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Summary Toast is a nutrient‐rich consumer staple with a unique taste. However, retrogradation affects its storage quality and shelf life. Therefore, in this study, we aimed to investigate the effects of enzymes on the baking quality of wheat dough and the storage quality of baked bread. Fungal α‐amylase (FAM), lipase (LIP), and maltose amylase (MAM) were added to wheat dough under quadruple fermentation to evaluate their effects on the quality of wheat dough and toasted bread during storage. FAM reduced the water absorption and stability of wheat flour, whereas LIP and MAM improved its properties. Moreover, all three enzymes increased the fermentation height and gas‐holding capacity of the dough, resulting in toast with a larger specific volume and low hardness. Toast containing 15 mg kg−1 MAM had the highest number of air holes and the best elasticity. Furthermore, 9 mg kg−1 FAM, 45 mg kg−1 LIP, and 15 mg kg−1 MAM retarded the retrogradation of toast during storage, reduced its hardness, and decreased the short‐range order and relative crystallinity. These findings indicate that enzymes can delay retrogradation in toast to extend its shelf life. These results further suggest that enzymes inhibit recrystallisation to delay toast ageing. Thus, this study provides theoretical references for the practical application of enzymes in bakery products. [ABSTRACT FROM AUTHOR]

Introduction: The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) is the most commonly used ischemic stroke subtype classification system worldwide and a required field in the US National Get With The Guidelines-Stroke (GWTGStroke) registry. However, stroke diagnostics have advanced substantially since the TOAST classification was designed 30 years ago, potentially making it difficult to apply reliably. Methods: In this prospective diagnostic accuracy study, we analyzed consecutive ischemic stroke patients admitted to a Comprehensive Stroke Center between July-October 2021. Clinical practice TOAST classification diagnoses rendered by the stroke team in the electronic medical record (EMR) at discharge were retrieved from GWTG-Stroke registry and compared to a reference ("gold") standard diagnosis derived from agreement between two expert raters after review of the EMR and patient imaging. Results: Among 49 patients; age was 72.3 years (±12.1), 53% female, and presenting NIHSS median 3 (IQR 1-11). Work-up included: brain imaging in 100%; cardiac rhythm assessment in 100%; cervical/cerebral vessel imaging in 98%; TTE ± TEE in 92%; and TCD emboli evaluation in 51%. Reference standard diagnoses were: LAA-6%, SVD-14%, CE-39%, OTH-10%, UND-M (more than one cause)-20%, and UND-C (cryptogenic)-10%. GWTG-Stroke TOAST diagnoses agreed with reference standard diagnoses in 30/49 (61%). Among the 6 subtype diagnoses, specificity was generally high (84.8%-97.7%), but sensitivity suboptimal for LAA (33%), OTH (60%), UND-M (10%), and UND-C (20%). Positive predictive value was suboptimal for 5 of the 6 subtypes: LAA (13%), SVD (58%), OTH (75%), UND-M (50%), and UND-C (50%). Discussion: Clinical practice TOAST classification subtype diagnoses entered into the GWTG-Stroke registry were accurate in only 61% of patients, a performance rate that, if similarly present at other centers, would hamper the ability of the national registry to provide dependable insights into subtype-related care. Development of an updated ischemic stroke subtype classification system, with algorithmic logic embedded in electronic medical records, is desirable. [ABSTRACT FROM AUTHOR]

Crispness is a textural characteristic that influences consumer choices, requiring a comprehensive understanding for product customization. Previous studies employing neural networks focused on acquiring audio through mechanical crushing of crispy samples. This research investigates the representation of crispy sound in time intervals and frequency domains, identifying key parameters to distinguish different foods. Two machine learning architectures, multi‐layer perceptron (MLP) and residual neural network (ResNet), were used to analyze mel frequency cepstral coefficients (MFCC) and discrete Fourier transform (DFT) data, respectively. The models achieved over 95% accuracy "in‐sample" successfully classifying fried chicken, potato chips, and toast using randomly extracted audio from ASMR videos. The MLP (MFCC) model demonstrated superior robustness compared to ResNet and predicted external inputs, such as freshly toasted bread acquired by a microphone or ASMR audio of toast in milk. In contrast, the ResNet model proved to be more responsive to variations in DFT spectrum and unable to predict the similarity of external audio sources, making it useful for classifying pretrained "in‐samples". These findings are useful for classifying crispness among individual food sources. Additionally, the study explores the promising utilization of ASMR audio from Internet platforms to pretrain artificial neural network models, expanding the dataset for investigating the texture of crispy foods. [ABSTRACT FROM AUTHOR]

IntroductionThe TOAST (Trial of ORG 10172 in Acute Stroke Treatment) is the most commonly used ischemic stroke subtype classification system worldwide and a required field in the US National Get With The Guidelines-Stroke (GWTG-Stroke) registry. However, stroke diagnostics have advanced substantially since the TOAST classification was designed 30 years ago, potentially making it difficult to apply reliably.MethodsIn this prospective diagnostic accuracy study, we analyzed consecutive ischemic stroke patients admitted to a Comprehensive Stroke Center between July–October 2021. Clinical practice TOAST classification diagnoses rendered by the stroke team in the electronic medical record (EMR) at discharge were retrieved from GWTG-Stroke registry and compared to a reference (“gold”) standard diagnosis derived from agreement between two expert raters after review of the EMR and patient imaging.ResultsAmong 49 patients; age was 72.3 years (±12.1), 53% female, and presenting NIHSS median 3 (IQR 1–11). Work-up included: brain imaging in 100%; cardiac rhythm assessment in 100%; cervical/cerebral vessel imaging in 98%; TTE ± TEE in 92%; and TCD emboli evaluation in 51%. Reference standard diagnoses were: LAA-6%, SVD-14%, CE-39%, OTH-10%, UND-M (more than one cause)-20%, and UND-C (cryptogenic)-10%. GWTG-Stroke TOAST diagnoses agreed with reference standard diagnoses in 30/49 (61%). Among the 6 subtype diagnoses, specificity was generally high (84.8%–97.7%), but sensitivity suboptimal for LAA (33%), OTH (60%), UND-M (10%), and UND-C (20%). Positive predictive value was suboptimal for 5 of the 6 subtypes: LAA (13%), SVD (58%), OTH (75%), UND-M (50%), and UND-C (50%).DiscussionClinical practice TOAST classification subtype diagnoses entered into the GWTG-Stroke registry were accurate in only 61% of patients, a performance rate that, if similarly present at other centers, would hamper the ability of the national registry to provide dependable insights into subtype-related care. Development of an updated ischemic stroke subtype classification system, with algorithmic logic embedded in electronic medical records, is desirable.

Background and Objective: The Trial of Org 10172 of Acute Stroke Treatment (TOAST) classification was introduced to classify ischemic stroke based on potential etiological mechanisms. The purpose of this study was to assess the characteristics of acute ischemic stroke patients based on the TOAST classification during the COVID-19 pandemic era. Subject and Methods: This research was a descriptive cross-sectional study from the medical records of acute ischemic stroke patients who were treated in Neurology ward of Hasan Sadikin Hospital in 2021. Results: A total of 136 acute ischemic stroke patients were involved in this study. Large-artery atherosclerosis (LAA) was the most common stroke subtype (30.1%) and hypertension is the most common risk factor (97%). The risk factors for hypercoagulation were found to be 79% in the Undetermined etiology classification and 100% in the Other etiology classification. Conclusion: In the COVID-19 pandemic era, hypercoagulation was found as the dominant risk factor in the Undetermined etiology and Other etiology classifications. The coagulopathy mechanism in COVID-19 could increase the risk of stroke in affected person who have conventional stroke risk factors.

