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1.
Surg Endosc ; 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32144557

RESUMO

BACKGROUND: Laparoscopic distal gastrectomy for early gastric cancer has been widely accepted, but laparoscopic total gastrectomy has still not gained popularity because of technical difficulty and unsolved safety issue. We conducted a single-arm multicenter phase II clinical trial to evaluate the safety and the feasibility of laparoscopic total gastrectomy for clinical stage I proximal gastric cancer in terms of postoperative morbidity and mortality in Korea. The secondary endpoint of this trial was comparison of surgical outcomes among the groups that received different methods of esophagojejunostomy (EJ). METHODS: The 160 patients of the full analysis set group were divided into three groups according to the method of EJ, the extracorporeal circular stapling group (EC; n = 45), the intracorporeal circular stapling group (IC; n = 64), and the intracorporeal linear stapling group (IL; n = 51). The clinicopathologic characteristics and the surgical outcomes were compared among these three groups. RESULTS: There were no significant differences in the early complication rates among the three groups (26.7% vs. 18.8% vs. 17.6%, EC vs. IC vs. IL; p = 0.516). The length of mini-laparotomy incision was significantly longer in the EC group than in the IC or IL group. The anastomosis time was significantly shorter in the EC group than in the IL group. The time to first flatus was significantly shorter in the IL group than in the EC group. The long-term complication rate was not significantly different among the three groups (4.4% vs. 12.7% vs. 7.8%; EC vs. IC vs. IL; p = 0.359), however, the long-term incidence of EJ stenosis in IC group (10.9%) was significantly higher than in EC (0%) and IL (2.0%) groups (p = 0.020). CONCLUSIONS: The extracorporeal circular stapling and the intracorporeal linear stapling were safe and feasible in laparoscopic total gastrectomy, however, intracorporeal circular stapling increased EJ stenosis.

2.
PLoS One ; 15(1): e0227747, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978097

RESUMO

We developed a visual ranking system by combining the parenchymal perfusion deficits (PPD) and hyperintense vessel signals (HVS) on arterial spin labeling (ASL) imaging. This study aimed to assess the performance of this ranking system by correlating with subtypes classified based on dynamic susceptibility contrast (DSC) imaging for evaluating the perfusion disturbance observed in patients with ischemic stroke. 32 patients with acute or subacute infarcts detected by DSC imaging were reviewed. Each patient's brain was divided into 12 areas. ASL ranks were defined by the presence (+) or absence (-) of PPD/HVS as follows; I:-/-, II:-/+, III: +/+, and IV: +/-. DSC imaging findings were categorized based on cerebral blood flow (CBF) and time to peak (TTP) as normal (normal CBF/TTP), mismatched (normal CBF/delayed TTP), and matched (decreased CBF/delayed TTP). Two reviewers rated perfusion abnormalities in the total of 384 areas. The four ASL ranks correlated well with the DSC subtypes (Spearman's r = 0.82). The performance of ASL ranking system was excellent as indicated by the area under the curve value of 0.94 using either matched or mismatched DSC subtype as the gold standard and 0.97 using only the matched DSC subtype as the gold standard. The two methods were in good-to-excellent agreement (maximum κ-values, 0.86). Inter-observer agreement was excellent (κ-value, 0.98). Although the number of patients was small and the number of dropouts was high, our proposed, ASL-based visual ranking system represented by PPD and HVS provides good, graded estimates of perfusion disturbance that agree well with those obtained by DSC perfusion imaging.


