ABSTRACT
Only two aneurysm formations in the internal carotid artery after gamma knife radiosurgery (GKRS) for pituitary adenomas are reported so far. Here, out of the 482 patients who underwent GKRS for pituitary adenomas at our institute, at least five developed aneurysms within the area of high single-dose irradiation. Three patients presented with epistaxis due to aneurysmal rupture and one presented with abducens paralysis due to nerve compression, while one was asymptomatic. The interval between irradiation and aneurysmal detection ranged from 14 to 21 years. Aneurysm formation in those conditions may be higher than previously thought.
Subject(s)
Adenoma , Aneurysm, Ruptured , Carotid Artery Diseases , Pituitary Neoplasms , Radiosurgery , Humans , Pituitary Neoplasms/diagnostic imaging , Pituitary Neoplasms/surgery , Radiosurgery/adverse effects , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/surgery , Adenoma/diagnostic imaging , Adenoma/surgery , Aneurysm, Ruptured/surgery , Carotid Artery Diseases/surgery , Retrospective Studies , Treatment Outcome , Follow-Up StudiesABSTRACT
OBJECTIVES: To investigate the efficacy and safety of larger valve sizing beyond the commercially recommended annular range in transcatheter aortic valve replacement (TAVR) with balloon-expandable transcatheter heart valve (THVs). BACKGROUND: The clinical implications of larger balloon-expandable THV implantation with underfilling are poorly evaluated. METHODS: This retrospective study included 692 consecutive patients who underwent TAVR with SAPIEN3. A total of 271 patients who underwent SAPIEN 3 implantation were analyzed based on three border zones (Zone 1: 300-345 mm2 , 23 vs. 20 mm; Zone 2: 400-430 mm2 , 26 vs. 23 mm; Zone 3: 500-546 mm2 , 29 vs. 26 mm). The primary endpoint was the effective orifice area (EOA) assessed by echocardiography at 1 year, and secondary endpoints were a 30-day mortality rate, procedural complications during TAVR, and a composite of death from any cause and heart failure requiring rehospitalization at 1 year. RESULTS: At 1-year follow-up, the EOA in the larger valve groups was greater than that in the recommended valve group in each zone (Zone 1: 1.45 ± 0.03 vs. 1.06 ± 0.06 cm2 , p < 0.001; Zone 2: 1.83 ± 0.05 vs. 1.41 ± 0.05 cm2 , p < 0.001; Zone 3: 1.93 ± 0.07 vs. 1.69 ± 0.07 cm2 , p = 0.02). No significant difference in the secondary endpoint was observed in any of the zones. CONCLUSIONS: Implantation of the out-of-range larger SAPIEN 3 THVs with underfilling was associated with greater EOA at the 1-year follow-up and feasible in the selected patients.
Subject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Humans , Prosthesis Design , Retrospective Studies , Transcatheter Aortic Valve Replacement/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: Postdilatation after transcatheter heart valve (THV) implantation was associated with larger aortic valve areas in large-scale registries; however, the specific effects of postdilatation are poorly understood. METHODS AND RESULTS: Among a total of 224 consecutive patients who underwent transcatheter aortic valve replacement using SAPIEN 3, 121 patients (54.0%) underwent postdilatation (same contrast volume: N = 101, +1 ml: N = 17, +2 ml: N = 3). THV diameter was assessed (a) during, (b) after implantation, (c) during postdilatation, and (d) after postdilatation by quantitative fluoroscopy. In the overall patients (N = 224), acute recoil was observed from during implantation (23.0 ± 2.0 mm) to after implantation (22.5 ± 2.0 mm, p < .001) with an absolute recoil of 0.52 ± 0.25 mm. After postdilatation (N = 121), THV diameter significantly increased from 22.5 ± 2.0 mm to 22.9 ± 2.1 mm (p < .001), with smaller absolute recoil (0.39 ± 0.21 mm, p < .001). Compared with those who did not undergo postdilatation, patients who underwent postdilatation had larger postprocedural THV area assessed by multi-slice computed tomography (471.4 ± 78.1 mm2 vs. 447.5 ± 76.3 mm2 , p = .02) and larger effective orifice area (EOA) assessed by echocardiography throughout 1 year (at 30 day, 1.66 ± 0.33 cm2 vs. 1.45 ± 0.27 cm2 , p < .001; at 6 month, 1.66 ± 0.33 cm2 vs. 1.44 ± 0.29 cm2 , p < .001; at 1 year, 1.69 ± 0.38 cm2 vs. 1.47 ± 0.30 cm2 , p < .001). CONCLUSIONS: Postdilatation after implantation of the SAPIEN 3 valve produced a larger THV diameter with less acute recoil, followed by larger EOA throughout 1 year. Further studies are needed to evaluate the impact of postdilatation on long-term clinical outcomes.
Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Balloon Valvuloplasty , Transcatheter Aortic Valve Replacement , Aged , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/physiopathology , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Balloon Valvuloplasty/adverse effects , Female , Heart Valve Prosthesis , Humans , Male , Recovery of Function , Registries , Time Factors , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/instrumentation , Treatment OutcomeABSTRACT
Aortic complex rupture is one of the most critical complications associated with transcatheter aortic valve implantation (TAVI). Its incidence is rare, and its mechanism varies by case; therefore, it is difficult to identify the predictors of complex rupture. Herein, we report a clinical case series of aortic complex rupture. Within our cohort, the frequency of complex rupture was 0.8% (4/497 consecutive patients) with an in-hospital mortality of 0. Among these four patients with complex rupture, two underwent emergent thoracotomy and surgical hemostasis without a heart-lung machine and surgical aortic valve replacement, whereas the other two were conservatively managed. The case overview revealed the following similarities: all the patients were elderly, small women; balloon-expandable valves were used; the annulus area was small with heavily calcified leaflet; and aggressive treatment strategy was used (i.e., oversizing and post-dilatation). In such cases, TAVI should be performed with a careful strategy. Once aortic complex rupture occurs, damage can be minimized through cooperation with an institutional heart team and calm management.
Subject(s)
Aortic Rupture/etiology , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Transcatheter Aortic Valve Replacement/adverse effects , Aftercare , Aged, 80 and over , Aortic Rupture/diagnostic imaging , Aortic Valve/pathology , Aortic Valve Stenosis/pathology , Aortography/methods , Calcinosis/pathology , Conservative Treatment/methods , Female , Hemostasis, Surgical/methods , Humans , Thoracotomy/methods , Treatment OutcomeABSTRACT
Parapharyngeal neuroglial heterotopia is a rare entity, and the specific radiographical findings are unclear. We present a case of parapharyngeal neuroglial heterotopia examined with proton magnetic resonance spectroscopy (1H-MRS) and 18F-fluorodesoxyglucose positron emission tomography (18F-FDG PET). Our neonate patient presented with neck mass and polyhydramnios during gestation. Computed tomography and magnetic resonance imaging demonstrated the morphological characteristics, but failed to establish the diagnosis. 1H-MRS showed a non-malignant pattern, but 18F-FDG PET demonstrated high glucose metabolism. Complete resection was achieved and the histopathological diagnosis was neuroglial heterotopia. Assessment of biological activity may be useful for both preoperative diagnosis and postoperative evaluation of residual lesions.
