Incomplete or failed thrombectomy in acute stroke patients with Alberta Stroke Program Early Computed Tomography Score 0-5 - how harmful is trying?

BACKGROUND AND PURPOSE: It is currently unknown whether mechanical thrombectomy (MT) for ischaemic stroke patients with low initial Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is clinically beneficial or even harmful. The purpose of this study was to investigate whether failed or incomplete MT in acute large vessel occlusion stroke with an initial ASPECTS ≤ 5 is associated with worse clinical outcome compared to patients not undergoing MT. METHODS: This observational cohort study included a consecutive sample of patients with anterior circulation stroke and initial ASPECTS ≤ 5 admitted between March 2015 and August 2019. Failed recanalization was defined as Thrombolysis in Cerebral Infarction (TICI) score 0-2a, and incomplete recanalization as TICI 2b. Clinical outcome was assessed using the modified Rankin Scale (mRS) at 90 days defining very poor clinical outcome as mRS > 4. RESULTS: One hundred and seventy patients were included. Ninety-nine patients underwent MT and 71 patients received best medical treatment only. Clinical outcome after failed or incomplete MT (TICI 0-2b) was significantly better compared to patients with medical treatment only (median mRS 5, interquartile range 4-6 vs 5-6, P = 0.03). In multivariable logistic regression analysis, failed or incomplete MT (TICI 0-2b) showed a significantly reduced likelihood for very poor outcome (odds ratio 0.39, 95% confidence interval 0.19-0.83, P = 0.01). Failed MT (TICI 0-2a) was not associated with a worse outcome compared to best medical treatment. CONCLUSIONS: Patients with failed or incomplete recanalization results (TICI 0-2b) showed a reduced likelihood for very poor outcome compared with those who did not receive MT. Evidence from randomized trials is needed to confirm that even failed or incomplete MT is not harmful in these patients.

Decoy peptides derived from the extracellular domain of toll-like receptor 2 (TLR2) show anti-inflammatory properties.

Toll-like receptor 2 (TLR2) recognizes bacterial derived- and synthetic-lipopeptides after dimerization with TLR1 or TLR6. Hyper-activation of TLR2 has been described in several inflammatory diseases and the discovery of inhibitors of its pro-inflammatory activity represent potential starting points to develop therapeutics in such pathologies. We designed peptides derived from the TLR2 sequence comprising amino acid residues involved in ligand binding (Pam3CSK4) or heterodimerization (TLR2/TLR1) as pointed out by structural data.2 We identified several peptides (P13, P13(LL), P16, P16(LL)) which inhibited TLR2/1 signaling in HEK293-TLR2 cells (MAPK activation and NF-kB activity). Moreover, P13L and P16L decreased TNFα release in human primary PBMCs and mouse macrophages. The peptides were selective for TLR2/1 as they did not inhibit the activity of other TLRs tested. P13L and P16L inhibited the internalization of Pam3CSK4 fluorescently labeled in macrophages and the heterodimerization of TLR2 with TLR1 as demonstrated by immunoprecipitation studies. Our data demonstrate that peptides derived from the region comprising the leucine-rich repeats (LRR) 11 and 13 in the extracellular domain of TLR2 are good starting points to develop more potent anti-inflammatory peptides with TLR2 inhibitory activity.

Aneurysm Recurrence Volumetry Is More Sensitive than Visual Evaluation of Aneurysm Recurrences.

PURPOSE: Considerable inter-observer variability in the visual assessment of aneurysm recurrences limits its use as an outcome parameter evaluating new coil generations. The purpose of this study was to compare visual assessment of aneurysm recurrences and aneurysm recurrence volumetry with an example dataset of HydroSoft coils (HSC) versus bare platinum coils (BPC). METHODS: For this retrospective study, 3-dimensional time-of-flight magnetic resonance angiography datasets acquired 6 and 12 months after endovascular therapy using BPC only or mainly HSC were analyzed. Aneurysm recurrence volumes were visually rated by two observersas well as quantified by subtraction of the datasets after intensity-based rigid registration. RESULTS: A total of 297 aneurysms were analyzed (BPC: 169, HSC: 128). Recurrences were detected by aneurysm recurrence volumetry in 9 of 128 (7.0 %) treated with HSC and in 24 of 169 (14.2 %) treated with BPC (odds ratio: 2.39, 95 % confidence interval: 1.05-5.48; P = 0.039). Aneurysm recurrence volumetry revealed an excellent correlation between observers (Cronbach's alpha = 0.93). In contrast, no significant difference in aneurysm recurrence was found for visual assessment (3.9 % in HSC cases and 4.7 % in BPC cases). Recurrences were observed in aneurysms smaller than the sample median in 10 of 33 (30.3 %) by aneurysm recurrence volumetry and in 1 of 13 (7.7 %) by visual assessment. CONCLUSIONS: Aneurysm recurrences were detected more frequently by aneurysm recurrence volumetry when compared with visual assessment. By using aneurysm recurrence volumetry, differences between treatment groups were detected with higher sensitivity and inter-observer validity probably because of the higher detection rate of recurrences in small aneurysms.

