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A novel highly fluorescent cadmium metal–organic framework, [Cd (DPTTZ) (OBA)] (IUST-3), synthesized by using two linkers 2, 5-di (pyridine-4-yl) thiazolo [5, 4-d] thiazole (DPTTZ) and 4, 4′-oxybis (benzoic acid) (OBA) simultaneously, which exhibits a two-dimensional framework. The characteristics of this Cd-MOF were investigated by single-crystal X-ray diffraction, Fourier transform infrared spectroscopy, elemental analysis, powder X-ray diffraction, and thermogravimetry analysis. The IUST-3 exhibits excellent luminescence property and good stability in water. Luminescent experiments indicate that the IUST-3 has remarkable sensitivity and selectivity for the detection of 4-nitroaniline (4-NA), and CrO42− anion with KSV = 1.03 × 105 M-1 (4-NA) and KSV = 2.93 × 104 M-1 (CrO42−) and low limit of detection 0.52 µM (4-NA) and 1.37 µM (CrO42−). In addition, the possible fluorescence quenching mechanism was explored in this paper.

A novel highly fluorescent cadmium metal–organic framework, [Cd (DPTTZ) (OBA)] (IUST-3), synthesized by using two linkers 2, 5-di (pyridine-4-yl) thiazolo [5, 4-d] thiazole (DPTTZ) and 4, 4'- oxybis (benzoic acid) (OBA) simultaneously, which exhibits a two-dimensional framework. The characteristics of this Cd-MOF were investigated by single-crystal X-ray diffraction (SXRD), fourier transform infrared spectroscopy (FT-IR), elemental analysis (EA), powder X-ray diffraction (PXRD), and thermogravimetry analysis (TGA). IUST-3 exhibits excellent luminescence property and good stability in water. Luminescent experiments indicate that IUST-3 has remarkable sensitivity and selectivity for the detection of 4-nitroaniline (4-NA), and CrO42– anion with KSV = 1.03×105 M-1 (4-NA) and KSV = 2.93×104 M-1 (CrO42–) and low limit of detection 0.52 µM (4-NA) and 1.37 µM (CrO42–). In addition, the possible fluorescence quenching mechanism was explored in this paper.

A novel highly fluorescent cadmium metal-organic framework, [Cd (DPTTZ) (OBA)] (IUST-3), synthesized by using two linkers 2, 5-di (pyridine-4-yl) thiazolo [5, 4-d] thiazole (DPTTZ) and 4, 4'-oxybis (benzoic acid) (OBA) simultaneously, which exhibits a two-dimensional framework. The characteristics of this Cd-MOF were investigated by single-crystal X-ray diffraction, Fourier transform infrared spectroscopy, elemental analysis, powder X-ray diffraction, and thermogravimetry analysis. The IUST-3 exhibits excellent luminescence property and good stability in water. Luminescent experiments indicate that the IUST-3 has remarkable sensitivity and selectivity for the detection of 4-nitroaniline (4-NA), and CrO

Background: The differentiation of a preclinical or prodromal Alzheimer’s disease (AD) is challenging particularly in patients with early onset Alzheimer’s or related dementias (EOARD). We report our experience on diagnostic lumbar puncture to diagnose EOARD at a tertiary neurocognitive referral center in Nottingham, England from March 2018 to October 2020. Objective: To assess amyloid-β42 (Aβ42), total tau, and Thr181-phosphorylated tau (p-tau) measurements in the cerebrospinal fluid (CSF) in patients with mild cognitive impairment (MCI) and in relation to their follow-up cognitive performance. Methods: Thirty participants aged 32–68 years old (mean 59 years; 57% female) were included. Clinical diagnosis was based on clinical presentation, neurocognitive profile, neuroradiological features (MRI, FDG-PET CT) and CSF Aβ42, total tau, and p-tau measurements. Results: Patients with MCI who progressed to AD (prodromal AD) had significantly higher CSF total (797.63 pg/ml) and p-tau (82.31 pg/ml), and lower Aβ42 levels (398.94 pg/ml) in comparison to their counterparts with stable MCI (total tau 303.67 pg/ml, p-tau 43.56 pg/ml, Aβ42 873.44 pg/ml) (p

