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1.
Artigo em Inglês | MEDLINE | ID: mdl-31868795

RESUMO

Proptosis is a common yet cardinal symptom that may indicate the development of a wide range of diseases. Causes of proptosis are usually classified into vascular, inflammatory, endocrine, and neoplastic. Herein, the authors describe a case where proptosis manifested as the primary and only symptom of a massive brain arteriovenous malformation. Deprived of any other conventional symptoms and signs of a brain arteriovenous malformation, such as headaches, nausea, vision loss, increased ocular pressure, and so on, brain imaging played a key role in confirming the diagnosis of this patient. This case proclaims how imperative it is for ophthalmologists to consider the potential of brain arteriovenous malformation as a cause of proptosis and actively engage in brain imaging for diagnosis.

2.
Diabetes Metab J ; 43(6): 776-784, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31701688

RESUMO

BACKGROUND: The objective of the study was to determine the impact of continuous care on health outcomes and cost of type 2 diabetes mellitus (T2DM) in Korea. METHODS: A nationwide retrospective, observational case-control study was conducted. Continuity of treatment was measured using Continuity of Care (COC) score. Information of all patients newly diagnosed with T2DM in 2004 was retrieved from the National Health Insurance database for the period of 2002 to 2013. The study examined 2,373 patients after applying exclusion criteria, such as for patients who died from conditions not related to T2DM. Statistical analyses were performed using frequency distribution, simple analysis (t-test and chi-squared test), and multi-method analysis (simple linear regression, logistic regression, and survival analysis). RESULTS: The overall COC score was 0.8±0.24. The average incidence of diabetic complications was 0.39 per patient with a higher COC score, whereas it was 0.49 per patient with a lower COC score. In both survival and logistic analyses, patients who had high COC score were significantly less likely to have diabetic complications (hazard ratio, 0.69; 95% confidence interval, 0.54 to 0.88). The average medical cost was approximately 3,496 United States dollar (USD) per patient for patients with a higher COC score, whereas it was 3,973 USD per patient for patients with a lower COC score during the 2006 to 2013 period, with a difference of around 477 USD, which is statistically significant after adjusting for other factors (ß=-0.152). CONCLUSION: Continuity of care for diabetes significantly reduced health complications and medical costs from patients with T2DM.

3.
BMC Neurol ; 19(1): 245, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640586

RESUMO

BACKGROUND: The purpose of this study was to report our preliminary experience of stent-assisted coiling (SAC) of wide-necked intracranial aneurysms with a single microcatheter in patients with parent arteries that were small-caliber, with stenosis, or a very tortuous course. METHODS: Between March 2018 and December 2018, we treated 394 aneurysms in 359 patients with endovascular treatment. Among 197 aneurysms treated by SAC, there were 16 cases (all wide-necked unruptured aneurysms) treated by SAC with a single microcatheter and a Neuroform Atlas stent. Follow-up angiography was performed at 6 to 12 months after SAC, and clinical follow-up was performed from 6 to 12 months in all patients. RESULTS: The reasons for SAC with a single 0.0165-in. microcatheter were small-caliber (n = 4), stenosis (n = 2), and very tortuous course (n = 10) of the parent arteries. There was no complication related to delivering or deploying the Neuroform Atlas stent as well as no failure of selecting aneurysm by cell-through technique. All patients had a modified Rankin score of 0 at discharge and at follow-up. Initial angiographic results showed six cases (37.5%) of complete occlusion. In follow-up angiographies, 12 cases (75.0%) achieved compete occlusion. CONCLUSION: When performing SAC of wide-necked intracranial aneurysms in parent arteries with small-caliber, stenosis, or a very tortuous course, cell-through SAC using a single microcatheter and a Neuroform Atlas stent within a 5 Fr- (or smaller) guiding or intermediate catheter might be a useful option.


