Neuroimaging Prediction of Hemorrhagic Transformation for Acute Ischemic Stroke

<b><i>Background:</i></b> Hemorrhagic transformation (HT) is a common complication of acute ischemic stroke, often resulting from reperfusion therapy. Early prediction of HT can enable stroke neurologists to undertake measures to avoid clinical deterioration and make optimal treatment strategies. Moreover, the trend of extending the time window for reperfusion therapy (both for intravenous thrombolysis and endovascular treatment) further requires more precise detection of HT tendency. <b><i>Summary:</i></b> In this review, we summarized and discussed the neuroimaging markers of HT prediction of acute ischemic stroke patients, mainly focusing on neuroimaging markers of ischemic degree and neuroimaging markers of blood-brain barrier permeability. This review is aimed to provide a concise introduction of HT prediction and to elicit possibilities of future research combining advanced technology to improve the accessibility and accuracy of HT prediction under emergent clinical settings. <b><i>Key Messages:</i></b> Substantial studies have utilized neuroimaging, blood biomarkers, and clinical variables to predict HT occurrence. Although huge progress has been made, more individualized and precise HT prediction using simple and robust imaging predictors combining stroke onset time should be the future goal of development.

Initiatives for immune-related adverse events by the outpatient pharmacist clinic

Early detection is the key in managing side effects because immune-related adverse events (irAEs) are becoming more serious, and their onset time differs. In our hospital, we conducted an outpatient pharmacist clinic for early detection of irAEs by self-care practice for the cases of immune checkpoint inhibitor administration. As a result of a retrospective survey of 207 cases, the percentage of irAEs found by pharmacist’s suggestion of the outpatient pharmacist clinic increased over time, and a high detection ratio was obtained even for irAEs with a late onset time. The incidence of serious irAEs was higher than that in the immediate post-marketing surveillance, and different factors were considered. Although there were some problems, the outpatient pharmacist clinic had a certain effect.

Ionospheric Plasma Flows Associated with the Formation of the Distorted Nightside End of A Transpolar Arc

We investigate ionospheric flow patterns from 28th January 2002 associated with the development of the nightside distorted end of a “J”-shaped Transpolar Arc (nightside distorted TPA). Based on the nightside ionospheric flows near to the TPA, detected by the SuperDARN radars, we discuss how the distortion of the nightside end toward the pre-midnight sector is produced. The “J”-shaped TPA was seen under southward Interplanetary Magnetic Field (IMF) conditions, in the presence of a dominant dawnward IMF-By component. At the onset time of the nightside distorted TPA, particular equatorward plasma flows at the TPA growth point were observed in the post-midnight sector, flowing out of the polar cap and then turning toward the pre-midnight sector of the main auroral oval along the distorted nightside part of the TPA. We suggest that these plasma flows play a key role in causing the nightside distortion of the TPA. SuperDARN also found ionospheric flows typically associated with “Tail Reconnection during IMF Northward Non-substorm Intervals” (TRINNIs) on the nightside main auroral oval before and during the TPA interval, indicating that nightside magnetic reconnection is an integral process to the formation of the nightside distorted TPA. During the TPA growth, SuperDARN also detected anti-sunward flows across the open-closed field line boundary on the dayside that indicate the occurrence of low-latitude dayside reconnection and ongoing Dungey cycle driving. This suggests that nightside distorted TPA can grow even in Dungey-cycle-driven plasma flow patterns.

A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection

Ultrasound-guided hydrodissection with 5% dextrose in water (DW5) creates a peri-nervous compartment, separating the nerve from the neighboring anatomical structures. The aim of this randomized study was to determine the minimum volume of lidocaine 2% with epinephrine 1:200,000 required when using this technique to achieve an effective median nerve block at the elbow in 95% of patients (MEAV95). Fifty-two patients scheduled for elective hand surgery received an ultrasound-guided circumferential perineural injection of 4 ml DW5 and an injection of local anesthetic (LA) following a biased coin up-and-down sequential allocation method. A successful block was defined as a light touch completely suppressed on the two distal phalanges of the index finger within a 30-min evaluation period. The MEAV95 of lidocaine 2% with epinephrine was 4 ml [IQR 3.5–4.0]. Successful median nerve block was obtained in 38 cases (82.6%) with median onset time of 20.0 [10.0–21.2] minutes (95% CI 15–20). The analgesia duration was 248 [208–286] minutes (95% CI 222–276). Using an ultrasound-guided hydrodissection technique with DW5, the MEAV95 to block the median nerve at the elbow with 2% lidocaine with epinephrine was 4 ml [IQR 3.5–4.0]. This volume is close to that usually recommended in clinical practice.Trial registration clinicaltrials.gov. NCT02438657, Date of registration: May 8, 2015.

Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient Clinic: Historical Cohort

The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.