COVID-19 is a significant global threat to public health. Despite the availability of vaccines and anti-viral drugs, there is an urgent need for alternative treatments to help prevent and/or manage COVID-19 symptoms and the underlying dysregulated immune response. We hypothesized that administration of InflawellA randomized placebo-controlled double-blind clinical trial was conducted, following definitive confirmation of COVID-19. Forty-seven hospitalized patients with moderate COVID-19 were enrolled and received either the InflawellOur clinical trial revealed an increase in the percentage of oxygen saturation level in patients that received the BAs compared to placebo (P 0.0001). In addition, the average duration of hospitalization was significantly shorter in the BAs group compared with the placebo group (P 0.04). Concomitantly, some improvement in the clinical symptoms including cough, dyspnea, myalgia, headache, and olfactory and gustatory dysfunction were detected in the BAs group. Hematologic findings showed a significant decrease in the percentage of neutrophils (P 0.006) and neutrophil-to-lymphocyte ratio (NLR) levels (P 0.003), associated with a significant increase in the percentage of lymphocytes in the BAs group compared with the placebo (P 0.002). Additionally, a significant decrease in CRP, LDH, IL - 6 and TNF - α levels was detected in the BAs group. Following the intervention, fewer patients in the BAs group were PCR-positive for COVID-19 compared to placebo, though not statistically significant.Overall, the treatment with InflawellThe trial has been registered in https://www.irct.ir with unique identifier: IRCT20170315033086N10 ( https://en.irct.ir/trial/51631 ). IRCT is a primary registry in the WHO registry network ( https://www.who.int/clinical-trials-registry-platform/network/primary-registries ).

Background and purpose The interrelation of cognitive performance, cerebrovascular damage and brain functional connectivity (FC) in advanced arteriosclerosis remains unclear. Our aim was to investigate the associations between FC, white matter damage and cognitive impairment in carotid artery disease. Methods Seventy-one participants with a recent cerebrovascular event and with written informed consent underwent resting-state functional magnetic resonance imaging and the Addenbrooke's Cognitive Examination - Revised (ACE-R). Network and inter-hemispheric FC metrics were compared between cognitively normal and impaired subjects, and interrelated with cognition. In order to explore the nature of FC changes, their associations with microstructural damage of related white matter tracts and cognitive performance were investigated, followed by mediation analysis. Results Participants with global cognitive impairment showed reduced FC compared to the cognitively intact subjects within the central executive network (CEN), and between hemispheres. Patients with executive dysfunction had decreased CEN FC whilst patients with memory loss demonstrated low FC in both the CEN and the default mode network (DMN). Global performance correlated with connectivity metrics of the CEN hub with DMN nodes, and between hemispheres. Cingulum mean diffusivity (MD) was negatively correlated with ACE-R and CEN-DMN FC. The cingulum MD-cognition association was partially mediated by CEN-DMN FC. Conclusions Long-range functional disconnection of the CEN with DMN nodes is the main feature of cognitive impairment in elderly subjects with symptomatic carotid artery disease. Our findings provide further support for the connectional diaschisis concept of vascular cognitive disorder, and highlight a mediation role of functional disconnection to explain associations between microstructural white matter tract damage and cognitive impairment.

Highlights • Altered hippocampal subfields functional connectivity in ischemic stroke patients. • Decreased connectivity between the hippocampus and inferior parietal lobe in the patients. • Increased connectivity in the hippocampus and cerebellum in the patients. • The degree of connectivity changes associated with the patients’ impaired memory function., Background Ischemic stroke with cognitive impairment is a considerable risk factor for developing dementia. Identifying imaging markers of cognitive impairment following ischemic stroke will help to develop prevention strategies against post-stroke dementia. Methods We investigated the hippocampal functional connectivity (FC) pattern following ischemic stroke, using resting-state fMRI (rs-fMRI). Thirty-three cognitively impaired patients after ischemic stroke and sixteen age-matched controls with no known history of neurological disorder were recruited for the study. No patient had a direct ischaemic insult to hippocampus on the examination of brain imaging. Seven subfields of hippocampus were used as seeds region for FC analyses. Results Across all hippocampal subfields, FC with the inferior parietal lobule was reduced in stroke patients as compared with healthy controls. This decreased FC included both supramarginal gyrus and angular gyrus. The FC of hippocampal subfields with cerebellum was increased. Importantly, the degree of the altered FC between hippocampal subfields and inferior parietal lobule was associated with their impaired memory function. Conclusion Our results demonstrated that decreased hippocampal-inferior parietal lobule connectivity was associated with cognitive impairment in patients with ischemic stroke. These findings provide novel insights into the role of hippocampus in cognitive impairment following ischemic stroke.

