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PURPOSE: Identification of the Adamkiewicz artery before aortic surgery is important for preventing postoperative complications due to spinal cord ischemia. The Adamkiewicz artery is difficult to identify due to its small diameter. Nitroglycerin has a vasodilatory effect and is used clinically to improve visualization of blood vessels on coronary computed tomography (CT) angiography. We investigated whether the vasodilatory effect of nitroglycerin could improve the ability to visualize the Adamkiewicz artery. METHODS: We extracted 33 cases wherein contrast-enhanced CT images were taken before and after aortic aneurysm surgery. Nitroglycerin was administered for coronary artery evaluation on the preoperative CT. However, no nitroglycerin was administered before the postoperative CT. Aortic contrast-to-noise ratio, CT value, image noise, and diameter of the Adamkiewicz artery and anterior spinal artery were measured. The depiction of the Adamkiewicz artery was graded into four grades and evaluated. These measurements were performed by two independent reviewers. RESULTS: In nitroglycerin-administered cases, the contrast-to-noise ratio and CT values were significantly higher (P < 0.001, P < 0.001, respectively); the Adamkiewicz artery and anterior spinal artery diameters were dilated (P = 0.005, P = 0.001, respectively). The Adamkiewicz artery score also improved significantly (P < 0.001). No significant difference was found in image noise. CONCLUSION: Nitroglycerin contributed to improving the Adamkiewicz artery's visualization.
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BACKGROUND: Using echocardiography to assess right ventricular (RV) function after cardioplegic arrest is challenging. Cardiac magnetic resonance (CMR) imaging is a superior alternative, with the feature tracking technique enabling quantitative assessment of myocardial deformation. METHODS: This single-center, prospective study from 2020 to 2022 assessed RV function in 42 patients who underwent open heart surgery with cardioplegic arrest. CMR data were collected preoperatively, one week postoperatively, and at follow-up (6-12 months after surgery), and assessed using the CMR feature tracking technique. RESULTS: Postoperatively, there was no significant change in RV end-diastolic volume, but RV end-systolic volume significantly decreased, leading to a notable increase in RV ejection fraction. By follow-up, both RV end-diastolic and end-systolic volumes had significantly reduced compared with the preoperative values. Right ventricular longitudinal contractility decreased after surgery but recovered to the preoperative values by follow-up, while RV circumferential contractility improved postoperatively and remained superior to the preoperative levels at follow-up. CONCLUSION: On CMR imaging, significant changes in RV systolic motion were observed after cardioplegic arrest, with decreased longitudinal but increased circumferential contractility. At follow up, these changes had reverted to the preoperative patterns by the mid-term (6-12 months).
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The prognostic significance of unconventional histology (UH) subtypes including intraductal carcinoma of the prostate (IDC-P), ductal adenocarcinoma, and cribriform pattern has been investigated for prostate cancer (PCa). However, little is known about magnetic resonance imaging (MRI) features and the oncological impact of tumor localization in localized PCa with UH. Clinical data of 211 patients with acinar adenocarcinoma (conventional histology [CH]) and 82 patients with UH who underwent robotic-assisted radical prostatectomy (RARP) were reviewed. Patients with UH are more likely to be older and have higher Gleason grade group, higher Prostate Imaging-Reporting and Data System (PI-RADS) v2.1 score, and larger tumor volume (TV) than those with CH. Multivariate analysis identified the presence of UH as an independent prognostic factor for progression-free survival (PFS) (hazard ration (HR) 2.41, 95% confidence interval (CI) 0.22-0.79, P = 0.0073). No significant difference in PFS was seen regarding tumor localization (transition zone [TZ] or peripheral zone [PZ]) in patients with UH (P = 0.8949), whereas PZ cancer showed shorter PFS in patients with CH (P = 0.0174). PCa with UH was associated with higher progression than PCa with CH among resection margin (RM)-negative cases (P < 0.0001). Further, increased PI-RADS v2.1 score did not correlate with larger TV in UH (P = 0.991), whereas a significant difference in TV was observed in CH (P < 0.0001). The prognostic significance of UH tumor was independent of tumor localization, and shorter PFS was observed even in RM-negative cases, indicating an aggressive subtype with micro-metastatic potential. Furthermore, UH tumors are more likely to harbor a large TV despite PI-RADS v2.1 score ≤ 3. These findings will help optimal perioperative management for PCa with UH.
