Sex differences in clinical risk factors in obese ischemic stroke patients with a history of smoking.

Clinical risk factors associated obesity and smoking, as well as their combined effect, are not fully understood. This study aims to determine sex differences in risk factors in a population of acute ischemic stroke (AIS) patients who are obese and with a history of previous or current smoking. METHODS: A retrospective analysis of risk factors in male and female AIS patients with baseline data of obesity and current or previous history of smoking, smoking, and obesity alone was determined. The primary predictor and outcome are risk factors associated with male and female AIS patients. Baseline risk factors were analyzed using a multivariate regression analysis to determine specific risk factors linked with the combined effect of obesity and current or previous history of smoking''. RESULTS: Male obese AIS patients who are current or previous smokers were more likely to be older patients(OR = 1.024, 95% CI, 1.022-1.047, P = 0.033) that present with coronary artery disease (OR = 1.806, 95% CI, 1.028-3.174, P = 0.040), a history of alcohol use (OR = 2.873, 95% CI, 1.349-6.166, P = 0.006), elevated serum creatinine (OR = 4.724, 95% CI, 2.171-10.281, P < 0.001) and systolic blood pressure (OR = 1.029, 95% CI, 1.011-1.047, P < 0.002). Females were more associated with depression (OR = 0.432, 95% CI, 0.244-0.764, P = 0.004), previous TIA (OR = 0.319, 95% CI, 0.142-0.714, P < 0.005), and higher levels of HDL (OR = 0.938, 95% CI, 0.915-0.962, P < 0.001). CONCLUSION: Our results reveal sex differences in risk factors in obese AIS patients with a current or past history of smoking. This finding emphasizes the need to develop management strategies to improve the care of obese AIS patients who are either current or former smokers.

Evaluating the Importance of Mentoring in Undergraduate Research Education Programs.

The National Institute of Health R25 Research Education Program was evaluated in the second year of implementation. Twelve mentors and 20 underrepresented minority students (URMs) scholars from partnerships and collaborations among five colleges and universities were added to the program to provide a more diverse research experience. Findings reveal that 100% of research mentors agree that the approachableness and accessibility of the program coordinator were beneficial in achieving mentorship goals and objectives. In addition, 85% of the students strongly agreed that the presentation of their research findings and the weekly reflection on goals, identification of accomplishments, and obstacles through the individual development plan were very effective. Of the 23 successfully tracked students for 2 years, six URMs (26.09%) obtained a bachelor's degree and were admitted into a graduate program; two were directly admitted to a PhD program in biomedical sciences.

Comorbidities in patients with vascular dementia and Alzheimer's disease with Neuropsychiatric symptoms.

INTRODUCTION: This study aimed to examine baseline risk factors in Alzheimer's Disease (AD) and Vascular dementia (VaD) patients with neuropsychiatry symptoms (NPS), and determine whether specific risk factors differ by subtypes of dementia for AD and VaD patients with NPS. METHODS: A retrospective data analysis was conducted to evaluate similarities and differences in the risk factors for AD and VaD with NPS. The analysis included 2949 patients with VaD and 6341 patients with clinical confirmation of AD and VaD with or without NPS collected between February 2016 and August 2021. The multivariate logistic regression analysis was used to determine the risk factors associated with AD and VaD with NPS, by predicting the increasing odds (odds ratios (ORs) of an association of a specific baseline risk factor with AD or VaD with NPS. The validity of the regression models was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of the models. RESULTS: In the adjusted analysis TSH (OR = 1.781, 95 % CI, p = 0.0025) and CHF (OR = 1.620, 95 %, p = 0.016) were associated with VaD with NPS, while a history of emergency department(ED) admission (OR = 0.277, 95 % CI, p = 0.003) likely to be associated with VaD patients without NPS. For AD patients, a history of CVA (OR = 1.395, 95 % CI, p = 0.032) and cancer (OR = 1.485, 95 % CI, p = 0.013) were associated with AD patients with NPS. DISCUSSION: The findings of this study indicate that an abnormal thyroid gland and CHF were linked to VaD patients with behavioral disturbances, while CVA and cancer were linked to AD patients with behavioral disturbances. These findings suggest the need to develop management strategies for the care of patients with AD and VaD with NPS.

Obstetric Neuropathy in Diabetic Patients: The "Double Hit Hypothesis".