BackgroundEarly reports have detailed a range of neurological symptoms in patients with the SARS-CoV-2 infection. However, there is a lack of detailed description and incidence of the neurological disorders amongst hospitalized COVID-19 patients. We describe a range of neurological disorders (other than non-specific neurological symptoms), including their clinical, radiological and laboratory findings, encountered in our cohort of COVID-19 patients admitted to a large tertiary institution.MethodsWe reviewed our prospectively collated database of all adult Neurology referrals, Neurology and Stroke admissions and Neurological multi-disciplinary team meetings for all hospitalized patients with suspected or proven COVID-19 from 17 March 2020 to 31 August 2020.ResultsTwenty-nine of 1243 COVID-19 inpatients (2.3%) presented with COVID-19-related neurological disorders. The mean age was 68.9 +/- 13.5(SD) years, age range of 34-97 years, and there were 16 males. 22 patients had confirmed, 5 were probable and 2 had suspected COVID-19 infection according to the WHO case classification. Eight patients (27%) required critical care admission. Neurological symptoms at presentation included acute confusion and delirium, seizures, and new focal neurological deficits. Based on the pre-defined neurological phenotype, COVID-19 patients were grouped into four main categories. 16 patients had cerebrovascular events (13 with acute ischaemic stroke and 3 had haemorrhagic features), 7 patients were found to have inflammatory, non-inflammatory and autoimmune encephalopathy (including 2 with known Multiple Sclerosis), whilst disorders of movement and peripheral nervous system were diagnosed in 3 patients each.ConclusionAlthough the exact prevalence and aetiology remain unclear, new onset of neurological disorders, in addition to anosmia, is non-sporadic during the acute COVID-19-infection. Longitudinal follow-up of these patients is required to determine the clinical and functional outcome, treatment response and long-term effects of the SARS-CoV-2 infection.

It is believed that black mulberry (Morus nigra) is a healthier fruit among mulberry species due to its high bioactive content. In the present study, the morphological and chemical variabilities of this species were investigated. There were statistical differences in terms of the morphological and chemical traits between the genotypes. Out of 37 morphological and seven chemical characters, 20 morphological and five chemical traits showed a coefficient of variation (CV) greater than 20.00%, indicating a high variability between the genotypes for these traits. The fruit weight varied between 1.79 and 5.69 g with an average of 3.85 g. The highest TSS content was 24.80%, while the lowest TSS was 11.20%, with an average of 18.42. The content of total anthocyanins was found between 57.62 and 475.65 mg CGE 100 g−1 FrWe. Total phenols ranged from 232.27 to 1777.73 mg GAE 100 g−1 FrWe. The fruit weight showed positive correlations with tree growth vigor, leaf length and leaf width. In addition, fruit weight was positively correlated with fruit length and fruit width. Furthermore, TSS was positively correlated with phenolic content and flavonoid content. The results obtained from the hierarchical grouping analysis separated genotypes into three and two main groups based on morphological and chemical characters, respectively. The present study increased knowledge about the phenotypic variation and phytochemical properties of black mulberry fruits and can be useful for producers, breeders, and processors.

Objectives The goal of this study was to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic r...

