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Background and Purpose This study was undertaken to determine factors of importance for the development of leukoaraiosis and to evaluate whether leukoaraiosis influences stroke outcome. Methods The study was prospective and consecutive and included 1084 unselected patients with acute stroke and transient ischemic attack admitted from the community of Bispebjerg (Copenhagen, Denmark) during a 25-month period from September 1, 1991, to September 30, 1993. All patients were treated in a stroke unit from the time of acute admission to completion of rehabilitation. Daily alcohol consumption and other putative risk factors were registered on admission, and patients were evaluated weekly to death or time of completed rehabilitation by means of neurological (Scandinavian Stroke Scale) and functional (Barthel Index) scores. Leukoaraiosis was diagnosed on computed tomographic scan. Multivariate analyses were applied to test relations independent of other influencing factors. Results Leukoaraiosis was present in 15% of the patients. Age was the only factor that significantly increased the risk of leukoaraiosis (odds ratio [OR] per 10-year increase, 2.4; 95% confidence interval [CI], 1.8 to 3.1), whereas the presence of atrial fibrillation was adversely related to leukoaraiosis (OR, 0.26; 95% CI, 0.13 to 0.52). Moderate daily alcohol consumption (1 to 5 drinks) reduced the risk of leukoaraiosis (OR, 0.50; 95% CI, 0.28 to 0.87), whereas heavy daily alcohol consumption (>5 drinks) tended to increase the risk (OR, 1.3; 95% CI, 0.5 to 3.3). Leukoaraiosis was not related to the presence of hypertension, diabetes, ischemic heart disease, atrial fibrillation, intermittent claudication, smoking, or sex. The presence of leukoaraiosis had no influence on neurological outcome ( P =.20), functional outcome ( P =.47), length of hospital stay ( P =.75), or mortality ( P =.31). Conclusions Moderate daily alcohol intake seems associated with a decreased risk of leukoaraiosis in stroke patients. The relation between alcohol intake and leukoaraiosis may even be U-shaped, like the relation between alcohol intake and coronary heart disease, alcohol intake and mortality, and alcohol intake and stroke. The presence of leukoaraiosis does not seem to influence the rehabilitation process or outcome of stroke.

Background: Many aspects of stroke-related headache, such as its incidence, pathophysiology, risk factors, and relation to stroke severity and outcome, are uncertain. Design: A prospective, community-based study including 1,128 consecutive acute stroke patients; 867 (77%) were able to communicate. Stroke severity and the clinical course were assessed using the Scandinavian Stroke Scale (SSS). CT was performed in 84% of patients. In the data analysis, multivariate regression analyses were used when appropriate. Results: Two hundred forty-one (28%) of the 867 patients had headache in relation to stroke onset. Independent risk factors were age (odds ratio [OR] per 20 years, 0.57; 95% confidence interval [CI], 0.43 to 0.86; p = 0.0001), female sex (OR, 1.6; CI, 1.2 to 2.2; p = 0.003), intracerebral hemorrhage (OR, 2.8; CI, 1.5 to 5.4; p = 0.002), stroke in the vertebrobasilar territory (OR, 1.7; CI, 1.1 to 2.3; p = 0.02), and ischemic heart disease (OR, 1.5; CI, 1.1 to 2.2; p = 0.01). In those patients in whom headache was lateralized (46%), it was ipsilateral to the lesion in 68% of cases ( p = 0.01). There was no correlation between headache and (1) initial stroke severity as measured with the SSS ( p = 0.75), (2) lesion size ( p = 0.77), (3) whether or not CT showed cortical involvement ( p = 0.29), (4) stroke outcome as measured with the SSS (p = 0.9), or (5) mortality ( p = 0.75). Conclusion: Stroke-related headache is associated with factors such as age and sex. In patients capable of providing reliable headache information, headache is more frequent in strokes confined to the vertebrobasilar than to the carotid territory and is not associated with stroke severity or whether or not the cortex was involved. Stroke-related headache is not related to stroke outcome.

