Serum high-density and low-density lipoprotein cholesterol is associated with abdominal aortic aneurysm presence: a systematic review and meta-analysis.

AIM: To summarize the present evidence for an association between high-density lipoprotein (HDL) or low-density lipoprotein (LDL) cholesterol and abdominal aortic aneurysm (AAA) presence, we performed a systematic review and meta-analysis of case-control studies that compared serum HDL or LDL cholesterol between patients with AAA and control subjects. METHODS: MEDLINE and EMBASE databases were searched to identify all case-control studies that compared serum HDL or LDL cholesterol between patients with AAA and control subjects. For each study, data regarding serum HDL or LDL cholesterol in both the AAA and control groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs). Study-specific estimates were combined using inverse variance-weighted average of logarithmic MDs in both fixed- and random-effects models. RESULTS: Our search identified 8 eligible studies including 812 patients with AAA and 8 267 control subjects. Pooled analysis demonstrated significantly lower serum HDL cholesterol (MD, -0.15 mmol/L; 95% CI, -0.24 to -0.07 mmol/L; P=0.0006) and significantly higher serum LDL cholesterol (MD, 0.25 mmol/L; 95% CI, 0.08 to 0.42 mmol/L; P=0.004) in the AAA group than those in the control group in random-effect models. There was significant study heterogeneity of results but no evidence of significant publication bias. Several sensitivity analyses did not substantively alter the overall result of our analysis. CONCLUSION: We found that, based on a systematic review and meta-analysis, serum HDL cholesterol is likely lower and serum LDL cholesterol is likely higher in patients with AAA than control subjects. Lower serum HDL cholesterol and higher serum LDL cholesterol may be associated with AAA presence.

Plasma fibrinogen and D-dimer concentrations are associated with the presence of abdominal aortic aneurysm: a systematic review and meta-analysis.

OBJECTIVES: To summarise the present evidence for an association between circulating fibrinogen or D-dimer and presence of abdominal aortic aneurysm (AAA) presence. DESIGN: MEDLINE database was searched to identify all case-control studies that compared plasma fibrinogen or D-dimer concentrations between patients with AAA and subjects without AAA. For each study, data regarding fibrinogen or D-dimer concentrations in both the AAA and control groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs). Study-specific estimates were combined using inverse variance-weighted average of logarithmic MDs in both fixed- and random-effects models. RESULTS: Our search identified 10 eligible studies including 834 cases with AAA and 6971 controls without AAA for fibrinogen and six studies including 264 patients with AAA and 403 subjects without AAA for D-dimer. Pooled analysis demonstrated significantly higher fibrinogen (fixed-effects MD, 0.37gl(-1); 95% CI: 0.30-0.44gl(-1)) and D-dimer (random-effects MD: 415.36ngml(-1); 95% CI: 128.97-701.76ngml(-1)) concentrations in the AAA group than those in the control group. CONCLUSIONS: We found that plasma fibrinogen and D-dimer concentrations are likely to be higher in cases with AAA than control subjects. Higher plasma fibrinogen and D-dimer concentrations may be associated with the presence of AAA.

Two-stage portal vein ligation facilitates liver regeneration in rats.

BACKGROUND/AIMS: Recent reports have demonstrated that some patients are unable to undergo scheduled liver resection after preoperative portal vein embolization due to insufficient hypertrophy of the future remnant liver. The present study examined whether two-stage portal vein ligation (PVL) increases hypertrophy of the future remnant liver compared to conventional PVL in rats. METHODS: Rats were divided into 3 groups: group A, ligation of left primary branch; group B, ligation of right and left primary branches; group C, ligation of the left primary branch, followed by 2-stage PVL 7 days postoperatively. To evaluate liver regeneration, the proliferating cell nuclear antigen labeling index (LI), mitotic index (MI) in the caudate lobe and weight ratio of caudate lobe to body weight were measured. RESULTS: The weight ratio of caudate lobe to body weight was significantly higher in group C than in groups A or B 14 days postoperatively. In groups A and B, LI and MI in the caudate lobe peaked 2 days postoperatively, then decreased to preoperative levels by 7-8 days postoperatively, but remained significantly elevated until 10-14 days postoperatively in group C. CONCLUSION: Two-stage PVL increases hypertrophy of the future remnant liver compared to conventional PVL in rats.

Ruptured cerebral aneurysms treated by stent-assisted GDC embolization--two case reports with long-term follow-up.