Association between tobacco smoking and prognosis of occupational hand eczema: a prospective cohort study.

BACKGROUND: Hand eczema (HE) is a common occupational skin disease. Tobacco smoking is known to be associated with adverse cutaneous effects. However, its influence on the prognosis of occupational HE has not yet been studied. OBJECTIVES: To evaluate relations between smoking status, severity and prognosis of occupational HE in patients taking part in an interdisciplinary tertiary individual prevention programme (TIP). METHODS: In a prospective, multicentre, cohort study 1608 patients with occupational HE taking part in a TIP were recruited and followed up for 3 years. The clinical and self-reported outcome data of smokers and nonsmokers were compared. RESULTS: Nonsmokers and smokers were equally distributed. During the TIP, the average self-reported daily cigarette consumption and the severity of HE decreased significantly (P < 0·01). However, at all time points HE was significantly more severe in smokers than in nonsmokers. This association was not dependent on the self-reported number of cigarettes smoked daily. Smokers had significantly more days of absence from work due to occupational HE than nonsmokers in the year before the TIP (P < 0·01) and in the following year (P = 0·02). After the TIP, smokers reported significantly more often that they had to give up their occupation (P = 0·02) than nonsmokers. CONCLUSIONS: The severity of occupational HE is increased in smokers. Tobacco smoking is associated with a higher number of days of absence from work and with not staying in the workforce owing to occupational HE. Thus, smoking confers a worse prognosis and interferes with the outcome of prevention programmes.

Intranidal signal distribution in post-contrast time-of-flight MRA is associated with rupture risk factors in arteriovenous malformations.

PURPOSE: To evaluate if arteriovenous malformations (AVMs) that are associated with a high rupture risk (HRR) are represented by different intranidal Time-of-Flight (TOF) magnetic resonance angiography intensity distributions compared to those with presumably low rupture risk (LRR). METHODS: Fifty post-contrast TOF datasets of patients with an AVM were analyzed in this study. The patients were classified to the HRR group in case of a deep location, presence of exclusive deep venous drainage, previous hemorrhagic event or a combination thereof. For each TOF dataset, the AVM nidus was semi-automatically delineated and used for histogram extraction. Each histogram was analyzed by calculating the skewness, kurtosis, mean and median intensity and full-width-half-maximum. Statistical analysis was performed using parameter-wise two-sided t-tests of the parameters between the two groups. RESULTS: Based on morphological analysis, 21 patients were classified to the HRR and 29 patients to the LRR group. Statistical analysis revealed that TOF intensity distributions of HRR AVMs exhibit a significant higher skewness (p=0.0005) parameter compared to LRR AVMs. Contrary to these findings, no significant differences were found for the other parameters evaluated. CONCLUSION: Intranidal flow heterogeneity, for example, caused by turbulent flow conditions, may play an important role for risk of a hemorrhage. An analysis of post-contrast TOF intensities within the nidus of an AVM may offer simple and valuable information for clinical risk estimation of AVMs and needs to be tested prospectively.

RFLP mapping of three new loci for resistance genes to powdery mildew (Erysiphe graminis f. sp. hordei) in barley.