Panpan Zhang, Yurong Zhang Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of ChinaCorrespondence: Yurong Zhang, Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277, Yanta West Road, Xi’an, Shaanxi Province, People’s Republic of China, Tel/Fax +86-02985323443, Email zhangyurong72@mail.xjtu.edu.cnPurpose: Homocysteine (Hcy) is recognized as a risk factor for stroke. Our study examined the relationship between plasma Hcy levels and stroke, along with its subtypes, among Chinese patients who experienced an acute stroke episode.Patients and Methods: We retrospectively enrolled patients with acute stroke and age- and sex-matched healthy controls admitted to the First Affiliated Hospital of Xi’an Jiaotong University from October 2021 to September 2022. Ischemic stroke subtypes were classified using the modified TOAST criteria. Multivariate logistic regression models were employed to probe the associations of plasma Hcy levels with total stroke, ischemic stroke and its subtypes, and hypertensive intracerebral hemorrhage (HICH), and the correlation between plasma Hcy levels and the National Institute of Health Stroke Scale (NIHSS).Results: The mean age of the total group was 63 years, with women representing 30.6% (246 individuals). Elevated Hcy levels were significantly associated with total stroke (OR 1.054, 95% CI: 1.038– 1.070), HICH (OR 1.040, 95% CI: 1.020– 1.060), ischemic stroke (OR 1.049, 95% CI: 1.034– 1.065), and the TOAST subtypes of ischemic stroke in large-artery atherosclerosis (LAA) (OR 1.044, 95% CI: 1.028– 1.062) and small-artery occlusion (SAO) (OR 1.035, 95% CI: 1.018– 1.052), but not with cardioembolic (CE) stroke. Moreover, only in the case of SAO stroke were the Hcy levels positively correlated with the NIHSS score (B=0.030, 95% CI: 0.003– 0.056, P=0.030).Conclusion: Plasma Hcy levels were found to be positively correlated with the risk of stroke, particularly in the context of LAA, SAO stroke, and HICH. Additionally, Hcy levels demonstrated a positive correlation with stroke severity in patients presenting with SAO stroke. These findings suggest potential clinical implications in stroke prevention, particularly for ischemic stroke (LAA, SAO subtypes) and HICH by employing homocysteine-lowering therapies. Future investigations are warranted to fully elucidate these associations.Keywords: homocysteine, ischemic stroke, hypertensive intracerebral hemorrhage, TOAST, NIHSS

Lisda Amalia Department of Neurology, Medical Faculty, Universitas Padjadjaran/RSUP Dr. Hasan Sadikin, Bandung, IndonesiaCorrespondence: Lisda Amalia, Jl. Eykman 38, Bandung, 40161, Indonesia, Email dr.lisda@gmail.comIntroduction: The categorization system used in the Trial Org 10172 classification in Acute Stroke Treatment (TOAST) provided more insight into the causal process. The aims of this study were to characterize individuals with acute ischemic stroke using the TOAST criteria and to determine risk variables for patients with acute ischemic stroke during the COVID-19 pandemic.Methods: A cross-sectional study was done on the medical records of acute ischemic stroke patients at Hasan Sadikin Hospital (RSHS) Bandung, Indonesia, who were hospitalized in the Neurology Department of Hasan Sadikin Hospital from January to December 2021. Eligible patients were divided into 2 groups, with and without COVID-19 infection.Results: There were 136 participants with acute ischemic stroke. Thirty-one percent of strokes were caused by atherosclerosis in the large arteries (LAA), followed by small-vessel occlusion (SVO) (25%), cardioembolism (CE) (22.1%), an undetermined cause (21.3%), and an other etiology (1.5%). CE risk factor was atrial fibrillation (p < 0.001), while hypertension, diabetes, and smoking were significant for LAA (p < 0.05). However, in patients with COVID-19 who had an acute ischemic stroke, most of the subtypes were stroke of undetermined etiology (76%), and hypercoagulation was the main risk factor (p < 0.001).Conclusion: Patients with and without COVID-19 show varied distributions of stroke subtypes according to the TOAST categorization. Hypercoagulation is a major risk factor for stroke of undetermined etiology in individuals with COVID-19 who suffer from acute ischemic stroke. Increased viral-mediated endothelial inflammation leading to aberrant coagulopathy may explain the correlation between COVID-19 and acute ischemic stroke.Keywords: acute ischemic stroke, TOAST, COVID-19, pandemic

Copyright of Community Connections: Studies on Education, Culture / Közösségi Kapcsolódások: Tanulmányok Kultúráról és Oktatásról is the property of Szeged University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Purpose: Vertebrobasilar occlusion stroke (VBOS) is innately associated with high morbimortality despite advances in endovascular thrombectomy (EVT). Nonetheless, notable outcome dissimilarities exist between angiographically categorized stroke subtypes. We aim to evaluate potential differences concerning clinical angiographic outcomes among etiological subtypes of VBOS based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Methods: We retrospectively reviewed prospective EVT databases at two tertiary care stroke centers for consecutive patients with VBOS who had preinterventional MRI and underwent EVT from January 2015 to December 2019. We identified three groups: large artery atherosclerosis (LAA), cardioembolic stroke (CES), and embolic stroke of undetermined source (ESUS). The primary endpoints were the rates of poor outcome (identified as 90-day modified Rankin scale score of 3–6) and mortality, while the secondary endpoint included the rates of incomplete reperfusion (identified as modified treatment in cerebral infarction scale mTICI 0–2b), and periprocedural symptomatic intracranial hemorrhage. We evaluated the association between the etiology and clinical angiographic outcomes through stepwise logistic regression analysis. Results: Out of 1823 patients, 139 (91 men; median age, 69 (61–76) years) with VBOS were qualified for the final analysis with incidence as follows: LAA (41%, n = 57), CES (35%, n = 48), and ESUS (24%, n = 34). Overall, incomplete reperfusion was realized in 41% (57/139) of the patients, a poor outcome in 65% (90/139), and mortality in 40% (55/139). Longer puncture to reperfusion interval (aOR 1.0182 [95% CI: 1.008–1.029]; p < 0.001) and utilization of combined aspiration-retriever technique (aOR 0.1998 [95% CI: 0.066–0.604]; p = 0.004) were associated with a greater likelihood of incomplete reperfusion (mTICI 0–2b) irrespective of the stroke etiology. After adjustment for confounding factors in the regression analysis, ESUS was an independent predictor of poor outcome (aOR 5.315 [95% CI: 1.646–17.163]; p = 0.005) and mortality (aOR 4.667 [95% CI: 1.883–11.564]; p < 0.001) at 90 days following EVT. Conclusion: The functional outcome following EVT for VBOS might depend on stroke etiology. According to our results, ESUS seems to be associated with the worst outcome, which needs further investigation to tailor the appropriate therapeutic plan. [ABSTRACT FROM AUTHOR]

Copyright of Culture Context / Konteksty Kultury is the property of Jagiellonian University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的 分析首次青年缺血性卒中患者出院、发病90d预后不良的相关危险因素。 方法 回顾性纳入18～45岁、发病72 h内的首次缺血性卒中患者，收集患者人口学信息、血管危险因素、实验室检查结果、入院和出院时NIHSS，以出院时和发病90 d mRS≥2分为预后不良，分别比较预后不良组和预后良好组危险因素的差异和病因分型特点，并采用多因素logistic回归分析出院和90 d预后不良的独立危险因素。 结果 研究共纳入691例首次青年缺血性卒中患者，出院预后不良234例（33.9%），90 d预后不良154例（22.3%）。出院时预后的独立危险因素包括入院时高NIHSS（OR 2.76，95%CI 2.07～3.68，P

