Association between Infarct Location and Hemorrhagic Transformation of Acute Ischemic Stroke following Successful Recanalization after Mechanical Thrombectomy.

BACKGROUND AND PURPOSE: The association between infarct location and hemorrhagic transformation of acute ischemic stroke after mechanical thrombectomy is not understood. We aimed to evaluate the association between CTP-based ischemic core variables at admission and hemorrhagic transformation after a successful thrombectomy. MATERIALS AND METHODS: We retrospectively analyzed patients who underwent endovascular thrombectomy for acute anterior circulation large-vessel occlusion between October 2019 and June 2021. We enrolled 146 patients with visible ischemic core on pretreatment CTP who had successful reperfusion. The ischemic core infarct territories were classified into the cortical and subcortical areas and then qualitatively and quantitatively analyzed by CTP. Logistic regression and receiver operating characteristic curve analyses were performed to determine the association between ischemic core variables and hemorrhagic transformation. RESULTS: Of the 146 patients analyzed, 72 (49.3%) had hemorrhagic transformation and 23 (15.8%) had symptomatic intracerebral hemorrhage. Multivariate analysis showed that subcortical infarcts were independently associated with hemorrhagic transformation (OR, 8.06; 95% CI, 2.31-28.10; P = .001) and subcortical infarct volume was independently linked to symptomatic intracerebral hemorrhage (OR, 1.05; 95% CI, 1.01-1.09; P = .039). The receiver operating characteristic curve indicated that subcortical infarcts can predict hemorrhagic transformation accurately (area under the curve = 0.755; 95% CI, 0.68-0.82; P < .001) and subcortical infarct volume can predict symptomatic intracerebral hemorrhage (area under the curve = 0.694; 95% CI, 0.61-0.77; P = .002). CONCLUSIONS: Subcortical infarcts seen on CTP at admission are associated with hemorrhagic transformation in patients after successful thrombectomy, and subcortical infarct volume may influence the risk of symptomatic intracerebral hemorrhage.

Risk factors contributing to early and late recurrence of haemoptysis after bronchial artery embolisation.

OBJECTIVE: To identify the risk factors for early and late relapse of haemoptysis after bronchial artery embolisation (BAE). DESIGN: We performed a retrospective study of 255 patients with haemoptysis who underwent BAE from January 2009 to June 2016 at the First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Using a Cox regression model, risk factors contributing to early (within the first month) and late (>1 month) recurrence were analysed. We censored recurrence-free patients at 1 month and patients without rebleeding after 1 month. RESULTS: The cumulative recurrence rate at 1, 6, 12, 24 and 48 months was respectively 14.9%, 16.9%, 20.6%, 31.0% and 39.9%, with a median follow-up of 574 days. Early relapse occurred in 38 of 255 patients, while late recurrence was found in 45 of the remaining 217 patients. The risk factors related to early recurrence were lung destruction on computed tomography of the chest and involvement of non-bronchial systemic arteries. The risk factors associated with late recurrence were tuberculosis sequelae, the presence of shunts and the use of gelfoam as an embolisation material. CONCLUSIONS: The variables related to incomplete embolisation were the risk factors for early rebleeding. The variables associated with same-vessel recanalisation and formation of a new collateral circulation influenced late recurrence.

Molecular Cloning and Characterization of Ribosomal Protein RPS9 in Echinococcus granulosus.

Ribosomal protein S9 (RPS9) is an essential functional gene that participates in DNA repair and developmental regulations. A sequence homolog of RPS9 has been found to be upregulated in the protoscoleces (PSCs) of Echinococcus granulosus treated with artemisinin. However, E. granulosus RPS9 (EgRPS9) has not been identified before. In the present study, the 657-base pair (bp) cDNA encoding EgRPS9 was cloned. Amino acid sequence analysis showed that EgRPS9 was similar to the RSP9 proteins from Schistosoma japonicum (SjRPS9, 86%) and Schistosoma mansoni (SmRPS9, 79%). Phylogenetic tree analysis showed that EgRPS9, SmRPS9, and SjRPS9 were clustered together. We detected the EgRPS9 gene and protein expression in PSCs exposed to artesunate (AS) which displayed a dose-dependent reduction in PSC viability for 24 hr. The results showed that the EgRPS9 ratio of the 10-µM AS-treated ( P < 0.01) and 40-µM AS-treated ( P < 0.05) groups were increased from that of the control group. In addition, the level of reactive oxygen species (ROS) in the AS-treated groups increased in a dose-dependent manner compared to the level in the control group. In conclusion, the expression of EgRPS9 could be induced by ROS and might participate in the oxidative damage-based anti-parasite mechanism of AS treatment.