Subcortical disconnection of cognitive neural networks is a key mechanism of cognitive impairment in patients with probable vascular cognitive disorder., Purpose To investigate associations between neuroimaging markers of cerebrovascular disease, including lesion topography and extent and severity of strategic and global cerebral tissue injury, and cognition in carotid artery disease (CAD). Materials and Methods All participants gave written informed consent to undergo brain magnetic resonance imaging and the Addenbrooke’s Cognitive Examination–Revised. One hundred eight patients with symptomatic CAD but no dementia were included, and a score less than 82 represented cognitive impairment. Group comparison and interrelations between global cognitive and fluency performance, lesion topography, and ultrastructural damage were assessed with voxel-based statistics. Associations between cognition, medial temporal lobe atrophy (MTA), lesion volumes, and global white matter ultrastructural damage indexed as increased mean diffusivity were tested with regression analysis by controlling for age. Diagnostic accuracy of imaging markers selected from a multivariate prediction model was tested with receiver operating characteristic analysis. Results Cognitively impaired patients (n = 53 [49.1%], classified as having probable vascular cognitive disorder) were older than nonimpaired patients (P = .027) and had more frequent MTA (P < .001), more cortical infarctions (P = .016), and larger volumes of acute (P = .028) and chronic (P = .009) subcortical ischemic lesions. Lesion volumes did not correlate with global cognitive performance (lacunar infarctions, P = .060; acute lesions, P = .088; chronic subcortical ischemic lesions, P = .085). In contrast, cognitive performance correlated with presence of chronic ischemic lesions within the interhemispheric tracts and thalamic radiation (P < .05, false discovery rate corrected). Skeleton mean diffusivity showed the closest correlation with cognition (R2 = 0.311, P < .001) and promising diagnostic accuracy for vascular cognitive disorder (area under the curve, 0.82 [95% confidence interval: 0.75, 0.90]). Findings were confirmed in subjects with a low risk of preclinical Alzheimer disease indexed by the absence of MTA (n = 85). Conclusion Subcortical white matter ischemic lesion locations and severity of ultrastructural tract damage contribute to cognitive impairment in symptomatic CAD, which suggests that subcortical disconnection within large-scale cognitive neural networks is a key mechanism of vascular cognitive disorder. Online supplemental material is available for this article.

Racism is a worldwide matter that is based on the physical characteristics of people's division into different categories on which some people become superior and some inferior. Racism and ethnicity are usually considered as the same concepts while in fact ethnicity is a sub-class of racism. In every nation, there are some ethnic groups with the same origin and similar customs that may or may not be judged equally by the power-handler ethnic groups. An example of such country is Afghanistan which is severely an ethnic country. This study explores the social, cultural, and scientific investigations done on the people's races and ethnical characteristics by using Afghan types as examples. Racism is not the result of scientific observation, but it is due to the human differences that happened between 16th and 19th century when people began differentiating among themselves. This aspect of racism is well expressed by the American sociologist "Feagin". In his view, the natural superiority of some people over others is rejected. The novel The Kite Runner depicts the two major Afghan ethnical populations, Pashtun and Hazara, and their social, cultural, and religious conflicts. Accordingly, this article will try to examine the root of ethnic prejudices and oppression among the Afghan people in the novel and the reasons for their ethnic conducts are explained and analyzed based on the Feagin’s denial of human difference. Moreover, by providing some evidence it is proved that the biological difference is just some excuses for the powerful section to gain their egotistic goals.

Background The clinical spectrum of myelin oligodendrocyte glycoprotein (MOG)-antibody-associated disease is expanding. Objective To describe an unusual case of MOG-antibody-associated hypertrophic pachymeningitis (HP). Methods Case study. Results A 57-year-old female presented with a generalised seizure on a background of 3 months history of progressive cognitive decline and behavioural changes. Brain Magnetic Resonance Imaging (MRI) revealed widespread pachymeningeal enhancement and hyperintense signal in both hippocampi. Cerebrospinal Fluid (CSF) examination was normal. The patient was found positive for MOG-antibody. She clinically improved with steroids and the MRI abnormalities completely resolved. Conclusions Clinicians might consider testing for MOG-antibody in cases with HP.

