Safety and outcomes of routine endovascular thrombectomy in large artery occlusion recorded in the SITS Register: An observational study.

BACKGROUND AND OBJECTIVE: We aimed to evaluate the safety and outcomes of thrombectomy in anterior circulation acute ischaemic stroke recorded in the SITS-International Stroke Thrombectomy Register (SITS-ISTR) and compare them with pooled randomized controlled trials (RCTs) and two national registry studies. METHODS: We identified centres recording ≥10 consecutive patients in the SITS-ISTR with at least 70% of available modified Rankin Scale (mRS) at 3 months during 2014-2019. We defined large artery occlusion as intracranial internal carotid artery, first and second segment of middle cerebral artery and first segment of anterior cerebral artery. Outcome measures were functional independence (mRS score 0-2) and death at 3 months and symptomatic intracranial haemorrhage (SICH) per modified SITS-MOST. RESULTS: Results are presented in the following order: SITS-ISTR, RCTs, MR CLEAN Registry and German Stroke Registry (GSR). Median age was 73, 68, 71 and 75 years; baseline NIHSS score was 16, 17, 16 and 15; prior intravenous thrombolysis was 62%, 83%, 78% and 56%; onset to reperfusion time was 289, 285, 267 and 249 min; successful recanalization (mTICI score 2b or 3) was 86%, 71%, 59% and 83%; functional independence at 3 months was 45.5% (95% CI: 44-47), 46.0% (42-50), 38% (35-41) and 37% (35-41), respectively; death was 19.2% (19-21), 15.3% (12.7-18.4), 29.2% (27-32) and 28.6% (27-31); and SICH was 3.6% (3-4), 4.4% (3.0-6.4), 5.8% (4.7-7.1) and not available. CONCLUSION: Thrombectomy in routine clinical use registered in the SITS-ISTR showed safety and outcomes comparable to RCTs, and better functional outcomes and lower mortality than previous national registry studies.

Intravenous thrombolysis for patients with in-hospital stroke onset: propensity-matched analysis from the Safe Implementation of Treatments in Stroke-East registry.

BACKGROUND AND PURPOSE: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in patients with in-hospital stroke (IHS) onset is associated with unfavorable functional outcomes at hospital discharge and in-hospital mortality compared to patients with out-of-hospital stroke (OHS) onset treated with IVT. We sought to compare outcomes between IVT-treated patients with IHS and OHS by analysing propensity-score-matched data from the Safe Implementation of Treatments in Stroke-East registry. METHODS: We compared the following outcomes for all propensity-score-matched patients: (i) symptomatic intracranial hemorrhage defined with the safe implementation of thrombolysis in stroke-monitoring study criteria, (ii) favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0-1 at 3 months, (iii) functional independence defined as an mRS score of 0-2 at 3 months and (iv) 3-month mortality. RESULTS: Out of a total of 19 077 IVT-treated patients with acute ischaemic stroke, 196 patients with IHS were matched to 5124 patients with OHS, with no differences in all baseline characteristics (P > 0.1). Patients with IHS had longer door-to-needle [90 (interquartile range, IQR, 60-140) vs. 65 (IQR, 47-95) min, P < 0.001] and door-to-imaging [40 (IQR, 20-90) vs. 24 (IQR, 15-35) min, P < 0.001] times compared with patients with OHS. No differences were detected in the rates of symptomatic intracranial hemorrhage (1.6% vs. 1.9%, P = 0.756), favorable functional outcome (46.4% vs. 42.3%, P = 0.257), functional independence (60.7% vs. 60.0%, P = 0.447) and mortality (14.3% vs. 15.1%, P = 0.764). The distribution of 3-month mRS scores was similar in the two groups (P = 0.273). CONCLUSIONS: Our findings underline the safety and efficacy of IVT for IHS. They also underscore the potential of reducing in-hospital delays for timely tissue plasminogen activator delivery in patients with IHS.

Benefit of thrombolysis for stroke is maintained around the clock: results from the SITS-EAST Registry.