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Imagen por Resonancia Magnética , Prostatectomía , Neoplasias de la Próstata , Humanos , Masculino , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Anciano , Persona de Mediana Edad , Clasificación del Tumor , Pronóstico , Estudios Retrospectivos , Próstata/patología , Próstata/cirugía , Próstata/diagnóstico por imagen , Procedimientos Quirúrgicos Robotizados/métodosRESUMEN
We investigated the wing vein network topology in fruit flies and observed that the posterior cross vein (PCV) disrupts the symmetry of the entire network. The fluidic engineering function of this vein's disposition remains unexplored although the wing vein network is known to transport blood. We examined the fluid mechanical effects of the PCV's disposition on this blood-transporting network through numerical simulations involving the removal and rearrangement of the vein, avoiding impractical physical manipulation. We characterised the geometry of each wing membrane cell, a portion of the wing membrane surrounded by a group of veins, by determining the ratio of its surface area to the contact area with the veins. We considered this ratio in association with the flow velocities of seeping water from the blood within the veins to the membrane and evaporating water from the membrane, based on the mass conservation law. We observed that the division of a membrane cell by the PCV maximises the ratio of the areas in the divided cell on the wing-tip side by virtually shifting this vein's connections in our geometric membrane model. We derived blood flow rate and pressure loss within the venous network from their geometry, using an analogy of the venous network with a circuit consisting of hydraulic resistors based on Kirchhoff and Ohm's laws. The overall pressure loss in the network decreased by 20% with the presence of the PCV functioning as a paralleled hydraulic resistor. By contrast, any other cross-vein computationally arranged on another membrane cell as the PCV's substitution did not exhibit a larger reduction in the pressure loss. Overall, our numerical analyses, leveraging geometry and a circuit analogy, highlighted the effects of the PCV's presence and position on the blood-transporting vein network.
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Hemodinámica , Venas , Animales , Drosophila , AguaRESUMEN
BACKGROUND: Primary adrenal leiomyosarcoma is a rare and aggressive mesenchymal tumor derived from the smooth muscle wall of a central adrenal vein or its tributaries; therefore, tumors tend to invade the inferior vena cava and cause thrombosis. The great majority of tumors grow rapidly, which makes the disease difficult to diagnose in its early clinical stages and needs differentiation from adrenocortical carcinomas for the selection of chemotherapy including mitotane which causes adrenal insufficiency. CASE PRESENTATION: We presented two patients with adrenal leiomyosarcoma who were referred to our hospital with abdominal pain and harboring large adrenal tumors and inferior vena cava thrombosis. The endocrine findings, including serum catecholamine levels, were unremarkable. These two patients were considered clinically inoperable, and CT-guided core needle biopsy was performed to obtain the definitive histopathological diagnosis and determine the modes of therapy. The masses were subsequently diagnosed as primary adrenal leiomyosarcoma based on the histological features and positive immunoreactivity for SMA (smooth muscle actin), desmin, and vimentin. CONCLUSIONS: Adrenal leiomyosarcoma derived from the smooth muscle wall of a central adrenal vein or its tributaries is rare but should be considered a differential diagnosis in the case of nonfunctioning adrenal tumors extending directly to the inferior vena cava. CT-guided biopsy is considered useful for histopathological diagnosis and clinical management of patients with inoperable advanced adrenal tumors without any hormone excess.