The two-hit model has been proposed to explain the effects of diabetes on mothers who are already in a putative subclinical damaged state and then undergo neuronal damage during the delivery process. However, the anatomical and pathophysiological mechanisms are not well understood. Our overarching hypothesis in this review paper is that pregnant women who are diabetic have a damaged peripheral nervous system, constituting the "first hit" hypothesis. The delivery process itself-the "second hit"-can produce neurological damage to the mother. Women with diabetes mellitus (DM) are at risk for neurological damage during both hits, but the cumulative effects of both "hits" pose a greater risk of neurological damage and pathophysiological changes during delivery. In our analysis, we introduce the different steps of our concept paper. Subsequently, we describe each of the topics. First, we outline the mechanisms by which diabetes acts as a detrimental variable in neuropathy by focusing on the most common form of diabetic neuropathy, diabetic distal symmetrical polyneuropathy, also known as distal sensorimotor neuropathy. The possible role of macrosomia in causing diabetic neuropathy and obstetric neurological injury is discussed. Second, we describe how vaginal delivery can cause various obstetrical neurological syndromes and pathophysiological changes. Third, we highlight the risk of obstetric neuropathy and discuss anatomical sites at which lesions may occur, including lesions during delivery. Fourth, we characterize the pathophysiological pathways involved in the causation of diabetic neuropathy. Finally, we highlight diabetic damage to sensory vs. motor nerves, including how hyperglycemia causes different types of damage depending on the location of nerve cell bodies.

Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients.

BACKGROUND: Specific clinical risk factors may contribute to improving or worsening neurological functions in acute ischemic stroke (AIS) patients pre-treated with a combined cholesterol reducer and recombinant tissue plasminogen activator (rtPA) therapy. In this study, clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy was investigated. METHODS: Retrospective data for baseline clinical and demographic data for patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center was analyzed. Improving (NIHSS score ≤ 7) or worsening (NIHSS score > 7) of neurologic functions were the determined measures of treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or improving neurologic functions. RESULTS: Adjusted multivariate analysis showed that in an AIS population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions. CONCLUSION: A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions. While combining statin with rtPA treatment may facilitate worsening neurologic functions in elderly AIS patients with atrial fibrillation, they should not be denied of this therapy. The decision to combine statin and rtPA for AIS patients with atrial fibrillation can be done after clinical stabilization following appropriate clinical management.

Motivation to Learn Neuroanatomy by Cadaveric Dissection is Correlated with Academic Performance.

Implementing educational activities, such as a wet lab with cadaveric brain dissection, is known to have a direct impact on medical students' motivation. These activities demonstrate the clinical relevance of concepts taught in the classroom setting. The correlation between motivation and academic performance is not clear. First year medical students participated in wet lab activities. The wet lab included cadaveric dissection of the surface and internal anatomy of the brain, as well as discussions facilitated by the neuroscience faculty and clinicians. Discussions were centered around the clinical relevance of the neuroanatomical features dissected during the wet laboratory activities. Following completion of the laboratory activities, students completed a survey, which was used to assess the students' motivation for learning neuroanatomy based on the Attention, Relevance, Confidence, Satisfaction (ARCS) model of motivation. These results were then correlated with performance on a laboratory examination that tested three-dimensional and cross-sectional knowledge of neuroanatomy and practical skills including the use of imaging techniques. The total mean score of motivation was generally high for all categories of ARCS model of motivation (4.26/5) and was highest for Relevance (4.46/5). When these results were correlated with students' performance on the lab examination, a positive correlation between students' motivation and lab examination scores was found (R2 = 0.877). Implementation of the neuroanatomy cadaveric dissection lab led to increased student motivation, which was positively correlated with students' academic performance. Clin. Anat. 32:128-135, 2019. © 2019 Wiley Periodicals, Inc.

Thrombolytic therapy in ischemic stroke patients with pre-stroke depression in the telestroke vs non-telestroke.