Assuntos
Infarto Encefálico/diagnóstico , Encéfalo/diagnóstico por imagem , Artérias Cerebrais/fisiopatologia , Angiografia por Ressonância Magnética/métodos , Imagem de Perfusão/métodos , Idoso , Idoso de 80 Anos ou mais , Encéfalo/irrigação sanguínea , Infarto Encefálico/fisiopatologia , Artérias Cerebrais/diagnóstico por imagem , Volume Sanguíneo Cerebral/fisiologia , Circulação Cerebrovascular/fisiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Marcadores de Spin
3.
Neurosurgery ; 86(2): 213-220, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30848283

RESUMO

BACKGROUND: It remains controversial whether carotid artery stenting (CAS) is needed in cases of tandem cervical internal carotid artery occlusion (cICAO) and intracranial large vessel occlusion (LVO). OBJECTIVE: To investigate the efficacy and safety of CAS in combination with endovascular thrombectomy (CAS-EVT) in cICAO-LVO patients and to compare its outcomes with those of EVT without CAS (EVT-alone). METHODS: We identified all patients who underwent EVT for tandem cICAO-LVO from the prospectively maintained registries of 17 stroke centers. Patients were classified into 2 groups: CAS-EVT and EVT-alone. Clinical characteristics and procedural and clinical outcomes were compared between 2 groups. We tested whether CAS-EVT strategy was independently associated with recanalization success. RESULTS: Of the 955 patients who underwent EVT, 75 patients (7.9%) had cICAO-LVO. Fifty-six patients underwent CAS-EVT (74.6%), and the remaining 19 patients underwent EVT-alone (25.4%). The recanalization (94.6% vs 63.2%, P = .002) and good outcome rates (64.3% vs 26.3%, P = .007) were significantly higher in the CAS-EVT than in the EVT-alone. Mortality was significantly lower in the CAS-EVT (7.1% vs 21.6%, P = .014). There was no significant difference in the rate of symptomatic intracranial hemorrhage between 2 groups (10.7 vs 15.8%; P = .684) and according to the use of glycoprotein IIb/IIIa inhibitor (10.0% vs 12.3%; P = .999) or antiplatelet medications (10.2% vs 18.8%; P = .392). CAS-EVT strategy remained independently associated with recanalization success (odds ratio: 24.844; 95% confidence interval: 1.445-427.187). CONCLUSION: CAS-EVT strategy seemed to be effective and safe in cases of tandem cICAO-LVO. CAS-EVT strategy was associated with recanalization success, resulting in better clinical outcome.

4.
Sci Rep ; 9(1): 12622, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477759

RESUMO

The porous materials of SnO2@NGO composite was synthesized by thermal reduction process at 550 °C in presence ammonia and urea as catalyst. In this process, the higher electrostatic attraction between the SnO2@NGO nanoparticles were anchored via thermal reduction reaction. These synthesized SnO2@ NGO composites were confirmed by Raman, XRD, XPS, HR-TEM, and EDX results. The SnO2 nanoparticles were anchored in the NGO composite in the controlled nanometer scale proved by FE-TEM and BET analysis. The SnO2@NGO composite was used to study the electrochemical properties of CV, GCD, and EIS analysis for supercapacitor application. The electrochemical properties of SnO2@NGO exhibited the specific capacitance (~378 F/g at a current density of 4 A/g) and increasing the cycle stability up to 5000 cycles. Therefore, the electrochemical results of SnO2@NGO composite could be promising for high-performance supercapacitor applications.

6.
J Am Chem Soc ; 141(38): 15348-15355, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31433168

RESUMO

A robust strategy is developed for preparing light-responsive block copolymer (BCP) particles in which shape and color can be actively controlled with high spatial and temporal resolution. The key to achieving light-responsive shape transitions of BCP particles is the design and synthesis of surfactants containing light-active groups (i.e., nitrobenzyl esters and coumarin esters) that modulate the amphiphilicity and interfacial activity of the surfactants in response to light of a specific wavelength. These light-induced changes in surfactant structure modify the surface and wetting properties of BCP particles, affording both shape and morphological transitions of the particles, for example from spheres with an onion-like inner morphology to prolate or oblate ellipsoids with axially stacked nanostructures. In particular, wavelength-selective shape transformation of the BCP particles can be achieved with a mixture of two light-active surfactants that respond to different wavelengths of light (i.e., 254 and 420 nm). Through the use of light-emitting, photoresponsive surfactants, light-induced changes in both color and shape are further demonstrated. Finally, to demonstrate the potential of the light-triggered shape control of BCP particles in patterning features with microscale resolution, the shape-switchable BCP particles are successfully integrated into a patterned, free-standing hydrogel film, which can be used as a portable, high-resolution display.