Two cases of acutely ruptured cerebral aneurysm of low dome/neck ratio treated by stent-assisted GDC embolization using balloon-expandable coronary stent, and also their long-term follow-up results are reported. After embolization, the basilar trunk aneurysm was completely occluded, and partial occlusion was obtained for the internal carotid (IC)-paraclinoid aneurysm. Oral ticropidine (200 mg/day) was given after the embolization, and no neurological events were seen during long-term follow-up (64-68 months). Follow-up angiograms of the basilar trunk aneurysm at 20 months showed complete occlusion and no in-stent stenosis. Follow-up angiograms of the IC-paraclinoid aneurysm at 52 months showed complete occlusion of the aneurysm, but mild stenosis at the distal end of the stent graft. These cases suggested that stent-assisted GDC embolization is effective for prevention of rebleeding from ruptured aneurysm during long-term observation even with sufficient dose of antiplatelets therapy. Caution should be taken on aneurysmal recanalization and parent artery stenosis due to stent deployment during long-term period.

Inhibition of histone deacetylase down-regulates the expression of hypoxia-induced vascular endothelial growth factor by rheumatoid synovial fibroblasts.

OBJECTIVE: To investigate the effect of FK228 on the in vitro expression of hypoxia-inducible factor-1 alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) by rheumatoid arthritis synovial fibroblasts (RASFs), and on the in vivo expression of VEGF and angiogenesis in the synovial tissue of mice with collagen-antibody-induced arthritis (CAIA). METHODS: RASFs were stimulated with IL-1beta and TNFalpha and then incubated under hypoxia (1 % O(2)) with various concentrations of FK228. The effects of FK228 on the expression of HIF-1alpha and VEGF mRNA were examined by quantitative real-time PCR. Changes in HIF-1alpha protein expression and the secretion of VEGF protein into the culture medium were examined by Western blot analysis and ELISA, respectively. Immunohistochemical analysis was carried out to investigate the expression and distribution of VEGF in synovial tissues of CAIA mice. RESULTS: The cytokine-stimulated expression of HIF-1alpha and VEGF mRNA was inhibited by FK228 in a dose-dependent manner. FK228 also reduced the expression of HIF-1alpha and VEGF protein. Intravenous administration of FK228 (2.5 mg/kg) suppressed VEGF expression, and also blocked angiogenesis in the synovial tissue of CAIA. CONCLUSION: FK228 may exhibit a therapeutic effect on RA by inhibition of angiogenesis through down-regulation of angiogenesis related factors, HIF-1alpha and VEGF.

Morphological Change of Unruptured Vertebral Artery Dissection on Serial MR Examinations. Evaluation of the Arterial Outer Contour by Basi-parallel Anatomical Scanning (BPAS)-MRI.

SUMMARY: Basi-parallel anatomical scanning (BPAS)- MRI is a simple MRI technique to reveal the surface contour of the intracranial vertebrobasilar artery. The purpose of this study was to investigate the usefulness of BPAS-MRI for observing the temporal course of unruptured vertebral artery (VA) dissection in patients by means of serial MR examinations. Since April 2003, we performed serial MR examinations in four patients with unruptured acute vertebral artery dissection. The frequency of the MR examinations during the follow-up period in each patient varied from twice within seven months to five times within 19 months. Both MRA and BPAS-MRI were obtained in each MR examination. We investigated the course of morphological changes within the dissected artery on BPASMRI (outer contour) and on MRA (inner lumen). Although the initial MRA showed fusiform dilatation, irregular stenosis or normal caliber at the dissected lesion, the initial BPAS-MRI disclosed fusiform dilatation in all of the four patients. In two patients, MRA finding of the VA lesion had changed, though the fusiform appearance had been stationary on BPAS-MRI. Then both dissolution of the fusiform dilatation on BPAS-MRI and normalization of the inner luminal caliber on MRA were confirmed within nine months. In one patient, fusiform dilatation on both BPAS-MRI and MRA resolved simultaneously on the MR examination at eight months after the initial symptom. In another patient, fusiform dilatation of the outer contour was still enlarging on BPAS-MRI ten months after the onset, though the fusiform dilatation on MRA had been stationary since the eighth week. We performed endovascular coil embolization in this patient eleven months after the initial symptom. Resolution of the fusiform dilatation on BPAS-MRI should be a healing sign of VA dissection. Persisting the fusiform dilatation or progressively enlarging outer contour on BPASMRI may be an unstable sign. BPAS-MRI provides more information about the instability of the dissected lesion. We should obtain not only MRA but also BPAS-MRI for the course observation of unruptured VA dissection.