BACKGROUND AND PURPOSE: Thrombolysis therapy remains the gold standard in acute ischemic stroke treatment, and rates of treatment with rtPA in ischemic stroke patients with comorbid depression has yet to be fully investigated. This study aims to examine clinical risk factors associated with inclusion or exclusion for rtPA in acute ischemic stroke populations with pre-stroke depression in the telestroke versus a non-telestroke setting. METHODS: We collected retrospective data from a regional stroke registry for pre-stroke depressed ischemic stroke patients from January 2010 to June 2016. Logistic regression was used to determine demographic and baseline clinical risk factors associated with inclusion and exclusion from rtPA. RESULTS: . In the adjusted analysis, increasing age (OR = 1.064, 95% CI, 1.006-1.125, P = 0.029), improved ambulation (OR = 3.513, 95% CI, (0.855-14.436, P = 0.018) and sleep apnea (OR = 4.458, 95% CI, 0.731-27.182, P = 0.05) were associated with inclusion for rtPA, while Caucasian race (OR = 0.119, 95% CI, 0.0168-0.908, P = 0.040), systolic blood pressure (OR = 0.945, 95% CI, 0.906-0.985, P = 0.008), and direct admission (OR = 0.028, 95% CI, 0.003-0.317, P = 0.004) were associated with exclusion from rtPA. In the telestroke setting, INR (OR = 1.016, 95% CI, 0-5.393, P = 0.163) was not significantly associated with rtPA inclusion or exclusion. CONCLUSION: Identifying contraindicators associated with exclusion from rtPA is significant to improve the use thrombolytic therapy in the telestroke and non telestroke settings.

Gender and thrombolysis therapy in acute ischemic stroke patients with incidence of obesity.

OBJECTIVE: To investigate clinical risk factors that were associated with gender differences in thrombolysis therapy in stroke patients with incidence of obesity. METHOD: Retrospective data of obese acute ischemic stroke patients were extracted from a stroke registry between January 2010 and June 2016. Gender differences in exclusion from rtPA or thrombolysis therapy were determined following an adjustment for differences in demographics, clinical risk factors using multiple regression analysis. Significant interactions between variables in the regression models were determined using variance inflation factors. RESULTS: A total of 1105 obese stroke patients were admitted, 549 were excluded from rtPA of which 51.7% were males and 48.3% were females. Among obese male stroke patients, age > 80 years (OR = 1.029, 95% CI, 1.005-1.054, P = 0.016), a history of peripheral vascular disease (OR = 3.008, 95% CI, 0.989-9.153, P = 0.052), and an elevated diastolic blood pressure (OR = 1.018, 95% CI, 1.001-1.035, P = 0.038) were associated with exclusion from rtPA therapy. In obese female stroke patients, coronary artery disease was associated with exclusion from rtPA (OR = 2.478, 95% CI, 1.270-4.836, P = 0.008) while antihypertensive therapy was associated with inclusion for rtPA (OR = 0.326, 95% CI, 0.139-0.764). CONCLUSION: Elderly obese male stroke patients with elevated diastolic blood pressure, history of peripheral vascular disease, and obese female stroke patients with a history of coronary artery disease were more likely to be excluded from rtPA.

Gender and thrombolysis therapy in stroke patients with incidence of dyslipidemia.

BACKGROUND: When untreated, dyslipidemia is a higher risk factor for stroke and stroke-related mortality in men than in women. However, when dyslipidemia is treated the risk reduction is the same, but men benefited from mortality reduction more than women. Whether there is a gender difference in exclusion criteria for the use of recombinant tissue plasminogen activator (rtPA) or thrombolysis therapy in an acute ischemic stroke subpopulation with dyslipidemia is yet to be investigated. METHOD: In a dyslipidemic stroke population obtained from a stroke registry, gender differences in exclusion risk factors were determined using clinical and demographic variables. Univariate analysis compared the recombinant tissue plasminogen activator (rtPA) group and the no rtPA group. Multiple regression analysis was used to determine demographic and clinical factors associated with inclusion and exclusion for rtPA in the total dyslipidemic stroke population and the subsets of the male and female population. The regression model was tested using the Hosmer-Lemeshow test, for the overall correct classification percentage. Significant interactions and multicollinearity between independent variables were examined using variance inflation factors. RESULTS: A total of 769 patients presented with acute ischemic stroke with incidence dyslipidemia; 325 received rtPA while 444 were excluded from rtPA. Of those excluded from rtPA, 54.30% were female and 45.72% were male. In an adjusted analysis, female patients with increased age (OR = 1.024, 95% CI, 1.001-1.047, P < 0.05), with a history of carotid artery stenosis (OR = 7.063, 95% CI, 1.506-33.134, P < 0.05), and previous stroke (OR = 1.978, 95% CI, 1.136-3.442, P < 0.05) were more likely to be excluded from rtPA. Male patients with atrial fibrillation (OR = 2.053, 95% CI, 1.059-3.978, P = 0.033), carotid artery stenosis (OR = 2.400, 95% CI, 1.062-5.424, P = 0.035), and previous stroke (OR = 1.785, 95% CI, 1.063-2.998, P = 0.028) were more likely to be excluded from rtPA. CONCLUSION: Although there are some similarities in the clinical risk factors for exclusion in both male and female stroke patients with incidence of dyslipidemia, there are differences as well. Elderly female stroke patients with incidence of dyslipidemia are more likely to be excluded from rtPA, even after adjustment for the effect of confounding variables. Further research should focus on how identified clinical risk factors can be targeted and managed to improve the use of rtPA in elderly female acute ischemic stroke population with incidence of dyslipidemia.

