Background Decreased diffusion (DD) consistent with acute ischemia may be detected on MRI after acute intracerebral hemorrhage (ICH), but its risk factors and impact on functional outcomes are not well defined. We tested the hypotheses that DD after ICH is related to acute blood pressure (BP) reduction and lower hemoglobin (HGB) and presages worse functional outcomes. Methods Patients who underwent MRI were prospectively evaluated for DD by certified neuroradiologists blinded to outcomes. HGB and BP data were obtained via electronic queries. Outcomes were obtained at 14 days and 3 months with the modified Rankin Scale (mRS), a functional scale scored from 0 (no symptoms) to 6 (dead). We used logistic regression for dependence or death (mRS 4 to 6). Results DD distinct from the hematoma was found on MRI in 36 of 95 patients (38%). DD was associated with greater BP reductions from baseline, and a higher risk of dependence or death at 3 months (OR 4.8, 95% CI 1.7 – 13.9, P=0.004) after correction for ICH Score (1.8 per point, 95%CI 1.2–3.1, P=0.01). Lower HGB was associated with worse ICH score, larger hematoma volume and worse outcomes, but not DD. Conclusions DD is common after ICH, associated with greater acute BP reductions, and associated with disability and death at 3 months in multivariate analysis. The potential benefits of acute BP reduction to reduce hematoma growth may be limited by DD. The prevention and treatment of cerebral ischemia manifested as DD is a potential method to improve outcomes.
Background: High blood pressure (BP) is a known risk factor for mobility and cognitive impairment in older adults. This study tested the association of cumulative BP exposure from young adulthood to midlife with gait and cognitive function in midlife. Furthermore, we tested whether these associations were modified by cerebral white matter hyperintensity (WMH) burden. Methods: We included 191 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults), a community-based cohort of young individuals followed over 30 years. Cumulative BP was calculated as the area under the curve (mm Hg×years) from baseline up to year 30 examination. Gait and cognition were assessed at the year 30 examination. Cerebral WMH was available at year 30 in a subset of participants (n=144) who underwent magnetic resonance imaging. Multiple linear regression models were used to assess the association of cumulative BP exposure with gait and cognition. To test effect modification by WMH burden, participants were stratified at the median of WMH and tested for interaction. Results: Higher cumulative systolic and diastolic BPs were associated with slower walking speed (both P =0.010), smaller step length ( P =0.011 and 0.005, respectively), and higher gait variability ( P =0.018 and 0.001, respectively). Higher cumulative systolic BP was associated with lower cognitive performance in the executive ( P =0.021), memory ( P =0.015), and global domains ( P =0.010), and higher cumulative diastolic BP was associated with lower cognitive performance in the memory domain ( P =0.012). All associations were independent of socio-demographics and vascular risk factors (body mass index, smoking, diabetes mellitus and total cholesterol). The association between cumulative BP and gait was moderated by WMH burden (interaction P <0.05). However, the relation between cumulative BP and cognitive function was not different based on the WMH burden (interaction P >0.05). Conclusions: Exposure to higher BP levels from young to midlife is associated with worse gait and cognitive performance in midlife. Furthermore, WMH moderates the association of cumulative BP exposure with gait, but not with cognitive function in midlife. The mechanisms underpinning the impact of BP exposure on brain structure and function must be investigated in longitudinal studies using a life course approach.
A family of precision ethylene/vinyl chloride polymers synthesized via acyclic diene metathesis (ADMET) followed by exhaustive hydrogenation is described in which chlorine atoms are present on each and every ninth, 15th, and 21st carbons, respectively, in the series. Detailed 1H NMR and 13C NMR experiments are used to establish the precise nature of the polymers and assign absolutely the observed NMR signals to the corresponding atoms in the precise repeat unit. Thermal analysis via TGA and DSC is also presented. Decomposition behavior measured by TGA indicates a distinct mechanism for decomposition for these precise polymers relative to PVC and random EVC polymers, highlighted by an enhanced stability to thermal HCl loss induced by inhibition of the cooperative zipper mechanism for HCl found in PVC. A homopolymer-like crystallization and melting behavior is inferred from sharp DSC peaks, indicative of a precise polymer structure in which long chain segments, incorporating the halogens, build the core crystal, as opposed to the sequence selection mechanism that operates in random EVC polymers.
For persons with DOC 29 to 170 days after TBI, FAST resulted in CNC gains and increased neural responsivity to vocal stimuli in language regions. Clinicians should consider providing the FAST to support patient engagement in neurorehabilitation.
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