7.
Stroke ; 50(6): 1490-1496, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31043149

RESUMO

Background and Purpose- Based on its mechanism, the use of balloon guide catheters (BGCs) may be beneficial during endovascular treatment, regardless of the type of mechanical recanalization modality used-stent retriever thrombectomy or thrombaspiration. We evaluated whether the use of BGCs can be beneficial regardless of the first-line mechanical endovascular modality used. Methods- We retrospectively reviewed consecutive acute stroke patients who underwent stent retriever thrombectomy or thrombaspiration from the prospectively maintained registries of 17 stroke centers nationwide. Patients were assigned to the BGC or non-BGC group based on the use of BGCs during procedures. Endovascular and clinical outcomes were compared between the BGC and non-BGC groups. To adjust the influence of the type of first-line endovascular modality on successful recanalization and favorable outcome, multivariable analyses were also performed. Results- This study included a total of 955 patients. Stent retriever thrombectomy was used as the first-line modality in 526 patients (55.1%) and thrombaspiration in 429 (44.9%). BGC was used in 516 patients (54.0%; 61.2% of stent retriever thrombectomy patients; 45.2% of thrombaspiration patients). The successful recanalization rate was significantly higher in the BGC group compared with the non-BGC group (86.8% versus 74.7%, respectively; P<0.001). Furthermore, the first-pass recanalization rate was more frequent (37.0% versus 14.1%; P<0.001), and the number of device passes was fewer in the BGC group (2.5±1.9 versus 3.3±2.1; P<0.001). The procedural time was also shorter in the BGC group (54.3±27.4 versus 67.6±38.2; P<0.001). The use of BGC was an independent factor for successful recanalization (odds ratio, 2.18; 95% CI, 1.54-3.10; P<0.001) irrespective of the type of first-line endovascular modality used. The use of BGC was also an independent factor for a favorable outcome (odds ratio, 1.40; 95% CI, 1.02-1.92; P=0.038) irrespective of the type of first-line endovascular modality used. Conclusions- Regardless of the first-line mechanical endovascular modality used, the use of BGC in endovascular treatment was beneficial in terms of both recanalization success and functional outcome.


Assuntos
Angioplastia com Balão , Sistema de Registros , Acidente Vascular Cerebral/cirurgia , Trombectomia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia
8.
J Atheroscler Thromb ; 26(11): 1007-1014, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30918163

RESUMO

AIM: Development of atherosclerotic plaques is affected by vascular geometry and hemodynamics. Hemodynamics in the basilar artery (BA) is unique as the flow converges from vertebral arteries (VAs). Here, we investigated the characteristics of BA plaque based on VA and BA geometry. METHODS: Consecutive patients evaluated using high-resolution magnetic resonance imaging (MRI) at a general health center were screened. Geometric characteristics of VA (VA dominancy and VA-BA angles) and BA (BA convexity and BA angles) were assessed. The burden of BA plaques was investigated in each wall (anterior, posterior, left, and right lateral). The characteristics of BA plaques were compared according to VA dominancy (right vs. left), BA angle of lateral view (lateral mid-BA angle; dichotomized), and total plaque burden (divided by tertiles). RESULTS: Of the 1029 subjects, BA plaques were observed in 98 (9.5%) patients, and were more frequently located at the anterior wall (32.4%) and posterior wall (35.0%) than the right wall (15.3%) and left lateral wall (17.6%). Right and left lateral plaques were more frequent in the left and right convex BA, respectively (p=0.009 and p=0.024, respectively). Anterior plaques were more frequently observed in low lateral mid-BA angle (p= 0.043). BA plaques were predominant in anterior and posterior walls in patients with lower plaque burden, whereas they were predominant in right and left lateral walls in patients with higher plaque burden (p=0.001 and p=0.025, respectively). CONCLUSIONS: Asymptomatic BA plaque location was associated with BA convexity and lateral mid-BA angle. The anteriorly and posteriorly located BA plaques may extend to the lateral walls as the plaque burden increases.

