Comparison of magnetic resonance angiography techniques to brain digital subtraction arteriography in the setting of mechanical thrombectomy: A non-inferiority study.

INTRODUCTION: We performed a non-inferiority study comparing magnetic resonance angiography (MRA) techniques including contrast-enhanced (CE) and time-of-flight (TOF) with brain digital subtraction arteriography (DSA) in localizing occlusion sites in acute ischemic stroke (AIS) with a prespecified inferiority margin taking into account thrombus migration. MATERIALS AND METHODS: HIBISCUS-STROKE (CoHort of Patients to Identify Biological and Imaging markerS of CardiovascUlar Outcomes in Stroke) includes large-vessel-occlusion (LVO) AIS treated with mechanical thrombectomy (MT) following brain magnetic resonance imaging (MRI) including both CE-MRA and TOF-MRA. Locations of arterial occlusions were assessed independently for both MRA techniques and compared to brain DSA findings. Number of patients needed was 48 patients to exclude a difference of more than 20%. Discrepancy factors were assessed using univariate general linear models analysis. RESULTS: The study included 151 patients with a mean age of 67.6±15.9years. In all included patients, TOF-MRA and CE-MRA detected arterial occlusions, which were confirmed by brain DSA. For CE-MRA, 38 (25.17%) patients had discordant findings compared with brain DSA and 50 patients (33.11%) with TOF-MRA. The discordance factors were identical for both MRA techniques namely, tandem occlusions (OR=1.29, P=0.004 for CE-MRA and OR=1.61, P<0.001 for TOF-MRA), proximal internal carotid artery occlusions (OR=1.30, P=0.002 for CE-MRA and OR=1.47, P<0.001 for TOF-MRA) and time from MRI to MT (OR=1.01, P=0.01 for CE-MRA and OR=1.01, P=0.02 for TOF-MRA). CONCLUSION: Both MRA techniques are inferior to brain DSA in localizing arterial occlusions in LVO-AIS patients despite addressing the migratory nature of the thrombus.

Sea Level Budgets Should Account for Ocean Bottom Deformation.

The conventional sea level budget (SLB) equates changes in sea surface height with the sum of ocean mass and steric change, where solid-Earth movements are included as corrections but limited to the impact of glacial isostatic adjustment. However, changes in ocean mass load also deform the ocean bottom elastically. Until the early 2000s, ocean mass change was relatively small, translating into negligible elastic ocean bottom deformation (OBD), hence neglected in the SLB equation. However, recently ocean mass has increased rapidly; hence, OBD is no longer negligible and likely of similar magnitude to the deep steric sea level contribution. Here, we use a mass-volume framework, which allows the ocean bottom to respond to mass load, to derive a SLB equation that includes OBD. We discuss the theoretical appearance of OBD in the SLB equation and its implications for the global SLB.

Incidence of orolingual angioedema after intravenous thrombolysis for stroke.

INTRODUCTION: Orolingual angioedema (OA) is a known adverse effect of intravenous (i.v.) alteplase. We analyzed all patients treated with i.v. alteplase for stroke at our hospital since approval of i.v. thrombolysis in Italy in 2004 to assess the incidence of this complication. PATIENTS AND RESULTS: Four hundred thirty-three patients received alteplase for stroke from April 2004 to May 2017. Two women developed OA (0.4%; 95% confidence interval 0.1 to 1.6%). Angioedema was mild in one case and severe in the other, with massive swelling of the lips, tongue, and oropharyngeal mucosa, and oropharyngeal bleeding, requiring intubation. Neither patient used ACE-inhibitors. DISCUSSION: The incidence of orolingual angioedema was very low in our series. Although OA is usually mild, anaphylactoid reactions may rarely occur, because of the variable degree of activation of the complement system and kinin cascade caused by alteplase. In such instances, admission to neurointensive care may be required. Specific bradykinin antagonists or drugs that target the kallikrein-kinin system are beginning to be used in the more severe cases. Thus, doctors and nurses caring for acute stroke patients need to be able to recognize and treat this complication.

GRACE, time-varying gravity, Earth system dynamics and climate change.