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients.

BACKGROUND: In acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. We investigated this in a population of hypertensive stroke patients. METHODS: Structured data from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke with history of hypertension were collected between January 2014 and June 2016. Clinical risk factors associated with inclusion or exclusion for recombinant tissue plasminogen activator (rtPA) in the telestroke and non telestroke were identified using multiple regression analysis. Associations between variables and rtPA in the regression models were determined using variance inflation factors while the fitness of each model was determined using the ROC curve to predict the power of each logistic regression model. RESULTS: The non telestroke admitted more patients (62% vs 38%), when compared with the telestroke. Although the telestroke admitted fewer patients, it excluded 11% and administered thrombolysis therapy to 89% of stroke patients with hypertension. In the non telestroke group, adjusted odd ratios showed significant associations of NIH stroke scale score (OR = 1.059, 95% CI, 1.025-1.093, P < 0.001) and coronary artery disease (OR = 2.003, 95% CI, 1.16-3.457, P = 0.013) with inclusion, while increasing age (OR = 0.979, 95% CI, 0.961-0.996, P = 0.017), higher INR (OR = 0.146, 95% CI, 0.032-0.665, P = 0.013), history of previous stroke (OR = 0.39, 95% CI, 0.223-0.68, P = 0.001), and renal insufficiency (OR = 0.153, 95% CI, 0.046-0.508, P = 0.002) were associated with rtPA exclusion. In the telestroke, only direct admission to the telestroke was associated with rtPA administration, (OR = 4.083, 95% CI, 1.322-12.611, P = 0.014). CONCLUSION: The direct admission of hypertensive stroke patients to the telestroke network was the only factor associated with inclusion for thrombolysis therapy even after adjustment for baseline variables. The telestroke technology provides less restrictive criteria for clinical risk factors associated with the inclusion of hypertensive stroke patients for thrombolysis.

Stroke and dyslipidemia: clinical risk factors in the telestroke versus non-telestroke.

BACKGROUND: Clinical risk factors related to not administering thrombolysis to acute ischemic stroke patients with incidence dyslipidemia is not clear. This issue was investigated in telestroke and non-telestroke settings. METHODS: We analyzed retrospective data collected from a stroke registry to compare exclusion risk factors in the telestroke and non-telestroke. We performed multivariate analysis was performed to identify risk factors that may result in exclusion from rtPA. Variance inflation factors were used to examine multicollinearity and significant interactions between independent variables in the model, while Hosmer-Lemeshow test, Cox & Snell were used to determine the fitness of the regression models. RESULTS: A greater number of patients with acute ischemic stroke with incidence dyslipidemia were treated in the non-telestroke (285) when compared with the telestroke network (187). Although non-telestroke admitted more patients than the telestroke, the telestroke treated more patients with rtPA (89.30%) and excluded less (10.70%), while the non-telestroke excluded from rtPA (61.40%). In the non-telestroke, age (adjusted OR, 0.965; 95% CI, 0.942-0.99), blood glucose level (adjusted OR, 0.995; 95% CI, 0.99-0.999), international normalized ratio (adjusted OR, 0.154; 95% CI, 0.031-0.78),congestive heart failure(CHF) (adjusted OR, 0.318; 95% CI, 0.109-0.928), previous stroke (adjusted OR, 0.405; 95% CI, 0.2-0.821) and renal insufficiency (adjusted OR, 0.179; 95% CI, 0.035-0.908) were all directly linked to exclusion from rtPA. In the telestroke, only body mass index (adjusted OR, 0.911; 95% CI, 0.832-0.997) significantly excluded acute ischemic stroke patients with incidence dyslipidemia from thrombolysis therapy. CONCLUSION: Despite having more patients with acute ischemic stroke that present incidence dyslipidemia, the non-telestroke patients had more clinical risk factors that excluded more patients from rtPA when compared with telestroke. Future studies should focus on how identified clinical risk factors can be managed to improve the use of rtPA in the non-telestroke setting. Moreover, the optimization of the risk-benefit ratio of rtPA by the telestroke technology can be advanced to the non-telestroke setting to improve the use of thrombolysis therapy.