Three new major, race-specific, resistance genes to powdery mildew (Erysiphe graminis f. sp. hordei) were identified in three barley lines, 'RS42-6*O', 'RS137-28*E', and 'HSY-78*A', derived from crosses with wild barley (Hordeum vulgare ssp. spontaneum). The resistance gene origining from wild barley in line 'RS42-6*O', showed a recessive mode of inheritance, whereas the other wild barley genes were (semi)-dominant. RFLP mapping of these three genes was performed in segregating F2 populations. The recessive gene in line 'RS42-6*O', was localized on barley chromosome 1S (7HS), while the (semi)-dominant genes in lines 'RS137-28*E', and 'HSY-78*A', were localized on chromosomes 1L (7HL) and 7L (5HL), respectively. Closely linked RFLP clones mapped at distances between 2.6cM and 5.3 cM. Hitherto, specific loci for powdery mildew resistance in barley had not been located on these chromosomes. Furthermore, tests for linkage to the unlocalized resistance gene Mlp revealed free segregation. Therefore, these genes represent new loci and new designations are suggested: mlt ('RS42-6*O'), Mlf ('RS137-28*E'), and Mlj ('HSY-78*A'). Comparisons with mapped QTLs for mildew resistance were made and are discussed in the context of homoeology among the genomes of barley (H-vulgare), wheat (Triticum aestivum), and rye (Secale cereale). Duplications of RFLP bands detected in the neighbourhood of Mlf and mlt might indicate an evolutionary interrelationship to the Mla locus for mildew resistance.

[Use of keratinocytes in therapy of ulcera crurum]. / Applikation von Keratinozyten in der Therapie von Ulcera crurum.

Freshly isolated keratinocytes were used for the treatment of non-healing leg ulcers (21 cases). For application, keratinocytes were suspended in fibrin (Tissucol Duo S). One or more applications of keratinocytes initiated granulation and reepithelialization of nearly all leg ulcers (20 cases). The method is compared with the established therapy entailing transplantation of allogenic keratinocyte sheets onto leg ulcers. Our method shows the advantages: autologous cells that are immediately and easily available, freedom from pain, and short-time immobilization (48 h) after application.

Protonation and free energy changes associated with formation of QBH2 in native and Glu-L212-->Gln mutant reaction centers from Rhodobacter sphaeroides.

Formation of the quinol QBH2 in Glu-L212-->Gln mutant [EQ(L212)] reaction centers (RCs) from Rhodobacter sphaeroides was investigated by measuring the proton uptake (using dyes), UV absorption changes, and free energy changes associated with the two-electron reduction of QB. The advantage of using the EQ(L212) RCs for these studies is that the individual protonation steps can be kinetically resolved and analyzed; conclusions reached regarding the mechanism of formation of QBH2 are expected to apply also to native RCs. The proton uptake by EQ(L212) RCs was strongly biphasic: the fast phase was essentially concomitant with the second electron transfer to QB- (approximately 1 ms at pH 7.5); the slow phase was approximately 2000-fold slower. The rate constant of the slow phase depended on the redox state of the primary quinone QA; for QA- the rate constant was larger (i.e., 8-fold at pH 6.0) than for QA. The electron and proton transfers to QB- in EQ(L212) RCs were modeled with a two-step scheme as follows: (1) fast, QA-QB- + H+(1)-->QA(QBH)-; (2) slow, QA(QBH)- + H+(2)-->QAQBH2, where reaction 1 involves concomitant electron transfer and proton uptake [Paddock, M. L., McPherson, P. H., Feher, G., & Okamura, M. Y. (1990) Proc. Natl. Acad. Sci. U.S.A. 87, 6803-6807]. The stoichiometry of the fast proton uptake associated with the two-electron reduction of QB varied from 1.1 to 1.4 H+/2e- at pH 6.5-8.5, consistent with the uptake of H+(1) plus an additional fractional proton uptake due to amino acid residues whose pKa values are shifted by interactions with the charge of (QBH)-. The total steady-state proton uptake stoichiometry was 2.0 H+/2e- at pH < or = 7.5, consistent with the formation of the quinol QBH2 (reactions 1 and 2). At pH 8.5, the steady-state proton uptake was 1.6 +/- 0.1 H+/2e-, which is consistent with an apparent pKa for H+(2) of approximately 8.5 [McPherson, P. H., Okamura, M. Y., & Feher, G. (1993) Biochim. Biophys. Acta 1144, 309-324]. The proton uptake kinetics indicate that Glu-L212 is a component of the proton transfer chain for H+(2) that connects reduced QB (buried in the RC protein) to the aqueous solvent as proposed previously [Paddock, M. L., Rongey, S. H., Feher, G., & Okamura, M. Y. (1989) Proc. Natl. Acad. Sci. U.S.A. 86, 6602-6606].(ABSTRACT TRUNCATED AT 400 WORDS)

[Keratinocytes from cell culture for therapy of skin defects. Review and personal results]. / Keratinozyten aus der Zellkultur zur Therapie von Hautdefekten. Ubersicht und eigene Resultate.