Continuous observations of temporal variations in the Earth's gravity field have recently become available at an unprecedented resolution of a few hundreds of kilometers. The gravity field is a product of the Earth's mass distribution, and these data-provided by the satellites of the Gravity Recovery And Climate Experiment (GRACE)-can be used to study the exchange of mass both within the Earth and at its surface. Since the launch of the mission in 2002, GRACE data has evolved from being an experimental measurement needing validation from ground truth, to a respected tool for Earth scientists representing a fixed bound on the total change and is now an important tool to help unravel the complex dynamics of the Earth system and climate change. In this review, we present the mission concept and its theoretical background, discuss the data and give an overview of the major advances GRACE has provided in Earth science, with a focus on hydrology, solid Earth sciences, glaciology and oceanography.

Heart rate variability in fibromyalgia patients and healthy controls during non-REM and REM sleep: a case-control study.

OBJECTIVES: To investigate heart rate variability (HRV) in fibromyalgia (FM) patients and healthy controls (HCs) during different sleep stages, and to examine the association of HRV with pain and sleep quality. METHOD: Polysomnography was recorded from 23 female FM patients and 22 age- and sex-matched HCs. HRV was recorded from bedtime until awakening including the standard deviation of normal-to-normal intervals (SDNN), the root mean square successive difference (RMSSD), and the low (LF; 0.04-0.15 Hz) and high (HF; 0.15-0.4 Hz) frequency power. Subjective scores of neck/shoulder pain and sleep quality were obtained at bedtime and awakening. RESULTS: Both patients and HCs showed high incidence of arousals per hour (FM: 16 ± 9.7; HCs: 17 ± 11). RMSSD was lower in patients than HCs during non-rapid eye movement (non-REM) stage 2 (N2) sleep (mean ± SD; 30 ± 12 ms vs. 42 ± 13 ms, p < 0.002) and during REM sleep (23 ± 11 ms vs. 37 ± 16 ms, p < 0.003). HRV did not differ between groups during N3 sleep (p > 0.19 for all comparisons). In patients, SDNN, RMSSD, and HF power showed modest positive correlations with sleep quality (HF power during N3 sleep showed the highest correlation; Spearman's ρ = 0.54) and modest negative correlations with neck/shoulder pain (RMSSD during N3 sleep showed the highest correlation with pain at bedtime; Spearman's ρ = -0.51). CONCLUSIONS: RMSSD, indicative of parasympathetic predominance, is attenuated in FM patients compared to HCs during N2 sleep and REM sleep. This difference was not present for the HF component. HRV during sleep in FM patients is moderately and positively associated with sleep quality and moderately and negatively associated with neck/shoulder pain.

Carotid artery stenting in patients with symptomatic carotid stenosis: a single-center series.

OBJECTIVES: Carotid angioplasty with stenting (CAS) in patients with carotid stenosis (CS) has become more restricted in France especially since the disclosure of such studies as EVA-3S and Stent-supported percutaneous angioplasty of the carotid artery versus endarterectomy (SPACE). This report is of a series of CS cases contraindicated for endarterectomy that underwent CAS at a French center of interventional neuroradiology. PATIENTS AND METHODS: Fifty-five patients with symptomatic CS more than 60% consecutively submitted to CAS between September 2008 and February 2011. The primary endpoint was either death or stroke within 30 days of the procedure; a secondary goal was to identify any possible factors that might have influenced the success and outcome of the intervention. RESULTS: The overall periprocedural stroke/death rate at 30 days was 5.4% (three out of 55 patients), with three non-disabling strokes and no deaths. Twenty-seven patients (49.1%) were treated with a cerebral protection device (CPD). Stent placement was achieved in all cases. Open- and closed-cell stents were implanted in 40 (72.7%) and 15 procedures (27.3%), respectively. Neither the use of a CPD, the carotid stent cell design nor any anatomical or technical factors were associated with a lower risk of stroke or death within 30 days of CAS. CONCLUSION: CAS in symptomatic patients with CS contraindicated for endarterectomy in this selected French series proved feasible and safe, with acceptable levels of morbidity. Use of a CPD, type of stent (open- or closed-cell), and anatomical and technical factors had no influence on the success of the procedure or the outcome within 30 days of the operation.