Clinical Risk Factors in Thrombolysis therapy: Telestroke Versus Nontelestroke.

BACKGROUND: The objective of this study is to determine clinical risk factors associated with exclusion from thrombolysis in telestroke and nontelestroke settings. These risk factors may offer clues for optimization of thrombolysis therapy in acute ischemic stroke population. MATERIALS AND METHODS: Retrospective data of patients with acute ischemic stroke via telestroke and nontelestroke assessment were analyzed. Univariate analysis was used to compare the recombinant tissue plasminogen activator (rtPA) group and the no rtPA group. A stepwise binary logistic regression identified factors associated with inclusion and exclusion from rtPA in the total telestroke population and the subsets of the telestroke population. RESULTS: Telestroke patients were more likely to be directly admitted rather than being initially evaluated in the emergency department (70.3% versus 9.9%) and were also substantially more likely to receive rtPA (89.5% versus 38.5%). In the nontelestroke group, patients with acute ischemic stroke were more likely to be excluded from rtPA if they possessed higher international normalized ratios (odds ratio [OR] = 4.978 [1.503-16.488]) or had a history of congestive heart failure (OR = 2.524 [1.213-5.252]), previous stroke (OR = 2.172 [1.286-3.667]), or renal dysfunction (OR = 4.204 [1.33-13.281]). The telestroke group only had 1 variable deemed statistically significant in its association with rtPA status. Patients who were directly admitted were less likely to be excluded from receipt of rtPA (OR = .322 [.112-0.927]). CONCLUSIONS: Factors associated with exclusion from rtPA in the nontelestroke setting did not exclude patients with acute ischemic stroke from thrombolysis therapy in the telestroke setting. Telestroke may offer methods for optimization of the risk-benefit ratio of rtPA, equipping clinicians to efficiently make treatment decisions.

A new insight into the ability to resist Ischemic brain injury: Does hibernation matter?: An Editorial comment for 'Arctic ground squirrel hippocampus tolerates oxygen glucose deprivation independent of hibernation season even when not hibernating and after ATP depletion, acidosis and glutamate efflux'.

Read the commented article 'Arctic ground squirrel hippocampus tolerates oxygen glucose deprivation independent of hibernation season even when not hibernating and after ATP depletion, acidosis and glutamate efflux' on doi: 10.1111/jnc.13996.

Alteration of the Disposition of Quinine in Healthy Volunteers After Concurrent Ciprofloxacin Administration.

This study evaluated the effects of concurrent ciprofloxacin administration on the disposition of quinine in healthy volunteers. Quinine (600-mg single dose) was administered either alone or with the 11th dose of ciprofloxacin (500 mg every 12 hours for 7 days) to 15 healthy volunteers in a crossover fashion. Blood samples collected at predetermined time intervals were analyzed for quinine and its major metabolite, 3-hydroxquinine, using a validated high-performance liquid chromatographic method. Administration of quinine plus ciprofloxacin resulted in significant increases (P < 0.05) in the total area under the concentration-time curve, maximum plasma concentration (Cmax), and terminal elimination half-life (T1/2b) of quinine compared with values with quinine dosing alone (AUC: 27.93 ± 8.04 vs. 41.62 ± 13.98 h·mg/L; Cmax: 1.37 ± 0.24 vs. 1.64 ± 0.38 mg/L; T1/2b: 16.28 ± 2.66 vs. 21.43 ± 3.22 hours), whereas the oral plasma clearance markedly decreased (23.17 ± 6.49 vs. 16.00 ± 5.27 L/h). In the presence of ciprofloxacin, there was a pronounced decrease in the ratio of AUC (metabolite)/AUC (unchanged drug) and highly significant decreases in Cmax and AUC of the metabolite (P < 0.05). Ciprofloxacin may increase the adverse effects of concomitantly administered quinine, which can have serious consequences on the patient. Thus, a downward dosage adjustment of quinine seems to be necessary when concurrently administered with ciprofloxacin.

