Standardized approach to direct first pass aspiration technique for endovascular thrombectomy: Description and initial experience with CANADAPT.

BACKGROUND: Endovascular thrombectomy (EVT) is standard of care for acute ischemic stroke. Stent assisted EVT with aspiration (SOLUMBRA) technique has remained a mainstay approach. There is growing evidence that A Direct Aspiration First Pass Technique (ADAPT) is a safe, efficient and effective approach for EVT, offering several advantages. This study describes and reports initial institutional experience in the use of a standardized scientific based aspiration only technique: CANADAPT. METHODS: Single center prospective cohort study was performed on consecutive patients treated for large/medium vessel ischemic stroke with CANADAPT. Intravenous thrombolytics were administered according to routine practice, independent of the decision to proceed with EVT. A sequential stepwise aspiration only technique was then applied, CANADAPT, consisting of three maneuvers, A, B and C. The reperfusion success rate, number of passes, use of rescue technique, complication rate and procedural cost were determined. RESULTS: Twenty-two patients were included in this case series representing M1 (17, 77%), M1/2 (2, 9%), carotid-T (2, 9%) and basilar (1, 5%) occlusions. First pass recanalization was achieved in 11 (50%) of patients. A further four patients had successful reperfusion with a second pass of CANADAPT (total 68% success rate). Only one patient had successful reperfusion with the aspiration catheter at the clot interface (CANADAPT A). All others required some withdrawal of the aspiration catheter for reperfusion (CANADAPT B and C). Seven patients had SOLUMBRA rescue. Of these, five patients (22% of total patients) had further successful reperfusion. Overall median procedural time was 23 min for first recanalization and 30 min for final recanalization. The cost per procedure was $6630 ± 1069 for CANADAPT, and $13,530 ± 2706 for SOLUMBRA techniques. CONCLUSIONS: CANADAPT represents a standardized scientific-based approach to aspiration only thrombectomy intervention. This initial study demonstrates the safety, efficiency and efficacy of this technique for use in EVT.

Natural and unnatural oil slicks in the Gulf of Mexico.

When wind speeds are 2-10 m s-1, reflective contrasts in the ocean surface make oil slicks visible to synthetic aperture radar (SAR) under all sky conditions. Neural network analysis of satellite SAR images quantified the magnitude and distribution of surface oil in the Gulf of Mexico from persistent, natural seeps and from the Deepwater Horizon (DWH) discharge. This analysis identified 914 natural oil seep zones across the entire Gulf of Mexico in pre-2010 data. Their ∼0.1 µm slicks covered an aggregated average of 775 km2. Assuming an average volume of 77.5 m3 over an 8-24 h lifespan per oil slick, the floating oil indicates a surface flux of 2.5-9.4 × 104 m3 yr-1. Oil from natural slicks was regionally concentrated: 68%, 25%, 7%, and <1% of the total was observed in the NW, SW, NE, and SE Gulf, respectively. This reflects differences in basin history and hydrocarbon generation. SAR images from 2010 showed that the 87 day DWH discharge produced a surface-oil footprint fundamentally different from background seepage, with an average ocean area of 11,200 km2 (SD 5028) and a volume of 22,600 m3 (SD 5411). Peak magnitudes of oil were detected during equivalent, ∼14 day intervals around 23 May and 18 June, when wind speeds remained <5 m s-1. Over this interval, aggregated volume of floating oil decreased by 21%; area covered increased by 49% (p < 0.1), potentially altering its ecological impact. The most likely causes were increased applications of dispersant and surface burning operations.

Early detection of cerebral glucose uptake changes in the 5XFAD mouse.

Brain glucose hypometabolism has been observed in Alzheimer's disease (AD) patients, and is detected with (18)F radiolabelled glucose, using positron emission tomography. A pathological hallmark of AD is deposition of brain ß- amyloid plaques that may influence cerebral glucose metabolism. The five times familial AD (5XFAD) mouse is a model of brain amyloidosis exhibiting AD-like phenotypes. This study examines brain ß-amyloid plaque deposition and (18)FDG uptake, to search for an early biomarker distinguishing 5XFAD from wild-type mice. Thus, brain (18)FDG uptake and plaque deposition was studied in these mice at age 2, 5 and 13 months. The 5XFAD mice demonstrated significantly reduced brain (18)FDG uptake at 13 months relative to wild-type controls but not in younger mice, despite substantial ß- amyloid plaque deposition. However, by comparing the ratio of uptake values for glucose in different regions in the same brain, 5XFAD mice could be distinguished from controls at age 2 months. This method of measuring altered glucose metabolism may represent an early biomarker for the progression of amyloid deposition in the brain. We conclude that brain (18)FDG uptake can be a sensitive biomarker for early detection of abnormal metabolism in the 5XFAD mouse when alternative relative uptake values are utilized.

