Bilateral amygdala stimulation reduces avoidance behavior in a predator scent posttraumatic stress disorder model.

OBJECTIVE The predator scent model of posttraumatic stress disorder (PTSD) produces prolonged abnormal anxiety and avoidance-like behaviors. Increased basolateral amygdala activity has been shown to correlate with severity of PTSD symptoms in human studies. Modulation of this increased amygdala activity by deep brain stimulation led to improved symptoms in prior studies that used a foot shock model of inducing PTSD. The predator scent model is a different technique that induces long-lasting avoidance behavioral responses by exposing the animal to an inescapable scent of one of its predators. The authors hypothesize that high-frequency stimulation of the bilateral basolateral amygdala will decrease avoidance and anxiety-like behaviors in a predator scent rodent model of PTSD. METHODS Rodents underwent cat urine exposure in a place preference protocol. Avoidance in the place preference paradigm and anxiety-like behavior in the elevated plus maze were measured before and after high-frequency stimulation. RESULTS Predator scent exposure resulted in long-term significant avoidance behavior in rodents. Bilateral stimulation significantly decreased avoidance behavior in rodents compared to no stimulation following predator scent exposure. There were no significant differences in anxiety behaviors on the elevated plus maze between stimulated and unstimulated cohorts. CONCLUSIONS Bilateral stimulation of the basolateral amygdala leads to decreased avoidance behavior compared to controls in a predator scent model of PTSD.

Correlation of the KHS Tuff of the Kibish Formation to volcanic ash layers at other sites, and the age of early Homo sapiens (Omo I and Omo II).

Hominin specimens Omo I and Omo II from Member I of the Kibish Formation, Ethiopia are attributed to early Homo sapiens, and an age near 196 ka has been suggested for them. The KHS Tuff, within Member II of the Kibish Formation has not been directly dated at the site, but it is believed to have been deposited at or near the time of formation of sapropel S6 in the Mediterranean Sea. Electron microprobe analyses suggest that the KHS Tuff correlates with the WAVT (Waidedo Vitric Tuff) at Herto, Gona, and Konso (sample TA-55), and with Unit D at Kulkuletti in the Ethiopian Rift Valley. Konso sample TA-55 is older than 154 ka, and Unit D at Kulkuletti is dated at 183 ka. These correlations and ages provide strong support for the age originally suggested for the hominin remains Omo I and Omo II, and for correlation of times of deposition in the Kibish region with formation of sapropels in the Mediterranean Sea. The Aliyo Tuff in Member III of the Kibish Formation is dated at 104 ka, and correlates with Gademotta Unit 15 in the Ethiopian Rift Valley.

Towards real-time cardiovascular magnetic resonance guided transarterial CoreValve implantation: in vivo evaluation in swine.

BACKGROUND: Real-time cardiovascular magnetic resonance (rtCMR) is considered attractive for guiding TAVI. Owing to an unlimited scan plane orientation and an unsurpassed soft-tissue contrast with simultaneous device visualization, rtCMR is presumed to allow safe device navigation and to offer optimal orientation for precise axial positioning. We sought to evaluate the preclinical feasibility of rtCMR-guided transarterial aortic valve implatation (TAVI) using the nitinol-based Medtronic CoreValve bioprosthesis. METHODS: rtCMR-guided transfemoral (n = 2) and transsubclavian (n = 6) TAVI was performed in 8 swine using the original CoreValve prosthesis and a modified, CMR-compatible delivery catheter without ferromagnetic components. RESULTS: rtCMR using TrueFISP sequences provided reliable imaging guidance during TAVI, which was successful in 6 swine. One transfemoral attempt failed due to unsuccessful aortic arch passage and one pericardial tamponade with subsequent death occurred as a result of ventricular perforation by the device tip due to an operating error, this complication being detected without delay by rtCMR. rtCMR allowed for a detailed, simultaneous visualization of the delivery system with the mounted stent-valve and the surrounding anatomy, resulting in improved visualization during navigation through the vasculature, passage of the aortic valve, and during placement and deployment of the stent-valve. Post-interventional success could be confirmed using ECG-triggered time-resolved cine-TrueFISP and flow-sensitive phase-contrast sequences. Intended valve position was confirmed by ex-vivo histology. CONCLUSIONS: Our study shows that rtCMR-guided TAVI using the commercial CoreValve prosthesis in conjunction with a modified delivery system is feasible in swine, allowing improved procedural guidance including immediate detection of complications and direct functional assessment with reduction of radiation and omission of contrast media.