Compensation by the unaffected upper extremity (UE) was studied in stroke patients who were unable to use the affected UE. The main aim was to evaluate the need of teaching compensatory techniques to stroke patients during rehabilitation of UE function. The study was prospective and community based and included 636 consecutive acute stroke patients. UE function and UE paresis were assessed weekly using the Barthel Index subscores for feeding and grooming and the Scandinavian Stroke Scale (SSS) subscores for arm and hand. Rehabilitation was performed according to the Bobath technique. Initially, 214 had severe UE paresis according to SSS; the arm could not move against gravity and the fingertips could not reach palm. In 64 of the 115 patients discharged alive, the affected UE definitely remained useless despite intensive and longstanding rehabilitation. Improvement of UE function was seen in 25 of these patients (39%) and was possible only through compensation by the unaffected UE. Patients who gained UE function by compensation were younger (p < 0.01), had less severe stroke (p < 0.01), smaller (p < 0.01), and subcortically located (p = 0.02) lesions and less affection of higher cortical function (p = 0.01). Recovery of UE function in more than half of the stroke patients with initial severe UE paresis can be achieved only by compensation by the unaffected UE.

Time course and degree of recovery of upper extremity (UE) function after stroke and the influence of initial UE paresis were studied prospectively in a community-based population of 421 consecutive stroke patients admitted acutely during a 1-year period. UE function was assessed weekly, using the Barthel Index subscores for feeding and grooming. UE paresis was assessed by the Scandinavian Stroke Scale subscores for hand and arm. The best possible UE function was achieved by 80% of the patients within 3 weeks after stroke onset and by 95% within 9 weeks; in patients with mild UE paresis, function was achieved within 3 and 6 weeks, respectively, and in patients with severe UE paresis within 6 and 11 weeks, respectively. Full UE function was achieved by 79% of patients with mild UE paresis and only by 18% of patients with severe UE paresis. A valid prognosis of UE function can be made within 3 and 6 weeks in patients with mild and severe UE paresis, respectively. Further recovery of UE function should not be expected after 6 and 11 weeks respectively, in these groups of patients.

Our objective was to study age-specific prevalence, computed tomographic (CT) characteristics, risk factors, and the prognostic influence on stroke outcome of silent infarction in acute stroke patients. The study was prospective and community-based and included 801 acute stroke patients, of whom 587 had first-ever stroke. A CT scan was performed in 500 (85%) of the 587 patients with first-ever stroke. CT was reviewed blindly, and infarcts were classified according to patient history as silent or symptomatic. Patients were evaluated initially with the Mini-Mental State Examination (MMSE) and weekly with both the Scandinavian Stroke Scale (SSS) and the Barthel Index (BI) from the onset of stroke to completion of rehabilitation. CT characteristics, risk factors, and stroke outcome were compared in stroke patients with and without silent infarction. The prevalence of silent infarction in patients with first-ever stroke and recurrent strokes was similar, at 29% (group aged 0 to 54 years, 16%; 55 to 64 years, 22%; 65 to 74 years, 30%; 75 years or older, 33%). Silent infarcts were small and subcortical. Independent risk factors were increasing age (odds ratio [OR], 1.95 per 25 years; confidence interval [CI], 1.19 to 3.15), hypertension (OR, 1.75; CI, 1.13 to 2.70), claudication (OR, 1.74; CI, 1.01 to 3.00), and male sex (OR, 1.72; CI, 1.12 to 2.64); other stroke risk factors such as atrial fibrillation and former transient ischemic attack were not independent risk factors. Patients with and without silent infarction did not differ in frequency of prestroke home care (P = .2). MMSE (P = .56), initial BI (P = .62) and SSS score (P = .08), BI (P = .85) and SSS score (P = .75) after completion of rehabilitation, or in the speed of recovery (P = .85). Length of hospital stay, mortality rate, and discharge rate to nursing home also did not differ between the two groups. This community-based study shows that silent infarction in stroke patients is more related to certain stroke risk factors than others and that silent infarction does not seem to influence the prognosis of stroke.