Asphalt volcanism and chemosynthetic life in the Campeche Knolls, Gulf of Mexico.

In the Campeche Knolls, in the southern Gulf of Mexico, lava-like flows of solidified asphalt cover more than 1 square kilometer of the rim of a dissected salt dome at a depth of 3000 meters below sea level. Chemosynthetic tubeworms and bivalves colonize the sea floor near the asphalt, which chilled and contracted after discharge. The site also includes oil seeps, gas hydrate deposits, locally anoxic sediments, and slabs of authigenic carbonate. Asphalt volcanism creates a habitat for chemosynthetic life that may be widespread at great depth in the Gulf of Mexico.

Methane ice worms: Hesiocaeca methanicola colonizing fossil fuel reserves.

During a research cruise in July 1997 in the Gulf of Mexico we discovered a gas hydrate approximately 1 m thick and over 2 m in diameter which had recently breached the sea floor at a depth of 540 m. The hydrate surface visible from the submarine was considerably greater than that of any other reported hydrate. Two distinct color bands of hydrate were present in the same mound, and the entire exposed surface of the hydrate was infested (2500 individuals/m2) with 2 to 4 cm-long worms, since described as a new species, Hesiocaeca methanicola, in the polychaete family Hesionidae (Desbruyères and Toulmond 1998). H. methanicola tissue stable isotope values are consistent with a chemo-autotrophic food source. No evidence of chemo-autotrophic symbionts was detected, but geochemical data support the presence of abundant free living bacteria on the hydrate. The activities of the polychaetes, grazing on the hydrate bacteria and supplying oxygen to their habitats, appears to contribute to the dissolution of hydrates in surface sediments.

Chemosynthetic mussels at a brine-filled pockmark in the northern gulf of Mexico.

A large (540 square meters) bed of Bathymodiolus n. sp. (Mytilidae: Bivalvia) rings a pool of hypersaline (121.35 practical salinity units) brine at a water depth of 650 meters on the continental slope south of Louisiana. The anoxic brine (dissolved oxygen

New light on the cholodny-went theory.

The existence of different auxin sensitivities in epidermal and subepidermal tissues (KV Thimann, CL Schneider 1938 Plant Physiol 25: 627-641) suggests a refinement to the Cholodny-Went theory which overcomes some of the difficulties associated with it. A model is presented to account for the inverse tropic responses of shoots and roots through differences in the respective locations of the auxin-sensitive tissues.

A Kinetic Analysis of Phytochrome Controlled Mesocotyl Growth in Zea mays Seedlings.

Mesocotyl elongation in 4 day old etiolated seedlings immediately following 3 hours of white light (3 h W) is reversibly controlled by phytochrome. Time-lapse video measurements were made of the 5 millimeter zone just below the coleoptile which is the main growth region of the mesocotyl. The growth kinetics were determined for five contiguous 1 millimeter zones subtending the coleoptile node for nonirradiated seedlings, for seedlings given 3 h W, and 3 h W followed by terminal far-red (FR) or red subsequent to the far-red (FR/R) irradiation. Each zone in nonirradiated seedlings exhibits exponential elongation kinetics during the early stages of elongation. This finding suggests that during elongation, a growth limiting factor is also exponentially increasing. Following 3 h W differences in the kinetic responses were found for each zone. In all zones, the inhibitory effect following the 3 h W is totally FR reversible. The effect of FR is reversed by R. The upper zone exhibits the fastest response and is the most plastic in its growth response. The three upper zones all exhibit spontaneous and sharp recoveries with time. It is suggested that the control by phytochrome is not inductive but rather continuous, the controlling factor being either the level of the far red-absorbing form of phytochrome (Pfr) or the ratio Pfr to total phytochrome.