Assuntos
Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Idoso , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
4.
J Neurointerv Surg ; 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337732

RESUMO

BACKGROUND: Discriminating a junctional dilatation from a true saccular aneurysm is clinically important. PURPOSE: To evaluate the usefulness of high-resolution three-dimensional proton density-weighted turbo spin-echo magnetic resonance imaging (PD MRI) in distinguishing a junctional dilatation from an aneurysm of the posterior communicating artery (PcomA). METHODS: Eighty-two consecutive patients with 83 PcomA lesions, which were evaluated by time-of-flight (TOF) MR angiography (MRA), PD MRI, and digital subtraction angiography (DSA), were enrolled. These radiologic data were retrospectively and independently reviewed by two neurosurgeons, and each diagnosis based on TOF MRA, PD MRI, and DSA was compared. The diagnostic efficacy (interobserver agreement, intermodality agreement, and diagnostic performance) of PD MRI was compared with that of TOF MRA. RESULTS: PD MRI showed higher AC1 (Gwet's agreement coefficient, PD MRI: 0.8942, 95% CI 0.8204 to 0.968; TOF MRA: 0.7185, 95% CI 0.5753 to 0.8617) and prevalence-adjusted bias-adjusted kappa coefficient (PABAK) (PD MRI: 0.8554, TOF MRA: 0.5904) than TOF MRA for interobserver agreement. For intermodality agreement, PD MRI also showed higher AC1 (PD MRI: 0.9069, 95% CI 0.8374 to 0.9764; TOF MRA: 0.7983, 95% CI 0.6969 to 0.8996) and PABAK (PD MRI: 0.8735, TOF MRA: 0.7289) than TOF MRA. The diagnostic performance of PD MRI was statistically superior to that of TOF MRA in sensitivity, specificity, positive predictive value, and negative predictive value. CONCLUSIONS: PD MRI could provide excellent diagnostic accuracy and better information in distinguishing a junctional dilatation from a true saccular aneurysm of the PcomA compared with TOF MRA.

5.
Korean J Radiol ; 20(8): 1285-1292, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339016

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of the coil-protected technique for liquid embolization in neurovascular malformations. MATERIALS AND METHODS: Twenty-two patients who underwent coil-protected liquid embolization for symptomatic cranial (n = 13) and spinal (n = 9) arteriovenous fistula (AVF) or arteriovenous malformations (AVMs) were identified. A total of 36 target feeder vessels were embolized with N-butyl cyanoacrylate and/or Onyx (Medtronic). This technique was used to promote delivery of a sufficient amount of liquid embolic agent into the target shunt or nidus in cases where tortuous feeding arteries preclude a microcatheter wedging techniqu and/or to prevent reflux of the liquid embolic agent in cases with a short safety margin. The procedure was considered technically successful if the target lesion was sufficiently filled with liquid embolic agent without unintentional reflux. Angiographic and clinical outcomes were retrospectively evaluated. RESULTS: Technical success was achieved for all 36 target feeders. Post-embolization angiographies revealed complete occlusion in 16 patients and near-complete and partial occlusion in three patients each. There were no treatment-related complications. Of the six patients who showed near-complete or partial occlusion, five received additional treatments: two received stereotactic radiosurgery for cerebral AVM, two underwent surgical removal of cerebral AVM, and one underwent additional embolization by direct puncture for a mandibular AVM. Finally, all patients showed complete (n = 19) or near-complete (n = 3) occlusion of the target AVF or AVM on follow-up angiographies. The presenting neurological symptoms improved completely in 15 patients (68.2%) and partially in seven patients (31.8%). CONCLUSION: The coil-protected technique is a safe and effective method for liquid embolization, especially in patients with various neurovascular shunts or malformations who could not be successfully treated with conventional techniques.

6.
Diabetes Res Clin Pract ; 155: 107796, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31326458

RESUMO

AIM: The aim of this study was to analyze the efficacy, insulin sensitivity and safety in the event of administering sulfonylurea-based drugs and metformin in combination with basal insulin. METHODS: A randomized, open-label, parallel, 16-week trial was conducted across four study centers. The 97 type 2 diabetic patients were selected and randomized into two groups, the insulin glargine plus fixed-dose combination glimepiride 1 mg and metformin 500 mg twice daily group (the G/M group) and the insulin glargine plus glimepiride 4 mg once daily group (the G group). The primary endpoint evaluated was change in HbA1c. The secondary endpoints evaluated were changes in fasting blood glucose (FPG), 2-h post prandial glucose (PPG 2 h), insulin, and C-peptide levels. RESULTS: The G/M group was found to have experienced a significantly greater decrease in HbA1c, as well as PPG 2 h compared to the G group. While no significant intergroup difference was found regarding FPG in the ITT, the G/M group in the PP set experienced a significantly greater decrease in FPG. CONCLUSION: Comparison of combined therapy consisting of either the G/M group or the G group indicated that both forms of therapy are relatively safe but that the former more effectively decreases blood glucose levels.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Resistência à Insulina , Insulina/uso terapêutico , Metformina/uso terapêutico , Compostos de Sulfonilureia/uso terapêutico , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Quimioterapia Combinada , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Segurança
7.
Korean J Radiol ; 20(3): 505-512, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30799582