The expression of mRNA for the basic fibroblast growth factor (FGF) gene was examined in seven human gastric carcinoma cell lines and in tissue from 29 gastric carcinomas together with the adjacent normal mucosa. Among the seven gastric carcinoma cell lines, the MKN45 cell line expressed mRNA for the basic FGF gene. Basic FGF protein production was confirmed by flow cytometric analysis and immunohistochemistry. Among the surgical specimens, 16 (55%) of 29 gastric carcinomas showed higher levels of basic FGF mRNA than the normal mucosa. Interestingly, in scirr-hous gastric carcinomas characterized by their fibrous stroma and rapid growth, 9 (69%) of 13, samples examined revealed higher levels of basic FGF mRNA than normal mucosa, whereas only 3 (33%) of the 9 well differentiated adenocarcinomas studied produced similar results. Immunohistochemically, basic FGF protein was localized in tumor cells. These results suggest that basic FGF produced by tumor cells may play an important role in producing fibrosis and angiogenesis in gastric carcinomas.

We examined 12 depressed tubular adenomas of the stomach pathologically and immunohistochemically in order to clarify the difference between the depressed type and the elevated type. Depressed tubular adenomas showed shallow mucosal depression and, of the 12, nine were endoscopically diagnosed as early gastric cancer. Histologically, the adenoma cells showed dysplasia in varying degree and focal adenocarcinoma occurred in two adenomas measuring over 2 cm. The mean height of the adenoma glands was 0.63 +/- 0.31 mm in the 12 depressed adenomas and 1.32 +/- 0.43 mm in 44 elevated adenomas, while the mean heights of the subjacent mucosa were 0.18 +/- 0.19 mm and 1.07 +/- 0.71 mm, respectively. Thus, depressed adenomas resulted from paucity of the mucosa subjacent to the adenoma glands and the height of the adenomatous glands was half that found in the elevated type. Goblet cells, a variety of endocrine cells and lysozyme-containing cells were found in nine, nine and eight depressed adenomas, respectively, in variable numbers. Hyperplasia of these cells was also detected in depressed adenomas showing mild or moderate dysplasia. Immunohistochemical examination revealed no difference in the phenotypic expression of adenoma cells as between the depressed and the elevated type.

We have studied 8 normal subjects, and 12 patients with idiopathic thrombocytopenic purpura whose platelet counts ranged from 9 x 10(9)/L to 40 x 10(9)/L. Autologous platelets labeled with 111Intropolone were used for evaluation of mean platelet survival, platelet turnover, platelet sequestration sites, and platelet production (turnover) to clearance (sum of platelet uptake in the liver and the spleen) ratio. Platelet survival correlated directly with platelet counts. There was no significant correlation between the platelet sequestration pattern and platelet count, survival, or turnover. Sum of platelet uptake in the liver and the spleen showed a significant inverse correlation with platelet survival. No significant correlation was found between platelet turnover and platelet count. There was a significant correlation between the platelet production to clearance index when all subjects were analyzed. The distribution of platelet turnover showed considerable individual variation; eight of twelve patients showed platelet turnover less than mean minus 2SD of the control value, but others showed normal range. We conclude that although platelet destruction mechanism in RES shows a primary role of thrombocytopenia, impaired rate of effective thrombopoiesis may also contribute to disease severity in ITP.

