Presence of intra-aneurysmal thrombi with delayed coil migration after embolization of an aneurysmal subarachnoid hemorrhage: illustrative case.

BACKGROUND: Coil migration is a rare, but notable complication of endovascular treatment. Risk factors include communicating segment aneurysms, aneurysmal shape, and technical factors. Although cerebral blood flow obstruction caused by early coil migration requires urgent coil removal, delayed coil migration is often asymptomatic, making it difficult to determine a treatment strategy. OBSERVATIONS: A 47-year-old woman was referred to the institute with acute-onset headache. She was diagnosed with subarachnoid hemorrhage due to rupture of the right internal carotid artery-posterior communicating artery aneurysm and underwent endovascular coil embolization. Following the procedure, the patient showed no obvious complications; however, 14 days later, images showed coil migration to the distal side, leading to surgical removal. Right frontotemporal craniotomy was performed, and the remaining coil was removed. The aneurysm was clipped again, and blood flow was confirmed. The patient was discharged 12 days after the craniotomy with transient oculomotor nerve palsy. At the 15-month follow-up, there was no aneurysm recurrence and the oculomotor nerve palsy showed improvement. LESSONS: Retrieval of the migrated coil by craniotomy is an effective remedial measure; however, intraoperative complications are common. Early detection, established protocols, and prompt treatment decisions are important for preventing undesirable outcomes.

Radiofrequency Ventro-oral Thalamotomy for Post-stroke Focal Dystonia in a Pediatric Patient.

Dystonia is a movement disorder that has various treatment options. For primary dystonia, stereotactic procedures such as deep brain stimulation (DBS) have demonstrated favorable outcomes. For secondary dystonia, however, the treatment outcomes remain inconclusive, and the heterogeneous etiological background is considered to contribute to the poor outcomes of the disease. Here, we report a rare pediatric case of post-stroke focal dystonia treated with conventional radiofrequency ventro-oral (Vo) thalamotomy. The patient was an 11-year-old girl with secondary focal dystonia in her right hand. The dystonia was considered to result from a stroke lesion in the putamen due to vasculitis following varicella-zoster virus infection. We hypothesized that the infarction of the putamen resulted in hyperactivity in the thalamus, and, thus, performed a radiofrequency Vo thalamotomy. Markedly decreased muscle tone in her right hand was noted immediately after surgery. However, the improvement was temporary, as her symptoms returned to baseline level by the 6-month follow-up. Although the observed improvement was temporary in this case, our findings may elucidate the possible mechanisms of secondary focal dystonia. Further studies are needed to establish an effective surgical treatment for secondary focal dystonia.

Dynamic assessment of internal carotid artery and elongated styloid process in a case of bilateral carotid artery dissection.

BACKGROUND: Vascular Eagle syndrome is that an elongated styloid process causes ischemic stroke due to internal carotid artery (ICA) dissection. Dynamic assessment using radiological imaging has not been well investigated. We assessed the change in the relative positional relationship between the elongated styloid process and the ICA using a cone-beam computed tomography (CBCT). CASE DESCRIPTION: A 46-year-old female presenting with disturbance of consciousness, right hemiparesis, and aphasia was admitted to our hospital. Initial CT analysis showed a bilateral elongated styloid process. Magnetic resonance angiography (MRA) showed occlusion of the left ICA and a near occlusion of the right ICA. MRA also revealed the intimal flap and intramural hematoma in the bilateral ICA. Digital subtraction angiography showed bilateral ICA occlusion and carotid artery stenting was performed subsequently. After that, we visualized the movement of carotid stent with CBCT fusion methods. The stent moved forward and backward at the attachment point of the styloid process during head rotation, and there was a possibility that mechanical stress was emphasized at this point. Styloidectomy was performed after her rehabilitation. The patient did not experience a recurrence of stroke. CONCLUSION: We showed that repeated attachment of the styloid process and ICA may trigger an ICA dissection during head rotation. This finding would be helpful for understanding the causes of vascular Eagle syndrome.

Influence of a home-based exercise program on the urine pH in elderly female subjects: a secondary analysis of a randomized controlled trial.

BACKGROUND: A low urine pH is a characteristic metabolic feature of metabolic syndrome and type 2 diabetes. The purpose of the current study was to investigate the effects of a 12-week home-based bench step exercise on the urine pH status of elderly female subjects. METHODS: The current study is a secondary analysis of a randomized controlled trial (RCT) in which 59 postmenopausal female subjects were randomized to either the exercise group (n = 29) or the control group (n = 30). The subjects in the exercise group were instructed to perform home-based exercises using a bench step at the anaerobic threshold (AT), with a goal of performing ≥140 min/week at home for 12 weeks. The subjects in the control group were instructed to not change their normal lifestyle. Urine was collected after overnight fasting, and the urine pH was measured using a urinary test strip. The inter-group-differences at baseline and the pre-post changes within groups were assessed using the Mann-Whitney U test and Wilcoxon's signed-rank test, respectively. Additionally, the difference in the post-intervention urine pH levels of the two groups, adjusted for the pre-intervention values (the estimated effect size) and the precision (95% confidence intervals) were investigated using an analysis of covariance. RESULTS: The pre-post comparison of the urine pH data using Wilcoxon's signed-rank test showed a significant increase in the urine pH levels of the exercise group (p < 0.05); there was no significant change in the urine pH levels of the control group. However, the estimated effect size (0.15) was small and the confidence interval straddled 0 (-0.25-0.55). CONCLUSIONS: Based on the results of the current secondary analysis of an RCT, we could not clearly conclude that exercise has a beneficial effect on the urine pH. Further well-designed RCTs should be conducted to determine whether aerobic exercise is truly able to ameliorate urine acidification. TRIAL REGISTRATION: The study was retrospectively registered in the University Hospital Medical Information Network (UMIN) as "Effect of step exercise on aerobic fitness and progression of atherosclerosis in the elderly" under the registration number UMIN 000026743 (the date of registration: March 28, 2017).