9.
Adv Ther ; 36(6): 1509, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30900197

RESUMO

Unfortunately the funding information is incorrect in the published article.

10.
ACS Nano ; 13(4): 4230-4237, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-30856312

RESUMO

Herein, we report a simple and robust strategy for preparing dual-responsive shape-switchable block copolymer (BCP) particles, which respond to subtle temperature and pH changes near physiological conditions (i.e., human body temperature and neutral pH). The shape transition of polystyrene- b-poly(4-vinylpyridine) BCP particles between lens and football shapes occurs in very narrow temperature and pH ranges: no temperature-based transition for pH 6.0, 40-50 °C transition for pH 6.5, and 25-35 °C for pH 7.0. To achieve these shape transitions, temperature/pH-responsive polymer surfactants of poly( N-(2-(diethylamino)ethyl)acrylamide- r- N-isopropylacrylamide) are designed to induce dramatic changes in relative solubility and their location in response to temperature and pH changes near physiological conditions. In addition, the BCP particles exhibit reversible shape-transforming behavior according to orthogonal temperature and pH changes. Colorimetric measurements of temperature and pH changes are enabled by shape-transforming properties combined with selective positioning of dyes, suggesting promising potential for these particles in clinical and biomedical applications.

11.
J Neurointerv Surg ; 11(10): 979-983, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30842306

RESUMO

BACKGROUD: The need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT. METHODS: We identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome. RESULTS: A total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870). CONCLUSION: CA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome.


Assuntos
Angioplastia com Balão/métodos , Isquemia Encefálica/cirurgia , Stents , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico por imagem , Resultado do Tratamento
12.
Gastric Cancer ; 22(1): 214-222, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30128720

RESUMO

BACKGROUND: With improved short-term surgical outcomes, laparoscopic distal gastrectomy has rapidly gained popularity. However, the safety and feasibility of laparoscopic total gastrectomy (LTG) has not yet been proven due to the difficulty of the technique. This single-arm prospective multi-center study was conducted to evaluate the use of LTG for clinical stage I gastric cancer. METHODS: Between October 2012 and January 2014, 170 patients with pathologically proven, clinical stage I gastric adenocarcinoma located at the proximal stomach were enrolled. Twenty-two experienced surgeons from 19 institutions participated in this clinical trial. The primary end point was the incidence of postoperative morbidity and mortality at postoperative 30 days. The severity of postoperative complications was categorized according to Clavien-Dindo classification, and the incidence of postoperative morbidity and mortality was compared with that in a historical control. RESULTS: Of the enrolled patients, 160 met criteria for inclusion in the full analysis set. Postoperative morbidity and mortality rates reached 20.6% (33/160) and 0.6% (1/160), respectively. Fifteen patients (9.4%) had grade III or higher complications, and three reoperations (1.9%) were performed. The incidence of morbidity after LTG in this trial did not significantly differ from that reported in a previous study for open total gastrectomy (18%). CONCLUSIONS: LTG performed by experienced surgeons showed acceptable postoperative morbidity and mortality for patients with clinical stage I gastric cancer.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Gastrectomia/mortalidade , Humanos , Incidência , Laparoscopia/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Gástricas/mortalidade , Resultado do Tratamento , Adulto Jovem
13.
Neuroradiology ; 61(3): 265-274, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30415319

