Enlighten-Research publications by members of the University of Glasgow http://eprints.gla.ac.uk Minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label phase 3 trial with blinded endpoint

BACKGROUND:Minimally invasive surgery procedures, including stereotactic catheter aspiration and clearance of intracerebral hemorrhage (ICH) with recombinant tissue plasminogen activator hold a promise to improve outcome of supratentorial brain hemorrhage, a morbid and disabling type of stroke. A recently completed Phase III randomized trial showed improved mortality but was neutral on the primary outcome (modified Rankin scale score 0 to 3 at 1 yr). OBJECTIVE: To assess surgical performance and its impact on the extent of ICH evacuation and functional outcomes. METHODS: Univariate and multivariate models were used to assess the extent of hematoma evacuation efficacy in relation to mRS 0 to 3 outcome and postulated factors related to patient, disease, and protocol adherence in the surgical arm (n = 242) of the MISTIE trial. RESULTS: Greater ICH reduction has a higher likelihood of achieving mRS of 0 to 3 with a minimum evacuation threshold of ≤15 mL end of treatment ICH volume or ≥70% volume reduction when controlling for disease severity factors. Mortality benefit was achieved at ≤30 mL end of treatment ICH volume, or >53% volume reduction. Initial hematoma volume, history of hypertension, irregular-shaped hematoma, number of alteplase doses given, surgical protocol deviations, and catheter manipulation problems were significant factors in failing to achieve ≤15 mL goal evacuation. Greater surgeon/site experiences were associated with avoiding poor hematoma evacuation. CONCLUSION: This is the first surgical trial reporting thresholds for reduction of ICH volume correlating with improved mortality and functional outcomes. To realize the benefit of surgery, protocol objectives, surgeon education, technical enhancements, and case selection should be focused on this goal.

Diabetes is a disease characterized by improper concentrations of blood glucose due to irregular insulin production or sensitivity. Coupled in islets of Langerhans within the pancreas, β-cells are responsible for the production and regulation of insulin based on changes in glucose levels. Using the Dual Oscillator Model (DOM), we will examine how calcium handling between individual pancreatic β-cells affects the synchronization of metabolic oscillations within electrically coupled islets. Calcium permeability was implemented into the DOM, and numerical solutions of the system were obtained via MATLAB using a modified ordinary differential equation solver for stiff systems and the Automatic Differentiation for MATLAB software. We developed a synchronization index to quantitatively describe the synchronization of variables between nearest neighboring cells and throughout the islet as a whole. We considered how calcium permeability between heterogeneous cells affects the behavior of metabolic oscillations and their synchronization. In particular, we examined fructose-1, 6-bisphosphate. In our study metabolic oscillations were always maintained. We also showed that, for low to moderate levels of electrical coupling, calcium permeability increased the synchronization index, but increasing calcium permeability had little effect on synchronization when cells were already strongly synchronized with strong electrical coupling. Heterogeneity due to glucose influx or initial state of the cells had similar synchronization results.

Parallel sparse matrix-matrix multiplication algorithms (PSpGEMM) spend most of their running time on inter-process communication. In the case of distributed matrix-matrix multiplications, much of this time is spent on interchanging the partial results that are needed to calculate the final product matrix. This overhead can be reduced with a one-dimensional distributed algorithm for parallel sparse matrix-matrix multiplication that uses a novel accumulation pattern based on the logarithmic complexity of the number of processors (i.e., where is the number of processors). This algorithm's MPI communication overhead and execution time were evaluated on an HPC cluster, using randomly generated sparse matrices with dimensions up to one million by one million. The results showed a reduction of inter-process communication overhead for matrices with larger dimensions compared to another one dimensional parallel algorithm that takes run-time complexity for accumulating the results.

Lamotrigine (LTG) is associated with the potential for a life-threatening rash (eg, Stevens-Johnson syndrome or toxic epidermal necrolysis). The incidence has been linked to rapid titration and an interaction with valproic acid that can increase the level of LTG. Providers often have difficulty discriminating between serious versus benign rashes, and the package insert recommends discontinuing the medication at the first sign of a rash. Therefore, many patients end up being taken off LTG when it may have been effective for them. We present a case where LTG is reintroduced with a faster initial titration than what is noted in the literature after development of a rash. This case is also unique in that the patient had been on LTG for years prior to emergence of the rash and demonstrates that retrials can be successful.