Apical involvement in geogrowth responses of the horizontal hypocotyl.

Hypocotyls of horizontal sunflower (Helianthus annuus L.) seedlings grow more than those of vertical seedlings during the 24 h period following geostimulus. The major contribution to this increased growth arises from extension in the basal half of the geostimulated hypocotyls. H seedling hypocotyls are flexed to a right angle so that the apical half is vertical and the basal half is horizontal, the growth rate of the basal half is similar to that of a vertical hypocotyl rather than a horizontal hypocotyl. These results are taken as indicating that the georesponse of the basal half is not independent of the apical half. It is concluded that the apical region exercises a co-ordinating role in the overall response of the hypocotyl to geostimulation.

The role of the apex in normal and tropic growth of sunflower hypocotyls.

Regional growth in vertical and horizontal etiolated sunflower hypocotyls from which the apical hook tissue had been either partly or wholly excised, was measured 24 h later, the regions having been demarcated with resin beads. Removal of the cotyledons (an excision which included the distal end of the shoot apex) had little effect on growth during this period but excision of the apical hook significantly reduced growth. In vertically orientated seedlings, removal of half of the hook severely reduced growth in all other growing regions and removal of the entire hook totally inhibited growth. This inhibition of growth was not a consequence of the removal of the region of growth but a consequence of the removal of a region on which growth was dependent. In horizontal seedlings, the situation was more complex inasmuch as a horizontal orientation itself induced growth in previously non-growing regions. This new growth was localised in its extent and was not as severely affected by progressive excision of the hook as was growth in vertical seedlings. The results are discussed in terms of overall growth co-ordination in the hypocotyl.

Image Analysis of Geo-Induced Inhibition, Compression, and Promotion of Growth in an Inverted Helianthus annuus L. Seedling.

The growth responses of a sunflower seedling (Helianthus annuus L.), subjected to repeated inversion, were characterized by time-lapse recording in conjunction with video image analysis. The investigation revealed a characteristic response pattern and established that the directional movement of the seedling is achieved by both inhibition and stimulation of growth in the normal growing regions. The complex growth changes in contiguous regions of the hypocotyl are such as seem to be inexplicable in terms of an environmentally imposed gradient of a single growth substance.

Is there a role for the apex in shoot geotropism?

Experiments with horizontal etiolated sunflower (Helianthus annuus L.) seedlings supported centrally such that both apical and basal ends are free to react to geostimulus, revealed that the apical end commences curvature 1 to 2 hours earlier than the basal end. The later curvature in the basal region is a consequence of the absence of growth in the initial period rather than merely slower growth. A comparison of zonal growth rates in a vertical and a horizontal seedling confirmed that geostimulus induces a renewal of growth in a region where growth had ceased. Removing the apical half of the hypocotyl showed that the curvature resulting from this growth initiation in the basal region is dependent on attachment to the apical region. Evidence that this dependence is unlikely to be due to energy deficiency is adduced. The prior response of the apical end to geostimulus and the apically dependent later initiation of new growth in the basal region are compatible with the delay inherent in message transport from apex to base and are considered as evidence for apical involvement in the totality of the seedling's georesponse.

The influence of adjacent tissue on hypocotyl hook opening.

The influence of the cotyledons and the tissue forming the proximal end of the hook in Helianthus annuus L. and Phaseolus mungo L. seedlings growing in the dark has been examined by comparing the growth of whole and decapitated seedlings in which the hook region was demarcated by the use of resin beads as surface markers. It is shown that although decapitated seedlings straighten and whole seedlings maintain a hooked configuration, the curved region in the control seedlings corresponding to that remaining in the decapitated plants also undergoes straightening in the course of the experiment. Maintenance of the hook in controls is thus a consequence of the continuous shifting of the differential growth to a more apical region which decapitation removes. The significance of this finding in relation to the suggestion that cotyledons export an endogenous hook-shutting factor is indicated.

The positive hook: the role of gravity in the formation and opening of the apical hook.