RESUMO

PURPOSE: White matter hyperintensities (WMH) and cerebral microbleeds (CMBs) are known to be associated with small vessel diseases (SVD) and neuroinflammation. The purpose was to investigate the relationship between CMBs and WMH in patients with systemic lupus erythematosus (SLE). METHODS: Thirty-one SLE patients with WMH and 27 SLE patients with normal brain MRI were compared. The presence, location, and grading of CMBs were assessed using susceptibility-weighted images. WMH volume was quantitatively measured. Clinical characteristics and serologic markers were compared. We also performed two separate subgroup analyses after (1) dividing WMH into inflammatory lesion vs. SVD subgroups and (2) dividing WMH into those with vs. without CMB subgroups. RESULTS: The WMH group showed more frequent CMBs than the normal MR group (p < 0.001). The WMH group showed higher SLE disease activity index, longer disease duration, and a higher incidence of antiphospholipid syndrome than the normal MR group (p = 0.02, 0.04, and 0.04, respectively). There was a moderate correlation between WMH volume and CMB grading (r = 0.49, p = 0.006). Within the WMH group, the inflammatory lesion subgroup showed more frequent CMBs and larger WMH volume than the SVD subgroup (p < 0.001 and 0.02, respectively). The WMH with CMB subgroup had larger WMH volume than the WMH without CMB subgroup (p = 0.004). CONCLUSION: In patients with SLE, CMBs could be related to large-volume WMH and inflammatory lesions. CMBs along with severe WMH could be used as an imaging biomarker of vasculitis in patients with SLE.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Hemorragia Cerebral/patologia , Criança , Feminino , Humanos , Lúpus Eritematoso Sistêmico/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Substância Branca/patologia
14.
Integr Med Res ; 7(4): 381-386, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30591893

RESUMO

Tic disorder is characterized as sudden, non-rhythmic, involuntary and repetitive movement or vocalization, and its onset occurs mainly in childhood or adolescence. The development of medication has been limited because of a lack of understanding of tic mechanisms, and behavioral treatment is recommended as a first-line treatment. In this case report, we observed three cases in which tic disorder or Tourette syndrome was treated with intraoral orthopedic treatment (FCST) combined with acupuncture and an herbal formula and was assessed using the Yale Global Tic Severity Scale (YGTSS), a visual analog scale (VAS) and video analysis. The symptoms were reduced in 30 days and remained at the reduced level until 240 or 300 days after the first day of treatment. Most of the symptoms were disappeared after 240-300 days. Therefore, we could conclude that orthopedic treatment combined with Korean medicine may be applied for tic disorder in accordance with the efficacy and low adverse event rate, and we also suggests a large-scale clinical report to provide concrete evidence before the global application.

15.
J Neurosurg ; : 1-7, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30497154

RESUMO

OBJECTIVEThe role of the balloon guide catheter (BGC) has not been evaluated in contact aspiration thrombectomy (CAT) for acute stroke. Here, the authors aimed to test whether the BGC was associated with recanalization success and good functional outcome in CAT.METHODSAll patients who had undergone CAT as the first-line treatment for anterior circulation intracranial large vessel occlusion were retrospectively identified from prospectively maintained registries for six stroke centers. The patients were dichotomized into BGC utilization and nonutilization groups. Clinical findings, procedural details, and recanalization success rates were compared between the two groups. Whether the BGC was associated with recanalization success and functional outcome was assessed.RESULTSA total of 429 patients (mean age 68.4 ± 11.4 years; M/F ratio 215:214) fulfilled the inclusion criteria. A BGC was used in 45.2% of patients. The overall recanalization and good outcome rates were 80.2% and 52.0%, respectively. Compared to the non-BGC group, the BGC group had a significantly reduced number of CAT passes (2.6 ± 1.6 vs 3.4 ± 1.5), shorter puncture-to-recanalization time (56 ± 27 vs 64 ± 35 minutes), lower need for the additional use of thrombolytics (1.0% vs 8.1%), and less embolization to a distal or different site (0.5% vs 3.4%). The BGC group showed significantly higher final (89.2% vs 72.8%) and first-pass (24.2% vs 8.1%) recanalization success rates. After adjustment for potentially associated factors, BGC utilization remained independently associated with recanalization (OR 4.171, 95% CI 1.523-11.420) and good functional outcome (OR 2.103, 95% CI 1.225-3.612).CONCLUSIONSBGC utilization significantly increased the final and first-pass recanalization rates and remained independently associated with recanalization success and good functional outcome.

