Directed evolution to increase camptothecin sensitivity of human DNA topoisomerase I

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Cerebral blood volume ASPECTS is the best predictor of clinical outcome in acute ischemic stroke: A retrospective, combined semi-quantitative and quantitative assessment

INTRODUCTION:The capability of CT perfusion (CTP) Alberta Stroke Program Early CT Score (ASPECTS) to predict outcome and identify ischemia severity in acute ischemic stroke (AIS) patients is still questioned. METHODS:62 patients with AIS were imaged within 8 hours of symptom onset by non-contrast CT, CT angiography and CTP scans at admission and 24 hours. CTP ASPECTS was calculated on the affected hemisphere using cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) maps by subtracting 1 point for any abnormalities visually detected or measured within multiple cortical circular regions of interest according to previously established thresholds. MTT-CBV ASPECTS was considered as CTP ASPECTS mismatch. Hemorrhagic transformation (HT), recanalization status and reperfusion grade at 24 hours, final infarct volume at 7 days and modified Rankin scale (mRS) at 3 months after onset were recorded. RESULTS:Semi-quantitative and quantitative CTP ASPECTS were highly correlated (p<0.00001). CBF, CBV and MTT ASPECTS were higher in patients with no HT and mRS ≤ 2 and inversely associated with final infarct volume and mRS (p values: from p<0.05 to p<0.00001). CTP ASPECTS mismatch was slightly associated with radiological and clinical outcomes (p values: from p<0.05 to p<0.02) only if evaluated quantitatively. A CBV ASPECTS of 9 was the optimal semi-quantitative value for predicting outcome. CONCLUSIONS:Our findings suggest that visual inspection of CTP ASPECTS recognizes infarct and ischemic absolute values. Semi-quantitative CBV ASPECTS, but not CTP ASPECTS mismatch, represents a strong prognostic indicator, implying that core extent is the main determinant of outcome, irrespective of penumbra size

Early Combined Percutaneous Aortic Valvuloplasty and Carotid Endarterectomy In A Patient With Minor Ischemic Stroke and High Perioperative Risk

Objectives: Here, we present the case of L.B., a 68-year-old Caucasian male patient who reported a sudden onset of right upper limb weakness and transient visual disturbance. Materials and methods: Therefore, he was referred to ER of S. Anna University Hospital of Ferrara. His medical history included moderate aortic valve stenosis due to previous rheumatic heart disease at early age, dyslipid- emia, hypertension and not significant epi-aortic trunks atherosclerosis. Arrived at the Hospital on May 24th 2020, neurological evaluation document- ed just a slight weakness of right upper limb (NIHSS 1); accordingly, he performed urgent brain CT, showing no acute lesions, and he was admitted to the Stroke Unit. A Carotid US was carried out, which showed an iso- hypoechogenic ulcerated plaque with hemodynamic stenosis of 70% at the origin of the left internal carotid artery; patient also underwent echocardiog- raphy, which documented an evolution of the previously known aortic valve stenosis in severe degree stenosis (left ventricular outflow tract diameter 2.3 cm, Aortic valve area 0,87 cm2 ). Results: Considered neurological and instrumental findings, an indi- cation was given for very early carotid TEA, but this was contraindicated for the high operative risk linked to the cardiac condition. Hence, on May 26th 2020, the patient underwent a coronary angiography + balloon percutaneous aortic valvuloplasty (inflation of a 20 ml balloon), as a bridge procedure in order to perform early carotid TEA intervention dur- ing the same day (after a few hours). Discussion and Conclusion: These procedures were carried out with- out complications and the patient had full neurological recovery at dis- charge, one week later. Furthermore, coronary angiography showed a critical stenosis of the middle tract of the LAD with a subcritical stenosis of common trunk. Thus, the patient was listed for a CABG and definitive surgical aortic valve replacement

Brain unidentified bright objects ("UBO") in systemic lupus erythematosus: sometimes they come back. A study of microembolism by cMRI and Transcranial Doppler ultrasound

The objectives of this report are to assess the occurrence of microembolic signals (MES) detected by transcranial Doppler ultrasound (TCD) in systemic lupus erythematosus (SLE) patients with (NPSLE) and without (SLE) neuropsychiatric involvement, and to verify the correlation between MES, clinical characteristics, especially the patent foramen ovale (PFO), and the presence of punctuate T2-hyperintense white matter lesions (WMHLs) detected by conventional magnetic resonance imaging (cMRI).Objectives The objectives of this report are to assess the occurrence of microembolic signals (MES) detected by transcranial Doppler ultrasound (TCD) in systemic lupus erythematosus (SLE) patients with (NPSLE) and without (SLE) neuropsychiatric involvement, and to verify the correlation between MES, clinical characteristics, especially the patent foramen ovale (PFO), and the presence of punctuate T2-hyperintense white matter lesions (WMHLs) detected by conventional magnetic resonance imaging (cMRI).Methods A TCD registration to detect MES from the middle cerebral artery was carried out in SLE and NPSLE patients after exclusion of aortic and/or carotid atheromatous disease. In all patients conventional brain magnetic resonance imaging (cMRI) and transesophageal echocardiography were performed. Patients were stratified in two groups, with and without WMHLs, and compared.Results Twenty-three SLE patients (16 NPSLE and seven SLE) were enrolled in the study. Overall MES were detected in 12 patients (52.1%), WHMLs were detectable in 15 patients (13 NPSLE and two SLE) while eight patients had normal cMRI (three NPSLE and five SLE). Matching TCD ultrasound and neuroimaging data, MES were detected in 10 (nine NPSLE and one SLE) out of 15 patients with WHMLs and in only two out of eight patients (two NPSLE and six SLE) with normal cMRI, both with NP involvement. A PFO was confirmed in all cases of MES detection.Conclusion MES are frequent findings in SLE patients, especially in those with focal WMHLs detected by cMRI and correlating with PFO. These findings should be taken into account and suggest caution in the interpretation of cMRI pictures along with a careful evaluation of MES in patients with cMRI abnormalities that should be included in the workup of SLE patients