Rescue use of endovascular snare for acute basilar artery embolic occlusion resistant to balloon angioplasty and fibrinolysis therapy.

A rescue clot disruption using a basket snare is described for acute basilar artery embolic occlusion resistant to balloon angioplasty and fibrinolysis therapy. In spite of failed balloon angioplasty in conjunction with fibrinolysis, a basket-shaped snare connected to a microguide wire could be used to catch and crush the clot in the upper basilar artery. The rescue use of a snare may be effective for angioplasty-resistant acute embolic stroke.

Robust and preceding speech detection using EMG.

EMG-based VAD is proposed. It is generally known that EMG signals are not affected by acoustic noise and preceding voice. Robust but preceding detection of speech can be expected by using these features. The proposed method extracts one VAD parameter to judge speech or silence from among n EMG signal channels. Experiments are performed to confirm the effectiveness of the proposed method. The results show that some EMG signals reliably precede voice by 30ms or more. Compared with conventional audio VAD, the proposed method seldom drops the speech head and the method's performance is relatively insensitive to background noise.

Clinical significance of alendronate in postmenopausal type 2 diabetes mellitus.

OBJECTIVES: To examine early changes in biochemical markers of bone turnover and bone mineral density (BMD) in a clinical trial of anti-resorptive agent alendronate versus alfacalcidol in postmenopausal women with type 2 diabetes mellitus. METHODS: 12 subjects (mean age; 73.1 +/- 6.3 yrs, duration of diabetes; 13.2 +/- 3.7 yrs) were administered alendronate sodium (5 mg/day) and 12 subjects (mean age; 70.7 +/- 7.8 yrs, duration of diabetes; 12.8 +/- 2.0 yrs) were administered alfacalcidol (0.5 microg/day) for 12 months. Urinary N-telopeptide cross-linked collagen type I (NTx), one of biochemical markers, and radial bone mineral density (BMD) were measured as a marker of bone turnover. RESULTS: After 12 months, urinary NTx did not change in women with alfacalcidol treatment, however urinary NTx significantly decreased after alendronate treatment. The BMD significantly decreased by 3.33% (p<0.05) in women with alfacalcidol treatment, while the BMD did not decrease in women with alendronate treatment. CONCLUSION: Alendronate that produces reduction in urinary NTx and inhibition of decrease in BMD may have a clinical significance to reduce the risk of bone fracture in postmenopausal type 2 diabetic women.

Successful staged treatment for ruptured blister-like dissecting aneurysm of the intracranial internal carotid artery: acute GDC embolization for the blister-like aneurysm followed by proximal occlusion with extracranial-intracranial bypass in the chronic stage.

The surgical treatment of ruptured blister-like dissecting aneurysm on the internal carotid artery (ICA) is still controversial. We report a case of this disease successfully managed by a staged treatment: GDC packing into the blister-like aneurysm in the acute stage followed by proximal occlusion in the chronic stage. The merit of this staged treatment is to prevent rerupture in the acute stage and to allow the proximal occlusion in the chronic stage with or without an extracranial-intracranial bypass, after assessment of tolerance of the ICA occlusion.

Displacement of central sulcus in cerebral arteriovenous malformation situated in the peri-motor cortex as assessed by magnetoencephalographic study.

BACKGROUND: Intra-operative monitoring of the position of the central sulcus (CS) is indispensable to properly treat a peri-motor cortex lesion. Noninvasive preoperative studies for identification of CS are also needed for choosing the optimal operative procedure. Magneto-encephalography (MEG) has recently been introduced for non-invasive preoperative investigation and cortical functional mapping. METHODS: Stereotactic mapping of functional CS anatomy was performed preoperatively on 13 subjects using somatosensory evoked fields with MRI-linked whole head MEG system. All subjects had a left sided peri-motor cortex lesion with diagnoses including the following conditions: three arteriovenous malformations (AVM), seven gliomas, three meningiomas. FINDINGS: Functional CS in supratentorial brain tumor and parietal AVM cases corresponded with anatomical CS identified by MRI. But the AVM cases in whom the nidus was situated within the peri-motor cortex showed discrepancies between anatomical CS and functional CS. INTERPRETATION: Careful consideration of the operative procedure combined with non-invasive cortical functional mapping is needed to optimally treat AVM and congenital brain lesions situated in the anatomical peri-motor cortex.

