health in England were identified and publicly available information was collated to map movement characteristics, target stakeholders and methodologies deployed, using an inductive, iterative approach. RESULTS: A total of 98 organisations working on health and climate change (and/or sustainability) were initially identified, of which 70 met the inclusion criteria. Most organisations target two or more stakeholders, with healthcare workers, management structures, and government being most commonly cited. Methodological approaches identified include Formal education programmes; Awareness-raising; Purchasing-procurement power; Advocacy; Financial; Media-messaging; Networking; Knowledge generation; and Policy making, of which education, awareness-raising, and advocacy are most commonly used. CONCLUSION: There is a tendency for climate change and health organisations in England to focus on individual level and sectoral change over system change. More could be made of the potential for the healthcare professions' voice and messaging for the wider climate movement. Given the rapid boom of climate change and health organisations in recent years, a mind-set shift that recognises different players as part of a cohesive ecosystem with better coordination and collaboration may reduce unnecessary work, and facilitate more cohesive outcomes.

Studying the anti-tyrosinase effect of Arbutus andrachne L. extracts.

Arbutus andrachne L. is widely distributed in Jordan. Tyrosinase is the key enzyme in the biosynthesis of melanin. This preliminary study was carried out to assess the possible anti-tyrosinase activity of A. andrachne extracts. Arbutin, hydroquinone and kojic acid were selected as inhibitor standards. Five different extracts (chloroform, butanol, ethanol, methanol and water) were prepared from A. andrachne stems and their activities were compared with the selected tyrosinase inhibitors. IC(50) was measured for both, standard and plant extracts. Among the different extracts, the methanolic extract exhibited the highest anttyrosinase activity with an IC(50) value (1 mg mL(-1)). Furthermore, 9 mg A. andrachne methanolic extract showed 97.49% inhibition of tyrosinase activity. Arbutin, hydroquinone, beta-sitosterol and ursolic acid were identified in the different extracts of A. andrachne by thin layer chromatography (TLC) and isolated by preparative TLC from the methanolic and chloroform stem extracts, respectively.

Supramolecular structures and stereochemical versatility of azoquinoline containing novel rare earth metal complexes.

Rare earth complexes of 5-(phenylazo)-8-hydroxyquinoline (HL) of composition [M(L)(2)X.H(2)O] [where M=La, Ce, Pr, Nd and X=NO(3)(-) or NCS(-)] have been prepared and characterized on the basis of their chemical analyses, (1)H NMR, magnetic measurements, conductance, and visible and IR spectral data. Composition, conductance and IR spectral data of the complexes show that the HL acts as a bidentate monobasic ligand. The visible spectra of Pr(3+) and Nd(3+) show characteristic f-f transitions, and the nephelauxetic effect (1-beta) of these transitions has been evaluated. These data indicate the weak involvement of the 4f orbitals in complex formation.

A rapid, selective and sensitive spectrophotometric method for the determination of Ce(III) using some bisazophenyl-beta-diketone derivatives.

A rapid, simple, selective and sensitive spectrophotometric method for the determination of cerium(III) using the title azo dyes [1,3-phenylenediamine bisazoacetylacetone (I(a));1,3-phenylenediamine bisazobenzoylacetone (I(b));1,4-phenylenediamine bisazoacetylacetone (I(c)); and 1,4-phenylenediamine bisazobenzoylacetone (I(d))] has been developed in neutral and slightly alkaline (pH 7.00, 7.50, 8.00 and 7.00) media. The 1:1 and 2:1 (M:L) complexes formed exhibit their highest absorbances in 30% (v/v) dioxane solutions, having formation constants (log K) of 4.44, 4.95. 5.63 and 5.22 and 8.51, 8.76, 9.73 and 9.37 respectively. Beer's law is obeyed over the concentration ranges 0.10-2.50, 0.05-3.00, 0.05-3.75 and 0.10-3.50 mug ml(-1) of cerium(III). More accurately, Ringbom optimum concentration ranges are 0.2-2.25, 0.2-2.6, 0.2-3.5 and 0.2-3.3 mug ml(-1) for the complexes of reagents I(a),I(b),I(c) and I(d) respectively. The molar absorptivities, Sandell sensitivities and relative standard deviations were also calculated. The interferences of 50 foreign ions on the determination of cerium(III) were studied. The method allows the determination of cerium(IV) after prior reduction to the trivalent state. The proposed method was used for cerium determination in two different monazite samples and the results were compared with certified values obtained using atomic absorption spectrometry, indicating that the procedure provided accurate and precise results.

Assay of terfenadine in pharmaceutical formulation and human plasma by adsorptive stripping voltammetry.