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Neoplasias de la Corteza Suprarrenal , Neoplasias de las Glándulas Suprarrenales , Leiomiosarcoma , Trombosis , Humanos , Leiomiosarcoma/diagnóstico , Leiomiosarcoma/patología , Trombosis/diagnóstico , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Diagnóstico Diferencial , Neoplasias de la Corteza Suprarrenal/diagnósticoRESUMEN
BACKGROUND/AIM: The purpose of this study was to examine the prognostic value of Prostate imaging-reporting and data system (PI-RADS) v2.1 scoring system in patients who underwent radical prostatectomy (RP). PATIENTS AND METHODS: Clinical data of 294 patients who received RP between 2006 and 2018 were reviewed and multiple parameters including PI-RADS v2.1 score were employed to identify predictive factors for biochemical recurrence (BCR). Tumor volume was calculated from prostatectomy specimens. RESULTS: Median age at operation and initial PSA level were 67 years old and 7.68 ng/ml, respectively. 44.9 and 24.8% of patients were diagnosed with PI-RADS score 4 and 5 prior to biopsies, respectively. BCR was observed in 17% of patients and median observation period was 63.43 months. After multivariate analysis, PI-RADS v2.1 score 5 [hazard ratio (HR)=2.24, p=0.0124] was an independent predictive factor of BCR in addition to clinical T stage (≥2c) (HR=2.32, p=0.0093) and biopsy Gleason score (≥8) (HR=2.81, p=0.0007). Furthermore, PI-RADS score 5 significantly stratified the prognosis in D'Amico intermediate- and high-risk groups (p=0.0174 and p=0.0013, respectively). We established novel risk classifications including PI-RADS v2.1 score and found that prognostic capabilities were improved as compared to the D'Amico classification. CONCLUSION: The PI-RADS v2.1 score exhibited significant prognostic value in patients with localized prostate cancer following RP. Risk classifications based on PI-RADS v2.1 score might provide better ability for predicting oncological outcomes as compared to the D'Amico classification system.
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Próstata , Neoplasias de la Próstata , Masculino , Humanos , Anciano , Próstata/diagnóstico por imagen , Próstata/cirugía , Próstata/patología , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/patología , Imagen por Resonancia Magnética , Estudios Retrospectivos , ProstatectomíaRESUMEN
A 67-year-old male patient required surgical management of an abdominal aortic aneurysm. Contrast-enhanced computed tomography showed a saccular infrarenal abdominal aortic aneurysm and occlusion of the origins of the celiac artery, superior mesenteric artery, and inferior mesenteric artery. Aortography revealed large amounts of blood flow from capillaries around the abdominal aorta to the inferior mesenteric artery and retrograde blood flow to a meandering mesenteric artery through the superior rectal artery. Considering the risk of bowel ischemia, we performed endovascular aneurysm repair with mesenteric artery bypass. The operation was successful, and his postoperative course was uneventful. This procedure could be useful and less invasive.
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We present the case of a 78-year-old woman who had unresectable advanced gastric cancer that had invaded the pancreas. Her hemoglobin level dropped to 7.0 g/dL during third-line chemotherapy. An upper gastrointestinal endoscopy showed a clot in the stomach, but the bleeding point could not be identified. She received a blood transfusion, but on the third day, she experienced a hemorrhagic shock. We conducted transcatheter arterial embolization(TAE)and subsequently performed embolization of the right gastroepiploic artery and the descending branch of the left gastric artery with an absorbable gelatin sponge. Following TAE, her hemoglobin level stabilized, and she was discharged from the hospital on the ninth day. We resumed chemotherapy, but she died 6.5 months after TAE due to the progression of gastric cancer. Based on this case, we suggest that TAE may be an effective treatment method for bleeding from unresectable advanced gastric cancer.
