Cognition and Cerebral Blood Flow After Extracranial Carotid Revascularization for Carotid Atherosclerosis: A Systematic Review.

PURPOSE: Extracranial atherosclerotic carotid stenosis is associated with inadequate cerebral blood flow (CBF) and cognitive dysfunction. The impact of extracranial carotid revascularization on cognition and how any cognitive change relates to changes in CBF are less clear. This review examines the effects of revascularization of extracranial carotid disease by carotid endarterectomy (CEA) or carotid stenting (CAS) on cognition, and how this relates to changes in CBF. METHODS: A systematic review of existing reports in the Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement recommendations. All original retrospective or prospective studies and clinical trials that compared pre- and postoperative cognitive function and CBF in patients with extracranial carotid stenosis who underwent CEA or CAS versus a control group, published between January 1985 and December 2022, were identified and considered eligible for inclusion in this study. FINDINGS: Seven studies (661 participants; 460 CEA or CAS) were identified. All were observational studies and of moderate to good methodologic quality. Six studies (619 participants; follow-up range 1 month to 2 years) demonstrated improvement in some cognitive domains following CEA or CAS, improvement in CBF following revascularization, and correlated some of these cognitive changes with changes in CBF. One study (42 participants; 3 months follow-up) found cognitive improvement following CEA, but found no improvement in CBF or any correlation between cognitive and CBF change. The literature however represented heterogenous study populations examining asymptomatic and/or symptomatic carotid stenosis, differing in treatment modality and criteria for control groups ranging from healthy volunteers to those with stenosis but not who underwent surgical revascularization, and finally, differing reporting methods. This heterogeneity precluded meta-analysis. IMPLICATIONS: Definitive conclusions are limited by variation in cognitive function assessment, timing of testing, and how these are correlated to CBF. However, research suggests a potential improvement in cognition which may be associated with improvement in CBF, particularly in those patients who have more significant CBF deficit at baseline. Further studies are required to better understand this association and provide a clearer picture of the cognitive effects of carotid revascularization.

A Technique of "Chimney Nellix" for the Management of Type 1a Endoleak After EVAR.

This report presents 3 procedures with visceral "chimney stenting" in conjunction with an endovascular aneurysm sealing (EVAS) device, known as chEVAS, for treatment of type 1a endoleak. It includes the first published chEVAS in a patient with previous fenestrated endovascular aneurysm repair (FEVAR). Cases include an 80-year-old man 8 years after FEVAR for a juxtarenal abdominal aortic aneurysm (AAA); an 85-year-old woman 9 months after endovascular aneurysm repair (EVAR) for a ruptured infrarenal AAA; and an 84-year-old woman 3 months after EVAR for a symptomatic infrarenal AAA. Technical success was achieved in all cases, with 1 postoperative death. The remaining 2 patients had no residual type 1a endoleak at 10 and 14 months respectively.

Aspiration Thrombectomy versus Conventional Catheter-Directed Thrombolysis as First-Line Treatment for Noniatrogenic Acute Lower Limb Ischemia.

PURPOSE: To examine the efficacy, safety, and procedural costs of percutaneous aspiration thrombectomy (PAT) as a first-line treatment for noniatrogenic acute lower limb ischemia (ALI) compared with conventional catheter-directed thrombolysis (CDT). MATERIALS AND METHODS: All patients who underwent endovascular intervention for ALI from January 2015 to August 2017 were included. Fifteen patients were treated with the use of primary PAT and 27 patients were treated with the use of primary CDT. The primary end point was complete thrombus clearance with improvement in Thrombolysis in Myocardial Infarction (TIMI) score. Adjunctive treatment for thrombus removal was considered to indicate technical failure. Treatment of underlying chronic disease was not considered to indicate technical failure. Procedural costs for each patient were calculated by itemizing all disposable equipment, facility overheads, and staff costs. RESULTS: Of the 15 primary PAT patients, technical success was achieved in 8 (53%); the remaining 7 (47%) required adjunctive CDT. Of the 27 primary CDT patients, technical success was achieved in 25 (89%); the remaining 2 (11%) required adjunctive PAT. There were 4 complications in the primary PAT group: 2 were procedure related and of a minor grade. There were 8 complications in the primary CDT group: All were procedure-related, including 2 major groin/retroperitoneal hemorrhage and 1 death from intracranial hemorrhage. Limb salvage was attained in all patients. There were no significant differences in average procedural costs per patient between the 2 groups. CONCLUSIONS: First-line use of PAT for endovascular treatment of ALI can reduce the need for CDT, with no significant cost difference.

A quantification of the relationship between neuronal responses in the rat rostral ventromedial medulla and noxious stimulation-evoked withdrawal reflexes.