Geochronology of the Turkana depression of northern Kenya and southern Ethiopia.

Mesozoic and Cenozoic sedimentary rocks in the Turkana Depression of northern Kenya and southern Ethiopia rest on basement rocks that yield K/Ar cooling ages between 433 and 522 Ma. Proven Cretaceous strata are exposed in Lokitaung Gorge in northwest Kenya. Eocene basalts and rhyolites in Lokitaung Gorge, the Nabwal Hills, and at Kangamajoj, date between 34 and 36 Ma, recording the earliest volcanism in the region. Oligocene volcanic rocks, with associated fossiliferous sedimentary strata at Eragaleit, Nakwai, and Lokone, all west of Lake Turkana, are 23 to 28 Ma old, as is the Langaria Formation east of Lake Turkana. Lower and Middle Miocene volcanic and sedimentary sequences are present both east and west of Lake Turkana, where ages from 17.9 to 9.1 Ma have been measured at many levels. Upper Miocene strata are presently known only at Lothagam, with ages ranging from 7.4 to 6.5 Ma. Deposition of Pliocene strata of the Omo Group begins in the Omo-Turkana, Kerio, and South Turkana basins -4.3 Ma ago and continues in parts of those basins until nearly the present time, but with some gaps. These strata are linked through volcanic ash correlations at many levels, as are Pleistocene strata of the Omo Group (principally the Shungura, Koobi Fora, and Nachukui formations). (40) Ar/(39) Ar dates on many volcanic ash layers within the Omo Group, supplemented by K/Ar ages on intercalated basalts and paleomagnetic polarity stratigraphy, provide excellent age control from 4.2 to 0.75 Ma, although there is a gap in the record between -1 Ma and 0.8 Ma. Members I to III of the Kibish Formation in the lower Omo Valley record deposition between 0.2 and 0.1 Ma ago; Member IV, correlative with the Galana Boi Formation, was deposited principally between 12 and 7 ka BP.

Stratigraphic placement and age of modern humans from Kibish, Ethiopia.

In 1967 the Kibish Formation in southern Ethiopia yielded hominid cranial remains identified as early anatomically modern humans, assigned to Homo sapiens. However, the provenance and age of the fossils have been much debated. Here we confirm that the Omo I and Omo II hominid fossils are from similar stratigraphic levels in Member I of the Kibish Formation, despite the view that Omo I is more modern in appearance than Omo II. 40Ar/39Ar ages on feldspar crystals from pumice clasts within a tuff in Member I below the hominid levels place an older limit of 198 +/- 14 kyr (weighted mean age 196 +/- 2 kyr) on the hominids. A younger age limit of 104 +/- 7 kyr is provided by feldspars from pumice clasts in a Member III tuff. Geological evidence indicates rapid deposition of each member of the Kibish Formation. Isotopic ages on the Kibish Formation correspond to ages of Mediterranean sapropels, which reflect increased flow of the Nile River, and necessarily increased flow of the Omo River. Thus the 40Ar/39Ar age measurements, together with the sapropel correlations, indicate that the hominid fossils have an age close to the older limit. Our preferred estimate of the age of the Kibish hominids is 195 +/- 5 kyr, making them the earliest well-dated anatomically modern humans yet described.

Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: in vitro evaluation and modification of existing devices.