BACKGROUND AND PURPOSE: The outcome of thrombolysis for early morning and sleep time strokes may be worse because of uncertainty of stroke onset time or differences in logistics. The aim of the study was to analyze if stroke outcome after intravenous thrombolysis differs depending on time of day when the stroke occurs. METHODS: The data collected in the Safe Implementation of Treatments in Stroke - Eastern Europe (SITS-EAST) Registry between September 2000 and December 2011 were used. Strokes were categorized as night-time 00:00-07:59, day-time 08:00-15:59 and evening-time 16:00-23:59 and were compared in terms of several outcome measures. All results were adjusted for baseline differences. RESULTS: A total of 8878 patients were enrolled: 18% had night-time, 54% day-time and 28% evening-time strokes. Onset-to-treatment time in patients with night-time strokes was 10 min longer than in day-time and evening-time strokes (P < 0.001). Symptomatic intracerebral hemorrhage by ECASS II definition occurred in 5.6%, 5.6% and 5.3% (adjusted P = 0.41) of the night-time, day-time and evening-time stroke patients, respectively; by SITS definition it occurred in 2.5%, 1.9% and 1.3% (adjusted P = 0.013) and by NINDS definition in 7.8%, 7.6% and 7.5% (adjusted P = 0.74). Patients with night-time, day-time and evening-time strokes achieved modified Rankin Scale score 0-1 in 33%, 31%, 31% (adjusted P = 0.34) and 0-2 in 52%, 51%, 50% (adjusted P = 0.23), and 13%, 15%, 16% respectively of patients died (adjusted P = 0.17) by 3 months. CONCLUSIONS: The time when stroke occurs (day versus evening versus night) does not affect the outcome after thrombolysis despite the fact that patients with night-time strokes have worse time management.

[Quadruparesis as a complication of acute pancreatitis--case report]. / Kvadruparéza ako komplikácia akútnej pankreatitídy--kazuistika.

Pancreatic encephalopathy is a rare complication of acute pancreatitis. Clinical features include focal neurological signs and acute oncet of dementia. Clinical picture can fiuctuate over the time and depends on phase of this disease. The progression and the regression of encephalopathy with relapse and remission of acute pancreatitis has been often described.

Morphologic changes in the gastric mucosa of rats after administration of N-methyl-N'-nitro-N-nitrosoguanidine. Electronmicroscopic study.

Electron microscopic findings of the effects of exposure to the cancerogenic substance N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) upon the gastric mucosa of rats are presented. MNNG was administered in drinking water at a concentration of 83 mg/l over a period of eight weeks. The resulting findings included occurrence of myelin figures in membrane structures of epithelial cells, occasional disappearance of nuclear membrane, numerous intranuclear cytoplasmic pseudoinclusions, and increased number of perichromatin and interchromatin granules and of nuclear corpuscles. Narrowing of the layer of peripheral condensed chromatin and broadening of the layer of dispersed chromatin were frequently observed. In the cytoplasm of epithelial cells, production of autophagous vacuoles was detected in differentiated types of cells, the presence of great amount of polysomes and profiles of rough endoplasmic reticulum diversely deformed was seen in the undifferentiated neck cells. These cells presented a marked proliferative activity. Some of the changes described in the nuclei of epithelial cells were also observed in different mesenchymal elements in the lamina propria mucosae. The demonstrated changes are indicative of both regressive and progressive effects of the cancerogen used in our experiment.

Antigenicity restoration of formaldehyde-treated material with chymotrypsin.

In histological preparations commonly fixed in formaldehyde and embedded in paraffin which on immunofluorescent examination yielded results negative results or but very poor immunofluorescence, prominently positive results were obtained by chymotrypsin treatment on using the method of fluorescent antibodies. Corresponding results were also obtained in cryostat sections fixed for some min up to several days in formaldehyde so that immunofluorescence was completely negative. The positive immunofluorescent results indicate total or partial restoration of antigenicity of tissue proteins previously altered by formaldehyde.

Immunohistochemical analysis of formaldehyde- and trypsin- or pepsin-treated material.

Immunohistochemical studies of paraffin sections of formaldehyde-fixed material and formaldehyde-fixed cryostat sections treated with trypsin or other enzymes were undertaken. Formaldehyde treatment resulted mostly in partial or total loss of antigenicity, as visualized by fluorescent antibody technique in tissue sections. The digestion of sections with trypsin resulted usually in total or partial restitution of antigenicity, previously altered with formaldehyde. This effect is suggested to consist primarily in breaking formaldehyde-induced intermolecular cross-links. Restitution of antigenicity altered by formaldehyde can also be achieved on using pepsin or other proteolytic enzymes, or by some other technique. When the effect of one enzyme proves insufficient, it can readily be complemented by the action of another enzyme applied subsequently. Mild trypsin treatment preserves well the morphological structure of most tissues.

Effects of feeding a single daily meal and of changes in lighting schedule on the circadian rhythms of oxidoreductases in the rat gastric mucosa.