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Embolización Terapéutica , Neoplasias Gástricas , Humanos , Femenino , Anciano , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/terapia , Procedimientos Quirúrgicos Vasculares , Hemorragia , HemoglobinasRESUMEN
Renovascular hypertension (RVH) is a common cause of secondary hypertension. However, there have been no reports on RVH due to radiation-induced abdominal aorta stenosis after renal autotransplantation. A 27-year-old woman with a history of neuroblastoma treated by radiation therapy and RVH treated with renal autotransplantation presented with hypertension and dyspnea. At age 19, she had experienced hypertensive heart failure due to RVH from radiation-induced left renal artery stenosis and had undergone renal autotransplantation involving the extraction of her left kidney. Her systolic blood pressure (BP) was well-controlled but had increased progressively. She was diagnosed with hypertensive heart failure and admitted to hospital. Although her dyspnea soon subsided after treatment, her BP remained high. Renal artery ultrasound revealed no obvious stenosis. The ankle brachial pressure index (ABI) showed a significant bilateral decrease to 0.71/0.71 (right/left) from 0.94/0.95 eight years before. Magnetic resonance angiography and aortic angiography revealed severe stenosis in the abdominal aorta, and the systolic pressure gradient of intra-aortic blood flow, distal and proximal to a stenotic lesion, was 58 mmHg. These arterial stenoses in the irradiated area were highly suggestive of radiation-induced vasculopathy. She finally underwent an endovascular VIABAHN VBX balloon-expandable stent-graft placement for this radiation-induced abdominal aorta stenosis, which resolved the pressure gradient. After the procedure, her ABI improved to 0.91/0.88 and her BP was well-controlled. This is the first case of successful stent-graft placement for RVH after renal autotransplantation due to radiation-induced abdominal aorta stenosis as a consequence of neuroblastoma.
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Estenosis de la Válvula Aórtica , Hipertensión Renovascular , Hipertensión , Neuroblastoma , Humanos , Femenino , Adulto Joven , Adulto , Constricción Patológica/etiología , Constricción Patológica/cirugía , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Hipertensión Renovascular/diagnóstico , Hipertensión Renovascular/etiología , Hipertensión Renovascular/cirugía , Hipertensión/complicaciones , Stents/efectos adversos , Estenosis de la Válvula Aórtica/complicaciones , Neuroblastoma/complicaciones , Neuroblastoma/radioterapia , Resultado del TratamientoRESUMEN
Purpose: Postembolization syndrome (PES) after renal arterial embolization (RAE) can reduce the patient's tolerance of the procedure and extend the length of hospital stay. We aimed to assess the efficacy of steroid administration in preventing PES in patients undergoing RAE for angiomyolipoma (AML). Material and Methods: Between May 2004 and March 2020, 29 RAE procedures in 26 patients with AML were performed. Patient information, including age, sex, tumor size, tuberous sclerosis complex-associated/sporadic AML, hemorrhagic/nonhemorrhagic AML, embolic material, steroid use, medication type, some blood laboratory parameters, hospital stay, and PES occurrence were retrospectively obtained. The prophylactic steroid protocol used in the study was as follows: 250 mg of intravenous methylprednisolone (Solu-Medrol) 2 h before the RAE procedure, followed by 2 days of intravenous prednisolone (Predonine; 2 mg/kg/day), which was tapered by halving the dose every 2 days within the course of 2 weeks. After the discharge, intravenous prednisolone was changed to oral prednisolone (Predonine). PES was defined as the presence of fever, pain, nausea, or vomiting. Data were compared between the steroid and non-steroid groups and between PES and non-PES groups. Results: The PES incidence rate was 76%, and a comparison between the steroid and non-steroid groups revealed that steroid use significantly decreased the incidence of PES (P < 0.001), including fever (P < 0.001), pain (P = 0.005), and nausea (P = 0.028). The use of anti-inflammatory drugs during the hospital stay was significantly lower in the steroid group (P = 0.019). Moreover, in the steroid group, C-reactive protein level was significantly lower (P = 0.006), whereas white blood cell count was significantly higher (P = 0.004). Conversely, the median length of hospital stay was not significantly shorter in the steroid group (P = 0.292). Conclusions: The prophylactic use of steroids before and after embolization of renal AML may be effective in preventing PES in this small retrospective study.