The controlled adsorptive accumulation of Zn(II)-terfenadine complex (1:1) onto a hanging mercury drop electrode (HMDE) provides the basis for determination of the antihistamine drug terfenadine by differential pulse cathodic adsorptive stripping voltammetry. The adsorbed Zn(II)-terfenadine complex (1:1) at the HMDE developed a stripping voltammetry peak at more negative potential than that of the free Zn(II) ions. The peak current was used for the determination of terfenadine in pharmaceutical formulation and human plasma in 0.1 mol l(-1) sodium perchlorate solution under the optimized conditions (E(acc), -0.5 V; t(acc) 360 s; scan rate, 5 mV s(-1) and pulse height 100 mV). The developed peak current (i(p)) showed a linear dependence with terfenadine concentration within the range of 6 x 10(-8) - 9 x 10(-7) mol l(-1). The recoveries were found 98.97-99.35%, 99.72-99.02% and 100.58-101.08% with the R.S.D. 0.16-0.27%, 0.25-0.82% and 0.44-1.14% in authentic form, pharmaceutical formulations and human plasma, respectively. The detection limits were 0.4505 and 0.6115 ng ml(-1) terfenadine in pharmaceutical formulations and human plasma, respectively.

Spectral and photophysical studies of inclusion complexes of 2-amino-4,6-dimethyl pyrimidine with beta-cyclodextrin.

The interaction of 2-amino-4,6-dimethyl pyrimidine (ADMP) with beta-cyclodextrin (beta-CD) has been studied by means of UV absorption, steady state and time resolved fluorescence techniques. Spectral characteristics, bandwidths and photophysical parameters indicating that ADMP experience two different environments in aqueous solutions: bulk water and 1:1 (ADMP:beta-CD) inclusion complexation. The size restriction of the upper rim of beta-CD partially include ADMP and prevent the possibility of formation of 1:2 complex. The effective polarity of the cyclodextrin cavity experienced by the induced ADMP is equivalent with the polarity of an 80:20 methanol-water mixture.

A method for linking motor vehicle victim and collision data collected by multiple county agencies.

OBJECTIVE: This study assessed roadside and bedside factors associated with early mortality following motor vehicle trauma. METHODS: This retrospective cohort study evaluated motor vehicle crashes in Orange County Florida in 2009 that became medical examiner cases. Data from the Department of Highway Safety and Motor Vehicles (DHSMV), emergency medical services (EMS), a level I trauma center, and the medical examiner were integrated for the analysis. The primary outcome measure was early death, defined by death within 48 hours of a motor vehicle trauma. Both traditional and nontraditional predictors of early mortality were assessed. RESULTS: The most significant factors associated with early mortality were as follows: (1) From autopsy: hemothorax (odds ratio [OR] = 8.26, 95% confidence interval [CI]: 1.83-37.3) and liver injury (OR = 4.26, 95% CI: 1.70-15.6); (2) from hospital data: systolic blood pressure (OR = 0.98, 95% CI: 0.96-0.99) and having cardiopulmonary resuscitation (CPR) performed in the emergency department (OR = 13.4, 95% CI: 1.51-118.72); and (3) from DHSMV: involvement of drugs and/or alcohol (OR = 4.27, 95% CI: 1.33-13.6), total fatalities (OR = 6.07, 95% CI: 1.57-23.5), speed of vehicle (OR = 1.06, 95% CI: 1.02-1.09), and number of lanes at the crash scene (OR = 1.58, 95% CI: 1.13-2.20). CONCLUSION: These results were made possible by integrating 4 distinct data sources. As future research in traffic-related injury moves toward prevention, it will be critical to evaluate new preventative strategies quickly and effectively. A unique number that is both patient and event specific that could be incorporated into each of these databases would make such integration seamless. Successful methods for linking data collected by the multiple agencies involved in motor vehicle collisions will ultimately provide invaluable information for medical personnel, researchers, engineers, planners, and policy makers at the local, state, and national levels to identify safety priorities to reduce crash-related injuries and fatalities.

Challenging boundaries: an enhanced recovery programme for radical cystectomy.