Objective: A new endoscopic thyroidectomy approach—transoral and submental endoscopic thyroidectomy (TOaST)—was applied in clinical practice and considered an improved approach for endoscopic thyroid surgery via the oral approach. This paper discusses the feasibility and effectiveness of this surgical method. Methods: A retrospective analysis was performed on the clinical data of 54 patients who had undergone TOaST in the thyroid disease center of the First Affiliated Hospital of Nanchang University between December 2020 and December 2021. The surgical data and techniques, complications, and cosmetic outcomes of these patients were studied. Results: Among the total 54 patients, 23 underwent unilateral subtotal thyroidectomy, 3 patients underwent bilateral subtotal thyroidectomy, 27 with unilateral thyroid cancer underwent affected thyroid + isthmus + central lymph node resection, and only 1 patient underwent total thyroidectomy. The mean operative time was 88.06 ± 12.03 min (range: 65–135 min), the mean intraoperative blood loss was 8.61 ± 4.60 ml (range: 5–20 ml), the mean postoperative drainage volume was 49.96 ± 9.88 ml (range: 30–60 ml), the mean drainage time was 36.61 ± 2.65 h (range: 32–50 h), and the mean length of hospital stay was 46.63 ± 3.28 h (range 45–70 h). One patient experienced transient recurrent laryngeal nerve injury, and another patient experienced transient parathyroid dysfunction; there was no superior laryngeal nerve injury and other complications, such as postoperative subcutaneous hematoma, hypercapnia, mental nerve injury, tracheoesophageal injury, infection, or lymphatic leakage. Conclusion: TOaST cannot only achieve a good therapeutic effect but also avoid mental nerve injury, reduce the discomfort of the patient's jaw, obtain a good cosmetic effect, and facilitate the operation of the operator. It is an endoscopic thyroidectomy technique with a certain clinical value. [ABSTRACT FROM AUTHOR]

This study explores the performance and relational role of toast intervention in Chinese dining contexts. The analysis of both interactional data and post-event interview data indicates that the detection of moral transgression and moral identification may outweigh the power relationship and social distance in the interactional practice, and that toast intervention, by default, is relationally constructive even in seemingly conflictive situations. As a complement to previous research on ritual communication, such as countering the heckler and bystander intervention which focus on genuine aggression, this study sheds light on the ritual act of toast intervention as 'mock intervention', which is a form of 'mock moral aggression' similar to ritual teasing. Thus, this study reveals the greater significance of moral identification compared to other contextual factors, and its role in explaining the relational consequences of toast intervention in Chinese dining contexts. [ABSTRACT FROM AUTHOR]

According to the food pyramid, cereals have long been one of the main raw materials and the first group in the diet of people. Acrylamide is produced by the Millard reaction when carbohydrate foods are exposed to heat. The amount of acrylamide in products such as cereals, flour products, coffees, potatoes and dried products is significant. Since Taftoon bread is one of the most widely used flour products in the country, in this study, was investigated the effect of asparaginase enzyme and Taftoon bread toasting degree on acrylamide content. For this purpose, the amount of acrylamide was investigated in three cases without toasting, level one toasting and level two toasting, as well as asparaginase enzyme at two concentrations of 250 and 500 ppm in Taftoon bread. Also the effect of these treatments was investigated on the texture and color of bread. According to the results, with increasing of toasting degree, acrylamide content increases too. And increasing of toasting degree leads to darkening of the color bread and increasing shear strength. Use of asparaginase enzyme at a concentration of 500 ppm, at the highest toasting degree was able to reduce the acrylamide content by 86% compared to the control sample. In this study, asparaginase enzyme had no significant effect on texture and color of bread. In the final, samples of bread were made available to the judges for sensory evaluation. The results showed that the asparaginase enzyme did not change the sensory properties of bread despite the decrease in acrylamide content. [ABSTRACT FROM AUTHOR]

The consumption of bakery products has increased due to the diversity of assortments, preparation technology and taste which determined the existence of a very large range of breads with high nutritional value. The objectives of the present study were: determining the quality parameters of the toast bread, emphasizing the statistically significant differences and correlations between the quality parameters and evaluation of nutritional aspects. Four assortments of toast sliced bread-Toast Integral (T.I.), Toast Classic (T.C.), Toast Graham (T.G.) and Toast with Rye (T.R.) were analyzed. The analyzes included: weight, humidity, acidity, porosity, elasticity, water activity. Also, the nutritional profile (content of fats, saturated fatty acids, carbohydrates, sugar, protein, fiber and salt) was evaluated and the results were compared with the values declared on the label. The assortments with higher fiber content, respectively T. I., T.G. and T.R. had higher humidity than T.C. The acidity was significantly increased in the assortments of fiber-rich breads (T.I., T.R., T.G.) compared to sliced white bread (T.C.). Except for the pair T.I. - T.R., the porosity constituted an element of statistical differentiation for all the other pairs of investigated assortments. Basically, the highest porosity was T.C. (87.13%), followed by T.R., T.I. and T.G. In T.I., the increase in weight was correlated with the decrease in porosity. This can be an effect of baking in the tray, so in conditions of constant volume (r = -0.627). The T.C. products with higher humidity were also characterized by higher elasticity (r = 0.582). The analyzed products were characterized by lower fat contents and saturated fat actions compared to the values written on the package. The quality parameters of the investigated products were characterized by low values of coefficients of variation, which suggests that technological processes are controlled, repeatable. It is necessary to revise the labels in order to correct the nutritional information provided to the consumer. [ABSTRACT FROM AUTHOR]

Through the present work we intend to make an approximation to the phenomenon of the toast, both from a sociocultural perspective (because if we take the classical tradition as a reference it is easily observable that it was articulated around the convivalia, a phenomenon that has reached our days, ramified in multiple articulations and formulations, but which maintains the original essence related to the fact of paying homage to a specific person in meetings or gatherings of various kinds, whether more formal or more familiar), as well as from a linguistic perspective that will cover various fields of analysis clearly delimited: pragmatics, since this act initially constitutes an element that has been included in the manifestations of courtesy or, eventually, impoliteness, as well as comparative linguistics between the Spanish and Polish languages. However, we would like to show that, ultimately, this article constitutes a modest tribute to Professor Anna Sawicka, an eminent figure of Spanish and Catalan letters at the Jagiellonian University of Kraków, and all the research carried out in it is not but our way of expressing our most sincere gratitude. [ABSTRACT FROM AUTHOR]

Objective: Classifications of stroke etiology is generally based on lesion pathology and ischemic stroke or hemorrhage were two main groups. Nowadays, most common classification is Trial of Org 10172 in Acute Stroke Treatment (TOAST) which was published in 1993. After the TOAST classification system, Causative Classification of Stroke System (CCS), Atherothrombosis, Small vessel disease, Cardiac causes, and Other uncommon causes (ASCO) classification systems were developed. The purpose of the study is to discuss whether CCS or ASCO systems can be replaced for TOAST classification system which is most commonly used to determine the stroke etiology. And to determine whether the number of patients can be decreased in an unidentified cause of the etiology group according to TOAST by these CCS or ASCO systems. Methods: Three hundred acute ischemic stroke patients hospitalized at Bakırköy Dr. Sadi Konuk Training and Research Hospital between 01.01.2016 and 30.06.2016 were evaluated retrospectively and they were assessed based on their neurological examination, laboratory findings and sub-types of stroke were identified according to TOAST, CCS, and ASCO etiology classifications. Results were compared based on TOAST, CCS, and ASCO. For comparison, obvious reasons for TOAST, obvious and potential reasons for CCS, and first and second evidence were used. Results: The mean age of 300 patients (176 male-124 female) was 67.13±14.19 years. No significant differences were detected between TOAST, CCS and ASCO systems for detecting etiological subtypes; large artery atherosclerosis, small artery disease, other determined causes or undetermined causes but significant differences were found between ASCO and CCS in determining cardioembolic subtype (p=0.002). Correlation analysis showed high and significant correlations between TOAST and CCS (r=0.765) and TOAST and ASCO (r=0.731). The correlation between CCS and ASCO (r=0.928). Conclusion: The traditional TOAST classification system, in use for a long time in determining stroke etiology, cannot be updated but it still maintains its practicality and availability compared to the new classification systems CCS and ASCO. There was no significant decrease in the number of patients in an undetermined etiology subgroup by CCS and ASCO compared to TOAST. As far as our results are concerned, CCS and ASCO systems have not superiority on TOAST. [ABSTRACT FROM AUTHOR]

