Sentinel Angiographic Signs of Cerebral Hyperperfusion after Angioplasty and Stenting of Intracranial Atherosclerotic Stenosis: A Technical Note.

Cerebral hyperperfusion syndrome is a serious complication of endovascular angioplasty and stent placement for long-standing intracranial stenosis, resulting in neurologic dysfunction, seizure, or reperfusion hemorrhage. Rigorous control of blood pressure is commonly used in the perioperative period to prevent cerebral hyperperfusion syndrome, but the optimal blood pressure is often arbitrary. We describe the angiographic features that reflect impaired cerebral autoregulation and microvascular transit abnormality, which may be used to gauge the optimal blood pressure parameters in the immediate postintervention period for prevention of cerebral hyperperfusion syndrome.

Periodontal regeneration: a challenge for the tissue engineer?

Periodontitis affects around 15 per cent of human adult populations. While periodontal treatment aimed at removing the bacterial cause of the disease is generally very successful, the ability predictably to regenerate the damaged tissues remains a major unmet objective for new treatment strategies. Existing treatments include the use of space-maintaining barrier membranes (guided tissue regeneration), use of graft materials, and application of bioactive molecules to induce regeneration, but their overall effects are relatively modest and restricted in application. The periodontal ligament is rich in mesenchymal stem cells, and the understanding of the signalling molecules that may regulate their differentation has increased enormously in recent years. Applying these principles for the development of new tissue engineering strategies for periodontal regeneration will require further work to determine the efficacy of current experimental preclinical treatments, including pharmacological application of growth factors such as bone morphogenetic proteins (BMPs) or Wnts, use of autologous stem cell reimplantation strategies, and development of improved biomaterial scaffolds. This article describes the background to this problem, addresses the current status of periodontal regeneration, including the background biology, and discusses the potential for some of these experimental therapies to achieve the goal of clinically predictable periodontal regeneration.

Infant Feeding Practices in a High HIV Prevalence Rural District of KwaZulu-Natal; South Africa

Aim: To describe infant feeding practices at birth and at 14 weeks post-partum in the Ugu-North Health District; KwaZulu-Natal; South Africa. Methods: A prospective; cohort study design was used. Mothers who delivered over a one-month period were interviewed at birth and 14 weeks later. Results: Initially; 168 mothers were interviewed within 24 hours of delivery; of whom 117 (70) were contactable at 14 weeks post-partum. The vast majority (96) initiated breast-feeding at birth. At birth; less than one-third (55/168 [32.7]) of mothers declared an intention to both breast and formula (mix) feed in the next 14 weeks; but by the 14th week post-partum over three-quarters (89/117 [76.1]) actually practised mixed feeding. At 14 weeks; the prevalence of exclusive breast-feeding was 18: 52of infants were offered water and 73solids. The majority (20/23 [87]) of HIV infected mothers chose to breastfeed their infants at birth. Nevertheless; they were significantly more likely to formula feed their infants compared to HIV negative mothers (3/23 [13.0] vs 2/145 [1.4]; OR 10.73; 95CI 1.34 - 99.16; p = 0.02). By 14 weeks; only 11of HIV positive mothers were still exclusively breast-feeding; while almost two-thirds (12/19 [63]) practised mixed feeding. This change was mainly ascribed to their need to return to school (40) or to work (20). Conclusions: Most infants were fed inappropriately by 14 weeks of age. The failure to maintain exclusive breast-feeding; despite high initiation rates; is of greatest concern. Routine prevention of mother-to-child transmission of HIV services was ineffective in influencing mothers to follow any feeding regimen exclusively