The increasing use of light emitting diodes (LED) and light receptors such as photodiodes and cameras in vehicles motivates the use of visible light communication (VLC) for inter–vehicular networking. However, the mobility of the vehicles presents a fundamental impediment for high throughput and link sustenance in vehicular VLC. While prior work has explored vehicular VLC system design, yet, there is no clear understanding on the amount of motion of vehicles in real world vehicular VLC use–case scenarios. To address this knowledge gap, in this paper, we present a mobility characterization study through extensive experiments in real world driving scenarios. We characterize motion using a constantly illuminated transmitter on a lead vehicle and a multi–camera setup on a following vehicle. The observations from our experiments reveal key insights on the degree of relative motion of a vehicle along its spatial axis and different vehicular motion behaviors. The motion characterization from this work lays a stepping stone to addressing mobility in vehicular VLC.

The goal of this study was to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic resonance imaging.IPH in carotid stenosis increases the risk of cerebrovascular events. Uncertainty remains whether risk of stroke alone is increased and whether stroke is predicted independently of known risk factors.Data were pooled from 7 cohort studies including 560 patients with symptomatic carotid stenosis and 136 patients with asymptomatic carotid stenosis. Hazards of ipsilateral ischemic stroke (primary outcome) were compared between patients with and without IPH, adjusted for clinical risk factors.IPH was present in 51.6% of patients with symptomatic carotid stenosis and 29.4% of patients with asymptomatic carotid stenosis. During 1,121 observed person-years, 66 ipsilateral strokes occurred. Presence of IPH at baseline increased the risk of ipsilateral stroke both in symptomatic (hazard ratio [HR]: 10.2; 95% confidence interval [CI]: 4.6 to 22.5) and asymptomatic (HR: 7.9; 95% CI: 1.3 to 47.6) patients. Among patients with symptomatic carotid stenosis, annualized event rates of ipsilateral stroke in those with IPH versus those without IPH were 9.0% versus 0.7% (50% stenosis), 18.1% versus 2.1% (50% to 69% stenosis), and 29.3% versus 1.5% (70% to 99% stenosis). Annualized event rates among patients with asymptomatic carotid stenosis were 5.4% in those with IPH versus 0.8% in those without IPH. Multivariate analysis identified IPH (HR: 11.0; 95% CI: 4.8 to 25.1) and severe degree of stenosis (HR: 3.3; 95% CI: 1.4 to 7.8) as independent predictors of ipsilateral stroke.IPH is common in patients with symptomatic and asymptomatic carotid stenosis and is a stronger predictor of stroke than any known clinical risk factors. Magnetic resonance imaging might help identify patients with carotid disease who would benefit from revascularization.

Tramadol is a potent analgesic drug which interacts with mu-opioid and has low effect on other opioid receptors. Unlike other opioids, it has no clinically significant effect on respiratory or cardiovascular parameters. Alakaline phosphatase is a hydrolase enzyme that prefers alkaline condition and removes phosphate group from different substrates. In this study, the interaction between tramadol and calf liver alkaline phosphatase was investigated. The results showed that tramadol can bind to alakaline phosphatase and inhibit the enzyme in an un-competitive manner. Ki and IC50 values of tramadol were determined as about 91 and 92 μM, respectively. After enzyme purification, structural changes on alakaline phosphatase-drug interaction were studied by circular dichroism and fluorescence measurement. These data revealed the alteration in the content of secondary structures and also conformational changes in enzyme occurred when the drug bound to enzyme-substrate complex.

Objective: Pruritus is a common and disturbing side effect of neuraxial opioids after cesarean section. The purpose of this study was to compare the efficacy of intravenous ondansetron and sub-hypnotic dose of propofol in control and treatment of intrathecal sufentanil induced pruritus in cesarean surgery. Methods: Totally, 90 parturient with American Society of Anesthesiology physical status grade I-II, undergoing spinal anesthesia with 2.5 μg sufentanil and 10 mg bupivacaine 0.5% were enrolled to this randomized, prospective, double-blind study. The women were randomly assigned to two groups who received 8 mg ondansetron or 10 mg propofol to treat pruritus grade ≥3. The patient was evaluated after 5 min and in the lack of successful treatment, the doses of two drugs repeated and if the pruritus is on-going, the exact treatment with naloxone was done. Findings: The incidence of pruritus was 69.3%. Both groups were well-matched. The peak time pruritus was 30-75 min after injection. The percentage of individuals consumed naloxone were 6.8% and 15.9% in ondansetron and propofol groups, respectively (P = 0.18). The mean score of satisfaction (according to visual analog scale criteria) was 9.09 ± 1.1 in ondansetron group and 9.3 ± 1.07 in the propofol group (P = 0.39). Conclusion: Ondansetrone and sub-hypnotic dose of propofol are both safe and well-tolerated. Due to their same efficacy in the treatment of intrathecal sufentanil-induced pruritus, they can be widely used in clinical practice.

