Comparison of the Clinical Efficacy and Safety of Standard and Ultrasound-Assisted Thrombolysis for Pulmonary Embolism: A Systematic Review and Meta-Analysis.

PURPOSE: Catheter-directed therapy has been increasingly used in acute pulmonary embolism (PE). Whether ultrasound-assisted thrombolysis (USAT) is superior to standard catheter-directed thrombolysis (SCDT) remains unclear. This is a systemic review and meta-analysis of comparative trials on USAT and SCDT for PE to determine whether either modality yielded better clinical efficacy and safety. MATERIALS AND METHOD: Major databases including PubMed, Embase, Cochrane Central, and Web of Science were searched through March 16, 2023. Studies that reported outcomes of SCDT and USAT for acute PE were included. Studies reported data on therapeutic efficacy (a reduction in the right ventricle [RV]/left ventricle [LV] ratio, a reduction in the systolic pulmonary artery pressure [mm Hg], change in Miller index, length of intensive care unit [ICU] and hospital stay) and safety outcomes (in-hospital mortality, overall and major bleeding events). RESULTS: A total of 9 studies with 2610 patients were included in the meta-analysis. The analysis showed significantly greater improvement in the RV/LV ratio in the SCDT group than in the USAT group (mean difference [MD]: -0.155; 95% confidence interval [CI]: -0.249 to -0.006). No statistically significant differences were found between groups comparing change in systolic pulmonary artery pressure (MD: 0.592 mm Hg; 95% CI: -2.623 to 3.807), change in Miller index (MD: -4.1%; 95% CI: -9.5 to 1.3%), hospital stay (MD: 0.372 days; 95% CI: -0.972 to 1.717), and ICU stay (MD: -0.073.038 days; 95% CI: -1.184 to 1). No significant difference was noted in safety outcomes, including in-hospital mortality (pooled odds ratio: 0.984; 95% CI: 0.597 to 1.622), and major bleeding (pooled odds ratio: 1.162; 95% CI: 0.714 to 1.894). CONCLUSIONS: In our meta-analysis of observational and randomized studies, USAT is not superior to SCDT in patients with acute PE.INSPLAY registration number: INPLASY202240082. CLINICAL IMPACT: This study compared SCDT and USAT in patients with acute pulmonary embolism. We found no additional benefit in PA pressure change, thrombus reduction, hospital stay, mortality and major bleeding rate. Additional study using consistent treatment protocol is necessary for further investigation.

Inhibition of Glutamate Release from Rat Cortical Nerve Terminals by Dehydrocorydaline, an Alkaloid from Corydalis yanhusuo.

Excessive release of glutamate induces excitotoxicity and causes neuronal damage in several neurodegenerative diseases. Natural products have emerged as potential neuroprotective agents for preventing and treating neurological disorders. Dehydrocorydaline (DHC), an active alkaloid compound isolated from Corydalis yanhusuo, possesses neuroprotective capacity. The present study investigated the effect of DHC on glutamate release using a rat brain cortical synaptosome model. Our results indicate that DHC inhibited 4-aminopyridine (4-AP)-evoked glutamate release and elevated intrasynaptosomal calcium levels. The inhibitory effect of DHC on 4-AP-evoked glutamate release was prevented in the presence of the vesicular transporter inhibitor bafilomycin A1 and the N- and P/Q-type Ca2+ channel blocker ω-conotoxin MVIIC but not the intracellular inhibitor of Ca2+ release dantrolene or the mitochondrial Na+/Ca2+ exchanger inhibitor CGP37157. Moreover, the inhibitory effect of DHC on evoked glutamate release was prevented by the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) inhibitor PD98059. Western blotting data in synaptosomes also showed that DHC significantly decreased the level of ERK1/2 phosphorylation and synaptic vesicle-associated protein synapsin I, the main presynaptic target of ERK. Together, these results suggest that DHC inhibits presynaptic glutamate release from cerebrocortical synaptosomes by suppressing presynaptic voltage-dependent Ca2+ entry and the MAPK/ERK/synapsin I signaling pathway.

Deep Learning-Based Classification and Semantic Segmentation of Lung Tuberculosis Lesions in Chest X-ray Images.

We present a deep learning (DL) network-based approach for detecting and semantically segmenting two specific types of tuberculosis (TB) lesions in chest X-ray (CXR) images. In the proposed method, we use a basic U-Net model and its enhanced versions to detect, classify, and segment TB lesions in CXR images. The model architectures used in this study are U-Net, Attention U-Net, U-Net++, Attention U-Net++, and pyramid spatial pooling (PSP) Attention U-Net++, which are optimized and compared based on the test results of each model to find the best parameters. Finally, we use four ensemble approaches which combine the top five models to further improve lesion classification and segmentation results. In the training stage, we use data augmentation and preprocessing methods to increase the number and strength of lesion features in CXR images, respectively. Our dataset consists of 110 training, 14 validation, and 98 test images. The experimental results show that the proposed ensemble model achieves a maximum mean intersection-over-union (MIoU) of 0.70, a mean precision rate of 0.88, a mean recall rate of 0.75, a mean F1-score of 0.81, and an accuracy of 1.0, which are all better than those of only using a single-network model. The proposed method can be used by clinicians as a diagnostic tool assisting in the examination of TB lesions in CXR images.

Paraplegia following spinal anesthesia in a patient with an undiagnosed metastatic spinal tumor.

Although extremely rare, paraplegia can be a complication following spinal anesthesia if the patient has a previously unrecognized spinal tumor. We describe a 75-year-old male patient who underwent retrograde ureteroscopic examination under spinal anesthesia. He developed complete paraplegia 24 hours later. Magnetic resonance imaging (MRI) revealed bone metastasis to T10, a vertebral body mass lesion at L3, and an epidural mass at T9-11 with cord compression. The aim of this case report is to highlight the importance of neurological examination of patients undergoing neuraxial block both in the pre-anesthetic interview and postoperative examination in the recovery period. Careful observation of the postoperative course is essential to exclude any possible neurological complications. If motor and sensory functions do not satisfactorily recover, an MRI examination should be undertaken without delay to determine whether the underlying pathology is treatable or reversible.