Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke.

BACKGROUND: Treatment outside office hours has been associated with increased workflow times for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Limited data suggest that this "off-hours effect" also exists for endovascular treatment (EVT). We investigated this phenomenon in a well-organized acute stroke care region in the Netherlands. METHODS: Retrospective, observational cohort study of consecutive patients with AIS who received reperfusion therapy in the Greater Amsterdam Area, consisting of 14 primary stroke centers and 1 comprehensive stroke center (IVT: 2009-2015, EVT: 2014-2017). Office hours were defined as presentation during weekdays between 8 AM and 5 PM, excluding National Festive days. Primary outcome was door-to-treatment time (door-to-needle [DNT] for IVT, door-to-groin [DGT] for EVT). For DGT, we used the door time of the first hospital. Other outcomes were in-hospital mortality, modified Rankin Scale (mRS) score at 90 days and symptomatic intracranial hemorrhage (sICH). We performed multivariable linear and logistic regression analyses and used multiple imputation to account for missing values. RESULTS: In total, 59% (2450/4161) and 61% (239/395) of patients treated with IVT and EVT, respectively, presented outside office hours. Median DNT was minimally longer outside office hours (32 vs. 30 min, p = 0.024, adjusted difference 2.5 min, 95% CI 0.7-4.2). Presentation outside office hours was not associated with a longer DGT (median 130 min for both groups, adjusted difference 7.0 min, 95% CI - 4.2 to 18.1). Clinical outcome and sICH rate also did not differ. CONCLUSION: Presentation outside office hours did not lead to clinically relevant treatment delays for reperfusion therapy in patients with AIS.

Intramedullary femoral nailing through the trochanteric fossa versus greater trochanter tip: a randomized controlled study with in-depth functional outcome results.

PURPOSE: In a level 1 university trauma center, an explorative randomized controlled study was performed to compare soft tissue damage and functional outcome after antegrade femoral nailing through a trochanteric fossa (also known as piriform fossa) entry point to a greater trochanter entry point in patients with a femoral shaft fracture. MATERIALS AND METHODS: Nineteen patients were enrolled and randomly assigned to two nail insertion groups; ten patients were treated with an Unreamed Femoral Nail(®) (UFN, Synthes(®), Solothurn, Switzerland) inserted at the trochanteric fossa and nine patients were treated with an Antegrade Femoral Nail(®) (AFN, Synthes(®), Solothurn, Switzerland) inserted at the tip of the greater trochanter. The main outcome measures were pain, gait, nerve and muscle function, along with endurance. Magnetic resonance imaging (MRI), electromyography (EMG), and Cybex isokinetic testings were performed at, respectively, 2 and 6 weeks and at a minimum of 12 months after surgery. RESULTS: The MRI and EMG showed, in both groups, signs of iatrogenic abductor musculature lesions (four in the UFN group and four in the AFN group) and superior gluteal nerve injury (five in the UFN group and four in the AFN group). The isokinetic measurements and the patient-reported outcomes showed moderate reduction in abduction strength and endurance, as well as functional impairment with slight to moderate interference with daily life in both groups, with no appreciable differences between the groups. CONCLUSIONS: Anatomical localization of the entry point seems to be important for per-operative soft tissue damage and subsequent functional impairment. However, the results of this study did not show appreciable differences between femoral nailing through the greater trochanter tip and nailing through the trochanteric fossa.

The influence of geometry and draught shields on the performance of passive samplers.

Passive samplers provide an excellent opportunity to perform indicative measurements or establish a dense network of measuring sites. A drawback compared with conventional active measuring methods is the larger spread of results. This variation can, to a large extent, be attributed to the influence of temperature, sampler geometry and wind on sampling results. A proper design of sampler geometry and optimum choice of draught shield can reduce the influence of wind velocity on a badge type sampler to less than 10%. Wire mesh screens prove to be inadequate in damping turbulence. Filters give good results. Attention should be paid to the size and isolation value of the walls of the sampler to prevent thermal updrafts occurring within the sampler. Tube type samplers are less influenced by wind, provided that turbulence is prevented from influencing diffusion within the sampler.

Active force-length relationship of human lower-leg muscles estimated from morphological data: a comparison of geometric muscle models.

Muscle fibre lengths, pennation angles, and sarcomere lengths were measured (the latter by a diffraction technique) for each of the muscles of three embalmed lower-leg specimens. From these data and filament lengths from Walker & Schrodt (1973), the optimum fibre lengths were determined. Relationships between length and active force (at full activation) of the lower-leg muscles were calculated by use of (i) a unipennate muscle model, (ii) a bipennate model, and (iii) bipennate models in which the cosine of the pennation angle is approximated as length independent. It is concluded that the first two models are equally useful and that the use of the last models is discouraged in case of strongly pennated muscles. Non-uniformity of fibre parameters within one muscle appears to have little effect on the force-length relationship.

CSF choline levels in neurologically disturbed children.

Choline levels in cerebrospinal fluid (CSF) were measured in a large group of neurologically disturbed children (n = 114) and in a control group (n = 15). Only 5 children showed CSF choline levels that differed more than 2 standard deviations from the mean of the total investigated group, suggesting that CSF choline levels are extremely stable. Of the 5 children showing extreme values, 3 suffered primarily from psychomotor retardation. Further analysis showed that the CSF choline levels in the medication-free patient group suffering from psychomotor retardation (n = 18) were significantly elevated in comparison with the control group. CSF choline levels of children were found to fit excellently in the regression line showing the increase of CSF choline levels with age as calculated earlier for adults. Therefore, CSF choline levels appear to increase linearly with age during the whole life span. From direct measurements and from measurements in consecutive fractions of lumbar CSF it is concluded that choline levels in intracranial CSF are 2-3 fold as high as those in lumbar CSF.

Speech timing measures of severity, psychomotor retardation, and agitation in endogenously depressed patients.

Mean duration and frequency of pauses within speech, pauses between speakers, and vocal activity were measured in 28 endogenous depressive during a psychiatric interview. A factor analysis on these variables revealed two factors accounting for 50% and 24% of the variance, respectively. Factor 1 could be interpreted as a pause factor. The mean durations of both types of pauses had high negative loadings, whereas the frequency of vocal activity, simultaneous speech, and pauses, and the mean duration of vocal activity had high positive loadings on this factor. The degree of retardation (a measure for slowed mental and physical activity) also was related to this factor (r = -0.67, p less than 0.001), whereas the relation between the severity of depression and this factor could only be established under certain conditions. The second factor was interpreted as a fragmentation of speech factor. The frequency of switching pauses (between speakers) and of vocal activity had high positive loadings, and the mean duration of vocal activity had a high negative loading. No clear relationships could be demonstrated between the degree of agitation (a measure for mental and physical overactivity) and speech and pause variables.

CSF choline levels in groups of patients with cranial trauma or extrapyramidal disorders.

Choline levels in lumbar cerebrospinal fluid (CSF) were measured in patients with craniocerebral trauma (N = 67), Parkinson's disease (N = 20), miscellaneous extrapyramidal disorders (N = 28) and Huntington's chorea (N = 5). No differences in CSF choline levels were observed between these diagnostic groups and a group of neurological controls (N = 22). However, CSF choline levels were found to increase with age.