Efficacy and safety of intravenous thrombolytic therapy in patients over eighty years.

INTRODUCTION: Intravenous thrombolytic therapy (IVTT) is licensed for patients under 80 years in many countries. In this study, we aimed to demonstrate functional results and complication rates of IVTT in patients over eighty years and whether there is a difference in efficacy and safety between low dose and standard dose recombinant tissue plasminogen activator (rTPA). METHODS: A retrospective observational study of patients over eighty who admitted to Suleyman Demirel University Faculty of Medicine Hospital between August 2016 and April 2021 and to Isparta City Hospital between April 2017 and April 2021 and diagnosed with acute ischemic stroke were conducted. Third month modified rankin scores (mRS) and mortality rates of patients and hemorrhagic transformations were determined. RESULTS: There were 29 patients in IVTT group and 25 patients in non-IVTT group. By the third month, it was observed that functional independence (mRS 0-2) ratio was increased more in IVTT group, but it wasn't statistically significant (p: 0.087). In mortality and symptomatic intracerebral hemorrhage rates, there wasn't statistically significant difference between IVTT and non-IVTT groups and low dose and standard dose rTPA groups by the third month. CONCLUSION: The efficacy and complication rates of IVTT in patients over 80 years were found similar to not receive IVTT. These results support the safety of IVTT in patients over 80 years. In low or standard dose rTPA preference, we observed that there was not statistically significance in efficacy and safety. We believe that these results will be supported by studies with larger number of patients.

The Lineage Theory of the Regional Variation of Individualism/Collectivism in China.

China has undergone a rapid process of modernization since 1949. The modernization process has accelerated with the development of the market economy and rural-to-urban migration after the 1980s. Nevertheless, Chinese regions still exhibit substantial differences in terms of individualist/collectivist cultural orientations. The rice theory and the climato-economic theory have attempted to explain this variation by analyzing provincial-level data. Based on a quantitative analysis of more granular, county-level variables spanning from the early 1990s until 2010, we offer an alternative account of this cultural variety based on lineage development in different Chinese regions. Using the ArcGIS geographic information system, we first present the regional distribution of individualism/collectivism indicators at the county level through descriptive statistics and spatial analysis. We also run a regression model to analyze county-level data on individualism/collectivism that includes three periods (1990, 2000, and 2010). Our multi-level analysis shows that lineage development is a critical variable that explains more regional variation of culture in China when compared to other variables. While rice farming, the key variable of the rice theory, is a significant variable, its explanatory power is less than the lineage variable. Finally, our analysis shows that the climato-economic theory fails to explain the regional variation of culture.

The clinical and histological characteristics of patients with biopsy-proven non-alcoholic fatty liver disease in the absence of insulin resistance.

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is closely associated with insulin resistance (IR). While a minority of patients with NAFLD does not have evidence of IR, no detailed characterization of this specific phenotype is currently available. This study was undertaken to investigate the clinical and histological characteristics of this patient group. Materials and Methods: We retrospectively reviewed the clinical records of 263 patients with biopsy-proven NAFLD. IR was defined by a Homeostatic Model Assessment of IR (HOMA-IR) score >2.73. The histological diagnosis of non-alcoholic steatohepatitis (NASH) was performed using 1) the steatosis, activity and fibrosis score and 2) the NASH Clinical Research Network (NASH CRN) criteria. Significant fibrosis was defined by the presence of a histological fibrosis score higher than F≥2. Patients with and without evidence of IR were compared concerning clinical, laboratory, and histological characteristics. Results: Of the 263 patients with biopsy-proven NAFLD, 53 (20.2%) patients had no evidence of IR. Patients without IR were younger [IR (-): 42 (22-65) years versus IR (+): 49 (22-71) years, p=0.001] and had a higher prevalence of men [IR (-): 39 (73.6%) versus IR (+): 113 (53.8%), p=0.009]. Moreover, they were characterized by a lower body mass index [IR (-): 30.06±3.61 kg/m2 versus IR (+): 33.19±5.06 kg/m2, p=0.000] and lower frequencies of metabolic risk factors-including the metabolic syndrome, diabetes, hypertension, hyperlipidemia, and lower waist/hip circumference. Liver histology was generally less severe in patients without IR; specifically, they showed a lower prevalence of NASH [IR (-): 38 (71.7%) versus IR (+): 190 (90.5%), p=0.000] and significant fibrosis [IR (-): 9 (17.0%) versus IR (+): 106 (50.5%), p=0.000] than did patients with IR. Multivariate analysis identified obesity [odds ratio (OR): 9.321, 95% confidence interval (CI): 1.031-84.261, p<0.05] and an international normalized ratio >1.1 (OR: 10.116, 95% CI: 1.325-77.225, p<0.05) as independent predictors of significant fibrosis in patients with NAFLD and no IR. Conclusion: Patients with NAFLD and no IR has less severe liver histology than patients with IR. However, obesity appears to be independently associated with significant fibrosis in this patient group.