INTRODUCTION: The implementation of enhanced recovery programmes (ERPs) in colorectal surgery has seen improvements in the length of inpatient stay with no increase in complications. We investigated the role of ERP in radical cystectomy at our institution. METHODS: Prospective data were collected from 26 consecutive patients prior to the introduction of the ERP and 51 patients who underwent open radical cystectomy within an ERP. Individuals in the ERP cohort did not receive bowel preparation or nasogastric drainage but received preoperative carbohydrate drinks, perioperative epidural analgesia and immediate mobilisation on day 1. Primary outcome measures included duration of intensive care unit (ICU) stay and length of hospital stay. Secondary outcome measures included the time to the passage of flatus and faeces, and time to mobilisation. Other measures that were analysed included operation time and complications. RESULTS: Baseline characteristics for both groups were similar. The median length of hospital stay fell from 11.5 days to 10.4 days and the mean ICU stay dropped from 2.4 days to 1.0 days (p=0.01). Time to removal of nasogastric tube, and time to passage of flatus and faeces were significantly shorter in the ERP group, as was the time to full oral diet. Clavien complication rates and 30-day mortality rates were similar in both groups. There were no readmissions. CONCLUSIONS: ERP in radical cystectomy is safe and not associated with any increase in complications or readmissions. It is associated with reductions in ICU stay, and could also reduce length of hospital stay and duration of postoperative ileus.

Regulation of human lung epithelial cell numbers by diesel exhaust particles.

Particulate air pollution is associated with respiratory morbidity and has cytotoxic and pro-inflammatory effects. The effects of diesel exhaust particles (DEP) on proliferation and apoptosis of A549 lung epithelial cells were examined. When deprived of serum (serum starvation), epithelial cell numbers fell, but DEP (5-200 microg.mL-1) prevented this. Using flow cytometric analysis of propidium iodide (PI) staining, DEP (10 microg.mL-1) increased cells in the S phase of cell cycle from 12.85 to 18.75% after 48 h, reversing serum starvation-induced G0/1 arrest. DEP also reduced the increase in apoptotic cells, as defined by double expression of annexin V/PI, observed after serum starvation (from 28.35 to 15.46%). The antioxidants, N-acetylcysteine (NAC; 33 mM) and AEOL10113 (10-100 microM), the N-terminal c-jun kinase inhibitor, SP600125 (33 microM), and nuclear factor-kappaB inhibitor, SN50 (33 microM), inhibited DEP-induced cell number increase. NAC inhibited DEP-induced reduction of G0/1 and increase in cells in the S and G2/M phases. Expression of p21CIP1/WAF1 mRNA and protein seen with serum starvation was reduced by DEP. In conclusion, diesel exhaust particles prevented serum starvation-led decreases in A549 epithelial cells by inducing cell cycle progression and preventing apoptosis, processes involving oxidative stress, inhibition of p21CIP1/WAF1 expression and stimulation of N-terminal c-jun kinase and nuclear factor-kappaB. Therefore, low-dose diesel exhaust particle exposure may lead to lung epithelial cell hyperplasia.

Sonic hedgehog is required for cardiac outflow tract and neural crest cell development.

The Hedgehog signaling pathway is critical for a significant number of developmental patterning events. In this study, we focus on the defects in pharyngeal arch and cardiovascular patterning present in Sonic hedgehog (Shh) null mouse embryos. Our data indicate that, in the absence of Shh, there is general failure of the pharyngeal arch development leading to cardiac and craniofacial defects. The cardiac phenotype results from arch artery and outflow tract patterning defects, as well as abnormal development of migratory neural crest cells (NCCs). The constellation of cardiovascular defects resembles a severe form of the human birth defect syndrome tetralogy of Fallot with complete pulmonary artery atresia. Previous studies have demonstrated a role for Shh in NCC survival and proliferation at later stages of development. Our data suggest that SHH signaling does not act directly on NCCs as a survival factor, but rather acts to restrict the domains that NCCs can populate during early stages (e8.5-10.5) of cardiovascular and craniofacial development.

Eosinophilia as a diagnostic value in patients suffering from schistosomiasis haematobium comparing to eosinophiluria and egg count in the urine.

Sixty cases ranging in age between 18-30 years old, 50 of them were suffering from schistosomiasis haematobium, they were selected from in- and out-patient clinic of Theodor Bilharz Research Institute. Patients were divided into three groups, 20 infected and not treated, 20 infected and treated then exposed again to infection and 10 were completely treated. The authors have a fourth group to serve healthy control. Blood samples were collected to count eosinophil percentage and absolute eosinophil count. Urine samples were collected to 1-study eosinophiluria by slide film staining with Leishman's stain, and 2- to count number of ova excreted in 10 ml urine by urine filtration technique. Eosinophila and eosinophiluria > 5% were considered as a diagnostic value for schistosomiasis haematobium as well as it correlation between them and intensity of infection by number of ova in urine.

Evaluation of ELISA, IFAT and trichinoscopy in experimental trichinosis: comparing larval antigens prepared from rat and pig muscles.