16.
Sci Rep ; 8(1): 17391, 2018 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-30478431

RESUMO

This paper demonstrates for the first time the fabrication of Zr-Cu alloy ingots from a Hf- free ZrO2 precursor in a molten CaCl2 medium to recover nuclear-grade Zr. The reduction of ZrO2 in the presence of CaO was accelerated by the formation of Ca metal in the intermediate stage of the process. Tests conducted with various amounts of ZrO2 indicate that the ZrO2 was reduced to the metallic form at low potentials applied at the cathode, and the main part of the zirconium was converted to a CuZr alloy with a different composition. The maximum oxygen content values in the CuZr alloy and Zr samples upon using liquid Cu were less than 300 and 891 ppm, respectively. However, Al contamination was observed in the CuZr during the electroreduction process. In order to solve the Al contamination problem, the fabrication process of CuZr was performed using the metallothermic reduction process, and the produced CuZr was used for electrorefining. The CuZr alloy was further purified by a molten salt electrorefining process to recover pure nuclear-grade Zr in a LiF-Ba2ZrF8-based molten salt, the latter of which was fabricated from a waste pickling acid of a Zr clad tube. After the electrorefining process, the recovered Zr metal was fabricated into nuclear-grade Zr buttons through arc melting following a salt distillation process. The results suggest that the removal of oxygen from the reduction product is a key reason for the use of a liquid CaCu reduction agent.

17.
Adv Ther ; 35(12): 2224-2235, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30414051

RESUMO

INTRODUCTION: Cerebrolysin is a neuroprotective drug used in the treatment of acute ischemic stroke. To our knowledge, this drug has never been evaluated in patients with aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to evaluate the effect of Cerebrolysin in patients with aneurysmal SAH. METHODS: Aneurysmal SAH patients who had their aneurysm obliterated at our institution from 2007 to 2016 were retrospectively studied. Patients received Cerebrolysin treatment or standard care only (control group). Subgroup analyses were performed according to Hunt and Hess grade (good grade ≤ 2, N = 216; poor grade ≥ 3, N = 246) and treatment procedure (clip or coil). RESULTS: In good-grade patients (N = 216), clinical outcomes and mortality did not differ significantly between the control and Cerebrolysin groups. In poor-grade patients (N = 246), the mortality rate was significantly lower in the Cerebrolysin group (8.7%) than in the control group (25.4%, p = 0.006). In patients who received microsurgical clipping (N = 328), the mortality rate was significantly lower in the Cerebrolysin group (7.3%) than in the control group (18.5%, p = 0.016). CONCLUSION: Cerebrolysin injection during the acute period of SAH appeared to reduce the mortality rate, especially in poor-grade patients. This study suggests the potential of Cerebrolysin for treating aneurysmal SAH. Further studies are needed to confirm our results.


Assuntos
Aminoácidos/uso terapêutico , Aneurisma Intracraniano/complicações , Fármacos Neuroprotetores/uso terapêutico , Hemorragia Subaracnóidea/tratamento farmacológico , Hemorragia Subaracnóidea/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
18.
Stroke ; 49(9): 2088-2095, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30354993

RESUMO

Background and Purpose- Stent retriever (SR) thrombectomy has become the mainstay of treatment of acute intracranial large artery occlusion. However, it is still not much known about the optimal limit of SR attempts for favorable outcome. We evaluated whether a specific number of SR passes for futile recanalization can be determined. Methods- Patients who were treated with a SR as the first endovascular modality for their intracranial large artery occlusion in anterior circulation were retrospectively reviewed. The recanalization rate for each SR pass was calculated. The association between the number of SR passes and a patient's functional outcome was analyzed. Results- A total of 467 patients were included. Successful recanalization by SR alone was achieved in 82.2% of patients. Recanalization rates got sequentially lower as the number of passes increased, and the recanalization rate achievable by ≥5 passes of the SR was 5.5%. In a multivariable analysis, functional outcomes were more favorable in patients with 1 to 4 passes of the SR than in patients without recanalization (odds ratio [OR] was 8.06 for 1 pass; OR 7.78 for 2 passes; OR 6.10 for 3 passes; OR 6.57 for 4 passes; all P<0.001). However, the functional outcomes of patients with ≥5 passes were not significantly more favorable than found among patients without recanalization (OR 1.70 with 95% CI, 0.42-6.90 for 5 passes, P=0.455; OR 0.33 with 0.02-5.70, P=0.445 for ≥6 passes). Conclusions- The likelihood of successful recanalization got sequentially lower as the number of SR passes increased. Five or more passes of the SR became futile in terms of the recanalization rate and functional outcomes.


