Effect of intravenous tirofiban and aspirin in reducing short-term and long-term neurologic deficit in patients with ischemic stroke: a double-blind randomized trial.

BACKGROUND: Thrombolysis with rt-PA is the only approved pharmacological therapy for acute ischemic stroke presently administrable in a 3-hour window (very recently extended to 4.5 h). After this time, the choice is limited to endovascular treatment and antiplatelet drugs, mainly aspirin (ASA), the efficacy of which in the acute phase of stroke has poorly been evaluated. We compared the efficacy of tirofiban, a GP-IIb/IIIa inhibitor, and ASA, with both drugs being administered within 6 h. METHODS: 150 patients were randomly assigned to treatment with tirofiban or ASA, both given for 3 days in a double-blind regimen. Major inclusion criteria were stroke onset within 6 h and a baseline National Institute of Health Stroke Scale (NIHSS) score of 5-25. Outcome variables were the proportion of patients with a NIHSS score reduction of > or =4 points after 72 h, and the proportion of patients with an mRS score of 0-1 at 3 months. RESULTS: The trial, originally planned to enroll 300 patients, was halted after enrollment of 150 patients at interim analysis due to the lack of a trend difference between the 2 treatment groups. Neurological improvement at 72 h was observed in 56% of the patients in each group. At the 3-month follow-up, minimal or absent disability was seen in 45% of the patients in the tirofiban group and 53% in the ASA group; these differences were not statistically significant. Three-month mortality was the same in both groups (10.6%); the rates of symptomatic intracranial hemorrhage were 1% (tirofiban) and 4% (ASA). CONCLUSION: In spite of the fact that the null hypothesis was not supported by our data, we found results supporting the safety (and potential efficacy) of ASA and tirofiban when used in the first hours of acute ischemic stroke. However, this needs to be confirmed by further studies.

Detecting chlorophyll, Secchi disk depth and surface temperature in a sub-alpine lake using Landsat imagery.

Some bio-physical parameters, such as chlorophyll a concentration, Secchi disk depth and water surface temperature were mapped in the sub-alpine Lake Iseo (Italy) using Landsat Thematic Mapper (TM) data acquired on the 7 March 1997. In order to adequately investigate the water-leaving radiance, TM data were atmospherically corrected using a partially image-based method, and the atmospheric transmittance was measured in synchrony with the satellite passage. An empirical approach of relating atmospherically corrected TM spectral reflectance values to in situ measurements, collected during the satellite data acquisition, was used. The models developed were used to map the chlorophyll concentration and Secchi disk depth throughout the lake. Both models gave high determination coefficients (R2 = 0.99 for chlorophyll and R2 = 0.85 for the Secchi disk) and the spatial distribution of chlorophyll concentration and Secchi disk depth was mapped with contour intervals of 1 mg/m3 and 1 m, respectively. A scene-independent procedure was used to derive the surface temperature of the lake from the TM data with a root mean square error of 0.3 degrees C.

Validation of satellite data for quality assurance in lake monitoring applications.

The operational application of remote sensing technologies to lake water quality monitoring requires products derived from remote sensing to be quantitatively self-consistent and have a certified accuracy. Fundamental elements in this quality assurance framework are sensor radiometric calibration and atmospheric correction models, which are briefly discussed in the paper. In order to evaluate the accuracy of present operational techniques to retrieve basic parameters from satellite data, such as water-leaving radiance and reflectance, an experiment was organised in the frame of SAtellite remote sensing for Lake MONitoring (SALMON), a European Union co-funded research project. A series of ship-based radiometric and atmospheric measuring campaigns were conducted on Lake Iseo and Lake Garda (Italy) together with limnological sampling. Four Landsat-5 Thematic Mapper (TM) scenes were acquired during different seasons and simultaneous in situ measurements were made. After the radiometric calibration procedure, satellite digital images were processed by applying two entirely image-based atmospheric correction models. These models account for the effects of both additive scattering and multiplicative transmittance effects in the atmosphere on the at-satellite measured signal. The results achieved using these procedures were evaluated by comparing satellite-based estimates with in situ measurements of water reflectance. The root mean square difference between Landsat TM-derived reflectance values and ground measurements was close to 0.010 reflectance for each TM spectral band. Such image-based correction models, requiring no in situ field measurements during the satellite overpass, constitute a valid method of lake water monitoring.

Relationship between apparent optical properties and photosynthetic pigments in the sub-alpine Lake Iseo.

