Endovascular removal of a permanent "TrapEase" inferior vena cava filter.

Inferior vena cava (IVC) filter placement has seen a rising trend over the past decade. Although effective in the prevention of future pulmonary emboli, filters are associated with several long-term complications including deep venous thrombosis, filter migration, filter fracture, and caval thrombosis. The IVC filters have evolved over the years to minimize these unwarranted sequelae. We describe a technique to remove a permanent IVC filter in a patient who no longer required mechanical protection.

Posterior reversible encephalopathy syndrome during posterior fossa tumor resection in a child.

Posterior reversible encephalopathy syndrome (PRES) has been described in the setting of malignant hypertension, renal disease, eclampsia, and immunosuppression. In addition, a single case of intraoperative (posterior fossa craniotomy) PRES has been reported; however, this case occurred in an adult. The authors present a clinically and radiographically documented case of intraoperative PRES complicating the resection of a posterior fossa tumor in a 6-year-old child. During tumor resection, untoward force was used to circumferentially dissect the tumor, and excessive manipulation of the brainstem led to severe hypertension for a 10-minute period. An immediate postoperative MR image was obtained to rule out residual tumor, but instead the image showed findings consistent with PRES. Moreover, the patient's postoperative clinical findings were consistent with PRES. Aggressive postoperative management of blood pressure and the institution of anticonvulsant therapy were undertaken. The patient made a good recovery; however, he required a temporary tracheostomy and tube feedings for prolonged lower cranial nerve dysfunction. Posterior reversible encephalopathy syndrome can occur as a result of severe hypertension during surgery, even among young children. With prompt treatment, the patient in the featured case experienced significant clinical and radiographic recovery.

A new optical and nuclear dual-labeled imaging agent targeting interleukin 11 receptor alpha-chain.

Optical imaging has great potential for studying molecular recognitions both in vivo and in vitro, yet nuclear imaging is the most effective clinical molecular imaging modality. The combination of optical and nuclear imaging modalities may provide complementary information for improving diagnosis and management of diseases. In this study we developed an optical and nuclear dual-labeled imaging agent, 111In-DTPA-Bz-NH-SA-K(IR-783-S-Ph-CO)-c(CGRRAGGSC)NH2, called DLIA-IL11Ralpha. 111In-DTPA-Bz-NH-SA is the radiotracer moiety; a near-infrared dye IR-783-S-Ph-COOH serves as the fluorescent emitter; and the cyclic peptide c(CGRRAGGSC), which is known to target interleukin 11 receptor alpha-chain (IL-11Ralpha), delivers the desired imaging agent to its target. Experiments revealed that the cyclic peptide c(CGRRAGGSC) continued to possess the targeting capability to IL-11Ralpha after the conjugation of the optical and nuclear tracers. Furthermore, the presence of the metal isotope chelator did not cause quenching of fluorescence emission. The cross validation and direct comparison of optical and nuclear imaging of a tumor was achieved using a single injection, and the preliminary results show the conjugate has tumor targeting capabilities in vivo.

Delayed deformation of self-expanding stents after carotid artery stenting for postendarterectomy restenoses.

Carotid artery stenting has become an acceptable alternative for treating patients with severe atherosclerotic lesions, particularly those with significant surgical risks, such as recurrent stenosis after endarterectomy. Stent deformation, a phenomenon primarily associated with balloon-expandable stents, is largely avoided by exclusively using self-expanding stents in treating carotid artery stenosis. Nonetheless, we herein report two patients who presented with delayed Wallstent deformation after carotid artery stenting for postendarterectomy restenosis. Our cases highlight the need for caution because delayed deformation of self-expanding stents can occur, particularly during treatment of patients with postendarterectomy stenosis. Furthermore, poststent surveillance is imperative in identifying patients with severe restenosis after carotid artery stenting who need reintervention.

Senseless physically interacts with proneural proteins and functions as a transcriptional co-activator.

The zinc-finger transcription factor Senseless is co-expressed with basic helix-loop-helix (bHLH) proneural proteins in Drosophila sensory organ precursors and is required for their normal development. High levels of Senseless synergize with bHLH proteins and upregulate target gene expression, whereas low levels of Senseless act as a repressor in vivo. However, the molecular mechanism for this dual role is unknown. Here, we show that Senseless binds bHLH proneural proteins via its core zinc fingers and is recruited by proneural proteins to their target enhancers to function as a co-activator. Some point mutations in the Senseless zinc-finger region abolish its DNA-binding ability but partially spare the ability of Senseless to synergize with proneural proteins and to induce sensory organ formation in vivo. Therefore, we propose that the structural basis for the switch between the repressor and co-activator functions of Senseless is the ability of its core zinc fingers to interact physically with both DNA and bHLH proneural proteins. As Senseless zinc fingers are approximately 90% identical to the corresponding zinc fingers of its vertebrate homologue Gfi1, which is thought to cooperate with bHLH proteins in several contexts, the Senseless/bHLH interaction might be evolutionarily conserved.