Subject(s)
Brain Diseases/diagnostic imaging , Choristoma/diagnostic imaging , Fluorodeoxyglucose F18 , Neuroglia/pathology , Pharyngeal Diseases , Positron-Emission Tomography , Radiopharmaceuticals , Female , Humans , Infant, Newborn , Magnetic Resonance Imaging , Tomography, X-Ray ComputedSubject(s)
Aortic Valve Stenosis , Intracranial Embolism , Stroke , Transcatheter Aortic Valve Replacement , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Humans , Intracranial Embolism/etiology , Intracranial Embolism/prevention & control , Risk Factors , Stroke/prevention & control , Transcatheter Aortic Valve Replacement/adverse effects , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the effect of reinforcement on the flexural properties of injection-molded thermoplastic denture base resins. MATERIALS AND METHODS: Three injection-molded thermoplastic denture base resins (polyamide, polyester, polycarbonate) were selected for this study, and a conventional heat-polymerized denture base resin (PMMA) was used as a control. Continuous unidirectional glass fiber-reinforced composite (FRC) and metal wire were used for reinforcement. Reinforced bar-shaped specimens (65 mm long, 10 mm wide, 3.3 mm high) were fabricated (n = 10). The flexural strength at the proportional limit (FS-PL) and the elastic modulus were measured using a three-point bending test. RESULTS: All the denture base material specimens reinforced with FRC possessed a significantly higher FS-PL compared to those without reinforcement. The FS-PL of the polycarbonate specimens reinforced with metal wire was significantly higher than that without reinforcement, and there was no significant difference in the FS-PL between the polycarbonate specimens reinforced with FRC and those with metal wire. The order of the elastic modulus according to the denture base material, arranged in terms of statistical significance, was as follows: PMMA (3.46 ± 0.53 GPa) > polycarbonate (2.69 ± 0.48 GPa) > polyester (2.00 ± 0.39 GPa) > polyamide (1.14 ± 0.35 GPa). The order of the elastic modulus according to the reinforcement, arranged in terms of statistical significance, was as follows: metal wire (2.74 ± 0.96 GPa) > FRC (2.40 ± 0.89 GPa) > no reinforcement (1.82 ± 0.83 GPa). CONCLUSION: Continuous unidirectional glass fiber-reinforced composite (FRC) reinforcement had a satisfactory reinforcing effect for the injection-molded thermoplastic denture base resins.
Subject(s)
Acrylic Resins/chemistry , Denture Bases , Denture Design , Dental Stress Analysis , Elastic Modulus , Glass , Humans , Materials Testing , Stress, MechanicalABSTRACT
Endoscopic endonasal surgery, an innovative surgical technique, is used to approach sinus lesions, lesions of the skull base, and intradural tumors. The cooperation of experienced otolaryngologists and neurosurgeons is important to achieve safe and reliable surgical results. The bath plug closure method is a treatment option for patients with cerebrospinal fluid(CSF)leakage. Although it includes dural and/or intradural procedures, surgery tends to be performed by otolaryngologists because its indications, detailed maneuvers, and pitfalls are not well recognized by neurosurgeons. We reviewed the cases of patients with CSF leakage treated by using the bath plug closure method with an endoscopic endonasal approach at our institution. Three patients were treated using the bath plug closure method. CSF leakage was caused by a meningocele in two cases and trauma in one case. No postoperative intracranial complications or recurrence of CSF leakage were observed. The bath plug closure method is an effective treatment strategy and allows neurosurgeons to gain in-depth knowledge of the treatment options for CSF leakage by using an endoscopic endonasal approach.
Subject(s)
Cerebrospinal Fluid Leak/surgery , Neuroendoscopy , Adult , Cerebrospinal Fluid Leak/diagnostic imaging , Female , Humans , Neuroendoscopy/methods , Neurosurgeons , Otolaryngologists , Patient Care TeamABSTRACT
Here, we discuss a case of carotid blowout syndrome successfully treated with endovascular parent artery occlusion. A 71-year-old woman underwent treatment for esophageal cancer resection, followed by 50-Gy radiotherapy, 19 years prior. Due to local recurrence, she underwent 66- and 72-Gy radiation treatments at 2 and 4 years after the initial treatment, respectively. Afterward, tracheostomy and enterostomy were performed. This time, she was transported to our emergency department because of acute eruptive bleeding from the tracheal tube. As her vitals indicated shock, emergency endovascular treatment was performed. Digital subtraction angiography revealed that the common carotid artery in the left-sided of the neck had a pseudoaneurysm extruding to the pharyngeal cavity, which was considered to be the lesion responsible for the acute rupture. She was diagnosed as having carotid blowout syndrome. Balloon test occlusion showed that the cross flow via the anterior and posterior communicating arteries was sufficient, so parent artery occlusion was chosen for bleeding control. Carotid bifurcation was preserved to keep the collateral circulation via the external carotid artery. The patient was discharged 22 days after treatment, without any neurological deficits. Although injured vessel removal with high-flow bypass was an ideal treatment to achieve bleeding control without ischemic complication, endovascular treatment can be an efficient second-best treatment. To minimize the risk of late ischemic complications, flow preservation via carotid bifurcation might be important.