KF19514, a phosphodiesterase 4 and 1 inhibitor, inhibits TNF-alpha-induced GM-CSF production by a human bronchial epithelial cell line via inhibition of PDE4.

OBJECTIVE AND DESIGN: Bronchial epithelium plays an important role in the regulation of inflammatory reactions in the airways. We investigated the effect of KF19514, a phosphodiesterase (PDE) 4 and 1 inhibitor, on granulocyte-macrophage colony-stimulating factor (GM-CSF) production by a human bronchial epithelial cell line, BEAS-2B. METHODS: BEAS-2B cells were stimulated with the tumor necrosis factor-alpha (TNF-alpha) and various concentrations of test agents for 48 h. Supernatants were assayed for GM-CSF by using an enzyme-linked immunosorbent assay (ELISA). In addition, intracellular cyclic AMP (cAMP) levels were measured in the presence of various agents. RESULTS: KF19514 significantly inhibited the release of GM-CSF by BEAS-2B cells in a concentration-dependent manner. The other PDE4 inhibitors and cAMP-elevating agents also inhibited the GM-CSF production. In the BEAS-2B cells, KF19514 and PDE4 inhibitors concentration-dependently increased intracellular cAMP levels. The inhibitory effect of KF19514 on the GM-CSF production was significantly reduced by a cAMP-dependent protein kinase A (PKA) inhibitor, H89. On the other hand, other PDE isozyme inhibitors did not inhibit the GM-CSF production by BEAS-2B cells, and did not elevate the intracellular cAMP levels. CONCLUSIONS: These results indicate that KF19514 and PDE4 inhibitors reduce TNF-alpha-induced GM-CSF production of BEAS-2B cells via a cAMP-dependent pathway. PDE4 may be a possible target for the regulation of cytokine production in epithelial cells.

Multi-stream HMM for EMG-based speech recognition.

A technique for improving the recognition accuracy of EMG-based speech recognition by applying existing speech recognition technologies is proposed. The authors have proposed an EMG-based speech recognition system that requires only mouth movements, voice need not be generated. A multi-stream HMM (hidden Markov model) and feature extraction technique are applied to EMG-based speech recognition. 3 channel facial EMG signals are collected from ten subjects when uttering 10 Japanese isolated digits. One channel corresponds to one stream. By examining various features, we found that the delta component of the static parameter leads to higher accuracy. Compared to equal stream weighting, the individual optimization of stream weights increased recognition accuracy by 4.0% which corresponds to a 12.8% reduction in error rate. This result shows that multistream HMM is effective for the classification of EMG.

Evaluations of the ring shaped EMG measurement system.

This paper describes two evaluations of our previously proposed ring shaped EMG measurement system. The first evaluation, based on the collection of EMG by the system, shows that no statistically significant difference is seen between 3 EMG electrode configurations: the electrode is pressed with a finger, the electrode is fixed by tape, and a conventional plate electrode. The second evaluation suggests that our system has higher usability than the conventional electrodes. These results show that the ring shaped EMG measurement system is effective for measuring EMG, especially as part of the user interface for EMG-based applications.

Basi-Parallel Anatomical Scanning (BPAS) - MRI: a Simple and Useful MRI Technique for Pre-Procedural Evaluation in Cases of Basilar Artery Occlusion.

SUMMARY: Basi-parallel anatomical scanning (BPAS)-MRI is a simple MRI technique that we designed to reveal the surface appearance of the vertebrobasilar artery within the cistern. Because it requires only 2 cm-thick heavily T2-weighted coronal imaging with gray-scale reversal, we can obtain BPAS-MRI with any MR machine of any company. BPAS-MRI can easily show the outer contour of the vertebrobasilar artery even if occluded. Therefore, BPAS-MRI can also reveal the occluded basilar trunk and the shape of basilar top branching that we cannot see with any other imaging modality before the recanalizing interventional procedure. To avoid a dangerous blind manipulation of guidewires or micro-catheters, BPAS-MRI should be obtained prior to the interventional procedure in cases of acute basilar artery occlusion.

The choice of treatment method for unruptured cerebral aneurysm. Investigation from clinical outcome, angiographical result, duration of hospital stay, and cost for treatment.

