Posterior circulation collaterals as predictors of outcome in basilar artery occlusion: a sub-analysis of the BASICS randomized trial.

Introduction and purpose: Basilar artery occlusion (BAO) is still one of the most devastating neurological conditions associated with high morbidity and mortality. In the present study, we aimed to assess the role of posterior circulation collaterals as predictors of outcome in the BASICS trial and to compare two grading systems (BATMAN score and PC-CS) in terms of prognostic value. Methods: We performed a sub-analysis of the BASICS trial. Baseline clinical and imaging variables were analyzed. For the imaging analysis, baseline CT and CTA were analyzed by a central core lab. Only those patients with good or moderate quality of baseline CTA and with confirmed BAO were included. Multivariable binary logistic regression analysis was used to test the independent association of clinical and imaging characteristics with a favorable outcome at 3 months (defined as a modified Rankin Score of ≤3). ROC curve analysis was used to assess and compare accuracy between the two collateral grading systems. Results: The mean age was 67.0 (±12.5) years, 196 (65.3%) patients were males and the median NIHSS was 21.5 (IQR 11-35). Median NCCT pc-ASPECTS was 10 (IQR10-10) and median collateral scores for BATMAN and PC-CS were 8 (IQR 7-9) and 7 (IQR 6-8) respectively. Collateral scores were associated with favorable outcome at 3 months for both BATMAN and PC-CS but only with a modest accuracy on ROC curve analysis (AUC 0.62, 95% CI [0.55-0.69] and 0.67, 95% CI [0.60-0.74] respectively). Age (OR 0.97, 95% CI [0.95-1.00]), NIHSS (OR 0.91, 95% CI [0.89-0.94]) and collateral score (PC-CS - OR 1.2495% CI [1.02-1.51]) were independently associated with clinical outcome. Conclusion: The two collateral grading systems presented modest prognostic accuracy. Only the PC-CS was independently associated with a favorable outcome at 3 months.

Risk Factors for Adult Depression: Adverse Childhood Experiences and Personality Functioning.

Background: Depressive disorder is one of the main health problems worldwide. Many risk factors have been associated with this pathology. However, while the association between risks factors and adult depression is well established, the mechanisms behind its impact remains poorly understood. A possible, yet untested explanation is the mediating impact of levels of personality functioning, i.e., impairments with regard to self and interpersonal. Method: Around 162 patients were assessed at the beginning of their therapy, with regard to risk factors, such as sociodemographic, physical, hereditary (Information Form), and adverse childhood experiences (ACE; CTQ). Depressive symptoms (Beck Depression Inventory, BDI) and personality functioning (OPD-SQ) were also measured. Associations between the related variables as well as other possible covariates were examined by means of zero-order correlations and bootstrapping-based mediation analysis. Results: Of all the risk factors taken into account, level of education and physical illness were associated with depression. On the other hand, the most significant predictor of depressive symptomatology was ACE, and this relationship was mediated by personality functioning. This indicates that patients presenting adverse childhood experiences are more likely to develop deficiencies in personality functioning, which in turn increases their likelihood of developing depressive symptomatology. Conclusion: These results reaffirm the importance of incorporating risk and vulnerability factors such as personality functioning in understanding depression.

Atrial undersensing secondary to quiet timer blanking in pediatric and congenital heart disease patients.

BACKGROUND: Atrial undersensing despite normal atrial lead parameters and high amplitude electrograms has been described in adult patients as a consequence of atrial amplifier saturation. Repetitive inputs cause amplifier ringing and undersensing occurs as a consequence of quiet timer blanking. High amplitude ventricular electrograms can also result in atrial blanking secondary to cross-chamber effect. This has not been described in pediatric patients or epicardial pacing systems and specific risk factors are not known. We describe five cases of atrial undersensing in pediatric and congenital heart disease patients with epicardial dual-chamber systems and high ventricular lead outputs. METHODS: This was a retrospective cohort study of all patients with dual-chamber pacing systems cared for at the Heart Institute at Children's Hospital Colorado. RESULTS: Five cases of atrial undersensing with normal atrial lead parameters were found. All were epicardial systems with acceptable lead parameters at implantation and Medtronic (Medtronic, Inc., Minneapolis, MN, USA) generators with unipolar leads. Ventricular pacing outputs were elevated at presentation, median 5.5 V (5-7.5). Presenting symptoms were exercise intolerance (four) and detection on routine monitoring (one). Successful interventions included reduction in ventricular lead pacing output (one), programming of rate response (two), and implantation of an alternative generator manufacturer (two). CONCLUSION: Atrial undersensing secondary to amplifier ringing and quiet timer blanking is an uncommon presentation but may be clinically important in patients with unipolar epicardial atrial leads and high pacing outputs from ventricular leads.