Subject(s)
Carotid Artery Diseases/surgery , Esophageal Neoplasms/radiotherapy , Radiation Injuries/surgery , Aged , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/etiology , Endovascular Procedures , Female , Humans , Radiation Injuries/diagnostic imaging , Radiotherapy/adverse effects , Recurrence , Treatment OutcomeABSTRACT
The prognosis of patients with WHO grade III gliomas is highly dependent on their genomic status such as the isocitrate dehydrogenase (IDH) 1/2 mutation and1p/19q co-deletion. However, difficulties have been associated with determining which tumors have certain genomic profiles by preoperative radiographical modalities, and the role of surgical resection in achieving better outcomes remains unclear. This retrospective study included 124 consecutive patients with newly diagnosed grade III gliomas. The genomic status of IDH1/2 and 1p/19q was analyzed in these patients. Tumors were then divided into 3 subgroups based on their genomic status; the IDH 1/2 mutation with the 1p/19q co-deletion (1p/19q co-del), the IDH 1/2 mutation without the 1p/19q co-deletion (non-1p/19q co-del), and the IDH 1/2 wild type (IDH wt). Survival times were compared between patients who underwent gross total resection and those who did not (GTR versus non-GTR). The relationships between genomic statuses and MR imaging characteristics such as ring-like or nodular enhancements by gadolinium, and very low intensity on T1-weighted images with blurry enhancements (T1VL) were also examined. Among all patients with grade III gliomas, GTR patients had longer median survival and progression-free times than those of non-GTR patients (undefined versus 87 months, p = 0.097, and 124 versus 34 months, p = 0.059, respectively). No significant differences were observed in survival between GTR and non-GTR patients in the 1p/19q co-del group (p = 0.14), or between GTR and non-GTR patients in the IDH wt group (26 and 27 months, p = 0.29). On the other hand, in non-1p/19q co-del group, survival was significantly longer in GTR patients than in non-GTR patients (undefined versus 77 months, p = 0.005). Radiographically, T1VL was detected in most tumors in the non-1p/19q co-del group (78.2 %), but only 6 (21.4 %) and 17 (41.5 %) tumors in the 1p/19q co-del and IDH wt groups, respectively. A correlation was not found between other genomic subgroups and MR imaging findings. Strict surgical removal is important to improve the prognosis of patients with grade III gliomas, especially for tumors with the IDH 1/2 mutation without the 1p/19q co-deletion. The MR finding of T1VL can be used to select candidates for more radical resection.