The rostral ventromedial medulla (RVM) regulates a range of involuntary behaviours but is most often associated with nociception via the action of pronociceptive ON cells and antinociceptive OFF cells. The phasic responses of ON and OFF cells determine whether or not incoming noxious signals provoke a withdrawal reflex, and previous studies have suggested that reflex RVM activity patterns actively shape motor output. Here we challenged the model by using juvenile rats, which are known to exhibit markedly different reflex responses compared with adults. By recording single-cell activity in the RVM and the electromyography responses of hindlimb flexor muscles to noxious thermal stimulation we found that the juvenile reflex had a shorter onset latency, was larger in amplitude and exhibited a decreased rise time compared with the adult reflex. The responses of ON and OFF cells faithfully tracked the shorter onset latency of the reflex by also responding earlier and, thus, still preceded the reflex. However, neither the reflex amplitude nor the ongoing response profile was predicted by the firing rate of RVM cells in either age group. Instead we found a close correspondence between RVM activity and the reflex only during the initiation of the response. Furthermore, the short rise time of the juvenile reflex was reflected in higher rates of change of both ON and OFF cell firing. Our data suggest that the RVM is associated only with the initiation of reflexes and does not shape ongoing muscle activity, which is more likely to be subserved by downstream spinal processes.

All-optical picoseconds logic gates based on a fiber optical parametric amplifier.

All-optical XOR-, OR-, NOT-, and AND-gate were demonstrated for 10 Gb/s return-to-zero on-off keying (RZ-OOK) signals using a single experimental setup. This setup can be set to output different logic by altering input power, state-of-polarization, center frequencies of input optical signals, and/or input bitstreams. Full-width at half-maximum pulsewidth of the input and the output signals were less than 5.1 ps in all cases showing a possibility of higher data rate operation at 80Gb/s or beyond.

Pulsed pump wavelength exchange for high speed signal de-multiplexing.

We report the first experimental demonstration of pulsed pump wavelength exchange in a highly nonlinear dispersion-shifted fiber for all-optical time de-multiplexing of 80 Gb/s return-to-zero (RZ) signals. Orthogonal pulsed pump and continuous wave (cw) pump are used in the fiber-based wavelength exchange for ultra-fast power switching. Error-free operation was achieved for the proposed all-optical 1:8 de-multiplexer over all time de-multiplexed 10 Gb/s RZ signals with

Diverse and atypical genotypes identified in Toxoplasma gondii from dogs in São Paulo, Brazil.

The prevalence of Toxoplasma gondii in 118 unwanted dogs from São Paulo City, São Paulo State, Brazil, was determined. Antibodies to T. gondii were assayed by the modified agglutination test and found in 42 (35.8%) dogs, with titers of 1:20 in 10, 1:40 in 6, 1:80 in 5, 1:160 in 5, 1:320 in 6, 1:640 in 7, and 1:1,280 or higher in 3. Hearts and brains of 36 seropositive dogs were bioassayed in mice, or cats, or both. Tissues from 20 seropositive dogs were fed to 20 T. gondii-free cats. Feces of cats were examined for oocysts. Toxoplasma gondii was isolated from 15 dogs by a bioassay in mice, from the brain alone of 1, from the heart alone of 4, and from both brains and hearts of 10. All infected mice from 5 of 15 isolates died of toxoplasmosis during primary infection. Four additional isolates were obtained by bioassay in cats. Genotyping of these 19 T. gondii isolates using polymorphisms at 10 nuclear markers including SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and a new SAG2 (an apicoplast marker Apico) revealed 12 genotypes. One isolate had Type III alleles at all 11 loci, and the remaining 18 isolates contained a combination of different alleles and were divided into 11 genotypes. The absence of Type II in Brazil was confirmed. The result supports previous findings that T. gondii population genetics is highly diverse in Brazil.

Optical label switching of DRZ/DPSK orthogonal signal generated by photonic-crystal fiber.

We demonstrate orthogonal label switching by using a dark-return-to-zero (DRZ) payload and differential phase-shift keying (DPSK) label generated by a dispersion-flattened photonic-crystal fiber. The high extinction ratio of both the payload and label improves the receiver margin. The DRZ payload introduces little cross talk to the DPSK label due to the RZ-like output of the demodulated DPSK. Simulations are performed to study the eye-closure penalty of the payload and label at different DRZ pulse widths. We compare the DRZ/DPSK with the RZ and DPSK signals numerically at the same data rate and show that the DRZ/DPSK has a strong tolerance to the polarization-mode dispersion. The DRZ/DPSK has a more compact spectrum suitable for the strong filtering requirements in WDM systems.

Nonlinear polarization rotation in a dispersion-flattened photonic-crystal fiber for ultrawideband (>100 nm) all-optical wavelength conversion of 10 Gbit/s nonreturn-to-zero signals.

We study the conversion bandwidth of the cross-polarization-modulation (XPoIM)-based wavelength conversion scheme with a dispersion-flattened highly nonlinear photonic-crystal fiber for signals with a nonreturn-to-zero (NRZ) modulation format. Both theoretical and experimental results show that the conversion bandwidth can be extended to cover a very wide band, including S-, C-, and L-bands for 10 Gbit/s NRZ signals (a total bandwidth of 120 nm is experimentally demonstrated). We also study the theoretical bandwidth limit for 40 Gbit/s NRZ signals. A significant extension of the conversion bandwidth using the XPoIM approach compared with the four-wave mixing approach previously reported is demonstrated.

