Systemic immune-inflammation index in dural arteriovenous fistula: a feasible biomarker reflecting its clinical characteristics.

PURPOSE: The systemic immune-inflammation index (SII), a marker of systemic inflammation, can be calculated using peripheral blood tests. Although the SII has been reported as a feasible biomarker in various cerebrovascular diseases, no studies have explored in dural arteriovenous fistula (DAVF). A retrospective cohort study was performed to test whether the SII reflects the clinical characteristics of DAVF and whether this index could serve as a feasible biomarker. METHODS: This study included 28 patients who underwent endovascular treatment (39 sessions) for DAVF between 2014 and 2023. The SII was calculated using the following formula: platelet count multiplied by neutrophil count divided by lymphocyte count. We investigated the correlation between the SII and various clinical characteristics of DAVF, including symptom manifestation, and digital subtraction angiography findings. Additionally, we compared pre- and post-endovascular treatment changes in the SII. RESULTS: A significantly higher SII was observed in patients with multiple lesions, clinical symptoms (particularly aggressive symptoms), pseudophelebitic pattern (PPP), and sinus occlusion. Multivariate regression analysis revealed that the presence of symptoms (coefficient 270.9, P = 0.021) and PPP (coefficient 272.4, P = 0.017) were independent factors contributing to SII elevation. Notably, following endovascular treatment, there was a significant decrease in the elevated SII in patients whose symptoms resolved (P = 0.039) and where the DAVF was angiographically cured (P = 0.012). CONCLUSION: Elevation of the SII in patients with advanced DAVF and its decrease following endovascular treatment suggests that the SII reflects the disease condition and indicates its potential as a promising biomarker.

Intravenous Administration of Mesenchymal Stem Cell-Derived Exosome Alleviates Spinal Cord Injury by Regulating Neutrophil Extracellular Trap Formation through Exosomal miR-125a-3p.

Spinal cord injury (SCI) leads to devastating sequelae, demanding effective treatments. Recent advancements have unveiled the role of neutrophil extracellular traps (NETs) produced by infiltrated neutrophils in exacerbating secondary inflammation after SCI, making it a potential target for treatment intervention. Previous research has established that intravenous administration of stem cell-derived exosomes can mitigate injuries. While stem cell-derived exosomes have demonstrated the ability to modulate microglial reactions and enhance blood-brain barrier integrity, their impact on neutrophil deactivation, especially in the context of NETs, remains poorly understood. This study aims to investigate the effects of intravenous administration of MSC-derived exosomes, with a specific focus on NET formation, and to elucidate the associated molecular mechanisms. Exosomes were isolated from the cell supernatants of amnion-derived mesenchymal stem cells using the ultracentrifugation method. Spinal cord injuries were induced in Sprague-Dawley rats (9 weeks old) using a clip injury model, and 100 µg of exosomes in 1 mL of PBS or PBS alone were intravenously administered 24 h post-injury. Motor function was assessed serially for up to 28 days following the injury. On Day 3 and Day 28, spinal cord specimens were analyzed to evaluate the extent of injury and the formation of NETs. Flow cytometry was employed to examine the formation of circulating neutrophil NETs. Exogenous miRNA was electroporated into neutrophil to evaluate the effect of inflammatory NET formation. Finally, the biodistribution of exosomes was assessed using 64Cu-labeled exosomes in animal positron emission tomography (PET). Rats treated with exosomes exhibited a substantial improvement in motor function recovery and a reduction in injury size. Notably, there was a significant decrease in neutrophil infiltration and NET formation within the spinal cord, as well as a reduction in neutrophils forming NETs in the circulation. In vitro investigations indicated that exosomes accumulated in the vicinity of the nuclei of activated neutrophils, and neutrophils electroporated with the miR-125a-3p mimic exhibited a significantly diminished NET formation, while miR-125a-3p inhibitor reversed the effect. PET studies revealed that, although the majority of the transplanted exosomes were sequestered in the liver and spleen, a notably high quantity of exosomes was detected in the damaged spinal cord when compared to normal rats. MSC-derived exosomes play a pivotal role in alleviating spinal cord injury, in part through the deactivation of NET formation via miR-125a-3p.

Simultaneous depiction of clot and MRA using 1 min phase contrast angiography in acute ischemic patients.

[Background and Purpose] Clot location and range predict clinical outcomes for acute ischemic stroke (AIS). We developed a new technique for visualizing occlusion clots, namely, the DEpicting blood clot and MRA using Phase contrast angiography with Image Calculation for Thrombectomy (DEPICT) method. The purpose of this study was to assess the clinical usefulness of DEPICT. [Methods] We used DEPICT in 36 AIS patients to obtain MRA and black blood images with 1-min phase contrast angiography (PCA). We created the black blood images by subtracting the MRA from the T1WI using the source image of PCA. We evaluated the motion artifact, detectability of clot, and precision in location and range compared these to that of susceptibility vessel sign in T2*WI and measured contrast ration (CR) of clot between the cistern and brain tissue. Motion artifact was visually evaluated using a 3-point scale. Detectability and precision of the location and range of occlusion clots were assessed by comparison with findings from digital subtraction angiography (DSA). Gwet's AC1 and kappa statistics were used to assess inter-observer agreement. [Results] DEPICT showed significant robustness for motion artifact compared with T2*WI (p = 0.0026, Wilcoxon signed-rank test). DEPICT showed 100% detectability for the clot. Further, DEPICT showed higher Gwet's AC1 and kappa statistic values with DSA than T2*WI. CR demonstrated a positive value. [Conclusions] DEPICT technique based on 1-min PCA offers both MRA and black blood T1W images that can be used to accurately evaluate both location and range of the clot.