Subject(s)
Brain Neoplasms/genetics , Chromosome Deletion , Chromosomes, Human, Pair 19/genetics , Glioma/genetics , Isocitrate Dehydrogenase/genetics , Mutation/genetics , Adult , Aged , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/mortality , Brain Neoplasms/surgery , Chromosomes, Human, Pair 1/genetics , DNA Modification Methylases/genetics , DNA Repair Enzymes/genetics , Female , Glioma/diagnostic imaging , Glioma/mortality , Glioma/surgery , Humans , Kaplan-Meier Estimate , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Tomography Scanners, X-Ray Computed , Tumor Suppressor Proteins/genetics , Young AdultABSTRACT
We aimed to design a rapid and reliable method to identify coronary lesions at high risk for the no-reflow phenomenon before elective coronary stent implantation using integrated backscatter intravascular ultrasound (IB-IVUS). The no-reflow phenomenon occurring during elective percutaneous coronary intervention (PCI) worsens patient prognosis, regardless of whether the phenomenon is transient or persistent. We retrospectively studied 353 coronary lesions to identify factors potentially promoting the no-reflow phenomenon, including lesion location and severity. We also performed component analysis by two- and three-dimensional IB-IVUS before elective stent implantation. The cutoff values of the true lipid volume and estimated lipid volume (lipid area at the minimal lumen diameter site × total stent length) for the no-reflow phenomenon were determined by receiver operating curve analysis. Type C lesions, regardless of location and a thrombolysis in myocardial flow grade of 0, were risk factors for the no-reflow phenomenon during PCI. The estimated lipid volume was significantly correlated with the true lipid volume (R 2 = 0.778, p < 0.0001). The cutoff value of the estimated lipid volume for the no-reflow phenomenon was 132.6 mm3 (area under the curve = 0.719), and the predictive value was equivalent to that of the true lipid volume. Lesions with an estimated lipid volume of ≥132.6 mm3 had a significantly higher risk of the no-reflow phenomenon during elective stent implantation (odds ratio, 4.35; 95 % confidence interval, 1.67-12.7; p = 0.0024). The simple and rapid measurement of the estimated lipid volume immediately before stenting during PCI constitutes a reliable predictor of lesions at high risk for the no-reflow phenomenon.
Subject(s)
Coronary Artery Disease/therapy , Coronary Circulation , Coronary Vessels/diagnostic imaging , No-Reflow Phenomenon/etiology , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/instrumentation , Stents , Ultrasonography, Interventional , Aged , Aged, 80 and over , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/physiopathology , Coronary Vessels/physiopathology , Female , Humans , Image Interpretation, Computer-Assisted , Lipids/analysis , Male , Middle Aged , No-Reflow Phenomenon/diagnosis , No-Reflow Phenomenon/physiopathology , Plaque, Atherosclerotic , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Risk Factors , Scattering, Radiation , Treatment OutcomeABSTRACT
A 69-year-old woman presented with anorexia, fever, and vomiting. The patient was not a compromised host. She was finally diagnosed with Listeria meningitis and treated with ampicillin and gentamicin. However, her condition worsened over time. Non-contrast head CT showed ventricular dilatation. As a result, continuous right ventricular drainage was performed. Non-contrast MRI revealed hydrocephalus due to stenosis of the fourth ventricle. She underwent endoscopic third ventriculostomy(ETV)to improve cerebrospinal fluid circulation. This procedure achieved a good result. The efficacy of ETV for post-infectious hydrocephalus has not been proven, but previous cases suggest that ETV would be effective in non-communicating hydrocephalus, even if it were a result of neuroinfection.
Subject(s)
Hydrocephalus/surgery , Meningitis/surgery , Third Ventricle/surgery , Ventriculostomy , Aged , Cerebrospinal Fluid Shunts , Female , Humans , Hydrocephalus/diagnosis , Meningitis/diagnosis , Treatment Outcome , Ventriculostomy/methodsABSTRACT
The flash visual evoked potential (VEP) is a useful diagnostic modality for visual preservation during surgery. Decreased VEP amplitude is recognized to indicate visual deterioration;however, whether intraoperative VEP can detect visual improvement remains unclear. We describe a craniopharyngioma case with a significant increase in VEP amplitude during surgery. A 67-year-old woman presented with progressive gait disturbance and impaired consciousness. Head magnetic resonance imaging demonstrated a sellar-suprasellar tumor compressing the optic chiasm upward with significant ventricular dilation. Her Glasgow Coma Scale was E3V3M5. Visual fields and acuity could not be examined because of impaired consciousness, and she could not see/recognize objects on a table. Preoperative VEP showed reproducible waveforms. Tumor removal by the extended transsphenoidal approach was performed with VEP monitoring. Increased VEP amplitude was observed after dural incision and persisted until the surgery ended. Postoperative VEP waveforms were also reproducible, but visual fields/acuity could not be examined because of cognitive dysfunction. Useful visual function was restored, and she became independent in daily life. The histological diagnosis was craniopharyngioma. The patient underwent ventriculo-peritoneal shunting for hydrocephalus 16 days after tumor removal. The postoperative course was uneventful and she was transferred to another hospital for rehabilitation. Intraoperative VEP may indicate visual improvement during surgery, which is a useful objective assessment for visual function in patients with impaired consciousness and cognitive dysfunction.