RESUMO

OBJECTIVE: We report the results of a pilot clinical study that evaluated the safety and efficacy of a newly-developed, retrievable flow diverter (FloWise; Taewoong Medical) for the treatment of internal carotid artery (ICA) aneurysm. MATERIALS AND METHODS: A total of 10 patients were enrolled. Inclusion criteria were 1) unruptured aneurysm with a dome size of ≥ 8 mm and a neck size of ≥ 4 mm at the ICA, or 2) two or more unruptured aneurysms of any size able to be spanned by a single FloWise at the ICA. Co-primary effectiveness end points were technical success of FloWise placement, and a 50% or greater decrease in aneurysm volume at the 6-month follow-up angiogram. The primary safety end point was the new development of neurological deficits persisting for more than 1-month post-treatment. RESULTS: Ten patients harboring 14 ICA aneurysms (median diameter, 9.4 mm; range, 2.3-31.0 mm) were enrolled between January 2016 and July 2017. FloWise placement was successful in all patients. There were no newly-developed neurological deficits during the 6-month clinical follow-up period. One patient did not receive follow-up imaging due to pregnancy. Nine patients with 12 aneurysms received a 6-month angiographic follow-up. Ten aneurysms (83.3%) showed decreases in volume greater than 50% (mean volume decrease, 82.8 ± 32.9%), of which 8 (66.7%, 95% confidence interval, 35.4-98.0%) showed complete occlusion. One patient was retreated due to mass symptom aggravation. CONCLUSIONS: In this pilot study, FloWise appeared to be safe and effective for ICA aneurysm treatment. A prospective multicenter study to validate the effectiveness and safety of FloWise would be worthwhile.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Stents , Adulto , Idoso , Angiografia , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/tratamento farmacológico , Pessoa de Meia-Idade , Projetos Piloto , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Prospectivos , Próteses e Implantes , Resultado do Tratamento
8.
J Environ Manage ; 235: 310-318, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30703645

RESUMO

Algal blooms intensified operational problems in water treatment due to the increases of taste- and odor-causing compounds and natural organic matter (NOM). Effects of powdered activated carbon (PAC) addition during algal blooms on NOM removal was investigated in this study using an algal-rich water. Water quality analyses including dissolved organic carbon (DOC), ultraviolet absorbance at 254 nm (UV254) and specific UV absorbance (SUVA) were performed to elucidate characteristics of NOM removal by PAC adsorption. Variations of MW distributions and emission/excitation matrix (EEM) spectra with increasing PAC dosages were also measured. In addition, formation potential (FP) of trihalomethanes (THMs), haloacetic acids (HAAs), and haloacetonitriles (HANs) was evaluated with increasing PAC dosage. The correlations between disinfection by-products formation potential (DBPFP) and water qualities such as DOC, UV254, SUVA, and EEM spectra were also investigated to identify factors associated with DBPFP. The PAC addition was effective to remove NOM, especially low molecular weights NOM and proteinaceous substances with weak aromatics. The PAC addition showed the consistent reduction of THMFPs, HAAFPs, and HANFPs with increasing PAC dosage while the greater reduction of HAN precursors was eminent compared to the other two FPs. The close correlations between UV254 and the three DBPFPs were obtained. The low molecular weight (i.e., 1-700 Da) NOM and three fluorescence spectra peaks, i.e., T1, A and C peaks, also showed high correlation factors with the three DBPFPs. Those analyses with high correlations with DBPFPs would provide useful information to reduce DBPs during algal blooms.