Copyright of Bosphorus Medical Journal / Boğaziçi Tıp Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Due to the high level of antioxidant activity of acorn fruits, they can be used as an ingredient the production of functional foods. The goal of the this research was to partially substitute wheat our with varying levels (10% - 50% w/w) of debittered acorn our and to investigate its effects on the rheological characteristics of the dough, total phenolic content (TPC), staling, colour indices and sensory properties of toast bread. The farinograph degree of softening and water absorption of the dough decreased with increasing the acorn our content, while the stability and time of development of the dough increased. Resistance and extensibility to deformation of the samples respectively increased and decreased compared to those of the control. Toast bread with 30% acorn our replacement was observed to have lower staling than the control. The highest TPC (9.44 mg GAE/g) and the lowest peroxide value (0.36 m eq O2/kg) were obtained for the bread having 30% acorn our substitution. Moreover, the breads showed darker crumbs with significantly lower specific loaf volumes. Overall, the bread with 30% of acorn our substitution showed good rheological, staling properties and reasonable anti-oxidant content compared to the control bread as well as the highest sensorial acceptability. [ABSTRACT FROM AUTHOR]

Traditional vascular risk factors and HIV-related factors can contribute to higher prevalence of ischemic stroke (IS) among HIV-infected patients. Understanding the underlying mechanism of IS could lead to proper management and prognosis. We aimed to determine the prevalence of IS subtypes among HIV-infected patients who were hospitalized due to IS. Medical records of patients who were hospitalized at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 2008 and 2019 due to first-ever IS with documented HIV infection were retrospectively analyzed. IS subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Among 6,952 patients who were hospitalized due to IS, 50 [0.7% (95% confidence interval: 0.5–1.0)] were HIV-infected patients and were included in the analysis. Common traditional stroke risk factors were dyslipidemia (62%), smoking (55.3%), hypertension (52%), and alcohol consumption (45%). The median (interquartile range) CD4 cell count was 294.5 (186–485) cells/mL and 74% were on antiretroviral therapy. The most common etiology of IS was small vessel occlusion (SVO) (48%), followed by stroke of undetermined etiology (UD) (26%), and stroke of other determined etiology (OD) (14%). Among patients with OD, 5 of 7 were from infectious-related cause. Virologically unsuppressed group had significantly higher proportion of OD (33.3% vs. 3.6%), UD (38.9% vs. 17.9%), and lower proportion of SVO (22.2% vs. 60.7%) based on TOAST classification compared with virologically suppressed group (p = .01). SVO was the most common cause of IS among HIV-infected patients and was more likely to occur among virologically suppressed group, suggesting that traditional vascular risk factors may play a larger role in developing IS. OD was more likely to occur among virologically unsuppressed group, most of which were infectious-related cause. [ABSTRACT FROM AUTHOR]

Due to the high level of antioxidant activity of acorn fruits, they can be used as an ingredient the production of functional foods. The goal of the this research was to partially substitute wheat flour with varying levels (10% - 50% w/w) of debittered acorn flour and to investigate its effects on the rheological characteristics of the dough, total phenolic content (TPC), staling, colour indices and sensory properties of toast bread. The farinograph degree of softening and water absorption of the dough decreased with increasing the acorn flour content, while the stability and time of development of the dough increased. Resistance and extensibility to deformation of the samples respectively increased and decreased compared to those of the control. Toast bread with 30% acorn flour replacement was observed to have lower staling than the control. The highest TPC (9.44 mg GAE/g) and the lowest peroxide value (0.36 m eq O2/kg) were obtained for the bread having 30% acorn flour substitution. Moreover, the breads showed darker crumbs with significantly lower specific loaf volumes. Overall, the bread with 30% of acorn flour substitution showed good rheological, staling properties and reasonable anti-oxidant content compared to the control bread as well as the highest sensorial acceptability.

Background and purpose: The objectives of the present analysis were to assess 28‐day stroke case fatality according to the stroke aetiology and to identify associated factors. Methods: All stroke events in adults aged ≥35 years between 2008 and 2017 were collected in a population‐based stroke registry in northern France. Results: Out of a total of 2933 strokes, there were 479 (16%) haemorrhagic strokes and 2454 (84%) ischaemic strokes; the 28‐day case fatality rates were 48% and 15%, respectively. Three‐quarters of the 28‐day case fatalities occurred within 6 days of the event for haemorrhagic strokes and within 16.5 days for ischaemic strokes. After an ischaemic stroke, the case fatality rate was higher for women (18%) than for men (12%, p < 0.0001); however, this difference disappeared after adjustment for age. Cardioembolic strokes (34%) and strokes of undetermined cause (33%) were the most common ischaemic subtypes, with case fatality rates of 16% and 18%, respectively. Large artery atherosclerosis (11%) and lacunar strokes (10%) were less common, and both types had a case fatality rate of 3%. Age at the time of the event and stroke severity were both significantly associated with case fatality. For some types of stroke, a history of cardiovascular events and residence in a nursing home were associated with a poor prognosis. Medical care in a neurology ward was inversely associated with case fatality, for all stroke subtypes. Conclusions: In northern France, post‐stroke case fatality remains high, especially for haemorrhagic stroke. Being treated in a neurology ward improved survival by around 80%. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the outcome differences among is chemic stroke sub types based on “Trial of ORG 10172 in Acute Stroke Treatment (TOAST)” system in a tertiary referral hospital. A hospital based prospectiv elongitudinal study was conducted involving 182 patients. Modified Rank in Scale (MRS) was used to assess functional out come, Kaplan-Meierproduct- limit method and Coxproportional hazards regression analys is were used to evaluate rates and identify predictors of survival and recurrent stroke. MRS were statistically different across stroke subtypesat 30 days and 6 months (p

Existing techniques have many limitations in the diagnosis and classification of ischemic stroke (IS). Considering this, we used metabolomics to screen for potential biomarkers of IS and its subtypes and to explore the underlying related pathophysiological mechanisms. Serum samples from 99 patients with acute ischemic stroke (AIS) [the AIS subtypes included 49 patients with large artery atherosclerosis (LAA) and 50 patients with small artery occlusion (SAO)] and 50 matched healthy controls (HCs) were analyzed by non-targeted metabolomics based on liquid chromatography–mass spectrometry. A multivariate statistical analysis was performed to identify potential biomarkers. There were 18 significantly different metabolites, such as oleic acid, linoleic acid, arachidonic acid, L-glutamine, L-arginine, and L-proline, between patients with AIS and HCs. These different metabolites are closely related to many metabolic pathways, such as fatty acid metabolism and amino acid metabolism. There were also differences in metabolic profiling between the LAA and SAO groups. There were eight different metabolites, including L-pipecolic acid, 1-Methylhistidine, PE, LysoPE, and LysoPC, which affected glycerophospholipid metabolism, glycosylphosphatidylinositol-anchor biosynthesis, histidine metabolism, and lysine degradation. Our study effectively identified the metabolic profiles of IS and its subtypes. The different metabolites between LAA and SAO may be potential biomarkers in the context of clinical diagnosis. These results highlight the potential of metabolomics to reveal new pathways for IS subtypes and provide a new avenue to explore the pathophysiological mechanisms underlying IS and its subtypes.