The present paper investigated the effect of restricted feeding (11.00 to 13.00 h) by a single daily meal upon the activity of various oxidoreductases of the rat gastric mucosa (SDH, alpha-GPDH, LDH, NADHTR), which at ad libitum feeding under normal lighting conditions with a dark night were shown to have distinct circadian activity variations related to the rat's nocturnal food intake preference (Zaviacic and Brozman 1978a). 1st part of the animals received food in 2-h-period by natural daylight (natural lighting conditions), the 2nd part at the same period of time but in the dark (lighting conditions reversed to natural). Checking the consumption of food, we found the animals to become adapted to the new time of food intake beginning with the 6th experimental day. The circadian rhythm of enzymes was examined on days 69, 83, 97, and 104 of limited feeding under the defined lighting schedule, at 06.00 h, 12.00 h, 18.00 h, and 24.00 h in groups of 5 animals. Synchronization of the highest dehydrogenases activities (particularly of SDH) with the time of restricted feeding was seen to develop in the gastric mucosa of the rat. The synchronization effect was more pronounced in the animals which received their food in the dark (and here even more in male than in female). The effect of light during food intake was found to be rather interfering with the development of synchronization of dehydrogenase activities with the time of food intake, and the influence was again more marked in male than in female. The time of food intake was at the feeding schedule restricted to daytime intake the main synchronizer for the circadian rhythm of oxidoreductases of the gastric mucosa of the rat, with the highest daily activities recorded around the feeding time and the lowest activities at night, which is the direct opposite of the circadian rhythm of the same enzymes determined in rats fed ad libitum under normal lighting conditions with a dark night.

Histochemical localization of enzymes in the normal rat gastric mucosa using the technique of the semipermeable membranes and the other methods.

In the paper we observed histochemically the distribution and activity of 16 enzymes in the normal rat gastric mucosa. The lysosomal enzymes were demonstrated by the method of semipermeable membranes (LOJDA 1972). At the proof of dehydrogenases aqueous and gel media were used. The parietal cells of the gastric mucosa contained a moderate activity of acid phosphatase, E-600 resistant esterase, and only a very slight activity of beta-glucuronidase and N-acetyl-beta-D-glucosaminidase. The macrophages of the interstice contained a high activity of beta-glucruonidase, acid phosphatase, E-600 resistant esterase and a low activity of N-acetyl-beta-D-glucosaminidase. The chief cells of the rat gastric mucosa, in contrast to the human, did not contain nonspecific esterase and also in them acid phosphatase was mostly lacking. The alkaline phosphatase was found only in the endothelium of the capillaries of the gastric mucosa. The parietal cells contained high activities of succinate dehydrogenase, alpha-glycerophosphate dehydrogenase, beta-hydroxybutyrate dehydrogenase, NADH tetrazolium reductase, a lower activity of NADPH tetrazolium reductase, as well as other soluable dehydrogenases. At the examination of dehydrogenases using aqueous as well as gel media with PMS during optimal short incubation periods, we found more and less active forms of parietal cells. The different oxidoreductase capacity of parietal cells in normal rat gastric mucosa can point to their unequal-functional load at the production of hydrochloric acid. The findings obtained are compared with the findings in older papers concerning different experimental animals and with the distribution of enzymes in the human gastric mucosa.

Circadian rhythms of oxidoreductases in the rat gastric mucosa. Histochemical study.

Examination of selected oxidoreductases (succinate dehydrogenase, mitochondrial glycerol-3-phosphate dehydrogenase, lactate dehydrogenase, NADH tetrazolium reductase) in the rat gastric mucosa revealed diurnal fluctation of enzyme activities with the most marked manifestation in succinate dehydrogenase. The maximum enzymatic activity found at 18.00 h and 24.00 h) points to the highest oxidoreductase capacity in the parietal cells just at the time when a rat usually expresses spontaneously the highest interest in food intake. The high activity of succinate dehydrogenase and other enzymes at that time is very likely the expression of a "fixed" metabolic adaptation of the parietal cells to the elevated production of hydrochloric acid, in connection with its role in the digestion of food in the stomach. The low enzymatic activity of most rat parietal cells during the day may represent the picture of "a resting afunctional".

Human hyaline cartilage--biochemical and immunochemical study.