Assuntos
Poluentes Químicos da Água , Purificação da Água , Adsorção , Carvão Vegetal , Desinfecção , Pós , Água
9.
J Environ Sci (China) ; 78: 247-256, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30665643

RESUMO

A monitoring method of biofouling in reverse osmosis (RO) system was proposed based on the fluorescent signal of resorufin, which is reduced by nicotinamide adenine dinucleotide released from viable cells during aerobic respiration. The fluorescent signal of resorufin reduced by planktonic cells and microorganisms of biofilm showed linearity, indicating its feasibility to monitor biofouling in a RO system. For the application of the method to the lab-scale RO system, the injection concentration of resazurin and the injection flow rate were optimized. Biofilm on RO membranes continuously operated in a lab-scale RO system was estimated by resorufin fluorescence under optimized detection condition. As a result, resorufin fluorescence on RO membrane showed a significant increase in which the permeability of RO system decreased by 30.48%. Moreover, it represented the development of biofilm as much as conventional biofilm parameters such as adenosine triphosphate, extracellular polymeric substances, and biofilm thickness. The proposed method could be used as a sensitive and low-cost technology to monitor biofouling without autopsy of membranes.


Assuntos
Biofilmes/crescimento & desenvolvimento , Incrustação Biológica/prevenção & controle , Osmose , Purificação da Água/métodos , Filtração/métodos , Membranas Artificiais
10.
Neurointervention ; 14(1): 35-42, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30636388

RESUMO

PURPOSE: The purpose of this study was to report the authors' experience with external ventricular drainage (EVD) before endovascular treatment (EVT) in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) and to investigate its relation to hemorrhagic complications. MATERIALS AND METHODS: Between March 2010 and December 2017, a total of 122 patients were recruited who had an aSAH, underwent EVT to secure the ruptured aneurysm, and had EVD performed within 72 hours of rupture. The pre-embo EVD group (n=67) comprised patients who underwent EVD before EVT, and the post-embo EVD group (n=55) comprised those who underwent EVD after EVT. RESULTS: Overall, EVD-related hemorrhage occurred in 18 patients (14.8%): six (8.9%) in the pre-embo EVD group and 12 (21.8%) in the post-embo EVD group (P=0.065). No rebleeding occurred between EVD and EVT in the pre-embo EVD group. Clinical outcomes at discharge did not differ significantly between groups (P=0.384). At discharge, the final modified Rankin Scale score in patients who experienced pre-embo rebleeding was better in the pre-embo EVD group than in the post-embo EVD group (P=0.041). Current use of an antiplatelet agent or anticoagulant on admission (odds ratio [OR], 2.928; 95% confidence interval [CI], 1.234-7.439; P=0.042) and stent use (OR, 2.430; 95% CI, 1.524-7.613; P=0.047) remained independent risk factors for EVD-related hemorrhagic complications. CONCLUSION: EVD before EVT in patients with aSAH in acute period did not increase the rate of rebleeding as well as EVD-related hemorrhagic complications. Thus, performing EVD before EVT may be beneficial by normalizing increased intracranial pressure. Especially in patients with rebleeding before the ruptured aneurysm is secured, pre-embo EVD may improve clinical outcomes at discharge.

11.
J Neurointerv Surg ; 11(4): 400-404, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30166335

RESUMO

BACKGROUND: Little has been reported about the feasibility and durability of a Low-profile Visualized Intraluminal Support Junior (LVIS Jr) Y-stenting device for wide-neck bifurcation aneurysms. PURPOSE: To evaluate the feasibility and durability of LVIS Jr Y-stenting for coiling of unruptured wide-neck bifurcation aneurysms. METHODS: We identified patients in whom LVIS Jr Y-stenting was attempted for unruptured wide-neck bifurcation aneurysms from a prospectively maintained registry of a referral hospital. Procedural success rate, treatment-related morbidity, and clinical and angiographic outcomes were retrospectively assessed. RESULTS: LVIS Jr Y-stenting was attempted for a total of 21 aneurysms in 21 patients (mean age 60±8.9 years; M:F=6:15): nine basilar artery, six anterior communicating artery, four middle cerebral artery, one internal carotid artery, and one vertebrobasilar fenestration aneurysms. The mean dome and neck size were 7.9±2.7 mm and 5.7±1.8 mm, respectively. All attempts were successful. Treatment-related morbidity occurred in one individual with a modified Rankin Scale (mRS) score of 2. Immediate postprocedural angiograms showed complete occlusion in 15 (71.4%) and neck remnant in 6 (28.6%) patients. All 21 patients had good outcomes (mRS score 0-2) for a mean of 12 months' follow-up (range 6-27 months); mRS score 0 in 20 patients and mRS score 2 in one patient, respectively. Follow-up imaging over a mean of 11 months (range 6-18 months) was available in 18 patients (85.7%). All aneurysms showed complete occlusion at follow-up. CONCLUSIONS: LVIS Jr Y-stenting and coiling for wide-neck bifurcation aneurysms seems to be feasible with acceptable safety and to provide durable aneurysm occlusion for wide-neck bifurcation aneurysms.


