A cute intracerebral hemorrhage (ICH) is the most serious and least treatable form of acute stroke 1 for which established prognostic factors include clinical severity and location and volume of hematoma at presentation.2 Although stress hyperglycemia is associated with adverse outcomes in many medical conditions, including acute ischemic stroke, 3,4 traumatic brain injury, 5 and acute myocardial infarction, 6 evidence specifically related to the critical condition of ICH is varied and conflicting because of previous studies being limited to small single-center series 7,8 with short duration of follow-up. 9 Animal models have shown that elevated blood pressure (BP) exacerbates cerebral injury after ICH 10 and of an association between hyperglycemia and cerebral edema. There may be a supra-additive effect of hyperglycemia and Background and Purpose-We aimed to determine associations of baseline blood glucose and diabetes mellitus with clinical outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Methods-INTERACT2 was an international prospective, open, blinded end point, randomized controlled trial of 2839 patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated systolic blood pressure randomly assigned to intensive (target systolic blood pressure <140 mm Hg) or guideline-based (systolic blood pressure <180 mm Hg) BP management. Associations of hyperglycemia at presentation (>6.5 mmol/L) and combined and separate poor outcomes of death and major disability (scores of 3-6, 3-5, and 6, respectively, on the modified Rankin scale) at 90 days were determined in logistic regression models. Results-In 2653 patients with available data, there were 1348 (61%) with hyperglycemia and 292 (11%) with diabetes mellitus. Associations of baseline blood glucose and poor outcome were strong and near continuous. After adjustment for baseline variables, the highest fourth (7.9-25.0 mmol/L) of blood glucose was significantly associated with combined poor outcome (adjusted odds ratio 1. Materials and MethodsINTERACT2 was an international, multicenter, prospective, openlabel, assessor-blinded end point, randomized controlled trial, the details of which are described elsewhere. 11 In brief, 2839 patients with computed tomography-confirmed spontaneous ICH within 6 hours of onset and elevated systolic BP (150-220 mm Hg) were randomly assigned to receive intensive (target systolic BP <140 mm Hg within 1 hour) or guideline-recommended (target systolic BP <180 mm Hg) BP-lowering therapy using locally available agents according to standardized protocols. The study protocol was approved by the appropriate ethics committee at each participating site, and written informed consent was obtained from the patient or an appropriate surrogate.Demographic and clinical characteristics recorded at the time of enrollment included a history of diabetes mellitus and level of blood glucose. Stroke severity was measured using the Glasgow coma scale and National Institutes of He...
Polymethylmethacrylate (PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950s to the recent advent of nanoparticle additives. Additives have been trialed to address problems with modern bone cements such as the loosening of prosthesis, high post-operative infection rates, and inflammatory reduction in interface integrity. This review aims to assess current additives used in PMMA bone cements and offer an insight regarding future directions for this biomaterial. Low index (< 15%) vitamin E and low index (< 5 g) antibiotic impregnated additives significantly address infection and inflammatory problems, with only modest reductions in mechanical strength. Chitosan (15% w/w PMMA) and silver (1% w/w PMMA) nanoparticles have strong antibacterial activity with no significant reduction in mechanical strength. Future work on PMMA bone cements should focus on trialing combinations of these additives as this may enhance favourable properties.
Background and Purpose-Intraventricular hemorrhage (IVH) with spontaneous intracerebral hemorrhage indicates a poor prognosis but uncertainty exists over the pattern of association. We aimed to elucidate risk associations of IVH and outcome in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) data set. Methods-INTERACT2 was an international prospective, open-blinded end point, randomized controlled trial in 2839 patients with intracerebral hemorrhage (<6 hours) with elevated systolic blood pressure randomly assigned to intensive (target systolic blood pressure <140 mm Hg) or guideline-based (systolic blood pressure <180 mm Hg) blood pressure management. Associations of baseline IVH in 740 of 2613 (28%) patients and poor outcomes (death and major disability defined on the modified Rankin Scale) at 90 days were determined in linear and logistic regression models. Results-Patients with IVH were significantly older and with greater neurological impairment, history of ischemic stroke, and larger hematomas more often deep hemisphere located at presentation, after adjustment for other baseline variables. Death or major disability occurred in 66% with IVH versus 49% in intracerebral hemorrhage-alone patients (adjusted odds ratio, 1.68; 95% confidence interval, 1.38-2.06; P<0.01). Associations of IVH volume and clinical outcomes were strong and near continuous. Adjusted analyses by thirds of IVH volume indicate thresholds of ≈5 and 10 mL for significantly increased odds of death and death or major disability, respectively. Conclusions-A strong association exists between the amount of IVH and poor outcome in intracerebral hemorrhage. An IVH volume of 5 to 10 mL emerges as a significant threshold for decision making on prognosis in these patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
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