We examined the effects of epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-alpha) on EGF receptor (EGFR) phosphorylation and the expression of mRNAs for oncogenes, growth factors, their receptors and metalloproteinase genes by MKN-28 gastric carcinoma cells which express EGF, TGF-alpha and EGFR genes. Both EGF and TGF-alpha stimulated EGFR phosphorylation, EGF and TGF-alpha induced FOS, MYC and ERBB-2 oncogene expression. Interestingly, EGF increased the expression of mRNAs for TGF-alpha and EGFR. On the other hand, TGF-alpha increased TGF-alpha mRNA but decreased the expression of mRNAs for EGFR and TGF-beta. Furthermore, mRNAs for interstitial collagenase, stromelysin and procollagen type I genes were also enhanced after treatment with EGF and TGF-alpha. These results indicate that EGF and TGF-alpha successively evoke cascade phenomena which favor tumor progression, invasion and extracellular matrix formation, acting as autocrine growth regulators for gastric carcinomas.

The DNA ploidy pattern and amplification of ERBB and ERBB2 genes were examined in paraffin-embedded tissue from gastric carcinomas using flow cytometry and a slot-blot hybridization technique. The incidence of aneuploidy in well differentiated adenocarcinomas (56%) was significantly higher (p less than 0.05) than that in poorly differentiated adenocarcinomas (21%). The DNA ploidy pattern was not remarkably different between the primary tumors and metastatic deposits in lymph nodes. Of the nine specimens having an aneuploid stem cell line in the primary tumor and/or in metastases, three showed ERBB2 gene amplification and one showed ERBB gene amplification. The incidence of epidermal growth factor (EGF) immunoreactivity in tumor cells showed no difference between diploid and aneuploid tumors. These findings indicate that aneuploidy is frequently associated with amplification of ERBB and ERBB2 genes.

Het evalueren van de gevolgen van een cva, ingedeeld naar zowel de ernst van het cva als het aanvankelijke niveau van de invaliditeit.

Background and Purpose The purpose of this study was to investigate in a community-based population the prevalence of both urinary (UI) and fecal (FI) incontinence and to analyze risk factors by means of multivariate analysis. Methods Included were 935 acute stroke patients admitted consecutively during 19 months. We evaluated UI and FI using subscores of the Barthel Index during the hospital stay and at 6-month follow-up. Results On admission, the proportions of patients with full UI, partial UI, and no UI were 36%, 11%, and 53%, respectively (8%, 11%, and 81% at 6-month follow-up). The proportions of patients with full FI, partial FI, and no FI on admission were 34%, 6%, and 60%, respectively (5%, 4%, and 91% at 6-month follow-up). By multivariate analysis, significant risk factors for UI and FI were age, severity of stroke, diabetes, and comorbidity of other disabling diseases. Conclusions On admission in the acute state, almost half of an unselected stroke population have UI and/or FI. The proportion ...

Objective: To determine the incidence, time course, and clinical importance of spontaneous reperfusion of cerebral infarcts in patients with acute stroke. Design: Prospective, community based. Setting: Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark. Patients: Included in the incidence and time course study were 354 unselected patients with acute ischemic stroke. Clinical outcome was studied in a subgroup of 36 patients admitted on the day of stroke onset and in whom it was known whether spontaneous reperfusion occurred within the first week after stroke onset. Measurements: Computed tomography and single photon emission computed tomography, with technetium Tc 99m exametazime used as a flow tracer. The Scandinavian Stroke Scale neurologic score was determined on admission, 1 and 2 weeks after stroke, and at discharge. Results: The incidence of spontaneous reperfusion was 77% in patients with cortical infarcts. The frequency of reperfusion increased rapidly from zero at the time of onset to 60% on day 7 after stroke, reaching a maximum on day 14, at which time 77% showed reperfusion. Marked clinical improvement was observed in patients with spontaneous reperfusion ( P =.001), while no improvement occurred in patients without reperfusion. Reperfusion was not observed in subcortical infarcts. Conclusions: The rate of spontaneous reperfusion increases gradually with time and occurs within the first 2 weeks after stroke onset in approximately four of five patients with cortical infarcts. Spontaneous reperfusion seemed to improve clinical outcome.

