Tailored Vessel-Catheter Diameter Ratio in a Direct Aspiration First-Pass Technique: Is It a Matter of Caliber?

BACKGROUND AND PURPOSE: The aspiration technique has gained a prominent role in mechanical thrombectomy. The thrombectomy goal is successful revascularization (modified TICI ≥ 2b) and first-pass effect. The purpose of this study was to evaluate the impact of the vessel-catheter ratio on the modified TICI ≥ 2b and first-pass effect. MATERIALS AND METHODS: This was a retrospective, single-center, cohort study. From January 2018 to April 2020, 111/206 (53.9%) were eligible after applying the exclusion criteria. Culprit vessel diameters were measured by 2 neuroradiologists, and the intraclass correlation coefficient was calculated. The receiver operating characteristic curve was used for assessing the vessel-catheter ratio cutoff for modified TICI ≥ 2b and the first-pass effect. Time to groin puncture and fibrinolysis were weighted using logistic regression. All possible intervals (interval size, 0.1; sliding interval, 0.01) of the vessel-catheter ratio were plotted, and the best and worst intervals were compared using the χ2 test. RESULTS: Modified TICI ≥ 2b outcome was achieved in 75/111 (67.5%), and first-pass effect was achieved in 53/75 (70.6%). The MCA diameter was 2.1 mm with an intraclass correlation coefficient of 0.92. The optimal vessel-catheter ratio cutoffs for modified TICI ≥ 2b were ≤1.51 (accuracy = 0.67; 95% CI, 0.58-0.76; P = 0.001), and for first-pass effect, they were significant (≤1.33; P = .31). The modified TICI ≥ 2b odds ratio and relative risk were 9.2 (95% CI, 2.4-36.2; P = 0.002) and 3.2 (95% CI, 1.2-8.7; P = .024). The odds ratio remained significant after logistic regression (7.4; 95% CI, 1.7-32.5; P = .008). First-pass effect odds ratio and relative risk were not significant (2.1 and 1.5; P > .05, respectively). The modified TICI ≥ 2b best and worst vessel-catheter ratio intervals were not significantly different (55.6% versus 85.7%, P = .12). The first-pass effect best vessel-catheter ratio interval was significantly higher compared with the worst one (78.6% versus 40.0%, P = .03). CONCLUSIONS: The aspiration catheter should be selected according to culprit vessel diameter. The optimal vessel-catheter ratio cutoffs were ≤1.51 for modified TICI ≥ 2b with an odds ratio of 9.2 and a relative risk of 3.2.

Composition of enamel pellicle from dental erosion patients.

Oral health is dependent upon a thin mobile film of saliva on soft and hard tissues. Salivary proteins adhere to teeth to form the acquired enamel pellicle which is believed to protect teeth from acid erosion. This study investigated whether patients suffering diet-induced dental erosion had altered enamel pellicles. Thirty patients suffering erosion were compared to healthy age-matched controls. Subjects wore a maxillary splint holding hydroxyapatite and human enamel blocks for 1 h. The acquired enamel pellicle was removed from the blocks and compared to the natural incisor pellicle. Basic Erosive Wear Examination scores confirmed that dental erosion was present in erosion patients and absent from healthy age-matched controls. Erosion patients had half the amount of proteins (BCA assay) within the acquired pellicle forming on splint blocks compared to normal controls (p < 0.05). In particular, statherin, a calcium-binding protein, was 35% less abundant (p < 0.05). Calcium concentration within the acquired pellicle was also reduced by 50% in erosion patients (p < 0.001). In contrast, the natural pellicle on the incisor had similar amounts of total protein in erosion patients and healthy controls. In summary, the formation of new acquired pellicles on surfaces was reduced in erosion patients, which may explain their greater susceptibility to acid erosion of teeth.

Comparison of the possible protective effect of the salivary pellicle of individuals with and without erosion.