Background: There are few contemporary epidemiological data on stroke for Central Europe. We performed a population-based study evaluating the incidence of stroke, stroke types, and ischemic stroke (IS) subtypes in Brno, the second biggest city in the Czech Republic (CR). Methods: Using the National Registry of Hospitalized Patients, and hospital databases, we identified all patients hospitalized with a stroke diagnosis in Brno hospitals in 2011. For Brno residents with validated stroke diagnosis, we calculated (a) the overall incidence of hospitalized stroke, (b) incidence rates for IS, subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), and (c) incidence rates for IS subtypes. We calculated the average annual age- and sex-standardized incidence (European Standard Population and World Health Organization), to compare our results with other studies. Results: The overall crude incidence of stroke in Brno was 213/100,000 population. The incidence of stroke for stroke types were as follows: SAH, 6.9; ICH, 26.4; and IS, 180 cases per 100,000 population, respectively. The WHO-standardized annual stroke incidence was 107 for all strokes and 88 for IS, 14.4 for ICH, and 5 for SAH. For IS subtypes, the WHO-standardized incidence was large artery atherosclerosis 25.8, cardioembolism 27.8, lacunar 21.6, other determined etiology 6.2, and undetermined etiology 6.5 cases per 100,000 population. Conclusions: The stroke incidence is lower than that previously reported for the CR and Eastern Europe probably reflecting socioeconomic changes in post-communistic countries in the region. These findings could contribute to stroke prevention strategies and influence health policies. [ABSTRACT FROM AUTHOR]

Background: Newer transoral thyroidectomy techniques that aim to avoid scars in the neck and maximize cosmetic outcomes have become more prevalent. We conducted a discrete choice experiment (DCE) to evaluate the influence of cosmetic concerns and other factors on patients' decision-making processes when choosing among different thyroidectomy approaches. Methods: A questionnaire was developed to identify key attributes driving patient preferences around thyroidectomy approaches using mixed analyses of patient focus groups, expert opinion, and literature review. These attributes included (i) risk of recurrent laryngeal nerve (RLN) injury, (ii) risk of mental nerve injury, (iii) travel distance for surgery, (iv) out-of-pocket cost, and (v) incision site. Using fractional factorial design, discrete choice sets consisting of randomly generated hypothetical scenarios across all attributes were created. A face-to-face DCE survey was administered to patients being evaluated in clinic for thyroid lobectomy for noncancerous thyroid disease. Participants chose among scenarios constructed from the choice sets of attributes. Analyses were conducted using a mixed logit model, and the trade-offs between different attributes that patients were willing to accept were quantified. Results: The DCE was completed by 109 participants (86 [79%] women; mean age 51.3 ± 3.0 years). Overall, the risk of having RLN and/or mental nerve injury, travel distance, and cost were the most influential attributes. Participants aged ≤60 years significantly preferred an approach without a neck incision and were willing to accept an additional $2332 USD in out-of-pocket cost, 693 miles of travel distance, 0.6% increased risk of RLN injury, and 2.2% risk of mental nerve injury. Patients aged >60 years significantly preferred a conventional neck incision and were willing to pay an additional $3401 out-of-pocket and travel 1011 miles to avoid a scarless approach. Conclusions: The risk of nerve injury, travel distance, and cost were the most important drivers for patients choosing among surgical approaches for thyroidectomy. Cosmetic considerations also influenced patient choices, but in opposing ways depending on patient age. [ABSTRACT FROM AUTHOR]

Objective: To document the toast production system and the perception of symptoms of damage to their health derived from exposure to wood smoke among the female population of the rural community of San José Cerro Gordo, municipality of Santa María Tonameca, Oaxaca. Methodology: The study was cross-sectional and descriptive, through a survey sociodemographic data, characteristics of the kitchen and stove, the making of toast and symptoms of damage to health from exposure to wood smoke were captured. Results: 80 women were interviewed, relatively young (40.13±16.02 years) and in reproductive age, 100% use the open stove, exposing themselves to smoke for 5.9±2.5 hours daily. This activity has been carried out for 11.9±6.5 years. 81.3% of them presented up to ten symptoms related to smoke poisoning, highlighting conditions in the respiratory system. Limitations: No clinical studies were conducted due to financial difficulties of the project. Conclusions: Making toast is an activity that will continue to be maintained as a subsistence strategy in the studied locality, so the health of the women involved will continue to be at risk. It is necessary to promote comprehensive strategies that combine the promotion of ecotechnologies with training in health and economic development, which help reduce exposure to wood smoke and promote better health conditions and marketing of toast. Finally, it is convenient to continue monitoring the health of the study population, in order to identify possible cases that warrant timely medical attention. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effect of zedo gum addition on physicochemical, rheological, and sensory and shelf life of toast dread. The gum was added to the flour (Z2: 0.25, Z3: 0.5, Z4: 0.75, and Z5% 1) and the bread samples were compared with the control one (Z1) .The rheological data showed that the addition of zedo gum increased water absorption, dough development time, stability time and farinograph quality number of samples Z4 and Z5 significantly (P <0.05). The results of extensographic measurements at 45, 90 and 135 min showed that increasing gum percentage caused a decrease in the resistance to extension of dough samples significantly (P<0.05). The lowest resistance to extension was observed in samples Z4 and Z3, respectively (P<0.05). In all studied areas, adding zedo gum resulted a significant increase in the ratio number of samples (P<0.05). The bread compression assessment showed that increasing the amount of gum, brought a decrease to the hardness of the breads, and during the study time, the firmness of all samples increased as a result of staling. Physicochemical results of bread samples showed that increasing gum content of samples increased moisture, ash and protein content significantly while the amount of fat decreased (P<0.05). Sensory evaluation of breads revealed that the sample Z5 had the highest sensory scores, in all studied factors; so it was selected as superior treatment. [ABSTRACT FROM AUTHOR]

Background and objectives: Using a modified American Association of Cereal Chemists parameter for white bread crumb, CFV20, toasted bread firmness was investigated according to color changes on the surface of toasted bread. Findings: The L* value decreased significantly with toasting level, compared with changes in both a* and b*. To characterize the relationship between color and the rheological properties of the bread surface, a rheological parameter for bread surface was proposed, Sin, which represents the slope of the force plotted against the plunger distance at a depth of <1 mm below the surface of the bread. The Sin value of the toasted bread corresponded well with toasting level and CFV20 when toasted at low levels, suggesting that the surface firmness reflects the inner firmness of the toasted bread. A tactility sensory evaluation also supported the change in the CFV20 of toasted bread. In addition, the sensory evaluation values did not seem to be intimately influenced by the panel number, at least between n = 5 and n = 12. The rheological property CFV20 increased with decreasing L*. Therefore, L* seems to be a simple tool for measuring the rheological properties of the inner toasted bread. Conclusions: Color determination using the L* value of the toasted bread surface can be used to estimate the inner firmness of the bread. Significance and novelty: The texture of toasted bread has not been reported. The parameter Sin was proposed as a rheological parameter representing the surface of toasted bread. The firmness of toasted bread according to the change in surface color was investigated in this study. [ABSTRACT FROM AUTHOR]