The development of a method to cultivate and expand human keratinocytes in vitro by Rheinwald and Green in the mid-1970s can be considered a milestone in the search for the ideal biological skin substitute. For more than 10 years, cultured keratinocytes have now been used for the treatment of various wounds. In this paper the present status knowledge and the authors own experience after treating 29 patients are discussed.

Automatic shape quantification of freely suspended red blood cells by isodensity contour tracing and tangent counting.

In several blood diseases, the resting red blood cells show deviations from the normal discoidal shape. This is of great diagnostic importance. Similar shape changes occur if cells are subjected to various physical and chemical treatments. An automatic on-line method is introduced which can quantify the mean shape of such cells, freely suspended and unaltered by the method. With the cells inside a special flow chamber, pictures are taken in the form of optical sections using a CCD camera. The image processing includes digitization, cumulation of regions of interest (ROI), contour determination by two-dimensional histogram and isodensity contour tracing, chain coding and tangent counting. The method determines the mean of the absolute number of tangents per section Ts, a quantitative unique shape factor, which allows quantification of pathological red blood cell shapes and follow-up shape changes in experiments, and makes different experiments quantitatively comparable.

Glycinebetaine as an osmoregulant and compatible solute in the marine cyanobacterium Spirulina subsalsa.

Glycinebetaine was found to be the major organic substrate accumulating under hypersaline growth conditions in the halotolerant cyanobacterium Spirulina subsalsa. In addition to its proposed role as osmolite, glycinebetaine is shown to specifically protect enzymatic activity. Glucose-6-phosphate dehydrogenase from S. subsalsa retained full activity in the presence of NaCl at concentrations as high as 1.5 M, provided that comparable concentrations of glycinebetaine were also present in the reaction mixture. A kinetic analysis indicated that glycinebetaine protected the enzyme against both NaCl-induced decrease in Vmax and reduction in affinity to glucose 6-phosphate. The alternative osmolites, glycerol and proline, protected the enzyme against the reduction in Vmax but not against the reduction in affinity to glucose 6-phosphate.

Photosynthetic activities in the petunia corolla.

Pink Petuniahybrida (cv Hit Parade Rosa) corollas were found to contain photosynthetically active chloroplasts. The corolla chloroplasts were similar to those of green leaves in size and structure. The chlorophyll (Chl) content of Petunia corollas increased during early stages of flower development, reaching a maximum just before anthesis. Chloroplasts isolated from corollas at this stage, carried out photosystem I-dependent electron transport at rates which were two-thirds of those measured in chloroplasts from green leaves, but full chain electron transport at only one-quarter of the rate carried out by chloroplasts from green leaves. Both the light saturated rate and the quantum yield for electron transport were lower in corolla chloroplasts, which also required lower intensities for light saturation. Reduced efficiency of photosystem II photoreactions in the corolla was also indicated by the ratio between variable and constant components of Chl fluorescence, which was lower in corollas compared to green leaves. The induction time of Chl fluorescence was at least three times shorter in corollas compared to green leaves, indicating a smaller number of functional photosystem II centers (per Chl) in the corolla. It is suggested that corolla chloroplasts of Petunia might have a role in flower developmental processes.

Triazine Resistance without Reduced Vigor in Phalaris paradoxa.

A triazine-resistant (R) biotype of Phalaris paradoxa L. (hood canarygrass) was superior to a triazine-susceptible (S) biotype in seed-germinability and seedling emergence. It was equal or superior to the S-biotype in growth under noncompetitive conditions. Rates of CO(2) uptake by R-plants were similar to those of S-plants, except at very low photon flux densities, where S-plants exhibited higher rates of CO(2) uptake. Fluorescence induction curves of chloroplasts isolated from R-plants indicated an alteration in photosystem II. Analysis of the light dependence of electron transport shows a reduction in quantum yield (Q(y)) in R- compared to S-chloroplasts. The same analysis, however, shows for R-chloroplasts an increase in the light-saturated electron transport rate (V(max)). The increase in V(max) compensates for the reduction of Q(y) over a wide range of photon flux densities, which may explain the similarity between R- and S-biotypes in photosynthetic potential and growth.