In this study we examined the expression of platelet-derived growth factor (PDGF) A-chain and PDGF receptor genes in seven human gastric carcinoma cell lines and 15 gastric carcinoma tissues. Expression of mRNA for PDGF A-chain was found in all gastric cell lines and all gastric carcinoma tissues. Two of the seven gastric carcinoma cell lines expressed PDGF receptor mRNA. Out of the 15 gastric carcinoma tissues, eight showed enhanced expression of PDGF receptor mRNA and all of them demonstrated prominent fibrous stroma. Moreover, the incidence of enhanced expression of PDGF receptor mRNA was higher in scirrhous carcinoma than in well differentiated adenocarcinoma. These results strongly suggest that PDGF produced by tumor cells acts as a paracrine growth factor for production of fibrous stroma in gastric carcinomas.

The dependences of brightness, emission efficiency η, average electric field EA, conduction current JA, and emission lifetime τ upon the device parameters such as film thickness, substrate temperature during evaporation, and Mn concentration have been systematically investigated in ZnS:Mn thin‐film electroluminescent devices. The value of η increases rapidly with film thicknesses below 3000 A but EA decreases slowly. These results can be explained by the increase of the crystallinity of the ZnS:Mn films. The value of η increases with the Mn concentration and reaches its maximum at about 0.45 wt %. At above this Mn concentration, η and τ decrease rapidly, EA increases, and JA decreases slowly. These results may be attributed to a decrease of hot electron energy and/or an increase of the nonradiative transition probability of the excited Mn centers. The brightness‐voltage (B‐V) hysteresis characteristic is observed in this Mn concentration region. This memory effect is also discussed.

Dielectric Relaxations in Poly(γ- n -alkyl L -glutamate)s I. Study of the Relaxations above Room Temperature Using the Direct-Current Technique

A new-type hydrofoil catamaran is designed and its resistance properties are elucidated by experiments. The new hydrofoil catamaran consists of two sharp hulls like knives and two rectangular hydrofoils with high aspect ratio. About 80 to 90 percent of the weight is supported by the hydrofoils at the design speed (40 kt for 200 ton) and the total resistance coefficient at this speed is much smaller than conventional high-speed crafts or other proposals. The transition from the mostly hull-borne condition to the mostly foil-borne condition is very smoothly made owing to the sharp hulls of which buoyancy works as stabilizer for ship motions.

In order to get detailed information about the β-relaxation due to motion of side chains in poly(γ-methyl L-glutamate) poly(γ-ethyl L-glutamate) and poly(γ-n-propyl L-glutamate), the frequency and temperature dependences of loss permittivity were determined in the frequency range from 10−4 Hz to 105 Hz and at temperatures ranging from ca. −100°C to ca. 60°C. The shape of the loss permittivity as a function of frequency was independent of the side-chain length. The loci of loss-permittivity peaks on the relaxation map could be represented by two straight lines independent of the side-chain length. They intersect in the glass transition region associated with the α-relaxation due to the motion of the main chain. The activation energy below the glass transition region was thought to be essentially due to side-chain motion and estimated to be ca. 18 kcal mol−1. The value of the activation energy and shape of the loss permittivity curve are very similar to those of the β-relaxation in poly(n-alkyl methacrylate)s. The two-site model analysis of the relaxation strength also showed similarity. On the basis of these results, the molecular mechanism of the α-relaxation and the nature of the glass transition are explained in terms of the motion of the α-helix.