Co-morbid conditions in use of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute ischaemic stroke.

BACKGROUND: The objective of this study was to characterize the comorbidities in a population of patients with an acute ischaemic stroke, comparing patients that received recombinant tissue plasminogen activator (rt-PA) to those that did not receive rt-PA. METHOD: In a retrospective sample of 663 patients admitted for acute ischaemic stroke, this study analysed the effects of co-morbid conditions in the use of rt-PA. It determined non-cerebrovascular risk factors (comorbidities) that differentiate patients who received rt-PA from those who did not receive rt-PA. RESULT: Patients with a history of carotid stenosis, CHF and previous strokes are significantly (p < 0.05) associated with high risk of not receiving rt-PA. A significant number of patients with a history of hypertension and smoking received rt-PA (p < 0.05). CONCLUSION: The findings indicate that certain risk factors including carotid stenosis, CHF and previous stroke history impact the treatment of patients with acute ischaemic stroke, specifically the decision to administer rt-PA. Treatment with rt-PA is dependent on stroke severity and onset to treatment time, but the findings suggest that rt-PA use may also depend on patient comorbidities.

Gender Differences in Exclusion Criteria for Recombinant Tissue-Type Plasminogen Activator.

BACKGROUND: Gender differences in the use of recombinant tissue-type plasminogen activator (r-tPA) in stroke are complicated. In this study, we investigated gender differences using r-tPA exclusion criterion in a stroke population. METHODS: We analyzed the data from ischemic stroke patients aged 18 years or older from the Greenville Health System stroke registry on r-tPA administration between January 2010 and December 2013. We identified exclusion criterion and used specific clinical factors to determine gender differences in stroke patients receiving r-tPA. RESULTS: Of the 633 patients who were eligible to receive r-tPA, less than half received r-tPA (n = 241) whereas 422 were not able to receive r-tPA. Of the 241 patients who received r-tPA, 49.4% were female and 50.6% were male. Of the 422 patients who did not receive r-tPA, more women (235) were excluded from r-tPA than men (187) (P < .05). There were no gender differences in warning signs and contraindications in female versus male stroke patients (P > .005). There were however gender differences in age group as more women (38%; n = 235) were more likely to be excluded if they are more than 80 years old than men (19%, n = 187). CONCLUSIONS: Within a large stroke population, exclusion criteria for r-tPA in women and men were similar with regard to race, initial National Institutes of Health Stroke Scale score, warning signs, and contraindications, but were different in the age group population exclusion criterion for intravenous r-tPA. We observed that intracerebral hemorrhage and match on computed tomography perfusion/magnetic resonance imaging or visible infarct greater than one third of the middle cerebral artery distribution were absolute criteria for exclusion.

Integrating basic, clinical, and health system science in a medical neuroscience course of an integrated pre-clerkship curriculum.

Basic science, clinical science, and health system science (HSS) have become three pillars of integration upon which modern, post-Flexner, medical education is now based. Because of this new approach to curricular integration in a clinical presentation curruculum, medical training is now placed in the context of healthcare delivery. This study described the design, implementation, and assessment of an integrated teaching strategy, including the effect on students' performance in a medical neuroscience course's summative and formative examinations of an integrated clinical presentation curriculum. The integrated teaching of basic science content, clinical case discussion, and HSS was performed in the first year of an allopathic integrated pre-clerkship curriculum. The two cohorts were from two different years, spring 2018 and 2019. The acceptance of the integrated teaching strategy by medical students was above 80% in all categories that were assessed, including enhancing the integrated experience in learning basic and clinical science materials in the context of HSS; understanding of the learning lessons; facilitation of self-directed learning; provision of a better learning environment; and a holistic understanding of materials including the relevance of HSS issues in the discussion of neurological cases in the medical career of the students. More than 90% of the students scored ≥70% in summative questions mapped to the four learning objectives of the integrated teaching session. The objectives are the correlation of structure to specific functions (94.0 ± 0.21), clinical anatomical features of the nervous system (95.0 ± 0.27), cross-sectional features of the nervous system (96.0 ± 0.31), and the effect of lesions on the structure and functional pathways of the nervous system (97.0 ± 0.34). This result was significantly higher when compared to students' performance in the non-integrated teaching cohort (p < 0.05). Formative assessments (F(7,159) = 92.52, p < 0.001) were significantly different between the two groups. When medical students were evaluated using the same questions for formative assessment, they performed better in the integrated teaching cohort (*p < 0.05) compared to the non-integrated teaching cohort (**p < 0.05).