Combination gemcitabine and cisplatin chemotherapy for metastatic or recurrent nasopharyngeal carcinoma: report of a phase II study.

BACKGROUND: To evaluate the efficacy and toxicity of combination gemcitabine plus cisplatin (GC) chemotherapy in metastatic or recurrent nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS: Forty-four patients of Chinese ethnicity with metastatic or recurrent NPC received ambulatory GC chemotherapy every 28 days (gemcitabine 1000 mg/m(2) days 1, 8 and 15; cisplatin 50 mg/m(2) days 1 and 8). There were 40 male and four female patients with a mean age of 47.4 years. More than half (54.5%) of the patients had received either prior platinum-based chemotherapy and/or radiotherapy to target lesions. RESULTS: There were nine complete responses and 23 partial responses in the 44 patients, achieving an overall response rate of 73% (78% for the 41 assessable patients). The mean duration of response was 5.3 months. Improved subjective symptom-control scores were found in 78% of patients with pre-existing symptoms, while 64% of patients experienced improved general well-being scores. Toxicity was mainly hematological: grade III/IV anemia, granulocytopenia and thrombocytopenia were found in 11, 37 and 16% of cycles, respectively. With a median follow-up of 17.2 months, 62% survived 1 year while 36% were alive and progression free. CONCLUSIONS: Gemcitabine plus cisplatin chemotherapy offers a satisfactory overall response rate, subjective patient improvement and safety profile for metastatic and recurrent NPC.

Uterine artery embolisation for treatment of fibroids: experience in Chinese women.

Twelve women with symptomatic fibroids were treated with transcatheter uterine artery embolisation with the use of polyvinyl alcohol (PVA) particles. For the nine women who were due for follow-up, reduction in uterine volume and dominant fibroid size were observed on magnetic resonance imaging. All the nine women had normal luteinising hormone (LH) and follicle stimulating hormone (FSH) levels before the procedure and during the follow-up. Seven of the nine women reported noticeable symptomatic improvement during the follow-up. Pain experienced was of variable level, but well controlled. Adequate analgesia is essential for the procedure. Longer follow-up and prospective fertility studies are required to evaluate the long-term effects before this procedure could be safely extended to younger age groups.

Forced unfolding modulated by disulfide bonds in the Ig domains of a cell adhesion molecule.

Cell adhesion molecules (CAMs) mediate cell attachment and stress transfer through extracellular domains. Here we forcibly unfold the Ig domains of a prototypical Ig superfamily CAM that contains intradomain disulfide bonds. The Ig domains of all such CAMs have conformations homologous to cadherin extracellular domains, titin Ig-type domains, and fibronectin type-III (FNIII) domains. Atomic force microscopy has been used to extend the five Ig domains of Mel-CAM (melanoma CAM)--a protein that is overexpressed in metastatic melanomas--under conditions where the disulfide bonds were either left intact or disrupted through reduction. Under physiological conditions where intradomain disulfide bonds are intact, partial unfolding was observed at forces far smaller than those reported previously for either titin's Ig-type domains or tenascin's FNIII domains. This partial unfolding under low force may be an important mechanism for imparting elasticity to cell-cell contacts, as well as a regulatory mechanism for adhesive interactions. Under reducing conditions, Mel-CAM's Ig domains were found to fully unfold through a partially folded state and at slightly higher forces. The results suggest that, in divergent evolution of all such domains, stabilization imparted by disulfide bonds relaxes requirements for strong, noncovalent, folded-state interactions.

Testicular volume of boys after inguinal herniotomy: combined clinical and radiological follow-up.

A total of 173 boys aged 10 to 179 months with previous unilateral inguinal herniotomy were called back for follow-up. Clinical and ultrasound examinations of the scrotum were performed. The interval between operation and follow-up was 6 to 123 months (mean 31.68 months). One boy (0.58%) had a more than 50% and 10 (5.8%) had a more than 25% decrease in testicular volume on the operated side when compared with the non-operated side.

The characteristics, perceptions and personalities of women seeking a reversal of their tubal sterilization.

The characteristics, perceptions and personalities of women who had sought a reversal of a tubal sterilization procedure and those who had not were studied. Women were more likely to request reversal of a tubal sterilization if they were less than 30 years old at the time of the operation or if they had changed their marital status since sterilization. Women who had undergone a tubal sterilization and later sought a reversal stated that at the time of the procedure they did not believe that their family was complete; they had not had sufficient time to consider the implications of undergoing a tubal sterilization; they felt that they had been "pressured" by their partner to be sterilized; and they perceived the potential to have a child as important, even if they did not wish for further children. Women who had had a tubal sterilization performed within a few days of childbirth for "health or medical reasons" and sought a reversal no longer believed that the reasons were valid. In spite of the inclusion of women who had changed their minds about tubal sterilization, no differences were detected in psychometric measures of personality and mental health between our groups. The findings of the survey confirm that a woman should make up her own mind whether or not to undergo a tubal sterilization, and the operation should not be available "on demand". Ways of overcoming the problem are suggested.