Aneurysmal Neck Clipping as the Primary Treatment Option for Both Ruptured and Unruptured Middle Cerebral Artery Aneurysms.

OBJECTIVE: Although middle cerebral artery (MCA) aneurysms are less amenable to coil embolization, an increasing number of studies support favorable endovascular treatment for them. The purpose of this study is to compare the outcomes of two different treatments (surgery versus coiling) and evaluate the benefits of surgical clipping for MCA aneurysms. METHODS: Here we retrospectively analyzed the outcomes of 178 ruptured and unruptured MCA aneurysms treated in patients between September 2008 and April 2012. Parameters assessing treatment outcomes include degree of aneurysm occlusion, presence of regrowth, clinical status, and complications. RESULTS: Among 178 MCA aneurysms, 153 were treated surgically. After a mean follow-up of 12 months, the surgery group showed a clinically significant complete occlusion rate (98%) compared with the coiling group (56%) (p<0.001). Follow-up radiologic evaluation showed a higher regrowth rate (four of 16 cases) in the coiling group than in the surgery group (one of 49 cases) (p=0.003). There was no statistically significant difference in favorable clinical outcome rate between the two groups. The procedure-related permanent morbidity and mortality rates were 2% (three of 153 cases) in the surgery group and 0% (0 of 25 cases) in the coiling group. CONCLUSION: Compared to endovascular treatment, surgical neck clipping for both ruptured and unruptured MCA aneurysms results in a significantly higher complete obliteration rate and less regrowth. Therefore, even in this endovascular era, we still recommend surgical clipping as the primary treatment option for MCA aneurysms rather than coil embolization.

Fabrication of high-quality single-crystal Cu thin films using radio-frequency sputtering.

Copper (Cu) thin films have been widely used as electrodes and interconnection wires in integrated electronic circuits, and more recently as substrates for the synthesis of graphene. However, the ultra-high vacuum processes required for high-quality Cu film fabrication, such as molecular beam epitaxy (MBE), restricts mass production with low cost. In this work, we demonstrated high-quality Cu thin films using a single-crystal Cu target and radio-frequency (RF) sputtering technique; the resulting film quality was comparable to that produced using MBE, even under unfavorable conditions for pure Cu film growth. The Cu thin film was epitaxially grown on an Al2O3 (sapphire) (0001) substrate, and had high crystalline orientation along the (111) direction. Despite the 10(-3) Pa vacuum conditions, the resulting thin film was oxygen free due to the high chemical stability of the sputtered specimen from a single-crystal target; moreover, the deposited film had >5× higher adhesion force than that produced using a polycrystalline target. This fabrication method enabled Cu films to be obtained using a simple, manufacturing-friendly process on a large-area substrate, making our findings relevant for industrial applications.

Resorption of bone graft after maxillary sinus grafting and simultaneous implant placement.

OBJECTIVES: The purpose of this study was to evaluate the sinus bone graft resorption over 3 years after two-stage implant placement. MATERIALS AND METHODS: The subjects for this study included 30 patients whose maxillary posterior ridges were too atrophic for implants. Bone-added osteotome sinus floor elevation was used in 15 maxillary sinuses, while the bone graft by lateral approach technique was used in 25 maxillary sinuses. The height from the top of the fixture to the sinus floor was estimated immediately after implant placement and the follow-up period was over 3 years. The surgery was classified with two groups: sinus bone grafting with and without autogenous bone. All implants were placed simultaneously. RESULTS: The mean vertical bone loss was 3.15±2.95 mm. The survival rate of implants was 94.7%. CONCLUSION: The amount of bone resorption was not significantly associated with the surgical methods, the type of bone graft materials used, or sinus perforation during surgery.

Predictors of ineffectual radial arterial pressure monitoring in valvular heart surgery.

BACKGROUND AND AIM OF THE STUDY: Unexpected sustained underestimation of the central aortic pressure by the radial arterial pressure commonly develops following cardiopulmonary bypass (CPB) in valvular heart surgery (VHS), leading to an inappropriate use of vasopressors. The study aim was to identify clinical predictors leading to a sustained inappropriate difference between the radial and femoral arterial pressure (IDRF) in VHS. METHODS: A total of 200 patients undergoing VHS was studied prospectively. Those patients who developed sustained IDRF (systolic IDRF > or =10 mmHg and/or mean IDRF > or =5 mmHg) from immediately after discontinuation of CPB until the end of the surgery were compared with patients who did not develop any IDRF. RESULTS: Data from seven patients who required second aortic cross-clamping and re-CPB were excluded from the analysis; thus, data from 193 patients were analyzed. In total, 53 patients (27.5%) developed sustained IDRF, whereas 80 patients (41.4%) did not develop any IDRF. In multivariate analysis, female gender, the presence of atrial fibrillation and diuretic use were identified as independent preoperative predictors; longer-duration aortic cross-clamping and use of larger amounts of vasopressin during CPB were identified as independent operative risk factors of the sustained IDRF. CONCLUSION: When an erroneously low radial arterial pressure is suspected following CPB in this subset of patients undergoing VHS, monitoring of the femoral or axillary arterial pressure should be considered to guide hemodynamic management, as there is an increased risk of persistence of this phenomenon.