Sex Differences in Severity and Risk Factors for Ischemic Stroke in Patients With Hyperlipidemia.

Objective: This study aims to determine sex differences in poststroke hypertriglyceridemia (serum triglyceride levels ⩾ 200 mg/dl) and high stroke severity in ischemic stroke patients. Method: Our study analyzed data from 392 males and 373 females with hypertriglyceridemia. Stroke severity on admission was measured using the National Institute of Health Stroke Scale (NIHSS) with a value ⩽7 indicating a more favorable post-stroke prognosis while a score of >7 indicates poorer post-stroke outcomes. Logistic regression models adjusted for demographic and risk factors. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each clinical risk factor were used to predict the increasing odds of an association of a specific clinical baseline risk factor with the male or female AIS with hypertriglyceridemia. Results: In the adjusted analysis, male patients with hypertriglyceridemia, diastolic blood pressure (OR = 1.100, 95% CI, 1.034-1.171, P = .002), and Ischemic stroke mortality (OR = 6.474, 95% CI, 3.262-12.847, P < .001) were significantly associated with increased stroke severity. In female patients with hypertriglyceridemia, age (OR = 0.920, 95% CI, 0.866-0.978, P = .008) was associated with reduced stroke severity, while ischemic stroke mortality score (OR = 37.477, 95% CI, 9.636-145.756, P < .001) was associated with increased stroke severity. Conclusion: Increased ischemic stroke mortality risk score was associated with increased severity in both male and female AIS patients with hypertriglyceridemia. Our findings provide information about sex differences in specific risk factors that can be managed to improve the care of male and female ischemic stroke patients with hypertriglyceridemia.

HO-SsNF: heap optimizer-based self-systematized neural fuzzy approach for cervical cancer classification using pap smear images.

Cervical cancer is a significant concern for women, necessitating early detection and precise treatment. Conventional cytological methods often fall short in early diagnosis. The proposed innovative Heap Optimizer-based Self-Systematized Neural Fuzzy (HO-SsNF) method offers a viable solution. It utilizes HO-based segmentation, extracting features via Gray-Level Co-Occurrence Matrix (GLCM) and Local Binary Pattern (LBP). The proposed SsNF-based classifier achieves an impressive 99.6% accuracy in classifying cervical cancer cells, using the Herlev Pap Smear database. Comparative analyses underscore its superiority, establishing it as a valuable tool for precise cervical cancer detection. This algorithm has been seamlessly integrated into cervical cancer diagnosis centers, accessible through smartphone applications, with minimal resource demands. The resulting insights provide a foundation for advancing cancer prevention methods.

Risk Factors Associated With Exclusion of Obese Patients Ischemic Stroke With a History of Smoking From Thrombolysis Therapy.

The objective of this study is to determine risk factors that may contribute to exclusion decision from recombinant tissue plasminogen activator (rtPA) in patients with acute ischemic stroke (AIS) with a combined current or history of smoking and obesity. This study was conducted on data from 5469 patients with AIS collected from a regional stroke registry. Risk factors associated with inclusion or exclusion from rtPA were determined using multivariate logistic regression analysis. The adjusted odds ratios and 95% confidence interval for each risk factor were used to predict the increasing odds of an association of a specific risk factor with exclusion from rtPA. In the adjusted analysis, obese patients with AIS with a history of smoking (current and previous) excluded from rtPA were more likely to present with carotid artery stenosis (OR = 0.069, 95% CI 0.011-0.442), diabetes (OR = 0.604, 95% CI 0.366-0.997), higher total cholesterol (OR = 0.975, 95% CI 0.956-0.995), and history of alcohol use (OR = 0.438, 95% CI 0.232-0.828). Higher NIHSS score (OR = 1.051, 95% CI 1.017-1.086), higher triglycerides (OR = 1.004, 95% CI 1.001-1.006), and higher high-density lipoprotein (OR = 1.028, 95% CI 1.000-1.057) were associated with the inclusion for rtPA. Our findings reveal specific risk factors that contribute to the exclusion of patients with AIS with a combined effect of smoking and obesity from rtPA. These findings suggest the need to develop management strategies to improve the use of rtPA for obese patients with AIS with a history of smoking.