Endoscopic Surgery for Supratentorial Deep Cavernous Malformation Adjacent to Cortical Spinal Tract: Preliminary Experience and Technical Note

In this study, we aimed to introduce a technical note and to explore the efficacy of endoscopic surgery combined with diffusion tensor imaging (DTI) navigation for supratentorial deep cerebral cavernous malformations (CCM). A prospectively maintained database of CCM patients was reviewed to identify all CCM patients treated by endoscopic surgery. The sagittal T1-weighted anatomical magnetic resonance imaging (MRI) and DTI were acquired before surgery. Endoscopic surgery was planned and performed based on preoperative DTI images and intraoperative DTI navigation. All patients were followed up more than 6 months. Motor function deficit and modified Rankin scale (mRS) scores were documented on follow-up. A final mRS score of 0–2 was considered a good outcome, and a final mRS score >2 was considered a poor outcome. Second DTI and 3DT1 were performed at 3 months after surgery. We tracked the ipsilateral corticospinal tract (CST) on pre- and postoperative DTI images. The overall mean FA values and the number of fibers of tracked CST were compared on pre- and postoperative DTI images. Risk factors associated with motor deficits and poor outcomes were analyzed. Seven patients with deep CCM and treated by endoscopic surgery were enrolled in this study. The mean value of preoperative mRS was 1.5 ± 0.98, but that score recovered to 0.86 ± 1.22 3 months later. The mRS scores were improved significantly according to statistical analysis (p = 0.012). According to the Spearman non-parametric test, only the fiber number of ipsilateral CST on postoperative DTI was significantly associated with muscle strength 6 months after surgery (p = 0.032). Compared with preoperative CST characteristics on DTI, the change of FA value (p = 0.289) and fiber number (p = 0.289) of ipsilateral CST on postoperative DTI was not significant It meant that the CST was protected during endoscopic surgery. Endoscopic surgery based on DTI navigation might be an effective method to protect fiber tracts in supratentorial deep CCM patients and improve long-term outcomes. However, more studies and cases are needed to confirm our findings

Analytical Study on an Oscillating Buoy Wave Energy Converter Integrated into a Fixed Box-Type Breakwater

An oscillating buoy wave energy converter (WEC) integrated to an existing box-type breakwater is introduced in this study. The buoy is installed on the existing breakwater and designed to be much smaller than the breakwater in scale, aiming to reduce the construction cost of the WEC. The oscillating buoy works as a heave-type WEC in front of the breakwater towards the incident waves. A power take-off (PTO) system is installed on the topside of the breakwater to harvest the kinetic energy (in heave mode) of the floating buoy. The hydrodynamic performance of this system is studied analytically based on linear potential-flow theory. Effects of the geometrical parameters on the reflection and transmission coefficients and the capture width ratio (CWR) of the system are investigated. Results show that the maximum efficiency of the energy extraction can reach 80% or even higher. Compared with the isolated box-type breakwater, the reflection coefficient can be effectively decreased by using this oscillating buoy WEC, with unchanged transmission coefficient. Thus, the possibility of capturing the wave energy with the oscillating buoy WEC integrated into breakwaters is shown

Tumor Tissue Detection using Blood-Oxygen-Level-Dependent Functional MRI based on Independent Component Analysis

Accurate delineation of gliomas from the surrounding normal brain areas helps maximize tumor resection and improves outcome. Blood-oxygen-level-dependent (BOLD) functional MRI (fMRI) has been routinely adopted for presurgical mapping of the surrounding functional areas. For completely utilizing such imaging data, here we show the feasibility of using presurgical fMRI for tumor delineation. In particular, we introduce a novel method dedicated to tumor detection based on independent component analysis (ICA) of resting-state fMRI (rs-fMRI) with automatic tumor component identification. Multi-center rs-fMRI data of 32 glioma patients from three centers, plus the additional proof-of-concept data of 28 patients from the fourth center with non-brain musculoskeletal tumors, are fed into individual ICA with different total number of components (TNCs). The best-fitted tumor-related components derived from the optimized TNCs setting are automatically determined based on a new template-matching algorithm. The success rates are 100%, 100% and 93.75% for glioma tissue detection for the three centers, respectively, and 85.19% for musculoskeletal tumor detection. We propose that the high success rate could come from the previously overlooked ability of BOLD rs-fMRI in characterizing the abnormal vascularization, vasomotion and perfusion caused by tumors. Our findings suggest an additional usage of the rs-fMRI for comprehensive presurgical assessment