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PURPOSE: This study aimed to predict the ability to insert a 4-5 French (Fr) catheter insertion with a guidewire into the common hepatic artery (CHA) based on celiac trunk morphology. METHODS: This retrospective study included 64 patients who underwent balloon-occluded transcatheter arterial chemoembolization (n = 56), transcatheter arterial chemotherapy (n = 2), or were fitted with an implantable port system (n = 6) between June 2019 and December 2019 in our institution. The morphology of the celiac trunk was classified into three types (upward, horizontal, and downward) based on celiac angiography. The aortic-celiac trunk angle was measured on sagittal images of preprocedural contrast-enhanced computed tomography (CT). We reviewed whether a 4-5-Fr shepherd's hook catheter could advance beyond the CHA using a 0.035-inch guidewire (Radifocus® Guidewire M; Terumo). Three patients were diagnosed with median arcuate ligament syndrome (MALS) based on the characteristic hook shape of the celiac artery on sagittal images of contrast-enhanced CT. The predictive ability of celiac angiography and preprocedural CT for CHA insertion success was evaluated. In unsuccessful cases, the balloon anchor technique (BAT) was attempted as follows: (1) a 2.7/2.8-Fr microballoon catheter (Attendant Delta; Terumo) was placed beyond the proper hepatic artery, and (2) the balloon was inflated as an anchor for parent catheter advancement. RESULTS: Upward, horizontal, and downward celiac trunk types were noted in 42, 9, and 13 patients, respectively. The median CT angle was 122.83° (first quartile-third quartile, 102.88°-136.55°). Insertion in the CHA using the guidewire was successful in 56 of 64 patients (87.50%), and the success rate in the downward type was significantly lower than that in the upward type [42/42 (100%) vs. 7/13 (53.85%), P < 0.001]. The CT angle was significantly larger downward in the unsuccessful group than in the successful group (121.03° vs. 140.70°, P = 0.043). Celiac angiography had a significantly higher area under the curve (AUC) than preprocedural CT (AUC = 0.91 vs. AUC = 0.72, P = 0.040). All three cases of MALS showed unsuccessful CHA insertion. In all eight patients with unsuccessful insertion, the catheter could be advanced using the BAT [8/8 (100%)]. CONCLUSION: Celiac angiography and preprocedural CT could predict CHA catheter insertion using a guidewire, and celiac angiography had high predictability. CT could detect MALS, a risk factor for unsuccessful CHA insertion.
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Carcinoma Hepatocelular , Quimioembolización Terapéutica , Neoplasias Hepáticas , Síndrome del Ligamento Arcuato Medio , Humanos , Carcinoma Hepatocelular/terapia , Catéteres , Arteria Celíaca/diagnóstico por imagen , Arteria Hepática/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Estudios RetrospectivosRESUMEN
PURPOSE: There have been several reports of central nervous system impairments associated with severe coronavirus disease 2019 (COVID-19) infection on head magnetic resonance imaging and angiography (MRI/A). However, head MRI/A is rarely performed in mild cases, and there have been few reports on intracranial changes after COVID-19 infection in these cases. Here, we report a comparative examination of the findings seen in common head MRI/A sequences in mild cases of COVID-19. METHODS: Of the 15,376 patients who underwent head MRI/A examination called "Brain Dock" between June 2020 and June 2021, 746 patients who received a COVID-19 antibody test were evaluated. Positive and negative patients were comparatively examined for head MRI/A findings such as cerebral white matter lesions, ischemic changes, cerebral microbleeds, cerebral aneurysms, arterial stenosis, sinusitis, and other abnormal findings. RESULTS: Overall, 31 (4.2%) patients were COVID-19 positive, and all of them had mild infections not requiring hospitalization. There was no significant difference in patient characteristics and head MRI/A findings between positive and negative patients. All positive patients showed no particular abnormalities in the nasal findings such as olfactory bulb atrophy or thickening of the olfactory mucosa. CONCLUSION: Intracranial lesions in mild patients do not show a clear difference from those in negative patients. This indicates that findings seen in common MRI/A sequences of severe patients are not likely in mild patients, supporting that there is relatively no damage to the central nervous system in mild patients.