Effects of home-based bench step exercise on inflammatory cytokines and lipid profiles in elderly Japanese females: A randomized controlled trial.

PURPOSE: The purpose of the current study was to investigate the effects of a 12-week home-based bench step exercise program on inflammatory cytokines and lipid profiles in elderly females. METHODS: Sixty-two postmenopausal females (65-85 years of age) were randomized to either the bench step exercise group (n=31) or the control group (n=31). The subjects in the bench step exercise group were instructed to perform bench step exercises at the exercise intensity corresponding to lactate threshold (LT), three times per day 10-20 min each session, for a goal of ≥140 min/week at home for 12 weeks. At baseline and 12 weeks, circulating levels of nine inflammatory cytokines (high-molecular-weight adiponectin, interleukin-4 [IL-4], IL-5, IL-6, IL-8, IL-15, tumor necrosis factor-α [TNF-α], TNF-ß and interferon-γ [IFN-γ]) and serum lipids including high-density lipoprotein cholesterol (HDL-C) were measured. RESULTS: The bench step training at the LT significantly increased HDL-C levels and decreased IFN-γ concentrations in the subjects with lower (< 63 mg/dL) baseline HDL-C levels (p<0.05). The change in IFN-γ inversely correlated with the change in HDL-C in the exercise group (ρ=-0.56, p<0.01), whereas this association was not observed in the control group. Additionally, principal component analysis-derived index of what we called "inflammatory status factor" was inversely associated with the changes in HDL-C in the exercise group. CONCLUSION: The bench step exercise-induced reduction in the IFN-γ levels may partially explain the degree of improvement in the HDL-C levels with the exercise program.

Effects of bench step exercise on arterial stiffness in post-menopausal women: contribution of IGF-1 bioactivity and nitric oxide production.

OBJECTIVE: To examine the effect of bench step exercise on arterial pulse wave velocity (PWV) and the associated contribution of insulin-like growth factor (IGF)-1 bioactivity and nitric oxide (NO). DESIGN: Twenty-six elderly (post-menopausal) women were randomly allocated to a bench step exercise group or a control group. The participants in the bench step exercise group practiced a 12-week home-based bench step exercise for 10-20min, 3 times daily (i.e., for a total of 140min/week at the intensity level of lactate threshold (LT)). In addition to conventional risk factors of atherosclerosis, PWV, IGF-1/IGF binding protein (IGFBP)-3 molar ratio (an index for IGF-1 bioactivity), and urinary nitrite/nitrate (NO(x)) excretion were measured before and after the intervention. RESULTS: BMI, systolic blood pressure, fasting plasma glucose, low-density lipoprotein cholesterol, LT, and PWV were significantly improved in the bench step exercise group. A significant positive correlation between changes in PWV and IGF-1/IGFBP-3 molar ratio, and a significant negative correlation between changes in IGF-1/IGFBP-3 molar ratio and urinary NO(x) excretion were found in the bench step exercise group. CONCLUSION: The bench step exercise leads to improvements in not only the classical risk factors of atherosclerosis but also the arterial stiffness in elderly women, partly through NO production via IGF-1 bioactivity.

NESH (Abi-3) is present in the Abi/WAVE complex but does not promote c-Abl-mediated phosphorylation.

Abl interactor (Abi) was identified as an Abl tyrosine kinase-binding protein and subsequently shown to be a component of the macromolecular Abi/WAVE complex, which is a key regulator of Rac-dependent actin polymerization. Previous studies showed that Abi-1 promotes c-Abl-mediated phosphorylation of Mammalian Enabled (Mena) and WAVE2. In addition to Abi-1, mammals possess Abi-2 and NESH (Abi-3). In this study, we compared the three Abi proteins in terms of the promotion of c-Abl-mediated phosphorylation and the formation of Abi/WAVE complex. Although Abi-2, like Abi-1, promoted the c-Abl-mediated phosphorylation of Mena and WAVE2, NESH (Abi-3) had no such effect. This difference was likely due to their binding abilities as to c-Abl. Immunoprecipitation revealed that NESH (Abi-3) is present in the Abi/WAVE complex. Our results suggest that NESH (Abi-3), like Abi-1 and Abi-2, is a component of the Abi/WAVE complex, but likely plays a different role in the regulation of c-Abl.

Identification of B cell adaptor for PI3-kinase (BCAP) as an Abl interactor 1-regulated substrate of Abl kinases.

In previous work we showed that Abl interactor 1 (Abi-1), by linking enzyme and substrate, promotes the phosphorylation of Mammalian Enabled (Mena) by c-Abl. To determine whether this mechanism extends to other c-Abl substrates, we used the yeast two-hybrid system to search for proteins that interact with Abi-1. By screening a human leukocyte cDNA library, we identified BCAP (B-cell adaptor for phosphoinositide 3-kinase) as another Abi-1-interacting protein. Binding experiments revealed that the SH3 domain of Abi-1 and the C-terminal polyproline structure of BCAP are involved in interactions between the two. In cultured cells, Abi-1 promoted phosphorylation of BCAP not only by c-Abl but also by v-Abl. The phosphorylation sites of BCAP by c-Abl were mapped to five tyrosine residues in the C-terminal region that are well conserved in mammals. These results show that Abi-1 promotes Abl-mediated BCAP phosphorylation and suggest that Abi-1 in general coordinates kinase-substrate interactions.