Early-start antiplatelet therapy after operation in patients with spontaneous intracerebral hemorrhage and high risk of ischemic events (E-start):Protocol for a multi-centered, prospective, open-label, blinded endpoint randomized controlled trial

BACKGROUND: For severe spontaneous intracerebral hemorrhage (sSICH) patients with high risk of ischemic events, the incidence of postoperative major cardiovascular/cerebrovascular and peripheral vascular events (MACCPE) is notable. Although antiplatelet therapy is a potential way to benefit these patients, the severe hemorrhagic complications, e.g., intracranial re-hemorrhage, is a barrier for early starting antiplatelet therapy. OBJECTIVES: This randomized controlled trial aims to identify the benefit and safety of early starting antiplatelet therapy after operation for sSICH patients with high risk of ischemic events. METHODS: This study is a multicenter, prospective, randomized, open-label, blinded-endpoint trial. We will enroll 250 sSICH patients with a high risk of ischemic events (including cerebral infarcts, transient ischemic attack, myocardial infarction, pulmonary embolism, and deep venous thrombosis). The participants will be randomized in a 1:1 manner to early-start group (start antiplatelet therapy at 3 days after operation) and normal-start group (start antiplatelet therapy at 30 days after operation). The early-start group will receive aspirin 100 mg daily. The control group will not receive antithrombotic therapy until 30 days after operation. The efficacy endpoint is the incidence of MACCPE, and the safety endpoint is the incidence of intracranial re-hemorrhage. DISCUSSION: The Early-Start antiplatelet therapy after operation in patients with spontaneous intracerebral hemorrhage trial (E-start) is the first randomized trial about early start antiplatelet therapy for operated sSICH patients with a high risk of ischemic events. This study will provide a new strategy and evidence for postoperative management in the future. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT04820972; Available at: https://clinicaltrials.gov/ct2/show/NCT04820972?term=NCT04820972&draw=2&rank=1. Chinese Clinical Trial Registry, identifier ChiCTR2100044560; Available at: http://www.chictr.org.cn/showproj.aspx?proj=123277

Complete genome sequence of methicillin-sensitive Staphylococcus aureus containing a heterogeneic staphylococcal cassette chromosome element

Staphylococcus aureus is a common human bacterium that sometimes becomes pathogenic, causing serious infections. A key feature of S. aureus is its ability to acquire resistance to antibiotics. The presence of the staphylococcal cassette chromosome (SCC) element in serotypes of S. aureus has been confirmed using multiplex PCR assays. The SCC element is the only vector known to carry the mecA gene, which encodes methicillin resistance in S. aureus infections. Here, we report the genome sequence of a novel methicillin-sensitive S. aureus (MSSA) strain: SCC-like MSSA463. This strain was originally erroneously serotyped as methicillin-resistant S. aureus in a clinical laboratory using multiplex PCR methods. We sequenced the genome of SCC-like MSSA463 using pyrosequencing techniques and compared it with known genome sequences of other S. aureus isolates. An open reading frame (CZ049; AB037671) was identified downstream of attL and attR inverted repeat sequences. Our results suggest that a lateral gene transfer occurred between S. aureus and other organisms, partially changing S. aureus infectivity. We propose that attL and attR inverted repeats in S. aureus serve as frequent insertion sites for exogenous genes.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000316747000011&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=8e1609b174ce4e31116a60747a720701BiologySCI(E)PubMed0ARTICLE3268-2745