Hyaline cartilage from the knee or rib of newborns was divided in neutral salts into a soluble and insoluble part. The insoluble part was treated with collagenase and was separated into 2 peaks by gel chromatography on Sephadex G-200. The 1st peak revealed a low concentration of proteins, no hydroxyproline, and very high levels or uronates. In the 2nd peak, very high values of hydroxyproline and very low values of uronate were found. Thus the 1st peak contained only proteoglycans and no collagen, while the entire collagen was found in the 2nd peak. The individual fractions were inoculated into rabbits to obtain antibodies. Compared to the fraction containing macromolecular proteoglycans, antisera proved remarkably suitable particularly for analysis of human spleen, yet also of other organs. These anti-cartilage antisera visualized primarily spongy structures of pericapillary sheaths and circumferential reticulum of the periarterial lymphatic sheaths, but to a lesser extent also other extracellular structures of the spleen and of other organs.

The use of anti-cartilage antisera in the study of human spleen.

Antisera against human hyaline cartilage, particularly antisera against collagenase-treated residue obtained after extraction of cartilage homogenate with 3.4 mol dm-3 NaCl and extraction with 0.05 mol dm-3 sodium citrate buffer at pH = 3.2, reacted with different fibrillary and membraneous structures of the human spleen. Very intensive immunofluorescence was observed in special spongiform structures at the end of the arterial system, referred to as spongy arterial terminals. Fibrillary and membraneous structures situated perivascularly, in lymphatic sheaths and the periphery of follicles displayed similar reactions. The discontinuous walls of sinuses and reticular fibrils in pulp cords reacted less intensively. The given antisera are used to advantage as immunohistologic reagents since they clearly visualize the basic structure, and particularly the spongy arterial terminals, otherwise inconspicuous. In the hyaline cartilage of the rib and knee, the cartilage channels yielded the most intensive reaction. Of the other organs studied the marked reaction in the mesangium of the renal glomerulus was the most remarkable.

Immunohistochemical staining using coupled immunofluorescence and immunocomplex technique.

An immunomicroscopic method combining the use of fluorescent antibodies and enzyme immunocomplex technique is presented. The basic steps of this procedure are: 1. Rabbit antiserum (IgG) to the antigen to be determined, 2. FITC-conjugated antirabbit globulin, 3. Peroxidase + antiperoxidase complex, 4. 3,3-diaminobenzidine + H2O2. The method renders it possible to study simultaneously in the same section antigens and antibodies that are to be localized, and that both by immunofluorescent and immunoenzymatic techniques, it provides means for further elimination of some of the deficiencies of immunofluorescent technique, and in suitable cases it also makes electronoptic examination available.

The adult human female urethra. Enzyme-histochemical study.

In the female urethra, the activity and distribution of 15 enzymes was determined by using both conventional and special histochemical methods. The enzymatic equipment differed according to the type of epithelial lining whose variation is characteristic for the female urethra. In the stratified squamous epithelium of the urethra, alkaline phosphatase, beta-glucuronidase, acetyl-beta-D-glucosaminidase, thiamine pyrophosphatase, and glucose-6-phosphatase exhibited but minimal or no activity, yet the other 10 enzymes studied displayed activity particularly in basally situated cells. Nearer to the lumen of the urethra, the activity in the epithelium kept decreasing and was mostly absent in superficial and desquamated cells. In the pseudostratified columnar and in the transitional epithelium of the urethra, the majority of enzymes showed an evenly distributed activity at all epithelial levels. In the apical parts of the most superficially situated cells bounding the lumen of the urethra, a distinct narrow zone of higher activity was observed. It was seen not only on determining the majority of dehydrogenases but also on examining acid phosphatase and naphthyl esterase. The endocrine cells occurring in the uroepithelial lining of the female urethra displayed, yet always with the exception of squamous epithelium (Zaviacic et al. 1983), distinct activity of acid hydrolytic enzymes, and of the enzymes studied it was particularly acid phosphatase. The majority of the demonstrated enzymes, of the dehydrogenases priority, is to be given to succinate dehydrogenase, enabled to differentiate readily between the highly active striated muscle fibers located in the most peripheral parts of the excisions along the urethral circumference and the smooth musculature of the urethral wall with a lower or only minimal activity.

Histochemistry and cytochemistry of thiamine pyrophosphatase (TPP-ase 3.6.1.) in the rat gastric mucosa.