Clinical Presentation of Pediatric Patients at Risk for Sudden Cardiac Arrest.

OBJECTIVES: To identify the clinical presentation of children and adolescents affected by 1 of 4 cardiac conditions predisposing to sudden cardiac arrest: hypertrophic cardiomyopathy, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and anomalous origin of the left coronary artery from the right sinus of Valsalva (ALCA-R). STUDY DESIGN: This was a retrospective review of newly diagnosed pediatric patients with hypertrophic cardiomyopathy, LQTS, CPVT, and ALCA-R referred for cardiac evaluation at 6 US centers from 2008 to 2014. RESULTS: A total of 450 patients (257 male/193 female; median age 10.1 years [3.6-13.8 years, 25th-75th percentiles]) were enrolled. Patient age was ≤13 years for 70.4% of the cohort (n = 317). Sudden cardiac arrest was the initial presentation in 7%; others were referred on the basis of abnormal or suspicious family history, personal symptoms, or physical findings. Patients with LQTS and hypertrophic cardiomyopathy were referred most commonly because of family history concerns. ALCA-R was most likely to have abnormal signs or symptoms (eg, exercise chest pain, syncope, or sudden cardiac arrest). Patients with CPVT had a high incidence of syncope and the greatest incidence of sudden cardiac arrest (45%); 77% exhibited exercise syncope or sudden cardiac arrest. This study demonstrated that suspicious or known family history plays a role in identification of many patients ultimately affected by 1 of the 3 genetic disorders (hypertrophic cardiomyopathy, LQTS, CPVT). CONCLUSION: Important patient and family history and physical examination findings may allow medical providers to identify many pediatric patients affected by 4 cardiac disorders predisposing to sudden cardiac arrest.

Studying neurodegenerative diseases in culture models.

Neurodegenerative diseases are pathological conditions that have an insidious onset and chronic progression. Different models have been established to study these diseases in order to understand their underlying mechanisms and to investigate new therapeutic strategies. Although various in vivo models are currently in use, in vitro models might provide important insights about the pathogenesis of these disorders and represent an interesting approach for the screening of potential pharmacological agents. In the present review, we discuss various in vitro and ex vivo models of neurodegenerative disorders in mammalian cells and tissues.

Knowledge and beliefs about epilepsy among people with and without epilepsy in urban Suriname.

Reducing the burden of epilepsy in low- and middle-income countries requires understanding of the cultural aspects of epilepsy. This cross-sectional study among individuals attending a clinic in an urban setting in Paramaribo, Suriname aimed to obtain information on the knowledge of and attitudes towards epilepsy and epilepsy treatment, comparing people with epilepsy (PWE) to those without epilepsy. This study also explored the help-seeking behavior and experience of having epilepsy in PWE. While the results of interviews with 49 PWE and 33 controls compared favorably to studies conducted in similar countries, a significant minority of PWE still rely on traditional remedies. Prejudices regarding social roles, schooling, and occupational choices of PWE also remain prevalent. Currently, the major source of information for both groups is the media, but there could be opportunities for the local epilepsy association to play a larger role. These findings, despite some selection bias, could be useful in bringing conventional medical treatment strategies to more PWE in Suriname, as well as empower patient organizations in designing stigma-reducing interventions.

Studying neurodegenerative diseases in culture models

Neurodegenerative diseases are pathological conditions that have an insidious onset and chronic progression. Different models have been established to study these diseases in order to understand their underlying mechanisms and to investigate new therapeutic strategies. Although various in vivo models are currently in use, in vitro models might provide important insights about the pathogenesis of these disorders and represent an interesting approach for the screening of potential pharmacological agents. In the present review, we discuss various in vitro and ex vivo models of neurodegenerative disorders in mammalian cells and tissues.

Induction of chromosomal aberrations by DNase I.

Chinese hamster ovary (CHO) cells were treated with bovine pancreatic DNase I using the method of electroporation. The enzyme induced chromosomal aberrations in a S-phase independent manner. The frequencies of polycentric chromosomes induced in the G1 phase of the cell cycle are positively correlated with the dose of DNase I. The distributions of DNase I-induced polycentric chromosomes were overdispersed.