Background: We previously reported that habitual consumption of dietary flavanol oligomers + polymers and anthocyanins is associated with a lower risk of ischemic stroke. However, no studies have investigated their relationship with ischemic stroke subtypes., Objectives: In this follow-up analysis, we aimed to examine the association of flavanol oligomers + polymers and anthocyanin intake with ischemic stroke subtypes, including the following: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) other determined etiology, and 5) undetermined etiology., Methods: Participants (n = 55,094) from the Danish Diet, Cancer, and Health Study were followed up for <16 y for first-time ischemic stroke events, which were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Intakes of flavanol oligomers + polymers and anthocyanins were calculated from food frequency questionnaires using the Phenol-Explorer database, and their relationships with ischemic stroke subtypes were investigated using restricted cubic splines within Cox proportional hazards models. After multivariable adjustment, higher habitual intakes (quintile 5 compared with quintile 1) of flavanol oligomers + polymers and anthocyanins were associated with a lower risk of specific ischemic stroke subtypes, including large-artery atherosclerosis [flavanol oligomers + polymers, hazard ratio {HR} (95% confidence interval {CI}): 0.64 (0.47, 0.87)], cardioembolism [anthocyanins, HR (95% CI): 0.45 (0.25, 0.82)], and small-vessel occlusion [flavanol oligomers + polymers, HR (95% CI): 0.65 (0.54, 0.80); anthocyanins, HR (95% CI): 0.79 (0.64, 0.97)], but not stroke of other determined or undetermined etiology., Conclusions: Higher habitual intakes of flavanols and anthocyanins are differentially associated with a lower risk of ischemic stroke from atherosclerosis and/or cardioembolism but not with other subtypes., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Purpose: Patients with ischemic stroke who attends emergency departments frequently and have high mortality and morbidity. Purpose of this study is to determine risk groups of ischemic stroke patients by using TOAST and Banford classifications and search whether is there a relationship between red cell distribution width (RDW), mean platelet volume (MPV) and mortality. Methods: We included patients older than 18 years old and who attend-ed XXX Numune Research and Training Hospital Emergency Department throughout two years between 01.07.2014-30.06.2016, patients aged 18 years and older who were diagnosed with ischemic stroke and hospitalized and had sufficient file information were included. Results: We included 404 patients this study. In our study 53.2% (n=215) of all cases were male, 46.8% (n=189) were female. When we look patients age distribution range the biggest group was over 65 years group with 57.7% (n=233) rate. Patients were groupped according to TOAST and Banford classification. MPV and RDW values of patients according to TOAST classification were low risk group 8.3±1.6, 15.7±2.3 and high risk group 8.0±1.5, 16.0±2.4 (p=0,096, p=0,054) respectively. MPV and RDW values were 7.9±1.5, 15.8±2.1 and 8.2±1.6, 15.9±2.6 (p=0,167, p=0,943) respectively in low risk group and high risk group according to Banford classification of patients. Conclusion: There are current studies investigating the utility of hematologic parameters in predicting mortality in emergency department management of patients with ischemic stroke. In the light of the data we obtained in our study, it was concluded that hematological parameters, especially MPV and RDW values were not an effective parameter in determining the prognosis. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a risk factor for atrial fibrillation (AF), stroke, and post-stroke disability. However, differing definitions and application of HF-criteria may impact model prediction. We compared the predictive ability of left ventricular ejection fraction (LVEF), a readily available objective echocardiographic index, with clinical HF definitions for functional disability and AF in stroke patients.Methods: We retrospectively analyzed ischemic stroke patients evaluated between January 2013 and May 2015. Outcomes of interest were: (a) 90-day functional disability (modified Rankin score 3-6) and (b) AF. We compared: (1) LVEF (continuous variable), (2) left ventricular systolic dysfunction (LVSD)-categories (absent to severe), (3) clinical history of HF, and (4) HF/LVSD-categories: (i) HF absent without LVSD, (ii) HF absent with LVSD, (iii) HF with preserved ejection fraction (HFpEF), and (iv) HF with reduced ejection fraction (HFrEF). Multivariable logistic regression was used to determine the predictive ability for 90-day disability and AF, respectively.Results: Six hundred eighty five consecutive patients (44.5% female) fulfilled the study criteria and were included. After adjustment, the LVEF was independently associated with 90-day disability (OR .98, 95% CI .96-.99, P = .011) with similar predictive ability (area under the curve [AUC] = .85) to models including the LVSD-categories (AUC = .85), clinically define HF (AUC = .86), and HF/LVSD-categories (AUC = .86). The LVEF, HF, LVSD-, and HF/LVSD-categories were independently associated with AF (P < .01, each) with similar predictive ability (AUC = .74, .74, .73, and .75, respectively).Conclusions: Compared to commonly defined HF definitions, the objectively determined LVEF possesses comparable predictive ability for 90-day disability and AF in stroke patients. [ABSTRACT FROM AUTHOR]

>bold<>italic/italic<>/bold< Precise subtype classification based on underlying pathophysiology is important to prevent recurrent attack in minor stroke patients. A newly developed Atherosclerosis, Small vessel disease, Cardiac source, Others (ASCO) phenotypic classification system aims to characterize patients using different grades of evidence for stroke subtypes. However, this system has not been specifically applied to minor stroke population. In our study, the impact of using the newer ASCO criteria on minor stroke etiologies was investigated, and compared with that of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. >bold<>italic/italic<>/bold< Consecutive patients with minor ischemic stroke (NIHSS ≤3) were assessed and subtyped by the ASCO and TOAST systems. Stroke etiologies were presented and compared. The McNemar test and >italic/italic< statistic were used to analyze the difference and concordance between the 2 algorithms, respectively. >bold<>italic/italic<>/bold< A total of 604 first-ever minor stroke patients were analyzed in the present study. Using TOAST classification, large artery atherosclerosis was the most frequent subtype (281, 46.5%), followed by small artery occlusion category (165, 27.3%). When ASCO was applied, 37 different profiles of stroke etiologies were identified. Using grade 1 of evidence, atherosclerosis (A1) was the most frequent subtype (308, 51.0%), followed by small vessel disease (S1, 178, 29.5%). Under consideration of grades 1 and 2, 239 (39.6%) patients were classified into more than 1 category. The ASCO system revealed determined etiologies in 104 of the 137 patients classified to cause undetermined subtype by TOAST classification. Good to very good accordance was observed between ASCO grade 1 and TOAST schemes across etiologic subtypes (>italic<κ>/italic< = 0.719–0.832) except cause undetermined category (>italic<κ>/italic< = 0.470). >bold<>italic/italic<>/bold< Application of ASCO decreased the proportion of patients assigned to cause undermined category compared to TOAST system. Comprehensive characteristics of ASCO system might be helpful in the personalized therapy or secondary prevention for individual patients in the future. [ABSTRACT FROM AUTHOR]

Background/aim: This study aimed to investigate the consistency between stroke and general neurologists in subtype assignment using the Trial of ORG-10172 in Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems. Materials and methods: Fifty consecutive acute ischemic stroke patients admitted to the stroke unit were recruited. Patients were classified by two stroke and two general neurologists, each from different medical centers, according to TOAST followed by the CCS. Each neurologist was assessed for consistency and compliance in pairs. Concordance among all four neurologists was investigated and evaluated using the kappa (ĸ) value. Results: The kappa (ĸ) value of diagnostic compliance between stroke neurologists was 0.61 (95% CI: 0.45-0.77) for TOAST and 0.78 (95% CI: 0.62-0.94) for CSS-5. The kappa (ĸ) value was 0.64 (95% CI: 0.48-0.80) for TOAST and 0.75 (95% CI: 0.60-0.91) for CCS-5 for general neurologists. Compliance was moderate [ĸ: 0.59 (95% CI: 0.52-0.65)] for TOAST and was strong [ĸ: 0.75 (95% CI: 0.68-0.81)] for CCS-5 for all 4 neurologists. 'Cardioembolism' (91.04%) had the highest compliance in both systems. The frequency of the group with 'undetermined etiologies' was less in the CCS (26%) compared to TOAST. Conclusion: The CCS system improved compliance in both stroke and general neurologists compared with TOAST. This suggests that the automatic, evidence-based, easily reproducible CCS system was superior to the TOAST system. [ABSTRACT FROM AUTHOR]

Introduction: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a well-known risk factor of atherosclerotic vascular diseases. Nevertheless, its role in the acute phase of ischemic stroke is still unclear. The aim of this study is to identify the relationship between Lp-PLA2 levels and early neurological deterioration (END) in acute ischemic stroke patients with Trial of Org 10 172 in Acute Stroke Treatment (TOAST) subtype of large arterial atherosclerosis (LAA). Methods: We enrolled Chinese patients with first ever acute ischemic stroke admitted to Neurology Department of Shenzhen Second People's Hospital within 48 h from onset of symptoms during January - November 2015. Demographic and laboratory information were collected while END was defined as an increase in the National Institute of Health Stroke Scale score by ≥ 1 point in motor power, or ≥ 2 points in the total score within 10 days after admission. Results: Overall 181 patients were involved; END was diagnosed in 30 patients within 10 days after admission. The odds ratio for END increased with increasing levels of Lp-PLA2 (intermediate level, OR = 1.96, 95%CI 1.02-4.27, p = 0.041; high level, OR = 2.99, 95%CI 1.26-5.73, p = 0.023). Conclution: Intermediate and high level of Lp-PLA2 was identified as independent predictor of END in multivariate analysis. Lp-PLA2 could be valued as a risk factor of END in patients with acute ischemic stroke with TOAST subtype of LAA. [ABSTRACT FROM AUTHOR]