The effect of an applied electric field on the charge recombination kinetics in reaction centers reconstituted in planar lipid bilayers.

Reaction Centers (RCs) from the photosynthetic bacterium Rhodopseudomonas sphaeroides were incorporated in planar bilayers made from monolayers derived from liposomes reconstituted with purified RCs. The photocurrents associated with the charge recombination process between the reduced primary quinone (QA-) and the oxidized bacteriochlorophyll donor (D+) were measured as a function of voltage (-150 mV less than V less than 150 mV) applied across the bilayer. When QA was the native ubiquinone (UQ) the charge recombination was voltage independent. However, when UQ was replaced by anthraquinone (AQ), the recombination time depended on the applied voltage V according to the relation tau = 8.5 X 10(-3) eV/0.175S. These results were explained by a simple model in which the charge recombination from UQ- proceeds directly to D+ while that from AQ occurs via a thermally activated intermediate state, D+I-QA, where I is the intermediate acceptor. The voltage dependence arises from an electric field induced change in the energy gap, delta G0, between the states D+I-QA and D+IQA-. This model is supported by the measured temperature dependence of the charge recombination time, which for RCs with AQ gave a value of delta G0 = 340 +/- 20 meV. In contrast, delta G0 for RCs with UQ as the primary acceptor, is sufficiently large (approximately 550 meV) so that even in the presence of the field, the direct pathway dominates. The voltage dependence shows that the electron transfer from I- to QA is electrogenic. From a quantitative analysis of the voltage dependence on the recombination rate it was concluded that the component of the distance between I and QA along the normal to the membrane is about one-seventh of the thickness of the membrane. This implies that the electron transfer from I to Q contributes at least one-seventh to the potential generated by the charge separation between D+ and QA-.

Reassembly of protein-lipid complexes into large bilayer vesicles: perspectives for membrane reconstitution.

Protein-lipid complexes in apolar solvents reassemble into large bilayer protein-lipid vesicles (PLVs) with diameters of several micrometers. PLVs form spontaneously upon hydration of the protein-lipid complex residue after solvent removal. This procedure has been applied to the following membrane proteins: bovine and squid rhodopsin, reaction centers from Rhodopseudomonas sphaeroides, beef heart cytochrome c oxidase, and acetylcholine receptors from Torpedo californica. PLVs have a large internal aqueous space (e.g., 790 mul/mg of lipid for cattle rhodopsin vesicles). Freeze-fracture replicas of PLVs revealed that both internal and external leaflets contained numerous intramembranous particles with diameters between 80 and 120 A, depending on the specific protein incorporated in the membrane. The optical spectral properties of rhodopsin and reaction centers in PLVs were similar to those recorded in the respective natural membrane. Furthermore, bovine rhodopsin in PLVs was chemically regenerable with 9-cis-retinal. Actinic illumination induced proton efflux from reaction center vesicles that was abolished by proton ionophores. Therefore, this method is suitable for the incorporation of some membrane proteins in their functional state. PLVs were penetrated with microelectrodes and visualized by the injection of a fluorescent dye. Preliminary electrical recordings were obtained by sealing PLVs to a hole in a septum separating two aqueous compartments. These studies suggest that PLVs assembled by this procedure permit the simultaneous analysis of reconstituted membranes by chemical, optical, and electrical techniques.

Functional reconstitution of photosynthetic reaction centers in planar lipid bilayers.

Planar lipid bilayers containing reaction centers from Rhodopseudomonas sphaeroides R-26 were formed by apposing two reaction center-lipid monolayers formed from a reaction center-lipid complex in hexane. Secondary donors (cytochrome c) and acceptors (ubiquinone-0) were added on opposite sides of the membrane. Upon illumination, this system generated transient and steady-state voltages and currents. The wavelength dependence of the photoresponse matched the absorption spectrum of reaction centers. A simple model based on the transfer of charges across the membrane that explains the salient features of the photoresponse is presented.