Embolisation for life-threatening haemoptysis complicated by systemic artery-pulmonary circulation shunts.

SETTING: Tertiary referral centre. OBJECTIVE: To retrospectively observe the characteristics of bronchial angiograms in the setting of systemic artery-pulmonary circulation shunts (SPS), and to evaluate the safety and effectiveness of bronchial artery embolisation (BAE) for these patients with life-threatening haemoptysis. DESIGN: The records of life-threatening haemoptysis patients with SPS who presented to a tertiary referral centre from January 2009 to March 2014 were reviewed. RESULTS: SPS consisted of bronchial artery-pulmonary artery shunt (AAS) in 30 cases, bronchial artery-pulmonary vein shunt (AVS) in 4 cases, non-bronchial systemic artery-pulmonary circulation shunt (n-BPS) in 7 cases and more than one type of SPS in 4 cases (AAS and AVS in 3 cases, three types of SPS in 1 case). BAE using polyvinyl alcohol (PVA) was successful in 97.8% (44/45) of the patients. Cumulative rates of freedom from recurrence at 1 month, 1 year and 2 years were respectively 97.8%, 93.2% and 85.4%. No major procedure-related complications occurred. No significant differences were found in recurrence rates or cumulative haemoptysis control rates among patients with different types of SPS complications (P = 0.55 and 0.46, respectively). CONCLUSION: BAE with PVA was safe and effective for life-threatening haemoptysis complicated by SPS.

Use of hyperbaric oxygen on flaps and grafts in China: analysis of studies in the past 20 years.

In China, hyperbaric oxygen (HBO2) has been widely applied in the treatment of ischemia/hypoxia related diseases including decompression sickness, carbon monoxide poisoning, diabetic foot ulcer and others. Wounds after skin grafts are an indication for HBO2 therapy in the Chinese Guideline for Hyperbaric Oxygen Therapy. In this study, we retrospectively reviewed the available studies on the application of HBO2 in the management of skin flaps. The mechanisms underlying the therapeutic effects of HBO2 were summarized, and therapeutic aspects in the HBO2 therapy of skin flaps in China were also described. Finally, some important issues influencing the therapeutic efficacy and further systemic reviews are proposed. Our findings may help to improve the quality of future studies in this field and to more rationally apply HBO2 therapy in patients receiving skin grafting procedures.

PRAP1 is a novel executor of p53-dependent mechanisms in cell survival after DNA damage.

p53 has a crucial role in governing cellular mechanisms in response to a broad range of genotoxic stresses. During DNA damage, p53 can either promote cell survival by activating senescence or cell-cycle arrest and DNA repair to maintain genomic integrity for cell survival or direct cells to undergo apoptosis to eliminate extensively damaged cells. The ability of p53 to execute these two opposing cell fates depends on distinct signaling pathways downstream of p53. In this study, we showed that under DNA damage conditions induced by chemotherapeutic drugs, gamma irradiation and hydrogen peroxide, p53 upregulates a novel protein, proline-rich acidic protein 1 (PRAP1). We identified functional p53-response elements within intron 1 of PRAP1 gene and showed that these regions interact directly with p53 using ChIP assays, indicating that PRAP1 is a novel p53 target gene. The induction of PRAP1 expression by p53 may promote resistance of cancer cells to chemotherapeutic drugs such as 5-fluorouracil (5-FU), as knockdown of PRAP1 increases apoptosis in cancer cells after 5-FU treatment. PRAP1 appears to protect cells from apoptosis by inducing cell-cycle arrest, suggesting that the induction of PRAP1 expression by p53 in response to DNA-damaging agents contributes to cancer cell survival. Our findings provide a greater insight into the mechanisms underlying the pro-survival role of p53 in response to cytotoxic treatments.