Correlations between malocclusions and dyslalias.

AIM: This was to evaluate the relationship between malocclusions and dyslalias and to plan a multidisciplinary approach between orthodontics and speech therapy. STUDY DESIGN: 880 children (448 males and 432 females) ranging in age from 6 to 10 years were examined at the Department of Orthodontics at Milan University to determine if a relationship between malocclusions and dyslalia exists and their correlations. METHODS: The children were examined by a speech therapist and an orthodontist. An examination of the occlusion and phonetics was conducted and compared with an age-matched control group. RESULTS: Correlations between malocclusion and dyslalia were found. The presence of Class III occlusion, diastema, increase in overjet, presence of open and deep bite, asymmetry have high tendency to be associated with speech disorders such as dyslalias. The presence of crowding and anterior cross bites have moderate tendency to be associated with such disorders; on the contrary Class II occlusion, upper incisors protrusion, posterior cross bite and TMD have low tendency to be associated with dyslalias. CONCLUSION: The effect of dyslalia on the speech organs is not constant. On the other hand, the effect of malocclusion on dyslalia seems to be more relevant and more frequent and to increase proportionally, depending on the severity of the malocclusion.

[Time trends of incidence rates of work accident with blood contamination in a North Italian teaching hospital]. / Ana+lisi dei trend temporali (2004-11) dei tassi di infortunio biologico in un ospedale universitario del nord Italia. Quali evidenze di efficacia dei sistemi di prelievo a vuoto?

Unbiased estimates of incidence rates of accidents with blood contaminations (ABC) and time trends is the milieu for assessing the effectiveness of preventive interventions. A standardised procedure for registration and follow-up of ABC was et up in a North Italian hospital since 2002. Accurate estimates of rate denominator, as full-time equivalent (FTE) person-years, was calculated, for exposed workers only and excluding periods of prolonged absence. In the observation period (2004-2011), training courses for head nurses on security procedures were repeatedly carried out as well as the progressive introduction of vacuum blood collection systems (since 2009). 1287 ABC have been reported, corresponding to an overall annual crude incidence rate of 4.73 per 100 FTE. Temporal trends, calculated on the biennial incidence, resulted in a reductions over the time period considered, in particular for needlestick injuries. Our results support the notions on the efficacy of the adopted prevention measures.

Wire-bow in situ measurements for powerful control of wire-wear during diamond-wire crystalline silicon sawing.

Original instrumental setups embedded in industrial-type multi-diamond-wire sawing equipment are presented for in situ measurements of the apparent wire diameter, the vertical force applied to the wire web, and the wire-web bow during the cutting of crystalline silicon bricks into wafers. The proportionality relationship between the vertical force and the wire bow during the cut of a Czochralski silicon brick is, for the first time, experimentally observed as expected by the theoretical calculations. As a result, the in situ bow measurement is shown to provide a direct control of the cutting efficiency, which is inversely proportional to the vertical force. In addition, the wire-wear evolution during successive cuts is analyzed using the in situ measurement of the apparent wire diameter together with the in situ bow measurements for equivalent cutting conditions using several bow sensors distributed above the wire web. The three-dimensional plot of the cutting efficiency resulting from the bow measurement processing gives access to the distribution of the cutting efficiency along the wire web during the progress of the cut. Given the homogeneous properties of the silicon material used, the cutting efficiency proves to be a representative of the wire-wear. Moreover, the unique capability of the in situ bow measurement to provide a distribution of the measurements on the wire web during the cut allows studying the wire web behavior and the wire cutting efficiency distribution for different cutting conditions. Thanks to the innovative design of the instrumentation coupled with a data analysis based on a deep understanding of the involved physical phenomena, the in situ bow measurement is demonstrated to be a powerful tool to optimize the cutting process in terms of wafer quality and cost efficiency. Moreover, it can provide real-time information opening the door for tuning the parameters during the cutting process.

Optimized synthesis of phosphatidylserine.