The acquired pellicle adheres to tooth surfaces and has been suggested to provide differing degrees of protection against acidic erosion. This study investigated whether pellicle formed on enamel blocks in patients suffering dietary dental erosion modified the effect of an in vitro simulated dietary challenge, in comparison with pellicle formed on enamel blocks in healthy subjects and to no-pellicle enamel samples. Sixty subjects recruited from dental erosion clinics were compared to healthy age-matched controls. Subjects wore a custom-made maxillary splint holding human enamel blocks for 1 h during which the acquired enamel pellicle was formed. Enamel blocks were removed from the splints and a simulated dietary erosive challenge of 10 min was performed. In addition the challenge was performed on 30 enamel samples without pellicle. Profilometry showed no statistical difference between samples from the erosion subjects with a mean step height of 1.74 µm (SD 0.88) and median roughness (Sa) of 0.39 µm (interquartile range, IQR 0.3-0.56) and the controls with 1.34 µm (SD 0.66) and 0.33 µm (IQR 0.27-0.38), respectively. The control samples without pellicle had Sa of 0.44 µm (IQR 0.36-0.69) and these differences were statistically significant compared to those from the healthy subjects (p = 0.002). Mean (SD) microhardness reduction with a 100-gram load for the erosion group was 113.5 (10) KHN, for healthy subjects was 93 (15.4) KHN and for the enamel samples without pellicle 139.6 (21.8) KHN and all groups were statistically different. The microhardness and roughness data suggested the pellicle influenced erosion under these study conditions.

A bienzyme electrochemical probe for flow injection analysis of okadaic acid based on protein phosphatase-2A inhibition: an optimization study.

A bienzyme electrochemical probe has been assembled and used to monitor the inhibition of the enzyme protein phosphatase-2A (PP2A) by okadaic acid (OA), taking advantage of the particular characteristics of a biochemical pathway in which PP2A is involved. This enzyme has significant activity toward glycogen phosphorylase a (PHOS a), which in turn catalyzes the conversion of glycogen to glucose-1-phosphate (G-1-P). In addition, PP2A is strongly inhibited by OA and its derivatives. Due to this combination of properties, PP2A was employed to develop an assay system involving a preliminary phase of off-line enzymatic incubations (OA/PP2A, PP2A/PHOS a, PHOS a/glycogen+phosphate). This off-line step was followed by the electrochemical detection of H2O2, which is the final product of two sequential enzymatic reactions: G-1-P with alkaline phosphatase (AP) producing glucose, then glucose with glucose oxidase (GOD) producing hydrogen peroxide. These two enzymes were coimmobilized on a nylon net membrane that was placed over an H2O2 platinum probe inserted into a flow injection analysis (FIA) system. During a first phase of the study, all analytical parameters were optimized. During a subsequent phase, the inhibition of PP2A enzyme by OA was evaluated. The calibration of the system shows a working range for detection of OA between 30 and 250 pg ml(-1). The total analysis time is the sum of 50 min for the off-line enzymatic incubations and 4 min for the biosensor response.

Endovascular treatment of middle cerebral artery aneurysms. Overall perioperative results. Apropos of 113 cases.

SUMMARY: The endovascular approach is described in 113 middle cerebral artery (MCA) aneurysms. The treatment failed in six cases with no adverse clinical consequences. Out of the 107 treated cases, it was possible to obtain a complete occlusion in 50 aneurysms (47%), whereas a residual aneurysm neck was observed in 54 cases (50%). Follow-up angiograms were performed in 60 cases, showing a 22% rate of further thrombosis of the aneurysm. Recanalization of the aneurysm was observed in 8% of cases, which required retreatment. The technique-related permanent morbidity rate was 9% while the mortality rate was 2%. A review of the surgical and endovascular literature is presented. The endovascular approach is particularly indicated when normal MCA branches do not arise from the aneurysm base. It must be meticulously planned in all other cases. Endovascular coil treatment of MCA aneurysms is feasible, with acceptable morbi-mortality rates.

Endovascular occlusion of the posterior cerebral artery in the treatment of p2 ruptured aneurysms.

SUMMARY: Four cases of posterior cerebral artery (PCA) aneurysms are described. The aneurysms were located at the P2 segment of PCA. All cases presented with a subarachnoid hemorrhage (SAH). Endovascular treatment was performed, with occlusion of the aneurysm and parent vessel, using platinum coils. Two patients developed a homonymus lateral hemianopia after treatment.