Subject(s)
Craniopharyngioma/surgery , Evoked Potentials, Visual , Aged , Craniopharyngioma/physiopathology , Electric Countershock , Female , Humans , Magnetic Resonance Imaging , Monitoring, Intraoperative , Pituitary Neoplasms , Treatment OutcomeABSTRACT
Microspatial arrangements of sulfate-reducing microorganisms (SRM) in surface microbial mats (~1.5 mm) forming open marine stromatolites were investigated. Previous research revealed three different mat types associated with these stromatolites, each with a unique petrographic signature. Here we focused on comparing "non-lithifying" (Type-1) and "lithifying" (Type-2) mats. Our results revealed three major trends: (1) Molecular typing using the dsrA probe revealed a shift in the SRM community composition between Type-1 and Type-2 mats. Fluorescence in-situ hybridization (FISH) coupled to confocal scanning-laser microscopy (CSLM)-based image analyses, and 35SO4(2-)-silver foil patterns showed that SRM were present in surfaces of both mat types, but in significantly (p < 0.05) higher abundances in Type-2 mats. Over 85% of SRM cells in the top 0.5 mm of Type-2 mats were contained in a dense 130 µm thick horizontal layer comprised of clusters of varying sizes; (2) Microspatial mapping revealed that locations of SRM and CaCO3 precipitation were significantly correlated (p < 0.05); (3) Extracts from Type-2 mats contained acylhomoserine-lactones (C4- ,C6- ,oxo-C6,C7- ,C8- ,C10- ,C12- , C14-AHLs) involved in cell-cell communication. Similar AHLs were produced by SRM mat-isolates. These trends suggest that development of a microspatially-organized SRM community is closely-associated with the hallmark transition of stromatolite surface mats from a non-lithifying to a lithifying state.
Subject(s)
Bacteria/metabolism , Sulfates/metabolism , Bacteria/classification , Bacteria/isolation & purification , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Caseins/chemistry , Cluster Analysis , Geographic Information Systems , Geologic Sediments/microbiology , Phylogeny , RNA, Small Untranslated/chemistry , Sulfates/chemistry , Sulfite Reductase (NADPH)/genetics , Sulfite Reductase (NADPH)/metabolismABSTRACT
PURPOSE: The purpose of this study is to compare the shear bond strength of ultraviolet (UV)-polymerized resin to 3D-printed denture materials, both with and without post-polymerization. Moreover, the effects of surface treatment and thermocycling on shear bond strength after post-polymerization were investigated. METHODS: Cylindrical 3D-printed denture bases and teeth specimens were prepared. The specimens are subjected to two tests. For Test 1, the specimens were bonded without any surface treatment or thermal stress for comparison with and without post-polymerization. In Test 2, specimens underwent five surface treatments: untreated (CON), ethyl acetate (EA), airborne particle abrasion (APA) with 50 µm (50-APA) and 110 µm alumina (110-APA), and tribochemical silica coating (TSC). A UV-polymerized resin was used for bonding. Half of the Test 2 specimens were thermocycled for 10,000 cycles. Shear bond strength was measured and analyzed using Kruskal-Wallis and Steel-Dwass tests (n = 8). RESULTS: In Test 1, post-polymerization significantly reduced shear bond strength of both 3D-printed denture materials (P < 0.05). No notable difference was observed between the denture teeth and the bases (P > 0.05). In Test 2, before thermocycling, the CON and EA groups exhibited low bond strengths, while the 50-APA, 110-APA, and TSC groups exhibited higher bond strengths. Thermocycling did not reduce bond strength in the latter groups, but significantly reduced bond strength in the EA group (P < 0.001). CONCLUSIONS: Post-polymerization can significantly reduce the shear bond strength of 3D-printed denture materials. Surface treatments, particularly APA and TSC, maintained bond strength even after thermocycling.