Assuntos
Angiografia Cerebral/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Angiografia Cerebral/tendências , Procedimentos Endovasculares/tendências , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/tendências , Resultado do Tratamento
12.
Chem Soc Rev ; 47(24): 9106-9136, 2018 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-30259933

RESUMO

Protein-based conjugates are valuable constructs for a variety of applications. Conjugation of proteins to fluorophores is commonly used to study their cellular localization and the protein-protein interactions. Modification of therapeutic proteins with either polymers or cytotoxic moieties greatly enhances their pharmacokinetics or potency. To label a protein of interest, conventional direct chemical reaction with the side-chains of native amino acids often yields heterogeneously modified products. This renders their characterization complicated, requires difficult separation steps and may impact protein function. Although modification can also be achieved via the insertion of unnatural amino acids bearing bioorthogonal functional groups, these methods can have lower protein expression yields, limiting large scale production. As a site-specific modification method, enzymatic protein labelling is highly efficient and robust under mild reaction conditions. Significant progress has been made over the last five years in modifying proteins using enzymatic methods for numerous applications, including the creation of clinically relevant conjugates with polymers, cytotoxins or imaging agents, fluorescent or affinity probes to study complex protein interaction networks, and protein-linked materials for biosensing. This review summarizes developments in enzymatic protein labelling over the last five years for a panel of ten enzymes, including sortase A, subtiligase, microbial transglutaminase, farnesyltransferase, N-myristoyltransferase, phosphopantetheinyl transferases, tubulin tyrosin ligase, lipoic acid ligase, biotin ligase and formylglycine generating enzyme.


Assuntos
Proteínas/análise , Coloração e Rotulagem/métodos , Animais , Biocatálise , Técnicas de Química Sintética/métodos , Humanos , Modelos Moleculares , Proteínas/síntese química , Proteínas/metabolismo
13.
World Neurosurg ; 119: e679-e685, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30092482

RESUMO

OBJECTIVE: To describe our experiences with microsurgical treatment of unruptured anterior choroidal artery (AchA) aneurysms, and to evaluate the incidence of and risk factors for procedure-related complications. METHODS: The study included 110 patients treated between January 2012 and December 2016. All patients met the following criteria: 1) microsurgical treatment of an unruptured AchA aneurysm was performed; and 2) clinical and radiographic follow-up data were available, including findings from preoperative digital subtraction angiography. The incidence of and risk factors for procedure-related complications were retrospectively evaluated. The χ2 test and Mann-Whitney U test were used in statistical analysis, and univariate analysis and multivariate logistic regression analysis were conducted. RESULTS: Procedure-related complications occurred in 5 patients (4.5%), including symptomatic complications in 4 patients (3.6%) and asymptomatic complications in 1 patient (0.9%). Multivariate logistic regression analysis indicated that the angle between the vertical line to the cranial base and the axis of the communicating segment of the internal carotid artery (MiC angle) (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.13-5.26; P = 0.038) and the angle between the projection line of the aneurysmal dome and the axis of the communicating segment of the internal carotid artery (DC angle) (OR, 3.82; 95% CI, 1.49-11.7; P = 0.014) were independent risk factors for procedure-related complications. CONCLUSIONS: When microsurgical treatment of unruptured AchA aneurysms was performed, the procedure-related complication rate was 4.5%. Patients with AchA aneurysms with a smaller MiC angle and smaller DC angle may be at a higher risk of procedure-related complications when undergoing microsurgical treatment.