Assuntos
Procedimentos Endovasculares/estatística & dados numéricos , Acidente Vascular Cerebral/cirurgia , Trombectomia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Infarto da Artéria Cerebral Média , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Falha de Tratamento
19.
Acta Neurochir (Wien) ; 160(7): 1407-1413, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29766339

RESUMO

BACKGROUND: Chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) is a major complication that leads to a medical burden and poor clinical outcomes. The aim of this study was to evaluate the predictive factors of shunt-dependent hydrocephalus focusing on postoperative fever and infection. METHOD: A total of 418 patients were included in this study and the patient demographic features, radiologic findings, days of fever burden, and infection were compared between the shunt (n = 72) and no shunt group (n = 346). Days of fever burden was defined as the total number of days with the highest body temperature ≥ 38.0 °C each day from day 1 to day 14. Pneumonia, urinary tract infection (UTI), meningitis, and bacteremia were recorded in all patients. RESULTS: The independent predictive factors for shunt-dependent hydrocephalus were older age ≥ 65, microsurgical clipping, placement of extraventricular drainage (EVD), days of fever burden, and infection. The incidence of shunt dependency was 2.4% in the no fever burden patients (n = 123), 14.9% in the 1-3 days of fever burden patients (n = 161), 27.0% in the 4-6 days of fever burden patients (n = 74), and 41.7% in the ≥ 7 days of fever burden patients with statistical significance among groups (p < 0.001). CONCLUSION: The rate of shunt dependency increased proportionally as the days of fever burden increased. Older age (≥ 65), microsurgical clipping, placement of EVD, days of fever burden, and infection were independent predictive factors for shunt dependency. Proper postoperative care for maintaining normal body temperature and preventing infectious disease can help reduce the rate of shunt dependency and improve clinical outcomes.


Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Drenagem/efeitos adversos , Febre/epidemiologia , Hidrocefalia/epidemiologia , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Subaracnóidea/cirurgia , Derivações do Líquido Cefalorraquidiano/métodos , Drenagem/métodos , Feminino , Febre/etiologia , Humanos , Hidrocefalia/etiologia , Masculino , Pessoa de Meia-Idade
20.
J Nanosci Nanotechnol ; 18(9): 6565-6569, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29677835

RESUMO

The detection and monitoring of colorless and odorless chemical warfare agents (CWAs) has become important due to the increasing threat of terrorist activities. To enhance the sensitivity and selectivity of CWAs a number of sensing materials have been developed, including the widely used polyvinylidene fluoride (PVDF). However, PVDF is limited by its low sensitivity and selectivity for many CWAs. In this study, polyhedral oligomeric silsesquioxane (POSS) was used as a sensing material for dimethyl methylphosphonate (DMMP) a simulant of sarin nerve gas. Sensitivity, selectivity, and reusability were investigated with an AT-cut 5 MHz quartz crystal microbalance. At room temperature, POSS exhibited a strong response for DMMP vapor at different concentrations from 20 ppm to 120 ppm leading to fast chemical adsorption and desorption. To investigate selectivity the volatile organic compounds (VOCs) ethanol, water, toluene, ACN, methanol, and n-hexane were tested at a fixed flow rate. Targeted VOCs showed lower responses than DMMP as measured with a quartz crystal microbalance (QCM) sensor, demonstrating the high selectivity of the method. POSS can be considered a potentially useful material for sensing nerve simulants.

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