Examen neurológico y rendimiento escolar: correlaciones a siete años plazo / Neurologic examination and achievement: a 7 years correlation study

Analizamos 146 niños provenientes de un seguimiento longitudinal de crecimiento y desarrollo del Area Norte de Santiago. Ellos fueron seguidos por varios años en aspectos biológicos, psicosociales y socioeconómicos. Aquí se comparan sus habilidades para leer y escribir y también sus rendimientos en una batería de exámentes neuromaduracionales, cuando ellos alcanzaron su tercer grado de enseñanza primaria, en relación a sus logros académicos, siete años más tarde. Se encontró una correspondencia altamente significativa entre las 2 evaluaciones. La capacidad de comprensión de lectura y resolución de problemas aritméticos simples fueron los aspectos más afectados en aquellos que exhibieron muchos signos neurológicos alterados. La escritura y habilidade4s de diseño fueron también comprometidas en cierto grado. La capacidad intelectual fue un factor determinante en esta correlación, ya que los niños con capacidad sobre el promedio tendieron a manifestar menos compromiso neurológico y mejores calificaciones académicas y viceversa. En todo caso, aquellos que mostraron muchos índices neuromaduracionales subnormales, tuvieron un menor rendimiento escolar, cualquiera que fuese el nivel mental. De 208 casos que ingresaron al estudio 62 se perdieron durante el lapso de 7 años. La mayoría de ellos fueron inhábiles para leer y escribir apropiadamente a nivel de tercer grado primario y también su examen neurológico demostró varias fallas menores. La gran mayoría de los sujetos perdidos había abandonado el sistema escolar en ese período. Por contraste 96% del grupo índice pudo ser reexaminado. Esta diferencia implica que entre el aprendizaje temprano, más el estado neurológico a la edad de 9 años y el rendimiento académico posterior, habría una correlación muy positiva para la serie completa. Se discuten las implicancias teórico-prácticas de estos datos

[Nuclear magnetic resonance in pathology of the central nervous system in children]. / La risonanza magnetica nucleare nella patologia del sistema nervoso centrale in età pediatrica.

The following study aims to establish the role of MRI in investigation of the CNS in children. 300 patients are examined, 220 affected by CNS disease. The examinations were performed using SE sequence (T1-weighted images TR = 350-700 ms TE = 30-60 ms; T2-weighted images TR = 1500-2000 ms TE = 50-200 ms). In most of the patients general anesthesia or sedation was necessary. Patients are divided into groups based on pathology and the advantages and shortcomings of MRI are discussed. In conclusion, MRI should be the technique of choice in the evaluation of malformative affections, white matter and inflammatory disease; it should be complementary to CT and angiography in tumors and vascular pathology.

[Intracranial hemorrhage studied with a high-field (1.5T) NMR apparatus]. / Studio dell'emorragia intracranica con apparecchio di RMN ad alta intensità di campo (1.5T).

Fifty-two patients were studied with high-field magnetic resonance imaging (1.5T), with T1- and T2-weighted spin-echo pulse sequences. The study was aimed at assessing the efficacy of MR imaging in the evaluation of intracranial hematomas. Characteristic intensity patterns were observed in the evolution of the hematomas, due to the physicochemical changes in hemoglobin. No acute hematomas were observed. In 35 sub-acute hematomas, peripheral hyperintensity could be observed on T1- and T2-weighted pulse sequences. This hyperintensity eventually fills in the hematoma in the chronic stage. In 17 chronic hematomas, a peripheral hypointense ring due to hemosiderin deposits was seen on T1- and T2-weighted scans. The authors conclude that high-field MR imaging is a very sensible diagnostic method in the evaluation of sub-acute and chronic hematomas.

Joubert syndrome: a case confirmed by computerized tomography.

The authors report a new case of Joubert syndrome (agenesis of the cerebellar vermis, mental retardation, disturbance of respiratory rhythm, ataxia, abnormal eye-movements) and review the relevant literature on the other nine cases reported. The diagnosis in the present case was confirmed by computerized tomography. Early recognition of this syndrome is important in view of the prognosis and for genetic counseling.