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A 46-year-old man visited our hospital complaining of dysphagia. He was diagnosed with unresectable esophageal cancer with multiple lung metastases(cStage â £b)and gastric cancer(L, Gre, T3N+M0, cStage â ¢). The esophageal lesion and the lung metastatic lesions showed shrinkage initially with 5-FU, CDDP(FP)therapy but then re-grew; therefore, the therapy was changed to nivolumab therapy. After three courses of nivolumab therapy, the patient visited our hospital with a high fever. He was admitted as an emergency patient with a diagnosis of esophageal perforation and mediastinal abscess. CT- guided drainage was performed, and a self-expanding metal stent(SEMS)was placed. He was discharged on the 31st day of hospitalization and nivolumab therapy was resumed. We report the first case of esophageal perforation during immunotherapy with nivolumab therapy for esophageal cancer.
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Neoplasias Esofágicas , Perforación del Esófago , Masculino , Humanos , Persona de Mediana Edad , Nivolumab/efectos adversos , Perforación del Esófago/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Esofágicas/patología , Fluorouracilo/uso terapéuticoRESUMEN
Incorporating hetero-metal-atom, e.g., titanium, into zeolite frameworks can enhance the catalytic activity and selectivity in oxidation reactions. However, the rational design of zeolites containing titanium at specific sites is difficult because the precise atomic structure during synthesis process remained unclear. Here, a titanosilicate with predictable titanium distribution was synthesized by mediating vacancies in a defective MSE-type zeolite precursor, based on a pre-designed synthetic route including modification of vacancies followed by titanium insertion, where electron microscopy (EM) plays a key role at each step resolving the atomic structure. Point defects including vacancies in the precursor and titanium incorporated into the vacancy-related positions have been directly observed. The results provide insights into the role of point defects in zeolites towards the rational synthesis of zeolites with desired microscopic arrangement of catalytically active sites.
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A 67-year-old male patient required surgical management of an abdominal aortic aneurysm. A contrast-enhanced computed tomography showed a saccular infrarenal abdominal aortic aneurysm, with occlusion of the origins of the celiac artery, superior mesenteric artery, and inferior mesenteric artery. An aortography revealed large amounts of blood flow from capillaries around the abdominal aorta to the inferior mesenteric artery and retrograde blood flow to the meandering mesenteric artery through the superior rectal artery. Considering the risk of bowel ischemia, we performed endovascular aneurysm repair with mesenteric artery bypass. The operation was successful, and the postoperative course was uneventful. This procedure may be useful and less invasive.
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An 85 year-old woman was transferred with a chief complaint of right thigh pain persisting for 5 days. Abdominal contrast-enhanced computed tomography clearly depicted a swollen appendix incarcerated in the right obturator cavity. She underwent an emergent laparoscopic appendectomy and the simultaneous repair of the obturator hernia. At laparoscopy, appendix was found to be incarcerated in the right obturator canal. The incarcerated appendix was successfully flushed out from the sac by spurting saline into the obturator hernia sac through the catheter inserted into the hernia sac. After a laparoscopic appendectomy, the hernia orifice was repaired using the uterine flap. The patient was discharged from the hospital without any sequelae. This report demonstrates a very rare case of obturator hernia incarcerated with appendix. Although patients with obturator hernia incarcerated with small intestine present with the symptoms related to bowel obstruction, patients with incarceration of appendix do not. Moreover, they would show no typical abdominal symptoms associated with acute appendicitis. Therefore, it is important to perform a radiological evaluation promptly to make a definitive diagnosis when a patient with persisting pain of the right thigh or right ileac fossa with a possibility of obturator hernia with incarceration of the appendix is encountered.