Assuntos
Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Microcirurgia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Idoso , Angiografia Digital , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
14.
Clin Neurol Neurosurg ; 173: 110-114, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30107354

RESUMO

OBJECTIVES: Therapeutic strategies for residual or recurrent aneurysm (RRA) after microsurgical clipping have not been well established. The purpose of this study was to report our retreatment experiences with previously clipped aneurysms and to demonstrate retreatment strategies for these RRAs. PATIENTS AND METHODS: From 1996-2016, we treated 68 RRAs after previous clipping. Among them, 34 patients underwent microsurgical retreatment, and the other 34 underwent endovascular retreatment. Radiographic images and clinical data were reviewed retrospectively to determine the treatment efficacy, clinical outcomes, and important factors for selecting the proper treatment modality. RESULTS: The most common aneurysm location was the middle cerebral artery (50%) in the microsurgery group and the internal carotid artery (47.1%) in the endovascular surgery group (p = 0.001). In the microsurgery group, 16 (47.1%) patients had additional clipping without removal of previous clips, 17 (50.0%) had clipping with removal of previous clips, and 1 (2.9%) had bypass surgery with trapping. In the endovascular surgery group, 28 (82.4%) patients had simple coiling, 5 (14.7%) had stent-assisted coiling, and 1 (2.9%) had a flow diverter. Procedure-related complications during retreatment occurred in 4 (5.9%) patients. Complete obliteration was achieved in 51 (75.0%) patients (microsurgery group, 82.4% and endovascular surgery group, 67.6%; p = 0.002). CONCLUSIONS: In properly selected cases, treatment of RRAs could be safely performed either by microsurgery or endovascular surgery and result in a good clinical outcome with acceptable morbidity. The decision to choose the treatment modality for RRAs after clipping is not easy but should be considered to lower the risk of retreatment.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Microcirurgia , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Artéria Carótida Interna/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Microcirurgia/efeitos adversos , Pessoa de Meia-Idade , Artéria Cerebral Média/cirurgia , Estudos Retrospectivos , Instrumentos Cirúrgicos/efeitos adversos
15.
World Neurosurg ; 116: e1223-e1229, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29886292

RESUMO

OBJECTIVE: The purpose of this study was to report the authors' experience with endovascular treatment (EVT) of ophthalmic artery (OA) aneurysms and to investigate risk factors for visual complications of EVT for unruptured OA aneurysms. METHODS: Fifty-four patients with unruptured OA aneurysms subjected to EVT were recruited for this study from March 2010 to December 2017. The clinical and angiographic outcomes of all 54 patients were investigated and analyzed retrospectively. RESULTS: Of the 54 patients included in this study, 5 patients (9.3%) had visual complications, including asymptomatic unintended OA occlusion in 2 patients (3.7%) and symptomatic complications in 3 patients (5.6%); 2 patients (3.7%) had transient visual complications, and 1 (1.9%) had a permanent complication. No subacute or delayed visual complications occurred during the 20.8-month follow-up period. OA incorporation by the aneurysm (odds ratio [OR], 3.471; 95% confidence interval [CI], 1.115-9.184; P = 0.038) and intentional OA occlusion (OR, 1.820; 95% CI, 1.248-6.221; P = 0.044) were independent risk factors for visual complications in a multivariate logistic regression analysis. CONCLUSIONS: The visual complication rate was 9.3% when performing EVT for unruptured OA aneurysms. OA aneurysms with OA incorporation by the aneurysm might be at higher risk of visual complications when performing EVT. Intentional OA occlusion should be performed with caution, even though a patient may have favorable collaterals during balloon test occlusion.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano/terapia , Artéria Oftálmica/cirurgia , Resultado do Tratamento , Adulto , Idoso , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
16.
World Neurosurg ; 116: e266-e272, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29730098

RESUMO

OBJECTIVE: We evaluated the clinical course and significance of postoperative subdural fluid collection (SFC) and identified the patients who were at risk of developing postoperative chronic subdural hematoma (CSDH) after the clipping of unruptured intracranial aneurysms (UIAs). METHODS: Between January 2012 and June 2014, we retrospectively reviewed 298 patients with UIAs treated by microsurgical clipping. Among them, 257 patients were enrolled in the present study. Subdural lesions (SDLs) were defined as SFC at 1-month follow-up computed tomography (CT) and a CSDH at any time within 1 month after the clipping of UIAs. We examined the volume changes, Hounsfield unit (HU) values, and the end results of SFC in serial CT scans. RESULTS: The incidence of postoperative CSDH that needed burr hole surgery was 2.5%. Changes in SFC volume that occurred within 1 week of surgery were a risk factor for the occurrence of SDL at the 1-month follow-up CT (odds ratio 34.039; P < 0.001). The corrected average HU value of SCF (cut-off value: 11.9, with a sensitivity of 83.3% and specificity of 73.7%) on postoperative day 7 was an independent risk factor for development of a CSDH at the 1-month follow-up CT (odds ratio 19.261; P = 0.003). CONCLUSIONS: SDLs seen during 1-month follow-up may be associated with the occurrence of increased SFC volume within a week after the clipping of UIAs. The corrected average HU value of the SFC on postoperative day 7 was the only risk factor for the development of CSDHs at 1-month follow-up CT.