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

Aim: The aim of this guideline is to present current and comprehensive recommendations for the management of brain arteriovenous malformations (bAVMs) located in eloquent areas.Methods: An extended literature search on MEDLINE was performed between Jan 1970 and May 2020. Eloquence-related literature was further screened and interpreted in different subcategories of this guideline. The writing group discussed narrative text and recommendations through group meetings and online video conferences. Recommendations followed the Applying Classification of Recommendations and Level of Evidence proposed by the American Heart Association/American Stroke Association. Prerelease review of the draft guideline was performed by four expert peer reviewers and by the members of Chinese Stroke Association.Results: In total, 809 out of 2,493 publications were identified to be related to eloquent structure or neurological functions of bAVMs. Three-hundred and forty-one publications were comprehensively interpreted and cited by this guideline. Evidence-based guidelines were presented for the clinical evaluation and treatment of bAVMs with eloquence involved. Topics focused on neuroanatomy of activated eloquent structure, functional neuroimaging, neurological assessment, indication, and recommendations of different therapeutic managements. Fifty-nine recommendations were summarized, including 20 in Class I, 30 in Class IIa, 9 in Class IIb, and 2 in Class III.Conclusions: The management of eloquent bAVMs remains challenging. With the evolutionary understanding of eloquent areas, the guideline highlights the assessment of eloquent bAVMs, and a strategy for decision-making in the management of eloquent bAVMs

Study of the human skin microbiome associated with acne vulgaris using metagenomic and metatranscriptomic approaches

Various diseases have been linked to the human microbiota, but the underlying molecular mechanisms of the human microbiota in disease pathogenesis are often poorly understood. Using acne as a disease model, my study aims to understand the functional capability changes and the molecular response of the skin microbiota to host metabolite signaling in disease pathogenesis. By metagenomic analysis, I found that the genes of a pathogenic gene island in the skin bacterium, Propionibacterium acnes, were significantly enriched in acne subjects. By metatranscriptomic analysis, I found that the transcriptional profiles of the skin microbiota separated acne patients from healthy individuals. The vitamin B12 biosynthesis pathway in P. acnes, was significantly down-regulated in acne patients. Through in-vivo and in-vitro experiments, I further demonstrated that host vitamin B12 modulates the activities of the skin microbiota and plays a signaling role in acne pathogenesis. To understand the molecular mechanism underlying the transcriptional regulation of P. acnes genes by vitamin B12, I analyzed ten putative regulatory elements in multiple P. acnes genomes and identified sequence variations among different strains. It suggests that the vitamin B12 modulation of P. acnes transcription is individual microbiome-dependent. My findings suggest a novel bacterial pathogenesis pathway in acne. My study also provides evidence that metabolite-mediated interactions between the host and the skin microbiota play essential roles in disease development. To further elucidate how the skin microbiota interacts with the host in disease pathogenesis, I have developed a protocol for enriching bacterial RNA from human skin biopsy samples, which lays a foundation for simultaneously analyzing the interactions between the skin microbiota and host cells at the transcriptional level

Hydrodynamic Investigation of an Oscillating Buoy Wave Energy Converter Integrated into a Pile-Restrained Floating Breakwater

An analytical model is developed based on linear potential flow theory and matching eigenfunction expansion technique to investigate the hydrodynamics of a two-dimensional floating structure. This structure is an integration system consisting of a breakwater and an oscillating buoy wave energy converter (WEC). It is constrained to heave motion, and linear power take-off (PTO) damping is used to calculate the absorbed power. The proposed model is verified against the published results. The proposed integrated structure is compared with the fixed structure and free heave-motion structure, respectively. The hydrodynamic properties of the integrated structure with the optimal PTO damping i.e., the transmission coefficient, reflection coefficient, capture width ratio (CWR), and heave response amplitude operator (RAO), are investigated. The effect of the PTO damping on the performance of the integrated system is also evaluated. Results indicate that with the proper adjustment of the PTO damping, the proposed integrated system can produce power efficiently. Meanwhile, the function of coastal protection can be compared with that of the fixed structure