BACKGROUND: Cardiovascular magnetic resonance (CMR) is considered an attractive alternative for guiding transarterial aortic valve implantation (TAVI) featuring unlimited scan plane orientation and unsurpassed soft-tissue contrast with simultaneous device visualization. We sought to evaluate the CMR characteristics of both currently commercially available transcatheter heart valves (Edwards SAPIEN™, Medtronic CoreValve®) including their dedicated delivery devices and of a custom-built, CMR-compatible delivery device for the Medtronic CoreValve® prosthesis as an initial step towards real-time CMR-guided TAVI. METHODS: The devices were systematically examined in phantom models on a 1.5-Tesla scanner using high-resolution T1-weighted 3D FLASH, real-time TrueFISP and flow-sensitive phase-contrast sequences. Images were analyzed for device visualization quality, device-related susceptibility artifacts, and radiofrequency signal shielding. RESULTS: CMR revealed major susceptibility artifacts for the two commercial delivery devices caused by considerable metal braiding and precluding in vivo application. The stainless steel-based Edwards SAPIEN™ prosthesis was also regarded not suitable for CMR-guided TAVI due to susceptibility artifacts exceeding the valve's dimensions and hindering an exact placement. In contrast, the nitinol-based Medtronic CoreValve® prosthesis was excellently visualized with delineation even of small details and, thus, regarded suitable for CMR-guided TAVI, particularly since reengineering of its delivery device toward CMR-compatibility resulted in artifact elimination and excellent visualization during catheter movement and valve deployment on real-time TrueFISP imaging. Reliable flow measurements could be performed for both stent-valves after deployment using phase-contrast sequences. CONCLUSIONS: The present study shows that the Medtronic CoreValve® prosthesis is potentially suited for real-time CMR-guided placement in vivo after suggested design modifications of the delivery system.

40Ar/39Ar age spectra from the KBS Tuff, Koobi Fora Formation.

40Ar/39Ar age spectra on anorthoclase phenocrysts from three pumice clasts in the KBS Tuff yield nearly ideal flat patterns, providing good evidence that the samples have remained undisturbed since crystallization. The ages are concordant at 1.88±0.02 Myr, and confirm that the KBS Tuff, a key marker bed in the Koobi Fora Formation, northern Kenya, is now very well dated. These results resolve the conflict between earlier 40Ar/39Ar and conventional K-Ar dating measurements on the KBS Tuff.

Technical development and initial animal experience with a novel, uncovered, self-expanding, highly flexible aortic stent with improved side branch access.

PURPOSE: To present a novel, uncovered, self-expanding aortic stent for use as a thoracoabdominal stent-graft extension to improve distal flow in aortic dissections complicated by malperfusion syndrome and to enhance the remodeling process in the abdominal aorta after thoracic endovascular aortic repair. METHODS: This aortic prosthesis is a laser cut, self-expanding nitinol stent that is designed to provide an optimal balance between radial support and flexibility to negotiate tortuous arterial anatomy. Undulating circumferential rings provide radial force, while flexibility is achieved through the shape and configuration of the longitudinal connectors that extend from the valley of one ring to the offset peak of the next ring. Delivery and deployment characteristics, in vivo flexibility of the stent, and side branch accessibility through the bare stent struts were evaluated in 4 anesthetized domestic swine weighing 68 to 73 kg. RESULTS: All 11 attempted stent implantations were successful in the 4 pigs using a retrograde transiliac access. The stents were positioned and deployed exactly at the intended target locations and conformed well to the aortic anatomy, even in the tortuous aortic arch, with no evidence of stent kinking or collapse. Overall, 21 major aortic side branches were intentionally covered with the bare stent struts; perfusion was not impaired in any branch vessel. Superselective catheterization of the side branches with coronary guiding catheters through the stent struts was possible for all vessels, as was side branch stenting in 3/3 attempts. CONCLUSION: This initial feasibility study demonstrates the ability to deploy this novel self-expanding aortic stent in pigs. The high flexibility of the stent allowed conformability with tortuous aortic anatomy. Access to side branches overstented with bare stent struts was excellent. Clinical evaluation of the device is planned for the near future.

A novel endovascular clip system for the treatment of intracranial aneurysms: technology, concept, and initial experimental results. Laboratory investigation.