Background and purpose The role of clinical factors, cerebral infarcts and hippocampal damage in vascular cognitive impairment (VCI) subtypes remains unclear. Methods Non-demented patients with carotid stenosis and recent transient ischemic attack/stroke had cognitive assessment and brain magnetic resonance imaging (MRI). Amnestic VCI was defined as memory impairment; non-amnestic VCI was any other subdomain impairment. Associations of MRI metrics [log-transformed total ischemic lesion load (log TILL), mesiotemporal atrophy (MTA) score, hippocampal mean diffusivity (hipMD)] with cognitive performance were assessed. Results A hundred and eight patients, 47 with amnestic VCI and 21 with non-amnestic VCI, were assessed. A higher MTA (odds ratio 12.89, P = 0.001) and left hipMD (odds ratio 4.43, P = 0.003) contributed to amnestic VCI versus normal. Age-adjusted fluency correlated with log TILL (P = 0.002). Age-adjusted memory was associated with left hipMD (P = 0.001), MTA (P < 0.001) but not log TILL (P = 0.14). Left hipMD, MTA and smoking showed classification potential between amnestic VCI versus normal (area 0.859, P < 0.001). Conclusions Neuroimaging assists stratification in amnestic VCI characterized by hippocampal changes and in non-amnestic VCI by higher ischemic burden. MTA and hippocampal diffusivity show diagnostic biomarker potential.

Key Clinical Message Subarachnoid hemorrhage as a presentation of cerebral venous sinus thrombosis (CVST) is a rare but recognized phenomenon. A high index of suspicion among clinicians and an awareness of subtle CT features can avoid delayed diagnosis of underlying CVST [Eur J Neurol., 17, 2010, 1249]. Prompt but careful anticoagulation can prevent significant associated morbidity and mortality.

IntroductionMoyamoya disease is a chronic progressive cerebrovascular occlusive disease with prominent basal collateral vessels which appear hazy like a puff of smoke on angiography. Neuropsychiatric disorders have been reported in 20–60% cases and the most common manifestations include depression, anxiety and other cognitive disorders. However, only a few case reports of onset of a psychotic disorder following a cerebrovascular accident. We present a rare presentation of Moyamoya disease in adulthood.CaseA 44-year-old man from Bangladesh presented with acute psychotic episodes of visual, auditory and tactile hallucinations, paranoia, somatoform disorders and non-epileptic attacks. He had a 3-year history of mental health disorders and was later admitted to the hospital with a headache and hemiparesis secondary to an intraventricular haemorrhage. The neuroimaging showed characteristic appearances of Moyamoya disease. Neurosurgical multidisciplinary meeting discussion opted for conservative management and stroke rehabilitation. Despite the improvement of his neurological deficits, he continued to show apathy, depression, psychogenic attacks with features of executive dysfunction. Due to family history of juvenile death in the family, the patient had genetic testing and was found to have the mutation in the gene Ring finger protein 213 (RNF213).ConclusionThis case highlights the awareness of neuropsychiatric manifestation of Moyamoya disease that could be related to the interruption of the striato-thalamo-cortical circuits. The susceptibility to Moyamoya disease-2 (MYMY2) may be conferred by variation in the RNF213 gene on chromosome 17q25.

Objective There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. Methods One hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events. Results One hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p

Background and Purpose— Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. Methods— One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. Results— Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P =0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P =0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without ( P P =0.004). Conclusions— The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.

