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Rationale: For patients with acute ischemic stroke and large vessel occlusions, intravenous thrombolysis and endovascular therapy are standard of care, but the effect of endovascular therapy is superior to intravenous thrombolysis. If a severe stroke with symptoms indicating large vessel occlusions occurs in the catchment area of a primary stroke center, there is equipoise regarding optimal transport strategy. Aim: For patients presenting with suspected large vessel occlusions (PASS ≥ 2) and a final diagnosis of acute ischemic stroke, we hypothesize that bypassing the primary stroke center will result in an improved 90-day functional outcome. Sample size: We aim to randomize 600 patients, 1:1. Design: A national investigator-driven, multi-center, randomized assessor-blinded clinical trial. The Prehospital Acute Stroke Severity Scale has been developed. It identifies most patients with large vessel occlusions in the pre-hospital setting. Patients without a contraindication for intravenous thrombolysis are randomized to either transport directly to a comprehensive stroke centers for intravenous thrombolysis and of endovascular therapy or to a primary stroke center for intravenous thrombolysis and subsequent transport to a comprehensive stroke centers for of endovascular therapy, if needed. Outcomes: The primary outcome will be the 90-day modified Rankin Scale score (mRS) for all patients with acute ischemic stroke. Secondary outcomes include 90-day mRS for all randomized patients, all patients with ischemic stroke but without large vessel occlusions, and patients with hemorrhagic stroke. The safety outcomes include severe dependency or death and time to intravenous thrombolysis for ischemic stroke patients. Discussion: Study results will influence decision making regarding transport strategy for patients with suspected large vessel occlusions. [ABSTRACT FROM AUTHOR]

ABSTRACT We propose a method to formulate probabilistic models of protein structure in atomic detail, for a given amino acid sequence, based on Bayesian principles, while retaining a close link to physics. We start from two previously developed probabilistic models of protein structure on a local length scale, which concern the dihedral angles in main chain and side chains, respectively. Conceptually, this constitutes a probabilistic and continuous alternative to the use of discrete fragment and rotamer libraries. The local model is combined with a nonlocal model that involves a small number of energy terms according to a physical force field, and some information on the overall secondary structure content. In this initial study we focus on the formulation of the joint model and the evaluation of the use of an energy vector as a descriptor of a protein's nonlocal structure; hence, we derive the parameters of the nonlocal model from the native structure without loss of generality. The local and nonlocal models are combined using the reference ratio method, which is a well-justified probabilistic construction. For evaluation, we use the resulting joint models to predict the structure of four proteins. The results indicate that the proposed method and the probabilistic models show considerable promise for probabilistic protein structure prediction and related applications. Proteins 2014; 82:288-299. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Being diagnosed with schizophrenia is associated with an increased risk of developing cardiovascular diseases such as Acute Coronary Syndrome (ACS). The aim of this study is to investigate the effect of schizophrenia on all-cause mortality, reinfarction and stroke rates following ACS. The length of hospital stay following admission for ACS and prevalence of cardiac risk factors are also investigated. Methods: Data from three nationwide databases in Denmark were used in this study, including; The Danish Civil Registration System, the National Patient register and the Danish Psychiatric Central Register. Patients diagnosed with a first ACS (unstable angina ICD-10 I20.0, NSTEMI ICD-10 I21.4 and STEMI ICD-10 I21.0-I21.3) between 2000-2014 were identified and categorized for an additional diagnosis of schizophrenia ICD-10 F20. The patients were matched 1:2 to a psychiatric healthy control (PHC) population on gender, age and year of first ACS diagnosis. The cardiac risk factors investigated were anemia, hypertension, diabetes mellitus (type 1 and 2) and hyperlipidemia. Results: A total of 1,383 patients diagnosed with any ACS were analyzed (schizophrenia = 461, PHC = 922). The mean age at the time of ACS diagnosis was 61.7 years and 69.0% were males. Having schizophrenia was associated with post-ACS all-cause mortality hazard ratios (HR) of 2.70 (CI 95%: 2.24-3.24) and post-ACS stroke HR of 1.77 (CI 95%: 1.11-2.82). No difference was found in the reinfarction rates between the populations. The length of hospital stays fluctuated from a lowest mean of 7.7 days (CI 95%: 5.4-10.0) to a highest mean of 9.7 days (CI 95%: 5.14-14.2). However, none of the comparisons on LoS resulted in statistically significant differences. Patients with schizophrenia were more likely to have anemia and there were no differences in prevalence of the remaining cardiac risk factors investigated. Conclusion: Patients with schizophrenia had increased all-cause mortality and stroke rates following ACS. However, no difference was found in the length of hospital stay between the populations. The only cardiac risk factor with a higher prevalence in the population with schizophrenia was anemia. [ABSTRACT FROM AUTHOR]