Two antigens were prepared, the first one was crude larval antigens derived from pigs and rats. The two antigens were tested by the enzyme linked immunosorbent assay (ELISA). The 2nd one, was two cuticular larval antigens derived from pigs and rats and were tested by the indirect immunofluorescent antibody test (IFAT). Both tests were used to evaluate the sensitivity and specificity of these different antigens. Serum samples from infected rats and pigs were tested with different antigens by ELISA and IFAT. At the end of experiment, all animals were killed and use trichinoscopy to reveal sensitivity and specificity versus ELISA and IFAT.

Genetic interactions among vestigial, hairy, and Notch suggest a role of vestigial in the differentiation of epidermal and neural cells of the wing and halter of Drosophila melanogaster.

In this paper we describe the results of genetic analysis of the vestigial locus by studying its interactions with hairy and Notch loci in Drosophila melanogaster. Different vestigial alleles in homo- and heterozygous combination with different hairy alleles show synergism in increasing both cell death and formation of ectopic bristles and produce ectopic veins. Interactions between N and vg also show synergism in increasing cell death and formation of ectopic bristles. Only synergism in cell death is seen between h and N. The interactions indicate that vg product plays a role in the differentiation of epidermal and neural cells of the wing disc by interacting with N and h products either directly or indirectly. Mechanisms of molecular interactions among the three loci are discussed.

A putative role for platelet-derived growth factor in angiogenesis and neuroprotection after ischemic stroke in humans.

BACKGROUND AND PURPOSE: Growth factors control two important processes in infarcted tissue, ie, angiogenesis and gliosis. We recently reported that transforming growth factor-beta1 (TGF-beta1) might be involved in angiogenesis after ischemic stroke in humans; here we present data of an extensive study on platelet-derived growth factor (PDGF) and its receptors. METHODS: We studied brain samples from patients who suffered from ischemic stroke for the expression of mRNA encoding PDGF-A, PDGF-B, and PDGF receptors (PDGF-R). Proteins were examined by Western blotting and immunohistochemistry using the antibodies to PDGF-AB, PDGF-BB, PDGF-R alpha, and PDGF-R beta. RESULTS: At the mRNA level, PDGF-A and PDGF-B were expressed mainly in neurons in penumbra. PDGF-R mRNA was strongly expressed in some astrocytes but mainly in type III/IV neurons in infarct and penumbra. The least expression was seen in the contralateral hemisphere (P<.001). In contrast, both PDGF-AB and PDGF-BB immunoreactive products were present in most cell types: PDGF-R alpha and PDGF-R beta mainly on neurons, and PDGF-R beta on some endothelial cells, with less staining of all the isoforms in the contralateral hemisphere. On Western blots, PDGF-AB and -BB were expressed more within white matter than gray matter of infarct/penumbra, whereas both isoforms of receptor were expressed mainly in gray matter compared with contralateral hemisphere. There was no or very weak expression of the receptor in white matter. CONCLUSIONS: PDGF proteins are highly expressed in white matter, suggesting that PDGF may exert its function in white matter participating either in regeneration of damaged axons or in glial scar formation. PDGF-BB and its receptor expressed on microvessel endothelial cells might be involved in angiogenesis after stroke. Thus, PDGF is likely to be angiogenic and neuroprotective in stroke.

Vascular endothelial growth factor and its receptor, KDR, in human brain tissue after ischemic stroke.

Ischemic stroke results from a reduction in cerebral blood flow to a focal region of the brain after the occlusion of an artery, causing damage to nervous tissue. There is a region of cerebral ischemic tissue (penumbra) surrounding an acute cerebral infarct that is dysfunctional but potentially viable. Restoration of perfusion in the penumbra may ameliorate the tissue damage. The identity and the role of growth factors that control the extent of tissue damage and its repair are poorly understood. Angiogenesis has been demonstrated to occur in brain tissues of patients surviving an acute ischemic stroke. In this paper we have investigated the status of a potent angiogenesis factor, vascular endothelial growth factor (VEGF), in patients after acute ischemic brain stroke. Western blotting and immunohistochemistry were used to determine protein expression, and in situ hybridization was used to quantify and localize mRNA synthesis. The expression of VEGF protein was increased in the penumbra compared with infarcted brain and contralateral hemisphere. Neurones, endothelial cells, and astrocytes in the penumbra in all patients studied had significant up-regulation of both VEGF165 and VEGF189 mRNA (p < 0.01, Wilcoxon Matched-Pairs Signed-Ranks Test) compared with infarcted tissue and the normal looking contralateral hemisphere that was used as a control. Immunohistochemistry demonstrated that kinase insert domain receptor was present in blood vessels within the infarct/penumbra and absent from the normal contralateral hemisphere. VEGF, which is important in angiogenesis, may also influence long term neuronal survival, and possibly its modulation may prove to be of therapeutic value for patients with ischemic stroke.