Here photo- and pH-responsive behavior of polymer micelles formed by synthesized azo-modified poly (monomethyl itaconate)s (PMMI-Azo) with appropriate amounts of azobenzene side groups (DSAzo) were reported. The PMMI-Azo polymer with DSazo = 20 was used for the preparation of micelles using dialysis method. Self-assembly behavior of the PMMI-Azo was studied by transmission electron microscopy (TEM), fluorescence spectroscopy, dynamic light scattering (DLS) and UV–Vis spectrophotometry techniques. It was found that the PMMI-Azo polymers self-assembled into spherical micelles with core-shell structures. TEM images and DLS analysis of the PMMI-Azo-20 micelles showed regular spherical micelles which increased in size and polydispersity index after UV irradiation, caused by isomerization. It was also found that with increasing the polymer concentration, the fluorescence intensity decreased obviously which could be attributed to the interactions between the closely located pyrene and azobenzene in the micelles core. Experimental results suggested that the micellization-enhanced fluorescence was caused by a slowdown in the rate of the trans-to-cis photoisomerization. Furthermore, it was found that the fluorescence intensity of the aqueous micellar solutions was sensitive to stimulus such as pH change and UV light irradiation, as a result of alteration in aqueous micellar association. The results clearly indicated the role of UV irradiation and pH in the state of the polymer micellar association which is responsible for fluorescence intensity.

Although new product development and its importance for companies as a new approach is accompanied by risks, identification of competitive advantage factors can be helpful for managers in reduction of decision-making risks. The Toos Nirro technical firm is a leading company in meeting the demands of its industry in Iran as it is one of the most effective manufacturing centers in Iran, which is committed to complying with modern standards and taking advantage of the latest scientific achievements and transfer of technology. The statistical population included experts and top managers at the Toos Niroo technical firm. The present study was conducted to identify and rate competitive advantage factors in new product development in the Toos Niroo technical firm. In addition to identification of the factors, they were also rated to reveal which factor ranked the high in new product development. This was an applied research which was carried out by a descriptive survey methodology. Using the Cochran method, a sample of 50 people was adopted and data were collected by questionnaire and analyzed using SPSS software (p < 0.15). Hypotheses were tested with the Kolmogorov–Smirnov and parametric tests. Results indicated that competitive advantage factors including quality, efficiency, innovation, and accountability were positively and significantly related to new product development.

BACKGROUND AND PURPOSE: MR imaging–detected carotid plaque hemorrhage is associated with an increased risk of recurrent ischemic cerebrovascular events and could be an indicator of disease progression; however, there are limited data regarding the dynamics of the MR imaging–detected carotid plaque hemorrhage signal. We assessed the temporal change of this signal and its impact on carotid disease progression. MATERIALS AND METHODS: Thirty-seven symptomatic patients with 54 carotid stenoses of >30% on sonography underwent serial MR imaging during 24 months. A signal-intensity ratio of >1.5 between the carotid plaque and adjacent muscle was defined as plaque hemorrhage, and a change in signal-intensity ratio of >0.31 between time points was considered significant. Sixteen patients underwent ≥2 carotid sonography scans to determine the peak systolic velocities and degree of stenosis with time. RESULTS: Of the 54 carotids, 28 had the presence of hyperintense signal on an MR imaging sequence (PH+) and 26 had the absence of hyperintense signal on an MR imaging sequence (PH−) at baseline. The signal-intensity ratio was stable in 33/54 carotid plaques, but 39% showed a change. Plaque hemorrhage classification did not change in 87% of carotid plaques, but 4 became PH+, and 3, PH−. As a group, PH+ carotids did not change significantly in signal-intensity ratio ( P = .585), whereas PH− showed an increased signal-intensity ratio at 24.5 months ( P = .02). In PH+ plaques, peak systolic velocities significantly increased by 22 ± 39.8 cm/s from baseline to last follow-up sonography ( Z = 2.427, P = .013). CONCLUSIONS: During 2 years, MR imaging–detected carotid plaque hemorrhage status remained stable in most (87%) cases with 4 (7%) incident plaque hemorrhages. PH+ plaques were associated with increased flow velocity during the follow-up period. MR imaging-PH : MR imaging–detected plaque hemorrhage PH : plaque hemorrhage PH+ : presence of hyperintense signal on an MR imaging sequence PH− : absence of hyperintense signal on an MR imaging sequence PSV : peak systolic velocity SIR : signal-intensity ratio