The aim of the present study was the evaluation of methods for estimating the content of bio-physical parameters in lake water on the basis of spectral reflectance measured above water surface, in particular the estimation of chlorophyll-a (chl-a) concentrations. Data sets considered refer to some sampling point located in the sub-alpine meso-eutrophic Lake Iseo, surveyed six times over the period March-July and once in November 1998, as these months were very important for the characterization of the springtime algal bloom, which affect the lake waters yearly. At each point station, limnological observations (chlorophyll, total suspended solids, Secchi disk depth) were conducted simultaneously with optical measurements. The latter consisted of water leaving radiance measured by means of a spectroradiometer above the water surface; moreover, a standard reflector radiance was also measured to obtain the water reflectance. Reflectance spectra were transformed according to two well-documented models and correlated to water quality parameters, to investigate their performances as retrieval algorithms under different conditions and referring to different analytical methods. Results outline the sensitivity of the models to chl-a concentrations, different phytoplankton composition, and the sampling depth.

Effectiveness of nonsurgical treatment for idiopathic scoliosis. Overview of available evidence.

To define further the effectiveness of nonsurgical therapy for idiopathic scoliosis, predefined criteria were established for selection and data retrieval from studies of therapy and natural history, and the results were synthesized quantitatively. Only studies of patients with no more than a 50 degree Cobb angle scoliosis were considered. Twenty-four reports were eligible. There was a fivefold proportion of failures among patients with scoliosis greater than 30 degrees at the start of therapy but no difference in progression between different kinds of nonsurgical therapies or between treated and untreated patients; these were the main findings of this quantitative analysis. These data cannot be used to prove the effectiveness or ineffectiveness of nonsurgical therapy for idiopathic scoliosis, and experimental controlled studies of different therapies seem to be justified both on ethical and scientific grounds. The findings of this overview can be used for their planning.

[Our experience in treating femoral neck fractures. Comments on cases treated from 1972 to 1984. A clinico-statistical study]. / La nostra esperienza sul trattamento delle fratture del collo di femore. Considerazioni sui casi trattati dal 1972 al 1984. Indagine clinico-statistica.

The Authors report the clinico-statistic results concerning 550 cases of femur neck fractures, representing the casuistry of 12 years' activity developed by the Ortopedico-Traumatological Department of the Hospital Institutes of the Association of the Bergamo Lowland Communes, USSL nr. 32 (from 1972 up to 1984). After considering the main etiologic factors of this injury, the Authors study the surgical techniques adopted, discuss the indications, state the results obtained, and do some remarks about the patients' functional and social recovery. The Authors emphasize the importance of an early and valid osteosynthesis allowing a quicker functional recovery, a reduction in the times of stay in bed and an extension in the average survival of such patients.

[Fractures of the proximal end of the femur: clinico-statistical data on 246 cases treated in the period 1972-1978]. / Fratture dell'estremo prossimale del femore: dati clinico-statistici su 246 casi trattati nel periodo 1972-1978.

During the past seven years an increasing number of hip fractures were treated in the new orthopaedic division of the Treviglio-Caravaggio Hospital. A survey was made of 246 cases treated in the 1972-1978 period. The mean age of the patients was found to be 69,9 years, and 64,6 % of them were women. Lateral fractures accounted for 66,6% of the cases and the mean age of these patients was 78 years. The average hospitalization time of the operated patients was 21,6 days and the mortality after 3 months was 16%. The Authors emphasize that the extensive adoption of surgical treatment in these fractures has improved the survival rate and shortened the hospitalization time.

[Current views on pathology and new therapeutic perspective. I: Immunological aspects of the neoplasm (author's transl)]. / Osteosarcoma: concetti attuali di patologia e nuove prospettive terapeutiche. Nota I: aspetti bioimmunologici della neoplasia.

Several experimental data support the evidence that Osteogenic Sarcoma is a virus-originated neoplasm. Cytogenetic and immunological aspects of this neoplasm are examined by the Authors on the basis of the latest advances in this field, and in view of possible therapeutic applications.

[Osteosarcoma: current views on pathology and new therapeutic perspectives. II: Criteria of prognosis and treatment (author's transl)]. / Osteosarcoma: concetti attuali di patologia e nuove prospettive terapeutiche. Nota II: Criteri prognostici e terapia.

The authors review recent studies and trials concerning the treatment of osteosarcoma, with special attention to current trends in immunology, radiology, surgery, and chemotherapy. Progress in immunobiological research seems to promise interesting practical developments; even today, however, modern chemotherapy combined with suitable ablative surgery affords a remarkably better prognosis for this malignancy.