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We determined to identify patients with unknown onset stroke who could have favorable 90-day outcomes after low-dose thrombolysis from the THAWS (Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes With Alteplase at 0.6 mg/kg) database.

This was a subanalysis of an investigator-initiated, multicenter, randomized, open-label, blinded-end point trial. Patients with stroke with a time last-known-well >4.5 hours who showed a mismatch between diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery were randomly assigned (11) to receive alteplase at 0.6 mg/kg intravenously or standard medical treatment. The patients were dichotomized by ischemic core size or National Institutes of Health Stroke Scale score, and the effects of assigned treatments were compared in each group. The efficacy outcome was favorable outcome at 90 days, defined as a modified Rankin Scale score of 0 to 1.

The median DWI-Alberta Stroke Program Early CT Score (ASPECTS) was 9, and the median ischemic core volume wafter low-dose thrombolysis than after standard treatment. Registration URL https//www.clinicaltrials.gov; Unique Identifier NCT02002325. URL https//www.umin.ac.jp/ctr; Unique Identifier UMIN000011630.

Patients developing unknown onset stroke with DWI-ASPECTS 5 to 8 showed favorable outcomes more commonly after low-dose thrombolysis than after standard treatment. Registration URL https//www.clinicaltrials.gov; Unique Identifier NCT02002325. URL https//www.umin.ac.jp/ctr; Unique Identifier UMIN000011630.

Oral anticoagulation is generally indicated for cardioembolic strokes, but not for other stroke causes. Consequently, subtype classification of ischemic stroke is important for risk stratification and secondary prevention. Because manual classification of ischemic stroke is time-intensive, we assessed the accuracy of automated algorithms for performing cardioembolic stroke subtyping using an electronic health record (EHR) database.

We adapted TOAST (Trial of ORG 10172 in Acute Stroke Treatment) features associated with cardioembolic stroke for derivation in the EHR. Using administrative codes and echocardiographic reports within Mass General Brigham Biobank (N=13 079), we iteratively developed EHR-based algorithms to define the TOAST cardioembolic stroke features, revising regular expression algorithms until achieving positive predictive value ≥80%. We compared several machine learning-based statistical algorithms for discriminating cardioembolic stroke using the feature algorithms applied to EHR data frofeatures.

Machine learning-based identification of cardioembolic stroke using EHR data is feasible. Future work is needed to improve the accuracy of automated cardioembolic stroke identification and assess generalizability of electronic phenotyping algorithms across clinical settings.

Machine learning-based identification of cardioembolic stroke using EHR data is feasible. Future work is needed to improve the accuracy of automated cardioembolic stroke identification and assess generalizability of electronic phenotyping algorithms across clinical settings.Purpose Public high school campuses in the United States are generally built with multiple dedicated physical activity facilities from soccer fields to swimming pools. When viewed from a community health standpoint, these campuses hold great potential (if accessible) in providing community members spaces where they can engage in physical activity during non-school hours. Guided by the Social-Ecological Model (SEM) the purpose of this study was to assess access to and use of all physical activity areas on public high school campuses during non-school hours on weekdays and weekend days. Method Direct observation using the SOPARC instrument was used to assess 19 public high schools across four districts in the Western U.S., by completing 3959 physical activity area sweeps. Results Facilities were accessible about half of the time (53.4%), but empty 91% of the time. Public high school campuses are an underused resource for community physical activity during non-school hours. Discussion Increased use of joint-use agreements would enable school districts to increase both the use of campus-based physical activity facilities and physical activity levels of community members who themselves fund the construction and maintenance of schools and school grounds through local taxes. This would help increase the schools’ caloric footprint and contribute to improving public health.

The class Ic antiarrhythmic drug flecainide prevents ventricular tachyarrhythmia in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT), a disease caused by hyperactive RyR2 (cardiac ryanodine receptor) mediated calcium (Ca) release. Although flecainide inhibits single RyR2 channels in vitro, reports have claimed that RyR2 inhibition by flecainide is not relevant for its mechanism of antiarrhythmic action and concluded that sodium channel block alone is responsible for flecainide’s efficacy in CPVT.

To determine whether RyR2 block independently contributes to flecainide’s efficacy for suppressing spontaneous sarcoplasmic reticulum Ca release and for preventing ventricular tachycardia in vivo.

We synthesized N-methylated flecainide analogues (QX-flecainide and

-methyl flecainide) and showed that

-methylation reduces flecainide’s inhibitory potency on RyR2 channels incorporated into artificial lipid bilayers.

-methylation did not alter flecainide’s inhibitory activity on humanen cardiac sodium channels are blocked. In mice with CPVT, sodium channel block alone did not prevent ventricular tachycardia. Hence, RyR2 channel inhibition likely constitutes the principal mechanism of antiarrhythmic action of flecainide in CPVT.

Flecainide remains an effective inhibitor of RyR2-mediated arrhythmogenic Ca release even when cardiac sodium channels are blocked. check details In mice with CPVT, sodium channel block alone did not prevent ventricular tachycardia. Hence, RyR2 channel inhibition likely constitutes the principal mechanism of antiarrhythmic action of flecainide in CPVT.

Infectious complications can be a major cause of morbidity and mortality in solid organ transplant recipients. Preservation fluid is necessary to maintain organ viability but may serve as a vector or infection. The utility of screening preservation fluid routinely for microbial growth and the impact of culture-positive preservation fluid is controversial. Research Question What is the clinical impact of a culture positive preservation fluid in a kidney transplant recipient?

This retrospective study was performed to define the incidence of post-operative infection related to PF and examine the negative sequelae of culture-positive PF. One hundred and fifty-two deceased donor renal transplant recipients from January 2015 to December 2017 were included for analysis.

Overall, 67% of patients (102/152) received an allograft from a culture-positive PF. Nearly 80% of microbial growth was consistent with skin flora, and coagulase-negative staphylococci was the most frequently isolated organism (56%). Sixty-seven percent of patients (68/102) with culture-positive PF received antimicrobial treatment for an average duration of 5 days.