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The objective of this study was to explore the outcome differen cesamong is chemic stroke sub types based on "Trial of ORG 10172 in Acute Stroke Treatment (TOAST)" system in a tertiary referral hospital. A hospital based prospectiv elongitudinal study was conducted involving 182 patients. Modified Rank in Scale (MRS) was used to assess functional out come, Kaplan-Meierproduct-limit method and Coxproportional hazards regression analys is were used to evaluate rates and identify predictors of survival and recurrent stroke. MRS were statistically different across stroke subtypesat 30 days and 6 months (p<0.0001 and (p<0.0001) respectively). Lacunar stroke was associated with milder deficits. Estimated rates of recurrent stroke were significantly differentat 30 days (p<0.0001)and at 6 months (p=0.009). Before adjusting forage, sex, stroke severity, and diabetes mellitus, infarct subtype was not an independent determinant of recurrent stroke within 30 days (p=0.057);but was at 6months (p=0.024), how ever after same adjustment it was independent determinant both at 30 days (p=0.030) and at 6 months (p=0.025). Estimated death rates were significantly different both at 3 0 days (p=0.026) and at 6 months (p=0.009).Ischemic stroke subtype wasan independent determinant of 6-month survival both before (p=0.016) and after (p=0.027) adjustment for different parameters; however, was not of 30-day survival both before (p=0.054) and after (p=0.993) same adjustment. Early recurrencerates were highest among largeartery atherosclerotic stroke. Lacunar strokehas betterpost stroke functional status. Survival is poorest among cardioembolic stroke. [ABSTRACT FROM AUTHOR]

Wonder Bread was the staple food of the American people in mid-20th century. In fact, the Wonder Bread factory of Interstate Bakery at Biddleford, Maine was the biggest producer of bread in the world in the 20th century. It was the impetus for the phrase, 'the greatest thing since sliced bread.' Due, in part to its powerful marketing strategy, sliced white bread was the symbol of white America. It became the leading character of the eating habits of America that stretched beyond race. Wonder Bread contributed to unifying the eating habits of a wide range of immigrants and thus helped in the integration of American multiracial society. The increased supply of Wonder Bread during wartime America encouraged an increased attention to nutrition. Since the 1960s, however, the middle-class American returned to homemade bread and bread made from whole wheat flour as health-consciousness increased. As greater ethnicity increased in America, so too did the cuisine of Americans and thus a greater diversity of meals, including the consumption of cereal for breakfast. Fewer Americans ate sliced bread for breakfast and lunch, and the sales of Wonder Bread decreased. Thus, we can see the rise and fall of Wonder Bread parallel the rise and decline of Anglo-American hegemony in mainstream culture. [ABSTRACT FROM AUTHOR]

Background and purpose: Clinical trials have shown that robust collateral flow has a relationship with good clinical outcome; however, different stroke subtypes were lumped together. This study explored the relationship between baseline collaterals and the onset‐to‐imaging time (OIT) and the correlation between pre‐treatment collateral status and clinical outcome amongst different subtypes. Method: Prospectively collected data from consecutive acute ischaemic stroke patients with acute middle cerebral artery occlusion who received reperfusion therapy were reviewed. The regional leptomeningeal score (20 points) was based on the scoring extent of contrast opacification in the six Alberta Stroke Program Early CT Score (ASPECTS) cortical regions (M1–6), parasagittal anterior cerebral artery territory and the basal ganglia by perfusion‐derived dynamic four‐dimensional computed tomography angiography (4D CTA). Stroke subtype was determined by the TOAST classification criteria. A 3‐months modified Rankin Scale score of 0–2 was defined as a good outcome. Results: The analysis included 158 patients: 30 (19.0%) patients had large artery atherosclerotic stroke (LAA), 87 (55.1%) cardioembolic stroke (CE) and 41 (25.9%) stroke of undetermined etiology. Baseline collateral was negatively correlated with OIT (P = 0.0205) in the CE group after adjusting for female sex, smoking, hyperlipidemia, baseline National Institutes of Health Stroke Scale (NIHSS) and baseline mismatch ratio, but not in the LAA group. Baseline collateral showed a strong relationship with good clinical outcome after adjusting for recanalization, baseline NIHSS, age and female sex (odds ratio 1.120, confidence interval 1.013–1.238, P = 0.027) in all patients and in the CE group (odds ratio 3.223, confidence interval 1.212–8.570, P = 0.019), but not in the LAA patients. Conclusions: Based on 4D CTA, sustained good leptomeningeal collaterals may predict good outcome in CE but not in LAA patients. Moreover, the extent of collaterals was associated with OIT in the CE patients, which indicates prompt reperfusion therapy in this group of patients. [ABSTRACT FROM AUTHOR]

Background and aims Only one study has examined endothelial function in subjects with acute ischemic stroke and no study has yet assessed arterial stiffness and reactive hyperemia peripheral arterial tonometry (RH-PAT) in ischemic stroke and its clinical subtypes. Our study aimed to evaluate arterial stiffness and endothelial dysfunction indexes in patients with acute ischemic stroke and the relationship between endothelial dysfunction indexes and arterial stiffness markers and stroke subtypes according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) Classification. Methods We enrolled 98 patients with a diagnosis of acute ischemic stroke and 105 hospitalized patients without a diagnosis of acute ischemic stroke. Arterial stiffness analysis was conducted by applanation tonometry to record radial artery pressure waveform continuously; augmentation index (Aix) and pulse wave velocity (PWV) were calculated. The reactive hyperemia index (RHI) was assessed by peripheral arterial tonometry. Results In comparison to controls, ischemic stroke subjects had higher mean levels of PWV, Aix, and significantly lower mean RHI values. Compared to subjects with lacunar and cardioembolic stroke, those with Large Artery AtheroSclerosis (LAAS) subtype of stroke had higher median levels of PWV and significantly lower median levels of RHI. On multinomial logistic regression analysis of predictive variables of stroke subtype (lacunar vs. LAAS and lacunar vs. cardioembolic), we observed a negative association between RHI value and LAAS subtype and a negative association of PWV with cardioembolic subtype. Conclusions Our findings underline the relationship between endothelial and arterial stiffness index correlations in patients with acute ischemic stroke, also suggesting the use of a combination of PAT and arterial stiffness indexes to better categorize patients with ischemic stroke. [ABSTRACT FROM AUTHOR]

Stroke is potentially the most devastating consequence of vascular disease, causing long-term disability and placing high medical, emotional, and financial burdens on the patient. WHO STEPS stroke surveillance study, provided the framework for our study of stroke patients in Chennai. In our center, we followed only the STEP 1 study and only hospital-based stroke data were collected. STEP 2 and 3 involved study of strokes in the community. We found that 78% of our patients were in the 6th to 8th decades of life; 72% had hypertension, either alone or in combination with other risk factors; 4 weeks after the stroke, 51% of our patients were independent with regard to mobility and the activities of daily living, while 14% had severe disability. We found a mortality rate of 14%. We concluded that the incidence of stroke in the community can be decreased further by effective risk factor modification. The admission delay needs to be shortened from> 48 h to less than 6 h. Our data also gave us fresh information about the recovery of motor function in stroke survivors at 28 days after the stroke.

PURPOSE: We preliminarily investigated the relevance of performing digital subtraction angiography (DSA) in addition to magnetic resonance angiography (MRA) in definition of ischemic stroke etiology in young patients. METHOD: DSAs and MRAs from 17 young patients with nonlacunar ischemic stroke were blindly analyzed and their impact on stroke management was evaluated. RESULTS: Etiologies were the same considering results of either DSA or MRA in 12/17 cases. In 15/17 patients no changes would have been made in treatment, regardless of the modality of angiography considered. CONCLUSION: These preliminary results suggest that DSA may be redundant in two thirds of ischemic strokes in young patients. Further larger prospective studies are necessary to determine indications of DSA in this age group.PROPÓSITO DO ESTUDO: Investigar de forma preliminar a relevância da realização de angiografia digital (AD) adicionalmente a angioressonância (AR) na definição de etiologias de acidente vascular cerebral isquêmico (AVCI) em pacientes jovens. MÉTODO: ADs e ARs de 17 pacientes jovens com AVCIs não-lacunares foram analisadas. Avaliamos o impacto destes exames no manejo clínico dos casos. RESULTADOS: Em 12/17 casos, as etiologias dos AVCIs de acordo com os resultados de AD ou de AR foram idênticas. Em 15/17 pacientes, nenhuma mudança de conduta terapêutica seria realizada, independentemente da modalidade de exame considerada. CONCLUSÃO: Estes resultados preliminares sugerem que os resultados da AD podem ser redundantes em relação à AR em até dois terços dos pacientes jovens com AVCI. Estudos prospectivos maiores são necessários para otimizar o estabelecimento de indicações de AD nesta faixa etária.