The synthesis of phosphatidyl serine containing saturated fatty acids was thoroughly studied and optimized in order to establish a protocol amenable to large-scale synthesis. The key step was a one-pot multicomponent reaction involving an O-benzyl phosphorodiamidite, protected serine and diacylglycerol, followed by in situ oxidation of the resulting phosphite. In order to replace expensive and poorly stable tetrazole, a screening of substitutes was carried out and imidazolium chloride was selected as the best suited one.

[The efficacy of multimodal treatment for symptomatic vertebral hemangiomas: A report of 27 cases and a review of the literature]. / Intérêt d'une prise en charge multimodale des hémangiomes vertébraux symptomatiques : à propos de 27 cas et revue de la littérature.

INTRODUCTION: Vertebral hemangiomas (VH) represent the most common primary bone tumor of the spine and are rarely symptomatic. Currently, there is no consensus for treatment and many therapeutic options are available, alone or in combination including cementoplasty, sclerotherapy, surgery, embolization and/or radiotherapy. OBJECTIVE: To evaluate the clinical and radiological outcome of a multimodal management for symptomatic VH. METHODS: A consecutive prospective and retrospective multicenter study was conducted to review cases of symptomatic VHs between 2005 and 2015. Clinical and radiological aspects, treatment modalities and complications were evaluated preoperatively; postoperatively and at last follow-up. We also reviewed the literature of studies concerning case series of VH, published after 1990 and involving more than 10 patients. RESULTS: Twenty-seven VHs were included in our series (mean age at diagnosis: 47.9 years), out of which 26 were symptomatic. Ten presented with neurologic deficit (37%). An epidural extension was noted in 13 patients (48%). Eleven patients (41%) underwent multimodal treatments. In the multimodal group, eradication was observed in 6 patients (54%), stable residue in 5 cases (46%) with no recurrence versus 3 eradication (23%), 9 stable residue (69%) and no recurrence in the monomodal group, (P>0.05). The literature comprised 14 studies including 458 patients. Only 4 studies were focused on multimodal treatments. CONCLUSION: Based on this study, the multimodal management of symptomatic VHs appeared safe and effective. Finally, we propose an algorithm for symptomatic VHS management based on the severity of epidural extension and fracture risk.

European Veterinary Renal Pathology Service: A Survey Over a 7-Year Period (2008-2015).

BACKGROUND: The European Veterinary Renal Pathology Service (EVRPS) is the first Web-based registry for canine renal biopsy specimens in Europe. HYPOTHESIS/OBJECTIVES: The aim was to verify whether differences exist between the clinical and laboratory presentation of dogs with nephropathy according to renal pathological findings, as defined by light and electron microscopy of renal biopsy specimens submitted to EVRPS. ANIMALS: Renal biopsy specimens of dogs were collected from the archive of the service (n = 254). Cases were included if both light and electron microscopy were available (n = 162). METHODS: Renal biopsy specimens were classified based on the morphological diagnoses. Thereafter, they were grouped into 3 disease categories, including immune-complex-mediated glomerulonephritis (ICGN), non-immune-complex-mediated GN (non-ICGN), and renal lesions not otherwise specified (RL-NOS). Differences among morphological diagnoses and among disease categories were investigated for clinical and laboratory variables. RESULTS: Serum albumin concentration was lower in dogs with ICGN than in those with non-ICGN (P = 0.006) or RL-NOS (P = 0.000), and the urine protein-to-creatinine ratio (UPC) was significantly higher in ICGN than in the other 2 disease categories. Regarding morphological diagnoses, albumin was significantly lower in amyloidosis (AMY) and membranous (MGN), membranoproliferative (MPGN) or mixed glomerulonephritis (MixGN) than in minimal change disease, primary (FSGS I) or secondary (FSGS II) focal and segmental glomerulosclerosis and juvenile nephropathies (JN). The UPC was higher in MPGN than in FSGS I and FSGS II. CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with ICGN, in particular MPGN, had higher protein loss than those with non-ICGN or RL-NOS, leading to more severe hypoalbuminemia. Clinical and laboratory differentiation among dogs with the different morphological diagnoses and among dogs with different disease categories was difficult due to overlapping results.

Observed changes in the Earth's dynamic oblateness from GRACE data and geophysical models.