Assuntos
Hematoma Subdural Crônico/etiologia , Aneurisma Intracraniano/cirurgia , Microcirurgia/efeitos adversos , Microcirurgia/instrumentação , Complicações Pós-Operatórias/etiologia , Instrumentos Cirúrgicos/efeitos adversos , Idoso , Feminino , Seguimentos , Humanos , Incidência , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Análise de Regressão , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X
17.
Exp Ther Med ; 13(5): 2558-2564, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28565879

RESUMO

Receptors for glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) are present in vascular endothelial cells. Previous studies investigating euglycemic status have demonstrated that GIP is directly involved in the physiology of blood vessels by controlling the blood flow rate of portal veins and that GLP-1 has a protective effect on blood vessels by acting on endothelial cells. However, to the best of our knowledge, the effects of GIP and GLP-1 on endothelial cells in patients with hyperglycemia remain unknown. Therefore, the present study investigated whether the effect of the incretin hormones GLP-1 and GIP differed with regards to the reversal of endothelial cell dysfunction caused by hyperglycemia. The production of nitric oxide (NO) was measured using the Griess reagent system kit and the expression of cyclic adenosine monophosphate (cAMP) in the cell was measured at a wavelength of 405 nm with the ELISA reader using the cyclic AMP EIA kit. Exposure of human umbilical vein endothelial cells (HUVEC) to a high glucose concentration decreased NO and endothelial nitric oxide synthase (eNOS) levels but increased inducible NOS (iNOS) levels. However, when HUVECs were pretreated with GLP-1, a reduction of iNOS expression was observed and the expression of eNOS and NO were increased, as opposed to pretreatment with GIP. The results differed according to the response of cAMP, the second messenger of incretin hormones: The GIP pretreatment group did not exhibit an increase in cAMP levels while the GLP-1 pretreatment group did. The results of the present study provide evidence that GLP-1, but not GIP, has a protective effect on endothelial function associated with cardiovascular disease, as it is associated with increased eNOS expression and the levels of NO. This effect may be due to an increase in the cAMP concentration during hyperglycemic events.

18.
Korean J Radiol ; 17(6): 931-939, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27833409

RESUMO

OBJECTIVE: Few studies have investigated treatment strategies for brain tumor with a coexisting unruptured intracranial aneurysm (cUIA). The purpose of this study was to evaluate the safety and efficacy of preoperative coiling for cUIA, and subsequent brain tumor surgery. MATERIALS AND METHODS: A total of 19 patients (mean age, 55.2 years; M:F = 4:15) underwent preoperative coiling for 23 cUIAs and subsequent brain tumor surgery. Primary brain tumors were meningiomas (n = 7, 36.8%), pituitary adenomas (n = 7, 36.8%), gliomas (n = 3, 15.8%), vestibular schwannoma (n = 1, 5.3%), and Rathke's cleft cyst (n = 1, 5.3%). cUIAs were located at the distal internal carotid artery (n = 9, 39.1%), anterior cerebral artery (n = 8, 34.8%), middle cerebral artery (n = 4, 17.4%), basilar artery top (n = 1, 4.3%), and posterior cerebral artery, P1 segment (n = 1, 4.3%). The outcomes of preoperative coiling of cUIA and subsequent brain tumor surgery were retrospectively evaluated. RESULTS: Single-microcatheter technique was used in 13 cases (56.5%), balloon-assisted in 4 cases (17.4%), double-microcatheter in 4 cases (17.4%), and stent-assisted in 2 cases (8.7%). Complete cUIA occlusion was achieved in 18 cases (78.3%), while residual neck occurred in 5 cases (21.7%). The only coiling-related complication was 1 transient ischemic attack (5.3%). Neurological deterioration did not occur in any patient during the period between coiling and tumor surgery. At the latest clinical follow-up (mean, 29 months; range, 2-120 months), 15 patients (78.9%) had favorable outcomes (modified Rankin Scale, 0-2), while 4 patients (21.1%) had unfavorable outcomes due to consequences of brain tumor surgery. CONCLUSION: Preoperative coiling and subsequent tumor surgery was safe and effective, making it a reasonable treatment option for patients with brain tumor and cUIA.