Case A 21-year-old male immigrant from Afghanistan presented with seizures 2 years previously. MRI brain was suggestive of a possible low-grade glioma affecting the right temporal lobe. After 2 years, he re-presented with symptoms of headache, intermittent pyrexia, raised intracranial pressure (opening pressure of >42 cm/H2O) requiring ventriculoperitoneal shunt to preserve his vision. MRI head revealed slight progression in appearance within the right medial temporal lobe and extension into the right cerebral peduncle with enhancement of the basal meninges as well as 7th and 8th nerve complexes. CSF consistently showed two-digit lymphocytes, with raised protein and moderately reduced glucose ratio. Large CSF samples for cytology and flow-cytometry, Acid-Fast-Bacilli, and IgG subtypes remained negative. He had lymphopaenia. CT body/PET scans revealed no lymphadenopathy. Originally, tuberculosis was considered and quadruple anti-tuberculosis therapy was given along with oral Prednisolone. His first negative tuberculosis culture after 6 weeks coincided with increasing widespread leptomeningeal spread into the intradural spinal cord. Brain biopsy from the basal leptomeninges and temporal lobe confirmed anaplastic astrocytoma. Conclusion Anaplastic astrocytoma can present as aggressive and diffuse leptomeningeal brain and spinal disease mimicking CNS tuberculosis. Persistently negative Acid-Fast-Bacilli from the CSF samples should prompt consideration of less typical primary brain tumours.

Introduction An unusual case of autoimmune, relapsing-remitting, polyneuropathy with myositis. No definitive treatment pathways are outlined for such atypical presentations. Case A 69 year old man presented in 2006 with diplopia, facial weakness, bulbar dysfunction, profound sensory motor neuropathy (distally more than proximally), and hyporeflexia. Blood at the time did not reveal any major abnormalities. Electrophysiology confirmed severe sensory and motor axonal polyneuropathies. Sural nerve biopsy was non-specific, whereas muscle biopsy specifically showed peri-vascular inflammatory cells. Following significant improvement with intra-venous methylprednisolone, he returned to a functional independent life. More debilitating similar episodes recurred six and nine years later with involvement of cranial nerves 2–7, 9–12, accompanied by predominantly upper limb weakness and hyporeflexia. Post-contrast neural MR and CSF constituents remained normal (negative antiganglioside antibodies). Electrophysiology confirmed progressive axonal peripheral polyneuropathy. Liver biopsy ruled out cirrhosis/autoimmune hepatitis. In 2016, repeat Ro antibodies were positive, with3-year history of Raynaud’s phenomenon. Patient was treated with immunoglobulin, intravenous Methylprednisolone, followed by oral steroids. Subsequently, intravenous Cyclophosphamide then Mycophenolate with ongoing tapered steroids resulted in good response, despite persistent muscle wasting without fasciculations. Conclusion We report a unique case of relapsing immune-mediated cranial and peripheral neuropathy with myositits, responsive to aggressive and sustained immunosuppressive therapy.

Introduction Posterior reversible encephalopathy syndrome (PRES) typically affects the posterior subcortical white matter although more anterior involvement has been described. Case We report the case of a 68-year-old woman with atypical PRES, who seven month previously presented with an episode of hypertension and heart failure associated with PRES. Following a full clinical recovery within a few days, she had returned to her normal independent life. Her second presentation with malignant hypertension, renal dysfunction, single seizure and fluctuating level of consciousness was rapidly followed by tetraplegia without any lower motor neuron signs. Magnetic resonance imaging of the brain within 48 hours revealed extensive vasogenic oedema in the deep white matter in both cerebral hemispheres including the brainstem and cerebellum, as well as in the frontoparietal region and temporal lobes with diffuse post-contrast enhancement. Extensive antihypertensive therapy and subsequent improvement in renal function contributed to both clinical and radiological improvement. Prolonged rehabilitation has been required to enable functional recovery. Conclusion We report an atypical PRES presenting with tetraplegia and reversible vasogenic oedema involving all brain areas, including temporal lobes, with diffuse post-contrast enhancement.