Cerebellar stroke is a rare condition with very nonspecific clinical features. The symptoms in the acute phase could imitate acute peripheral vestibular disorders or a brainstem lesion. The aim of this study was to assess the usefulness of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification in cerebellar stroke and the impact of clinical features on the prognosis. We retrospectively analyzed 107 patients with diagnosed ischemic cerebellar infarction. We studied the clinical features and compared them based on the location of the ischemic lesion and its distribution in the posterior interior cerebellar artery (PICA), superior cerebellar artery (SCA), and anterior inferior cerebellar artery (AICA) territories. According to the TOAST classification, stroke was more prevalent in atrial fibrillation (26/107) and when the lesion was in the PICA territory (39/107). Pyramidal signs occurred in 29/107 of patients and were more prevalent when the lesion was distributed in more than two vascular regions ( p = 0.00640). Mortality was higher among patients with ischemic lesion caused by cardiac sources ( p = 0.00094) and with pyramidal signs ( p = 0.00640). The TOAST classification is less useful in assessing supratentorial ischemic infarcts. Cardioembolic etiology, location of the ischemic lesion, and pyramidal signs support a negative prognosis. [ABSTRACT FROM AUTHOR]

Background: Ischemic stroke patients subtyped as of undetermined cause (SUC) usually outnumber those with determined cause subtypes. Etiological stroke classifications may lead to neglect of parallel, noncausative findings. Atherosclerosis progresses over decades and is associated with high morbidity and mortality in young stroke patients in long-term follow-up studies. We compared the prevalence of carotid atherosclerosis in all TOAST subtypes among young patients with acute ischemic stroke. Methods: We investigated 150 patients aged 15-60 years with documented acute ischemic stroke, and 84 controls free of cardiovascular disease. Stroke etiology was classified according to TOAST criteria. Carotid intima-media thickness (cIMT) measurements were obtained from 12 standardized multiangle measurements in the common carotid artery, carotid bifurcation, and internal carotid artery. Results: The causes of stroke were 5.3% large-artery atherosclerosis (LAA), 26.7% cardioembolism, 21.3% small-artery occlusion (SAO), 10% stroke of other determined cause, and 36.7% stroke of undetermined cause (SUC). cIMT was increased in patients with LAA (1.56 mm, P = .002), SAO (1.11 mm, P = .006), and SUC (1.10 mm, P = .004) compared to controls (cIMT 0.86 mm). Segmental cIMT distribution differed across stroke subtypes, age groups, and sexes. Conclusions: Atherosclerotic disease is prevalent in the majority of young and middle-aged ischemic stroke patients, requiring determined investigation and aggressive treatment of modifiable risk factors. [ABSTRACT FROM AUTHOR]

Background: Whether the presence of hyperdense artery sign (HAS) correlates with clot characteristics and response to intravenous thrombotic therapy (IVT) remains to be determined. Given that the existent literature was mainly from the Western nations, the current study aimed to examine the relationships among HAS, clot characteristics, and outcome of IVT in a Han Chinese sample in Taiwan. The specific objectives are (1) to correlate HAS with clot characteristics and (2) to explore relationships between HAS and effectiveness/complication of IVT. Methods: We enrolled 75 patients treated with IVT following acute large arterial infarctions. All patients had a baseline brain computed tomography and a follow-up image at 24 hours after thrombolysis. Correlations were explored between HAS and clot characteristics. Multivariable logistic regressions were employed to examine the relationships between HAS and response to IVT at 24 hours, including early improvement and all forms of intracerebral hemorrhage (ICH). Results: In this Han Chinese sample in Taiwan, 50.7% of the patients had HAS and 64% had early improvements following IVT. Those with HAS tended to have clots lodging at main trunks of cerebral arteries but no significant associations were found between HAS and stroke etiology. In multivariable logistic regressions, HAS predicted neither early improvement nor ICH complication. Conclusions: Instead of clot etiology, we found that it might be clot location that correlated with HAS. HAS was not associated with early improvement or ICH complication after IVT in this Han Chinese sample. We also showed that some other patient characteristics were likely to influence outcomes of IVT, which warrant clinical attention. [ABSTRACT FROM AUTHOR]

Background and Purpose: Seizures are a known complication of ischemic stroke (IS). This study assesses the long-term incidence and characteristics of poststroke seizures in a well-defined population.Methods: Using the Rochester Epidemiology Project medical records-linkage system, we identified all incident cases of IS among Rochester, Minnesota, residents from 1990 to 1994 and followed the patients in the comprehensive medical record through March 2014. All patients with poststroke seizures were identified, and data regarding incident IS, seizures, and status at last follow-up were analyzed.Results: We identified 489 patients with first IS. Mean follow-up was 6.5 (standard deviation 6.3) years. New onset seizures occurred in 35 patients (7.2%). Patients with poststroke seizure did not differ from those without in terms of IS etiologic subtype (P = .44) or IS risk factors (P > .05). Early seizures (within 14 days of index stroke) developed in 14 patients (40%), the majority within the first 24 hours (n = 9, 64.3%). The median time of seizure onset for the remaining 21 patients was 13.8 months. Functional outcome, as measured by modified Rankin Scale (mRS), was worse following development of poststroke seizures (mean mRS score 2.9 after IS, 3.3 following index seizure; P = .005), and mortality was higher as well, even after adjusting for IS etiologic subtype (HR 1.52, 95% confidence interval 1.07-2.16, P = .02).Conclusion: Development of poststroke seizures is an infrequent but significant complication of IS, portending a worse short-term functional outcome and a higher long-term mortality rate. Seizure occurrence did not differ based on IS etiologic subtype or stroke risk factors. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the association between inflammatory and metabolic markers and short-time outcome with acute ischemic stroke subtypes. A total of 121 patients was classified according to TOAST criteria, such as large artery atherosclerosis (LAAS), lacunar infarct (LAC), cardioembolic infarct (CEI), other determined etiology (ODE), and undetermined etiology (UDE). The functional impairment was evaluated within the first eight hours of stroke and the outcome after three-month follow-up using the modified Rankin Scale. Blood samples were obtained up to 24 h of stroke. Compared with 96 controls, patients with LAAS, CEI, and LAC subtypes showed higher levels of white blood cells, high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), metalloproteinase 9 (MMP-9), glucose, and iron ( p < 0.05); and lower high-density lipoprotein cholesterol (HDL-C) ( p < 0.0001); platelets, insulin, insulin resistance, and homocysteine were higher in LAC ( p < 0.0001); ferritin was higher in LAAS ( p < 0.0001); and total cholesterol (TC) was lower in LAAS and CEI ( p < 0.01). When stroke subtypes were compared, insulin was higher in LAAS vs. LAC and in LAC vs. CEI ( p < 0.05); and TC was lower in LAAS vs. LAC ( p < 0.05). Outcome and rate of mortality after three-month were higher in LAAS vs. LAC ( p < 0.001 and p = 0.0391 respectively). The results underscored the important role of the inflammatory response and metabolic changes in the pathogenesis of ischemic stroke subtypes that might be considered on the initial evaluation of stroke patients to identify those that could benefit with individualized therapeutic strategies that taken into account these markers after acute ischemic event. [ABSTRACT FROM AUTHOR]