OBJECT: The authors describe a novel device for the endovascular treatment of intracranial aneurysms, the endovascular clip system (eCLIPs). Descriptions of the device and its delivery system as well as the results of flow model tests and the treatment of experimental aneurysms are provided. METHODS: The eCLIPs comprises a flexible hybrid implantable device (an anchor and a covered leaf) and a balloon catheter delivery system, designed to be positioned and activated in the parent vessel in such a way that the covered portion will abut the aneurysm neck. The eCLIPs was subjected to testing in glass, elastomeric, and cadaveric flow models to determine its navigability, orientation, and activation compared with commercially available stents. In a second experiment, 8 carotid artery sidewall aneurysms in swine were treated using eCLIPs. The degree of occlusion was observed on angiography immediately following and 30 days after device activation, and a histological analysis was performed at 30 days. RESULTS: The device could navigate tortuous glass models and human cadaveric vessels. Compared with commercially available stents, the eCLIPs performed well. It could be navigated, oriented, and activated easily and reliably. With regard to the 8 porcine experimental aneurysms, immediate postactivation angiograms confirmed complete occlusion of 4 lesions and near occlusion of the other 4. Angiographic follow-up at 30 days postactivation showed occlusion of all 8 aneurysms and patency of all parent vessels. Histopathological analysis revealed aneurysm healing, with smooth-muscle cells growing across the lesion neck to allow reendothelialization. CONCLUSIONS: Aneurysm occlusion with a single extrasaccular endovascular device has potential advantages. The authors believe that eCLIPs may prove to be a useful tool in the endovascular treatment of cerebral aneurysms. The system should reduce risks associated with coiling, procedure time, costs, and radiation exposure. The device satisfactorily occluded 8 experimental sidewall aneurysms. The observed healing pattern is similar to that seen after microsurgical clipping.

Physiological remodeling of bifurcation aneurysms: preclinical results of the eCLIPs device.

OBJECTIVE Intracranial bifurcation aneurysms are complex lesions for which current therapy, including simple coiling, balloon- or stent-assisted coiling, coil retention, or intrasaccular devices, is inadequate. Thromboembolic complications due to a large burden of intraluminal metal, impedance of access to side branches, and a high recurrence rate, due largely to the unmitigated high-pressure flow into the aneurysm (water hammer effect), are among the limitations imposed by current therapy. The authors describe herein a novel device, eCLIPs, and its use in a preclinical laboratory study that suggests the device's design and functional features may overcome many of these limitations. METHODS A preclinical model of wide-necked bifurcation aneurysms in rabbits was used to assess functional features and efficacy of aneurysm occlusion by the eCLIPs device. RESULTS The eCLIPs device, in bridging the aneurysm neck, allows coil retention, disrupts flow away from the aneurysm, leaves the main vessel and side branches unencumbered by intraluminal metal, and serves as a platform for endothelial growth across the neck, excluding the aneurysm from the circulation. CONCLUSIONS The eCLIPs device permits physiological remodeling of the bifurcation.

The second-generation eCLIPs Endovascular Clip System: initial experience.

OBJECTIVE Treatment of wide-necked intracranial aneurysms is associated with higher recanalization and complication rates; however, the most commonly used methods are not specifically designed to work in bifurcation lesions. To address these issues, the authors describe the evolution in the design and use of the eCLIPs (Endovascular Clip System) device, a novel hybrid stent-like assist device with flow diverter properties that was first described in 2008. METHODS A registry was established covering 13 international centers at which patients were treated with the second-generation eCLIPs device. Aneurysm morphology and rupture status, device neck coverage, coil retention, and procedural and late morbidity and mortality were recorded. For those patients who had undergone successful implantation more than 6 months earlier, the final imaging and clinical follow-up results and need for re-treatment were recorded. RESULTS Thirty-three patients were treated between June 2013 and September 2015. Twenty-five (76%) patients had successful placement of an eCLIPs device; 23 (92%) of these 25 patients had complete data. Eight cases of nondeployment occurred during the 1st year of use, consistent with a learning curve; no failures of deployment occurred thereafter. Two periprocedural transient ischemic attacks and 2 asymptomatic thrombotic events occurred. Twenty-one (91%) of 23 patients underwent follow-up at an average of 8 months (range 3-18 months); 9 (42.9%) of these 21 patients demonstrated an improvement in Raymond grade at follow-up; no cases of worsening Raymond grade were recorded, and 17 (81.0%) patients sustained a modified Raymond-Roy Classification class of I or II angiographic result at follow-up. Two delayed ruptures were recorded, both in previously coiled, symptomatic giant aneurysms where the device was used as a part of a salvage strategy. CONCLUSIONS The second-generation eCLIPs device is a viable treatment option for bifurcation aneurysms. The aneurysm occlusion rates in this initial clinical series are comparable to the initial experience with other bifurcation support devices.