SUMMARY: To compare complications, anigographical results, duration of postoperative hospital stay and cost for treatment of surgical clipping and coil embolization in the treatment of unruptured cerebral aneurysm. One hundred and nine non-giant saccular aneurysms in 90 patients were treated by either endovascular treatment (E group) or direct surgery (S group) in our Neurosurgical Department between April 1996 and April 2002. The complications and angiographical results were reviewed. The duration of postoperative hospital stay and cost for the treatment were calculated from bills for health insurance for 38 operations and 12 embolizations in 47 patients whose aim of hospitalization was only treatment for their unruptured aneurysm. Neck clipping was performed for 89 aneurysms (S group), wrapping for four (S group), embolization using Guglielmi's detachable coils (GDCs) for 15 (E group), and failed embolization followed by clipping for one (E group). The postoperative temporary deficit (disappeared within one month) and permanent deficit was seen in five cases (6.7%) and in three cases (morbidity: 4.0%) of S group, and in one case (6.7%) and none (morbidity; 0%) of E group, respectively. No death was seen in both group (mortality; 0% in both group). The rate of angiographical complete occlusion of the aneurysm was significantly higher in S group (P = 0.015, 88% in S group vs 50% in E group). The postoperative hospital stay was significantly shorter in E group (P= 0.000013, mean days: 17.1 in S group vs 6.3 in E group), but cost for treatment was rather cheep in S group (N.S., mean cost: 1684329 yen in S group vs. 2259011 in E group). This retrospective study suggested that surgical treatment may be less expensive treatment with higher rate of postoperative angiographical complete occlusion than coil embolization, and treatment-related complication rate was similar in both treatment.

The Role of GDC Embolization as a Second Choice in the Treatment of Ruptured Cerebral Aneurysm. Retrospective Analysis from Mid-Term Outcome.

SUMMARY: We investigated the role of GDC embolization as a second choice for the treatment of ruptured cerebral aneurysm. From september 1997 to may 2001, 139 ruptured aneurysms out of 151 consecutive ruptured aneurysms transferred to our hospital were treated by clipping (first choice) or GDC embolization (second choice). Patient selection was decided by more than two neurosurgeons under the policy that GDC embolization is the second choice of treatment. The mid-term (longer than three months) outcome of both group was examined. One hundred and nineteen Ans (BA two, ICparaclinoid one, IC-PC or IC-Ach 36, IC-ant. Wall two, ACoA34, ACA six, MCA38) were treated by clipping (clipping group), 20 Ans (surgical difficulty; BA three, IC-paraclinoid three, VA dissection six, general complications; IC-PC two, IC-dissection one, ACoA four, VAPICA one) by GDC embolization (GDC group) within 24 hours after admission. SAH grade and GOS of each group were Gr1: 35&4, Gr2: 41&5, Gr3: 23&5, Gr4: 11&4, Gr5: 9&2, respectively, and GR: 79&14, MD: 8&3, SD: 11&0, VS: 8&0, D: 13&3 respectively. Good prognosis (better than MD) was gained in 73% of clipping group and 85% of GDC group. No rebleeding was seen in GDC group. GDC embolization for the cases with surgical difficulty or general complication raised the overall outcome. GDC embolization would be suitable for IC-paraclinoid Ans, BA-VA Ans, and ruptured VA dissections. Because of the good clinical outcome gained in the GDC group, GDC treatment would be the first choice of treatment for such aneurysms as geometrically suitable for coiling.

Retinal embolization and cerebellar asymptomatic embolization after carotid stenting using distal balloon protection. A case report.

SUMMARY: We describe a rare case of having both symptomatic ipsilateral retinal embolization and asymptomatic cerebellar embolization occurring after carotid stenting with use of distal protect device. In this case, external carotid angiograms revealed accessory meningeal arteryophthalmic artery and occipital artery-vertebral artery anastomoses. This case suggested that the protection for external carotid artery should be considered during carotid stenting to avoid retinal embolization and cerebellar or cerebral embolization in cases showing angiographical anastomoses between external carotid artery and ophthalmic artery or intracranial arteries.

Contralateral inferior petrosal sinus approach for transvenous embolization of a dural arteriovenous fistula at isolated jugular bulb. Technical case report.

A contralateral inferior petrosal sinus approach is described for the successful treatment of a case of a dural arteriovenous fistula at an isolated right jugular bulb presenting with chemosis. A microcatheter could be inserted into the right jugular bulb from the left jugular bulb through the left inferior petrosal sinus, basilar sinus on the dorsum sellae, and the right inferior petrosal sinus. This unusual approach represents an alternative route to the jugular bulb.