ABSTRACT
The short-chain fatty acids responsible for gut homeostasis are volatile fatty acids produced by commensal bacteria in the gut as fermentation products from undigested food components. Among the short-chain fatty acids, butyrate is important for maintaining intestinal tract anaerobic conditions, promoting epithelial barrier functions, and inducing regulatory T cells that suppress inflammatory bowel disease and allergic diarrhea. However, the type of food-derived molecular components and mechanisms by which they regulate the growth and butyrate production of butyrate-producing bacteria are not clearly understood. Agathobacter rectalis is a butyrate-producing bacterium highly colonized in the gut of the Japanese population. In this study, we investigated the effects on A. rectalis of a soy sauce-like seasoning made by brewing with a low salt concentration. The soy sauce-like seasoning promoted the growth of A. rectalis 2.6-fold. An ethanol precipitate prepared from the soy sauce-like seasoning was critical for promoting the growth of A. rectalis and the production of butyrate, propionate, and lactate. Fourier transform infrared spectroscopy (FT-IR) analysis suggested that polysaccharides were active ingredients in the ethanol precipitate of the soy sauce-like seasoning. Inulin, a representative prebiotic with effects against butyrate-producing bacteria, had a limited effect on the growth of A. rectalis compared with the soy sauce-like seasoning. Our results indicate that polysaccharides in a soy sauce-like seasoning contributed to the growth of A. rectalis and enhanced production of butyrate, propionate, and lactate.
ABSTRACT
OBJECTIVE: Transsphenoidal surgery for lactotroph pituitary neuroendocrine tumor (PitNET) lowers serum prolactin concentrations, occasionally below the normal range. However, the clinical significance of postoperative hypoprolactinemia is still unclear. In this study, we retrospectively reviewed the female patients with lactotroph PitNET who were treated with transsphenoidal surgery to elucidate the influence of postoperative hypoprolactinemia on regular menstruation restoration and endocrinological remission. RESULTS: The serum prolactin levels in all thirty three participating females had decreased following surgery. Serum prolactin levels in seven patients had decreased below the lower limit of normal ranges (hypoproactinemia group) and in the remaining twenty six patients, it was within the normal range (non-hypoproractinemia group). In hypoprolactinemia group, regular menstruation was restored in all patients with only lactotroph axis deficiency. Nine patients from the non-hypoprolactinemia group experienced re-elevation of serum prolactin concentration (27%). No patient in hypoprolactinemia group experienced the relapse of hyperprolactinemia. These data suggest that early postoperative hypoprolactinemia after transsphenoidal surgery for lactotroph PitNET is not only a good predictive factor for endocrinological remission but also no unfavorable effects on regular menstruation restoration.