The paper deals with the histochemical and cytochemical distribution of thiamine pyrophosphatase (TPP-ase 3.6.1.) in the normal rat gastric mucosa using the method of NOVIKOFF and GOLDFISCHER (1961). In light microscopy, activity was demonstrated only in the GOLGI apparatus of the foveolar mucous cells; in the other specialized gastric mucosal cells no activity was established. At electron microscopic level, the reaction product was localized in the membranes of the cisternae of the GOLGI apparatus of foveolar mucous cells, undifferentiated neck cells, parietal cells, chief cells and in endocrine cells. The reaction product was not found in the endoplasmic reticulum of any of the above mentioned types of cells with the exception of parietal cells. The deposits of the reaction product in the cytoplasmic membrane, in the capillary endothelium and on the surface of the plasma membrane of foveolar mucous cells represents the sites of activity of alkaline phosphatase. The examination of the TPP-ase in the gastric mucosa inables us to estimate the activity of the GOLGI apparatus of gastric mucosal cells in the norm and in different pathological conditions connected with its changes.

Immunofluorescence and enzyme cytochemical analysis of arterial terminals in the human spleen.

The simultaneous application of immunofluorescent and enzyme cytochemical methods made it possible to analyze the components of the walls of the arterial branches and arterial capillaries, and particularly the spongy arterial terminals in the red pulp of human spleen. The endothelium was identified by alkaline phosphatase demonstration, the basement membranes (BM) by means of antisera to glomerular BM, the media by using the same antisera, and the adventitia by means by antisera to hyaline cartilage, which are presumed to react particularly with adventitial structures. In the spongy arterial terminals visualized by means of anti-hyaline-cartilage antisera, the endothelium and mostly also BM could be detected, yet the enzyme cytochemical reaction to acid phosphatase and alpha-naphthyl acetate esterase and the immunofluorescent reaction to lysozyme yielded negative reactions. The findings suggest that neither macrophages nor other cells containing the given enzymes in detectable form are accumulated in these structures.

[Morphology of the human rib perichondrium from the aspect of arthroplasty of the small joints of the hand]. / Morfológia l'udského rebrového perichondria z hl'adiska artroplastiky drobných kl'bov ruky.

The human rib perichondrium is a suitable material for reconstruction interventions on small joints of the hand. Optical and electron microscopy analysis of the human rib perichondrium has shown some features different from the similar perichondrium in rabbits. In its superficial layers there are apart from the vascularity also myelinized nerve fibres, fat-cells and heparinocytes. In the medium layer and in the inner layer of the perichondrium there are cells which by their characteristics correspond to fibrocytes. Among them are collagen fibrillae coated with materials which can be fixed by the ruthenium red. The inner layer cannot be exactly distinguished from the cartilage of the rib.

Arthroplasty for major defects of articular areas of fingers.

The costal perichondrium is a suitable material for the reconstruction of major damage to articular areas, even bone tissue in small joints of the hand. A modelled silicone implant conditions and simultaneously defines the shape of the reconstructed areas. Together with the perichondrium reconstruction, it helped to fill the defect and for a suitable shape of the articular areas. Morphological findings of the perichondrium transformation showed a steady growth and a rising frequency of hyalinization of larger foci containing chondrocyte-like cells. After 8 years the cartilage surface showed a thick layer of hyaline cartilage.

[Cardiomyopathy with hepatic necrosis after several years of using Norbiogest Spofa]. / Kardiomyopatia s hepatálnou nekrózou pri viacrocnom uzívaní Norbiogestu SPOFA.

PIP: Findings in a 28 year old woman who had been using the hormonal contraceptive Norbiogest Spofa for 3 years are described. She ceased taking the pill 40 days prior to her death. Congestive cardiomyopathy, massive hepatic necrosis, and hemorrhagic infarctions in the lungs and spleen were diagnosed at autopsy. The disease probably occurred in connection with previous pregnancies and had been gradually deteriorating her condition during drug application. Findings in the liver, lung, and spleen are considered a consequence of chronic heart insufficiency, even when the effect of the drug on venostatically changed organs could not be excluded. (author's modified)^ieng

[Relation between toxoplasmosis and orofacial clefts in children]. / Nase sledovanie vzt'ahu toxoplazmózy k orofaciálnym rázstepom detí.

The authors performed a serological observation of toxoplasmosis by using the methods of IFT, CFT and ELISA in 118 mothers and their children with orofacial clefts. The results were compared with those gained in the control group of healthy mothers and their children. Titre means of toxoplasma antibodies in inflicted mothers and their children were higher than in the control group. The results were evaluated statistically. The authors assume that a certain proportion of orofacial clefts may be induced by toxoplasmosis. (Tab. 6, Ref. 13.).