A new methodology is proposed to estimate changes in the Earth's dynamic oblateness ([Formula: see text] or equivalently, [Formula: see text]) on a monthly basis. The algorithm uses monthly Gravity Recovery and Climate Experiment (GRACE) gravity solutions, an ocean bottom pressure model and a glacial isostatic adjustment (GIA) model. The resulting time series agree remarkably well with a solution based on satellite laser ranging (SLR) data. Seasonal variations of the obtained time series show little sensitivity to the choice of GRACE solutions. Reducing signal leakage in coastal areas when dealing with GRACE data and accounting for self-attraction and loading effects when dealing with water redistribution in the ocean is crucial in achieving close agreement with the SLR-based solution in terms of de-trended solutions. The obtained trend estimates, on the other hand, may be less accurate due to their dependence on the GIA models, which still carry large uncertainties.

Stent retriever thrombectomy for acute ischemic stroke: Indications, results and management in 2015.

The functional benefit of stent retriever thrombectomy in acute ischemic stroke has been clearly demonstrated in recent positive MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT and THRACE trials. Thrombectomy, in association with intravenous thrombolysis, should now be offered to patients with documented occlusion of the distal internal carotid or proximal middle cerebral arteries, with a relatively normal unenhanced computed tomography (CT), and within 6hours after the onset of symptoms. Thrombectomy results in a mean absolute decrease in handicap of 22% (14 to 31%). Of the 3 up to 8 patients treated, 1 is independent at 3 months according to the initial selection. In case of a contraindication to thrombolysis, early primary thrombectomy should be considered. In acute basilar artery occlusion, thrombectomy should be performed alone or combined with thrombolysis. In an effort to increase the number of patients treated, a very rapid transfer to interventional neuroradiology centers is mandatory. In the future, thrombectomy should be evaluated in patients with distal arterial occlusion, or beyond 6hours after the onset of symptoms, or when the time of symptoms onset is unknown.

Lessons Learned: Studying the Vulnerable Brain.

Neurotoxicity related to early exposure to various insults, both anesthesia-related and nonanesthesia-related, is a topic of ongoing and increasing interest. To better understand the process by which this might occur, the fifth PANDA Symposium convened a session in which 4 notable neuroscientists discussed current concepts and research in neurodevelopment, highlighting periods of particular susceptibility and ways in which neural connectivity and systemic functioning may be affected.

Endovascular Treatment of Intracranial Aneurysms with the WEB Device: A Systematic Review of Clinical Outcomes.

BACKGROUND AND PURPOSE: Despite the improvement in technology, endovascular treatment of bifurcation intracranial wide-neck aneurysms remains challenging, mainly due to the difficulty of maintaining coils within the aneurysm sac without compromising the patency of bifurcation arteries. The Woven EndoBridge (WEB) device is a recent intrasaccular braided device specifically dedicated to treating such aneurysms with a wide neck by disrupting the flow in the aneurysmal neck and promoting progressive aneurysmal thrombosis. MATERIALS AND METHODS: Using several health data bases, we conducted a systematic review of all published studies of WEB endovascular treatment in intracranial aneurysms from 2010 onward to evaluate its efficacy and safety profile. RESULTS: The literature search identified 6 relevant studies (7 articles) including wide-neck bifurcation aneurysms in ≥80% of cases. Clinical data supporting the efficacy and safety of the WEB are limited to noncomparative cohort studies with large heterogeneity from a methodologic standpoint. The WEB deployment was feasible with a success rate of 93%-100%. Permanent morbidity (mRS of >1 at last follow-up) and mortality were measured at 2.2%-6.7% and 0%-17%, respectively. The adequate occlusion rate (total occlusion or neck remnant) varied between 65% and 85.4% at midterm follow-up (range, 3.3-27.4 months). CONCLUSIONS: Endovascular treatment of bifurcation wide-neck aneurysms with the WEB device is feasible and allows an acceptably adequate aneurysm occlusion rate; however, the rate of neck remnants is not negligible. The WEB device needs further clinical and anatomic evaluation with long-term prospective studies, especially of the risk of WEB compression. Prospective controlled studies should be encouraged.