Cardiovascular effects of oral tri-iodothyronine in patients undergoing valvular cardiac surgery.

BACKGROUND: Cardiopulmonary bypass produces a state of functional hypothyroidism characterized by low levels of circulating tri-iodothyronine (T3). Theoretically, supplementing T3 should result in improved hemodynamics as well as patients' outcome. The aim of the present study was to determine whether pretreatment with single oral T3 could prevent serum T3 reduction, and improve hemodynamics and clinical outcome. METHODS: Forty-seven patients undergoing valvular heart surgery were included in the study. Patients were randomly assigned into two groups (T = T group; C = control group) the day before surgery and received single oral T3 40 microg or placebo before operation. Blood samples were collected for determination of serum levels of total T3, T4 and TSH before administration of oral T3 or placebo (baseline), 1, 6 and 18 hour after weaning of cardiopulmonary bypass. Hemodynamic parameters and medication were recorded during the intraoperative period and throughout the first 24 h after arrival at the intensive care unit. RESULTS: T3 levels were significantly higher in the T group 1 hr after weaning of cardiopulmonary bypass. T3 levels in the T group were all maintained within the normal range throughout the study period, whereas it was decreased to below normal level in the C group at 18 hr after weaning of cardiopulmonary bypass. In the T group, vasoactive agent requirements were reduced during and after cardiopulmonary bypass. CONCLUSIONS: Pretreatment with single oral T3 prevented the reduction in T3 level after valvular heart surgery, with subsequent reduction in vasoactive agent requirement.

Relationship of serum osteoprotegerin levels with coronary artery disease severity, left ventricular hypertrophy and C-reactive protein.

OPG (osteoprotegerin) is an inhibitor of osteoclastogenesis and recent work suggests it has a role in atherosclerosis. Therefore we measured serum OPG levels in patients with coronary artery disease, compared the serum OPG levels among the different groups according to the number of stenotic vessels and determined whether there was any correlation with aortic calcification, LV (left ventricular) mass index and serum CRP (C-reactive protein) levels. Subjects (n=100; mean age, 57 years) who underwent coronary angiograms were enrolled. Blood pressure, body mass index, fasting blood glucose, lipid profiles and CRP levels were measured and the LV mass indices were calculated using ECGs. Serum OPG levels were measured by ELISA. The presence of calcification in the aortic notch was checked by a chest X-ray. The subjects were divided into four groups according to the number of stenotic vessels. The mean serum OPG levels increased significantly as the number of stenotic vessels increased, and the mean serum OPG levels were higher in the group with three-vessel disease compared with the groups with no- or one-vessel disease. The mean serum CRP level was significantly higher in the group with three-vessel disease compared with the groups with no-, one- and two-vessel disease. Age and LV mass index showed significant positive correlations with serum OPG levels, although significance was lost after an adjustment for age. Serum CRP levels were positively correlated with serum OPG levels even after an adjustment for age. There were no differences in serum OPG levels according to the presence of fasting hyperglycaemia or aortic calcification. In conclusion, serum OPG level was related to the severity of stenotic coronary arteries and serum CRP levels. LV mass indices showed no significant correlation with OPG levels. The precise mechanism for the role of OPG in atherosclerosis needs to be investigated further.

Downregulation of p38 kinase pathway by cAMP response element-binding protein protects HL-60 cells from iron chelator-induced apoptosis.

The signaling mechanisms that control apoptotic events evoked by iron chelators are largely unknown. We found that cAMP response element-binding protein (CREB) is cleaved during iron chelator deferoxamine (DFO)-induced apoptosis, and that the cleavage is largely prevented by the cell-permeable analog of cAMP, dibutyryl-cAMP (dbcAMP), a known CREB activator. In addition, dbcAMP profoundly reduced DFO-induced apoptosis along with significant suppression of caspase-3 and -8 activation and inhibition of loss of mitochondrial potential. These results led us to investigate whether CREB activation is functionally connected with the MAPK family members because we previously demonstrated that p38 kinase is involved in iron chelator-induced apoptosis of HL-60 cells. dbcAMP by itself rapidly induced CREB phosphorylation but dramatically inhibited DFO-induced phosphorylation of all three MAPK family members. However, disruption of CREB expression by antisense oligodeoxyribonucleotide (AS-ODN) only restored p38 kinase activation, and simultaneously attenuated dbcAMP-induced protection of HL-60 cells from DFO-induced cell death. Conversely, inhibition of p38 kinase activity by SB203580 significantly reduced DFO-induced CREB cleavage as well as apoptosis, indicating a cross-talk between CREB and p38 kinase. Collectively, these results demonstrate that cAMP-dependent CREB activation plays an important role in protecting HL-60 cells from iron chelator-induced apoptosis, presumably through downregulation of p38 kinase.