Effect of Age and Gender on Voice Onset Time: Data from Sinhalese

Objective: To documenting the voice onset time in voiced and unvoiced stop consonants in Sinhala and to investigating the effects of age and gender on voice onset time values in Sinhalese speakers. Methods: Three groups of participants were employed. Group 1 included 20 children, Group 2 included 20 adults and Group 3 consisted of 20 elderly subjects. All the subjects spoke the dialect of central province of Sri Lanka. Words consisting of three Sinhala short vowels /a/, /i/ and /u/ in were recorded. Voice onset time values from two voiced and voiceless stop consonants were extracted. Results: Voiced stop consonants had significantly longer voice onset time values compared to voiceless stop consonants. Significant effect of age as well as gender on voice onset time values were also observed. Conclusion: Supplementary investigations on the normative aspects of voice onset time among the Sinhala population would provide additional insights and validated tools for indexing the articulatory and acoustic characteristics of stop consonants in Sinhalese. Keywords: Voice Onset Time, Sinhalese, Elderly, Sinhala, Acoustic analysis

Acoustic classification of coronal stops of Eastern Punjabi

Punjabi is an Indo-Aryan language which contrasts a rich set of coronal stops at dental and retroflex places of articulation across three laryngeal configurations. Moreover, all these stops occur contrastively in various positions (word-initially, -medially, and -finally). The goal of this study is to investigate how various coronal place and laryngeal contrasts are distinguished acoustically both within and across word positions. A number of temporal and spectral correlates were examined in data from 13 speakers of Eastern Punjabi: Voice Onset Time, release and closure durations, fundamental frequency, F1-F3 formants, spectral center of gravity and standard deviation, H1*-H2*, and cepstral peak prominence. The findings indicated that higher formants and spectral measures were most important for the classification of place contrasts across word positions, whereas laryngeal contrasts were reliably distinguished by durational and voice quality measures. Word-medially and -finally, F2 and F3 of the preceding vowels played a key role in distinguishing the dental and retroflex stops, while spectral noise measures were more important word-initially. The findings of this study contribute to a better understanding of factors involved in the maintenance of typologically rare and phonetically complex sets of place and laryngeal contrasts in the coronal stops of Indo-Aryan languages.

Automatic Detection of Slow Slip Events Using the PICCA: Application to Chilean GNSS Data

The detection of transient events related to slow earthquakes in GNSS positional time series is key to understanding seismogenic processes in subduction zones. Here, we present a novel Principal and Independent Components Correlation Analysis (PICCA) method that allows for the temporal and spatial detection of transient signals. The PICCA is based on an optimal combination of the principal (PCA) and independent component analysis (ICA) of positional time series of a GNSS network. We assume that the transient signal is mostly contained in one of the principal or independent components. To detect the transient, we applied a method where correlations between sliding windows of each PCA/ICA component and each time series are calculated, obtaining the stations affected by the slow slip event and the onset time from the resulting correlation peaks. We first tested and calibrated the method using synthetic signals from slow earthquakes of different magnitudes and durations and modelled their effect in the network of GNSS stations in Chile. Then, we analyzed three transient events related to slow earthquakes recorded in Chile, in the areas of Iquique, Copiapó, and Valparaíso. For synthetic data, a 150 days event was detected using the PCA-based method, while a 3 days event was detected using the ICA-based method. For the real data, a long-term transient was detected by PCA, while a 16 days transient was detected by ICA. It is concluded that simultaneous use of both signal separation methods (PICCA) is more effective when searching for transient events. The PCA method is more useful for long-term events, while the ICA method is better suited to recognize events of short duration. PICCA is a promising tool to detect transients of different characteristics in GNSS time series, which will be used in a next stage to generate a catalog of SSEs in Chile.

Association between Sleep Time and Blood Pressure in Korean Adolescents: Cross-Sectional Analysis of KNHANES VII

Background: Hypertension is highly related to sleep, and there have been a number of studies on sleep deprivation and the occurrence of hypertension. However, there is still insufficient research on the relationship between hypertension and various factors related to sleep. Thus, this study attempted to investigate the relationship between hypertension and sleep time-related variables in Korean adolescents. Methods: A total of 1470 adolescents (709 girls and 761 boys) between 12 and 18 years of age were enrolled through the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII). The systolic and diastolic blood pressure were measured. Sleep time-related variables such as sleep onset time, wake time, and sleep duration (weekday and weekend, each) were also investigated using a questionnaire. We performed multivariate regression analyses to determine the independent effects of the variables. Results: Systolic blood pressure was negatively correlated with the wake time (r = −0.081; p = 0.002) and sleep onset time (r = −0.088; p = 0.001) on weekends. There was a positive correlation between diastolic blood pressure and weekday sleep onset time (r = 0.158; p = 0.000) and weekend sleep onset time (r = 0.184; p = 0.000). The sleep duration on weekdays and weekends showed a negative correlation (r = −0.136; p = 0.000, r = −0.088; p = 0.001, respectively). In the multivariate linear regression analysis results, the sleep onset time on weekends was significantly correlated with elevated diastolic blood pressure. Conclusions: Delayed sleep onset time on weekends was significantly associated with increased diastolic blood pressure in Korean adolescents. Further investigation is needed to confirm the clinical significance of these findings.

De LaurentESE

An increasing amount of sociolinguistic research has been concentrated on diachronic idiolect change: the change of an individual’s dialect over time. This paper adds to this growing topic by analyzing the English idiolect change of Giada De Laurentiis, a heritage speaker of Italian. The study analyzes De Laurentiis’ LOT, START, and GOAT vowels, as well as the voice onset time (VOT) of voiceless stops [k] and [p] by measuring the utterances of the code-switched word ‘mascarpone’ across 20 seasons on television. The data reflect the influence of L2 US English (rhoticity, diphthongization, lengthened VOTs) on heritage Italian in De Laurentiis’ idiolect.