Assuntos
Neoplasias Encefálicas/diagnóstico , Embolização Terapêutica/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Neoplasias Encefálicas/cirurgia , Artérias Carótidas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Stents , Resultado do Tratamento
19.
Neurointervention ; 11(2): 99-104, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27621946

RESUMO

PURPOSE: To compare clinical and angiographic outcomes between balloon-assisted (BAC) and stent-assisted coiling for internal carotid artery unruptured aneurysms (ICA-UA). MATERIALS AND METHODS: A total of 227 ICA-UA in 190 patients were treated with BAC (120 patients, 141 ICA-UA) or SAC (70 patients, 86 ICA-UA. We compared characteristics of patients and ICA-UA, and clinical and angiographic outcomes between groups. RESULTS: Aneurysm size and neck diameter were greater for SAC than in BAC, but aneurysm volume and coil packing density were not different between groups. Immediate angiographic occlusion grade was better for BAC than for SAC. Periprocedural thromboembolic events were more frequent during SAC (11.6%) than BAC (2.4%) per aneurysm, but hemorrhagic events were the opposite (2.4% for BAC and none for SAC per aneurysm) (p < 0.05). At discharge, treatment-related morbi-mortality rates were 1.6% for BAC and 1.4% per patient for SAC. At clinical follow-up (BAC, 118 patients [98.3%] for a mean of 48.4 months; SAC, 69 patients [98.6%], for a mean of 37.4 months), 1 additional treatment-related infarction occurred during SAC, resulting in a modified Rankin scale score of 4. Thus, overall treatment-related morbi-mortality rates were 1.7% in BAC and 2.9% in SAC. At imaging follow-up (BAC, 135 aneurysms [95.7%] for 28.3 months; SAC, 81 aneurysms [94.1%] for 23.9 months), BAC and SAC showed stable or improved occlusion in 94.1% and 95.0%, minor recurrence in 4.4% and 2.5%, and major recurrence in 1.5% and 2.5%, respectively. CONCLUSION: Both BAC and SAC were safe and effective techniques for ICA-UA. There were no differences in morbi-mortality and recurrence rates between groups.

20.
Environ Pollut ; 215: 314-321, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27213572

RESUMO

This study compared the two most frequently used disinfectants (i.e., chlorine and ozone) to understand their efficiency in wastewater effluents and the ecotoxicity of disinfection by-products created during chlorination and ozonation. Four trihalomethanes (THMs) and nine haloacetic acids (HAAs) were measured from a chlorine-disinfected sample and two aldehydes (i.e., formaldehydes and acetaldehydes) were analyzed after ozonation. Chlorination was effective for total coliform removal with Ct value in the range of 30-60 mg-min/L. Over 1.6 mg/L of ozone dose and 0.5 min of the contact time presented sufficient disinfection efficiency. The concentration of THMs increased with longer contact time (24 h), but that of HAAs showed little change with contact time. The measured concentration of formaldehyde at the ozone dose of 1.6 mg/L and the contact time of 9 min showed the greatest value in this study, approximately 330 µg L(-1), from which the corresponding ecotoxicity was determined using an indicator species, Daphnia magna. The ecotoxicity results were consistent with the toxicological features judged by occurrence, genotoxicity, and carcinogenicity. Both the disinfection efficiency as well as the DBP formation potential should therefore be considered to avoid harmful impacts on aquatic environments when a disinfection method is used for wastewater effluents.


Assuntos
Cloro/química , Daphnia/efeitos dos fármacos , Desinfetantes/química , Desinfecção/métodos , Halogenação , Ozônio/química , Águas Residuárias/química , Acetaldeído/análise , Acetaldeído/toxicidade , Animais , Cloro/toxicidade , Cloroacetatos/análise , Cloroacetatos/toxicidade , Desinfetantes/toxicidade , Formaldeído/análise , Formaldeído/toxicidade , Ozônio/toxicidade , Trialometanos/análise , Trialometanos/toxicidade , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/toxicidade , Purificação da Água/métodos
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