In the in-hospitalization health examination section of one of the Tokyo metropolitan hospitals, 356 adult males, who showed normal results were studied, divided into two groups, the alcohol drinking group and non-drinking group, by occupation, physique, age, family history, hemoglobin content, white and red blood cell count, total serum cholesterol, fasting blood sugar level, Kunkel value, value of GPT, and systolic and diastolic blood pressure. The following results were obtained: 1) Systolic and diastolic blood pressure is significantly high in the group which habitually drink alcohol. 2) Other examinations such as diet habit, family history of cerebral hemorrhage show that those in the group drinking alcohol and with high salt intake, family history of apoplexy and overweight have a significantly high blood pressure. 3) Comparing the blood pressure of the examinees who had health examinations two times (there being 2 to 11-year time interval between the first and second examination), a rise in the blood pressure is shown in the group which has four possible causes of hypertension, that is high salt intake, drinking alcohol habitually, overweight and family history of cerebral hemorrhage. The same tendency is found in the group which has three of the four items (alcohol drinking, high salt intake and family history, or alcohol drinking, high salt intake and ove1·weigh t), and in the group having two items (alcohol drinking habit and high salt intake). Therefore, it is very important to give careful directions to those who habitually drink alcohol, high salt intake, overweight and family history of cerebral hemorrhage, and in whom a rise of blood pressure in the future can be anticipated. This will help control the hypertension and show the way of making good use of the results of health examination.

Comparison of physical constitution and strength were made, in 183 workers, between sportsmen and non-sportsmen engaged in desk or operative work. 1. In the case of desk workers, sportsmen were better than non-sportsmen in physical constitution and strength. By exercise on bicycle ergometer, no differences were observed between sportsmen and non-sportsmen in R.M.R., oxygen intake and increasing rate of respiration, while sportsmen showed less increase and faster recovery of pulse rate and somewhat greater oxygen pulse in working state. These indicated that the sportsmen accommodated more easily to the exercise showing better efficiency. 2. In the case of operatives, distinct difference were not found between sportsmen and non-sportsmen as regards physical constitution and strength, and R.M.R., oxygen intake, oxygen pulse, respiration and pulse rate during exercise. These showed that workmen being trained daily in their work can accommodate to sports as well.

We recorded visual neurons with the Elgiloy microelectrode in the frontal eye field of the alert monkey. After determining their visual receptive field, saccadic eye movements were induced by applying electric pulses at the recording site through the same electrode. The saccades were generally induced so as to bring the gaze angle to a part within the receptive field.

Reduced expression of nm23 gene is implicated in high metastatic potential In a variety of malignancies. To elucidate the role of nm23 in human gastric carcinomas, we examined loss of heterozygosity (LOH) of nm23 gene by Southern blotting, nm23 mRNA expression by Northern blotting and nm23 protein expression by Western blotting as well as immunohistochemistry in both primary and metastatic tumors. LOH of nm23 gene was found in 2 (8%) out of the 23 informative gastric carcinomas. Twenty‐two (84%) out of the 26 cases expressed nm23 mRNA at higher levels in primary tumor tissue than in corresponding non‐neoplastic mucosa. No obvious correlation was observed between clinico‐pathological features and LOH of nm23 gene or nm23 mRNA expression. On the other hand, 52% of the gastric carcinomas showed reduction of nm23 immunoreactivity in the metastatic tumor of regional lymph nodes, as compared to the primary tumor. Interestingly, 71% of the gastric carcinomas showed weaker nm23 immunoreactivity in the liver metastasis than in the primary tumor. These results suggest that nm23 overexpression is linked with development of gastric carcinomas and the decrease in expression of nm23 participates in metastasis.

A C/A single nucleotide polymorphism (SNP) in the E-cadherin gene promoter has been shown to affect transcriptional efficiency in vitro. In this study, we analyzed the C/A SNP in 106 gastric carcinoma cases and 90 cancer-free controls compared with clinicopathological parameters. The genotype of C/C, C/A, and A/A was found in 61 (58%), 34 (32%) and 11 (10%) of 106 gastric carcinoma cases and in 32 (36%), 52 (58%) and 6 (6%) of 90 cancer-free controls, respectively. The genotype of C/C was significantly more frequent in gastric carcinoma cases than in cancer-free controls (p