Severe hyponatremia: a danger of low-iodine diet.

Two patients who were placed on a low-iodine diet in preparation for testing and possible treatment with radio-iodine developed severe hyponatremia that required hospitalization. In elderly patients or those with risk factors for hyponatremia, serum sodium should be measured.

Sapropels and the age of hominins Omo I and II, Kibish, Ethiopia.

The provenance and age of two Homo sapiens fossils (Omo I and Omo II) from the Kibish Formation in southern Ethiopia have been much debated. Here we confirm that Omo I and the somewhat more primitive-looking Omo II calvariae are from similar stratigraphic levels in Member I of the Kibish Formation. Based on (40)Ar/(39)Ar age measurements on alkali feldspar crystals from pumice clasts in the Nakaa'kire Tuff, a tuffaceous bed in Member I just below the hominin levels, we place an older limit of 198+/-14 ka (weighted mean age=196+/-2 ka) for the hominins. A younger limit of 104+/-7 ka (weighted mean age=104+/-1 ka) is provided by feldspars separated from pumice clasts in the Aliyo Tuff in Member III. Geological evidence indicates rapid deposition of each member of the Kibish Formation, concurrent with deposition of sapropels in the Mediterranean Sea. The (40)Ar/(39)Ar age measurements, together with correlations with sapropels, indicate that the hominin fossils are close in age to the older limit. Our preferred estimate of the age of the hominins is 195+/-5 ka, making them the earliest well-dated anatomically modern humans yet described.

Assessment of stent dimensions with a novel intracoronary balloon-based system: comparative study versus intravascular ultrasound and quantitative coronary angiography. The CAMUS - Coronary Angioplasty Metricath vs. UltraSound Trial.

AIMS: To compare measurements of coronary stent dimensions using a novel, low pressure balloon catheter-based technique - Metricath (MC), with those obtained by intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA). BACKGROUND: Intravascular ultrasound (IVUS), the current gold standard to optimize stent placement is expensive, not widely available, and needs expertise for interpretation. METHODS AND RESULTS: We compared cross-sectional diameter and area measurements obtained by MC, IVUS, and QCA immediately after successful stent implantation. The order of measurements was randomized. Both on-line and off-line (independent core lab) analysis was performed.Measurements were obtained in 21 patients at 22 stents in the LAD (n=10), RCA (n=6), and LCx (n=6). Nominal stent diameter was 2.5-3.5 mm. Average stent diameter was 2.54+/-0.28 mm by QCA, 2.77+/-0.31 mm by IVUS, and 2.86+/-0.28 mm by MC (P<0.001 QCA versus MC, P=0.13 IVUS versus MC). Results of on-line area measurements showed a small but significant difference between IVUS and MC 0.53 mm2, 95% confidence interval 0.17-0.90 mm2, P<0.01. Regression analysis demonstrated, however, that MC correlated best with off-line IVUS (diameter: y=1.01x, R2=0.83, P<0.001; area: y=1.02x, R2=0.81, P<0.001). Bland-Altman analysis showed a mean difference in diameter between on-line MC and off-line IVUS of 0.03+/-0.12 mm and between MC and off-line QCA of 0.10+/-0.23 mm. CONCLUSION: MC is a new, promising method providing information on average stent dimensions that is equivalent to that obtained by off-line IVUS analyzed in an independent core lab.

Minimally invasive ureteral stent retrieval.

PURPOSE: We developed a minimally invasive (noncystoscopic) method for retrieving ureteral stents. MATERIALS AND METHODS: A total of 30 consecutive patients underwent placement of a ureteral stent with a stainless steel bead attached to its distal end. The stent was later removed by a urethral catheter with a rare earth magnet attached to its proximal end. RESULTS: In 29 of the 30 patients the stent with the attached bead was removed without difficulty or patient discomfort. The single failure occurred in a patient with a large median prostate lobe. CONCLUSIONS: Minimally invasive, nonendoscopic ureteral stent retrieval was achieved in 97% of patients. The attractive force of the magnet for the bead was sufficient to attract and extract the stent. No adverse effects of the procedure or the stainless steel bead were noted. This magnet retrieval system is a feasible, simpler and less invasive alternative to cystoscopic retrieval of ureteral stents.