Photographic observations on germinating seedlings of Lepidium sativum L., Cucumis sativus L., and Helianthus annuus L. showed that the hypocotyl hook is not present in the seed but forms during the early stages of growth. Evidence that gravity plays a major role in inducing curvature of the hypocotyl, and in maintaining the hook once it has been formed, was obtained from clinostat experiments, from the use of morphactin to remove geotropic sensitivity and from inversion of seedlings to change the direction of the geostimulus. In L. sativum and H. annuus gravity perception seemed to be the only mechanism responsible for hook formation. In C. sativus hook formation was additionally aided by the mode of emergence of the cotyledons from the seed coat but gravity played an indirect role in regulating such emergence. Further evidence that hook formation is linked to a georesponse was derived from a comparison of hypocotyl development in wild-type Arabidopsis thaliana seedlings with that of an ageotropic mutant, hook formation being found to occur only in the wild type. Hook formation and maintenance is discussed in terms of contrasting geosensitivity between the apical and basal ends of the hypocotyl and it is suggested that light-induced hook opening is a reversal to a condition of uniformly negative georesponse throughout the hypocotyl.

Energy Supply and Light-enhanced Chloride Uptake in Wheat Laminae.

The light-supported component of (36)Cl uptake from 5 mM K(36)Cl by green laminae, either chopped or vacuum-infiltrated, of Triticum aestivum L. seedlings has been determined by subtraction of dark uptake values from light uptake values and the energy sources for the uptake elucidated on the basis of the effects of 3-(3,4-dichlorophenyl)-1,1 dimethylurea (DCMU), carbonyl cyanide p-trifluoromethoxy-phenylhydrazone (FCCP), antimycin A(1) (AA), and N(2) on light and dark uptake. The light-supported Cl(-1) uptake is shown to be partially inhibited by DCMU or AA but unaffected or stimulated by FCCP or N(2). There is no additive effect on inhibition caused by DCMU + N(2) or FCCP + AA but there is an added inhibition caused by DCMU + AA, DCMU + FCCP, and by FCCP or AA in anaerobic conditions. The effect of these inhibitors on photosynthetic gas exchange of chopped tissue has also been determined. On the basis of the results it is concluded that the uptake of Cl(-), supported in the dark by oxidative phosphorylation, is enhanced by light and may be supported by cyclic and non-cyclic electron-flow energy. Uptake is not obligatorily linked to any one energetic pathway and there may be switching from one source to another.

Light-enhanced Chloride Uptake by Wheat Laminae: A Comparison of Chopped and Vacuum-infiltrated Tissue.

The time course of (36)Cl(-) uptake from 5 mm KCl by 1.5-mm leaf segments of Triticum aestivum L. seedlings has been determined over 24 hours both in the light and in the dark. A light-enhanced uptake of Cl(-) develops after a few hours. Using whole laminae which have been water-injected by vacuum infiltration, a light-enhanced uptake is apparent from zero time. Uptake values achieved in the light by the two types of tissue are similar but in the dark there is a restricted uptake by the whole infiltrated laminae. It is considered that the slower uptake by whole laminae relative to chopped tissue in the dark is due to cuticular resistance to solute penetration, whereas in the light the impediment is overcome by stomatal opening. A light-enhanced uptake unrelated to stomatal opening is discernible in both tissues. Its energetic basis has not been defined but may be related to substrate exhaustion. The absorption mechanism is not impaired by vacuum infiltration.

Effect of vacuum infiltration on photosynthetic gas exchange in leaf tissue.

Using a manometric method, photosynthetic oxygen evolution and (14)CO(2) fixation have been determined for leaf tissue of Triticum aestivum L., Hordeum vulgare L., Phaseolus vulgaris L., and Lemna minor L. Approximately similar values in the range 0.2 to 0.4 millimoles grams fresh weight(-1) hour(-1) were obtained for both gases. In tissue subjected to vacuum infiltration, O(2) evolution and (14)CO(2) fixation were barely measurable. It is considered that the elimination of photosynthetic gas exchange results from a decreased supply of CO(2) to the chloroplasts. Chopping wheat laminae also leads to a reduction in photosynthetic gas exchange, slices 1 millimeter or less giving only 10 to 20% of the value for whole tissue. Respiration is unaffected by either treatment. Carbonic anhydrase did not improve photosynthetic gas exchange in infiltrated tissue. The use of sliced or vacuum-infiltrated leaf tissue in photosynthetic studies is discussed.