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Apendicitis , Hernia Obturadora , Obstrucción Intestinal , Enfermedad Aguda , Anciano de 80 o más Años , Apendicectomía , Apendicitis/complicaciones , Apendicitis/diagnóstico por imagen , Apendicitis/cirugía , Femenino , Hernia Obturadora/complicaciones , Hernia Obturadora/diagnóstico por imagen , Hernia Obturadora/cirugía , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , DolorRESUMEN
Genetic modification to restore cell functions in the brain can be performed through the delivery of biomolecules in a minimally invasive manner into live neuronal cells within brain tissues. However, conventional nanoscale needles are too short (lengths of ~10 µm) to target neuronal cells in ~1-mm-thick brain tissues because the neuronal cells are located deep within the tissue. Here, we report the use of nanoscale-tipped wire (NTW) arrays with diameters < 100 nm and wire lengths of ~200 µm to address biomolecule delivery issues. The NTW arrays were manufactured by growth of silicon microwire arrays and nanotip formation. This technique uses pinpoint, multiple-cell DNA injections in deep areas of brain tissues, enabling target cells to be marked by fluorescent protein (FP) expression vectors. This technique has potential for use for electrophysiological recordings and biological transfection into neuronal cells. Herein, simply pressing an NTW array delivers and expresses plasmid DNA in multiple-cultured cells and multiple-neuronal cells within a brain slice with reduced cell damage. Additionally, DNA transfection is demonstrated using brain cells ex vivo and in vivo. Moreover, knockdown of a critical clock gene after injecting a short hairpin RNA (shRNA) and a genome-editing vector demonstrates the potential to genetically alter the function of living brain cells, for example, pacemaker cells of the mammalian circadian rhythms. Overall, our NTW array injection technique enables genetic and functional modification of living cells in deep brain tissue areas, both ex vivo and in vivo.
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Encéfalo , ADN , Animales , Encéfalo/metabolismo , Mamíferos/genética , Neuronas , ARN Interferente Pequeño/genética , TransfecciónAsunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Embolización Terapéutica , Enbucrilato , Procedimientos Endovasculares , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Enbucrilato/uso terapéutico , Endofuga/diagnóstico por imagen , Endofuga/etiología , Endofuga/terapia , Humanos , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos VascularesRESUMEN
A 61-year-old man presented with retroperitoneal hemorrhage caused by an aneurysm rupture of the pancreaticoduodenal arcade (PDA), and acute celiac artery dissection distal to celiac axis stenosis. Owing to the gradual growth of the false lumen, we planned to deploy a stent to the celiac artery dissection and embolize the PDA aneurysm. Prior to stent placement, we assessed the acute celiac artery dissection distal to the stenosis using four-dimensional computed tomography (CT) angiography through expiration/inspiration/expiration cycle. We diagnosed median arcuate ligament syndrome considering that the celiac axis showed a hooked narrowing at end-expiration, and the compression decreased at end-inspiration. Additionally, the true lumen distal to the stretched axis dilated in the inspiration phase. Therefore, we could advance a catheter into the true lumen during inspiration and successfully deploy a stent. Subsequently, laparoscopic median arcuate ligament release was performed after the stent deployment. A postoperative CT scan showed good patency in the stent, with disappearance of the blood filling the false lumen and with reduced celiac axis stenosis.
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Aneurisma Roto , Embolización Terapéutica , Síndrome del Ligamento Arcuato Medio , Aneurisma Roto/terapia , Angiografía , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/cirugía , Angiografía por Tomografía Computarizada , Disección , Hemorragia , Humanos , Masculino , Síndrome del Ligamento Arcuato Medio/diagnóstico por imagen , Persona de Mediana Edad , Páncreas , Stents , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We used computational modeling, based on Density Functional Theory, to help understand the preference for the formation of silanol nests and the substitution of Si by Ti or Al in different crystallographic positions of the MSE-type framework. All these processes were found to be energetically favorable by more than 100 kJ/mol. We suggested an approach for experimental identification of the T atom position in Ti-MCM-68 zeolite via simulation of infrared spectra of pyridine and acetonitrile adsorption at Ti. The modeling of adsorption of hydrogen peroxide at Ti center in the framework has shown that the molecular adsorption was preferred over the dissociative adsorption by 20 to 40 kJ/mol in the presence or absence of neighboring T-atom vacancy, respectively.