Subject(s)
Menstruation , Pituitary Neoplasms , Prolactin , Humans , Female , Pituitary Neoplasms/surgery , Prolactin/blood , Adult , Middle Aged , Retrospective Studies , Menstruation/physiology , Neuroendocrine Tumors/surgery , Neuroendocrine Tumors/blood , Postoperative Complications/etiology , Lactotrophs , Hyperprolactinemia/blood , Hyperprolactinemia/etiology , Hyperprolactinemia/surgery , Hyperprolactinemia/physiopathology , Young AdultABSTRACT
OBJECTIVE: To investigate the prevalence and intensity of grasp reflexes and to examine changes in these reflexes after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS: We enrolled 147 patients with probable iNPH. A standard procedure was used to determine the presence of grasp reflexes, and the intensity of these reflexes was assessed using a four-category classification. Clinical rating scales and their correlation with grasp reflexes were also evaluated. Grasp reflexes were reassessed in 72 patients 1 year after surgery. RESULTS: We found that approximately 50.3% of patients with iNPH exhibited a positive grasp reflex. Among these patients, 69% exhibited bilateral positivity, while the remaining patients showed unilateral positivity. Furthermore, the intensity of the grasp reflex was significantly correlated with the severity of gait and with cognitive, urinary, motor, and behavioural symptoms. Surgical interventions led to a reduction (41.7%) or maintenance (30.6%) of the reflex intensity in 72.3% of iNPH patients. The changes in reflex intensity showed significant positive correlations with changes in the number of steps of the Timed Up and Go test and Trail Making Test-A scores but not with changes in total scores on the iNPH Grading Scale. CONCLUSION: This retrospective study identified grasp reflexes as a highly prevalent phenomenon in patients with iNPH. These reflexes can assist in evaluating the severity of various symptoms, including cognitive, gait, urinary, motor and emotional symptoms.
Subject(s)
Hydrocephalus, Normal Pressure , Reflex , Humans , Hydrocephalus, Normal Pressure/physiopathology , Hydrocephalus, Normal Pressure/surgery , Male , Female , Aged , Retrospective Studies , Aged, 80 and over , Reflex/physiology , Hand Strength/physiology , Severity of Illness Index , Middle AgedABSTRACT
Percutaneous coronary intervention with a drug-eluting stent was successfully performed without a side branch (SB) occlusion. In this case, a directional coronary atherectomy catheter played an important role in modifying the plaque at the proximal left anterior descending artery and in crossing a wire to the jeopardized SB.
ABSTRACT
BACKGROUND: Endoscopic hematoma evacuation is one of the most promising procedures for the treatment of intracerebral hemorrhage (ICH) to avoid severe outcomes, such as death or dependency. However, the effect of the procedure on the functional outcome remains controversial. Thus, standardization and sophistication are required to enhance the surgical results. This study aimed to evaluate the potential efficacy of ultrasonography (US) in endoscopic hematoma evacuation. METHODS: This study included 39 consecutive patients with spontaneous supratentorial ICH who underwent endoscopic hematoma evacuation between April 2019 and July 2021. The patients were divided into two groups, namely, surgery with or without US assistance. Rebleeding and evacuation rate were set as the primary endpoints, and operation time, requirement for repeat puncture, and modified Rankin scale at discharge were set as the secondary endpoints. During surgery, the burr hole was placed, and the dura mater was widely opened. The US probe was applied on the brain surface via the burr hole to detect the depth and direction of the hematoma cavity. With US assistance, the hematoma cavity was punctured with a cannula, and the transparent port was introduced into the hematoma cavity along the tract. The hematoma was gently evacuated with the irrigation-suction instrument. RESULTS: Of the 39 cases, 9 underwent endoscopic hematoma evacuation with US assistance. Rebleeding was noted in 0 and 2 (6.7%) patients with and without US assistance, respectively (p = 0.43). The mean hematoma evacuation rates were 78.6 and 80.6% in patients with and without US assistance, respectively (p = 0.80). In all cases with US assistance, the cavity could be reached with a single tap. However, repeat puncture was required in 20 (66.7%) cases without US assistance (p = 0.04). In one case, an unexpected residual hematoma was detected using US, which was applied after hematoma evacuation and before wound closure. The operation time was not extended even if US was used during the surgery. CONCLUSIONS: US-assisted hematoma evacuation is an effective procedure that can assist in the precise insertion of the puncture cannula and exclusion of the residual hematoma. US might contribute toward improving the accuracy of each step of the procedure, thus leading to better clinical outcomes.