[Familial Mediterranean Fever-Associated Lenticulostriate Artery Aneurysm Presenting with Intracranial Hemorrhage and Disappearing Spontaneously: A Case Report].

Lenticulostriate artery (LSA) aneurysm is relatively rare, and the need for surgical intervention is controversial. Here, we report a case of ruptured LSA aneurysm which was accompanied by familial Mediterranean fever (FMF). A 45-year-old woman with a history of FMF presented with sudden onset of headache and vertigo. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Digital subtraction angiography revealed a fusiform aneurysm (3mm) at the distal site of medial LSA. Observation was selected, and the aneurysm gradually decreased and eventually disappeared on the 105th day from the onset. This was the first report describing an LSA aneurysm associated with FMF. It suggests that such aneurysms could be treated conservatively with close radiological follow-up.

Validity and Reliability of a 2-Min Walk Test to Assess the Exercise Capacity in Vertebral Compression Fracture Patients: A Pilot Study.

BACKGROUND: The 2-min walk test (2MWT) may be a simple and easy measurement of exercise tolerance for vertebral compression fracture (VCF) patients. But, the validity and reliability of the 2MWT in patients with VCFs have not been verified. The aim of this pilot study was to investigate the validity and reliability of the 2MWT in VCF patients. METHODS: Ten patients with VCFs were selected from the inpatient convalescence rehabilitation ward. These patients were required to walk for a minimum of 6 minutes. The study was conducted over three test days. On the first and second test days, the participants completed one trial of the 2MWT each day. These data were used in the analyses for an intra-class correlation coefficient (ICC [1,1]). On the third test day, participants completed the 6-min walk test (6MWT). These data assessed the construct validity of the 2MWT. Participants completed testing on 3 days within a 5-day period. RESULTS: A significant correlation was found between the 2MWT and the 6MWT (r=0.945; p<0.05), which suggested a high construct validity of the 2MWT. The intraclass correlation coefficient of the repeated 2MWTs was high (ICC=0.98; p<0.05), intimating that it had a high test-retest reliability. CONCLUSION: The 2MWT is a valid test for the assessment of exercise capacity in patients with VCFs. It is practical, simple, and well tolerated by patients with VCFs.

Effects of home-based interval walking training on thigh muscle strength and aerobic capacity in female total hip arthroplasty patients: a randomized, controlled pilot study.

UNLABELLED: Due to the reduced physical activity of patients who have undergone total hip arthroplasty (THA), there are no home-based exercise training regimens for preventing muscle atrophy and aerobic capacity impairment in these patients. We examined whether interval walking training (IWT) could prevented these issues. Twenty-eight female patients (∼60 years of age) who had undergone THA more than 2 months prior were randomly divided into IWT (n = 14) and control (CNT, n = 14) groups. The IWT subjects trained at a target of 60 min of fast walking at >70% peak aerobic capacity for walking (VO2peak) per wk for 12 wk, while those in the CNT maintained their previous sedentary life during the same period. We measured the energy expenditure of the daily physical activity, except during sleeping and bathing, every minute and every day during the intervention. We also measured the isometric knee extension (FEXT) and flexion (FFLX) forces, VO2peak, and anaerobic threshold during the graded cycling exercise (VO2AT) before and after the intervention. All subjects, except for one in IWT, completed the protocol. FFLX increased by 23% on the operated side (P = 0.003) and 14% on the non-operated side of IWT (P = 0.006), while it only increased on the operated side of CNT (P = 0.03). The VO2peak and VO2AT in IWT increased by 8% (P = 0.08) and 13% (P = 0.002), respectively, and these changes were significantly higher in the IWT than in CNT group (both, P<0.05). In conclusion, IWT might be an effective home-based training regimen for preventing the muscle atrophy from reduced daily physical activity in THA patients. TRIAL REGISTRATION: UMIN-CTR UMIN000013172.

Incremental shuttle walk test as a valuable assessment of exercise performance in patients with pulmonary arterial hypertension.

BACKGROUND: Nearly all clinical trials investigating patients with pulmonary arterial hypertension (PAH) have used the 6-min walk test (6MWT) to evaluate exercise tolerance. The incremental shuttle walk test (SWT), however, has been proposed as a more valid and reproducible alternative to the 6MWT in the evaluation of exercise tolerance in patients with chronic obstructive pulmonary disease. The efficacy of SWT in clinical practice to evaluate the exercise capacity of patients with PAH was investigated. METHODS AND RESULTS: The peak oxygen consumption (pVO2) and oxygen consumption at anaerobic threshold (VO2 at AT), the gold standard for measurement of exercise tolerance, 6MWT and SWT were measured in 19 clinically stable PAH patients (WHO functional class II-III) and the data compared. There was a higher correlation between SWT walk distance and pVO2 than between 6MWT walk distance and pVO2 (r=0.866 and 0.765, respectively; P<0.05), and a higher correlation between SWT walk distance and VO2 at AT than between 6MWT walk distance and VO2 at AT (r=0.775 and 0.587, respectively; P<0.05). No adverse events occurred during the exercise tests. CONCLUSIONS: SWT is a better reflection than 6MWT of exercise tolerance in PAH patients, and thus is a preferable alternative for assessment of exercise tolerance in PAH patients.