Cigarette Smoke Initiates Oxidative Stress-Induced Cellular Phenotypic Modulation Leading to Cerebral Aneurysm Pathogenesis.

OBJECTIVE: Cigarette smoke exposure (CSE) is a risk factor for cerebral aneurysm (CA) formation, but the molecular mechanisms are unclear. Although CSE is known to contribute to excess reactive oxygen species generation, the role of oxidative stress on vascular smooth muscle cell (VSMC) phenotypic modulation and pathogenesis of CAs is unknown. The goal of this study was to investigate whether CSE activates a NOX (NADPH oxidase)-dependent pathway leading to VSMC phenotypic modulation and CA formation and rupture. APPROACH AND RESULTS: In cultured cerebral VSMCs, CSE increased expression of NOX1 and reactive oxygen species which preceded upregulation of proinflammatory/matrix remodeling genes (MCP-1, MMPs [matrix metalloproteinase], TNF-α, IL-1β, NF-κB, KLF4 [Kruppel-like factor 4]) and downregulation of contractile genes (SM-α-actin [smooth muscle α actin], SM-22α [smooth muscle 22α], SM-MHC [smooth muscle myosin heavy chain]) and myocardin. Inhibition of reactive oxygen species production and knockdown of NOX1 with siRNA or antisense decreased CSE-induced upregulation of NOX1 and inflammatory genes and downregulation of VSMC contractile genes and myocardin. p47phox-/- NOX knockout mice, or pretreatment with the NOX inhibitor, apocynin, significantly decreased CA formation and rupture compared with controls. NOX1 protein and mRNA expression were similar in p47phox-/- mice and those pretreated with apocynin but were elevated in unruptured and ruptured CAs. CSE increased CA formation and rupture, which was diminished with apocynin pretreatment. Similarly, NOX1 protein and mRNA and reactive oxygen species were elevated by CSE, and in unruptured and ruptured CAs. CONCLUSIONS: CSE initiates oxidative stress-induced phenotypic modulation of VSMCs and CA formation and rupture. These molecular changes implicate oxidative stress in the pathogenesis of CAs and may provide a potential target for future therapeutic strategies

Redefining Onyx HD 500 in the Flow Diversion Era

We report the largest US case series results using Onyx HD-500 (EV3), a new liquid embolic agent, in the successful treatment of 21 patients with wide-neck intracranial aneurysms (mean size 4.5 mm), which are at increased risk of incomplete occlusion or recanalization with standard endovascular intervention utilizing detachable platinum coils. All aneurysms were located in the anterior circulation, and three aneurysms presented as acute subarachnoid hemorrhages. Complete aneurysm occlusion was present in 19 of 21 patients (90%). On six-month followup, one patient with an initially small residual neck progressed to total occlusion. Aneurysm recanalization was not detected in any patients on mean follow up of 8.9 months in 11 patients. Four patients experienced transient neurologic deficits in the immediate postoperative period and one in a delayed fashion. Embolization with the liquid embolic agent Onyx appears to be a safe and effective endovascular modality of treatment for wide-neck aneurysms or recurrent aneurysms that had previously failed treatment with detachable coils

Paradoxical Worsening of Ocular Symptoms after Spontaneous Closure of a Carotid Cavernous Fistula: Case Report

We report an interesting case of a spontaneous occlusion of a carotid cavernous fistula (CCF) causing a paradoxical worsening of orbital symptoms. A 59-year-old woman presented to our institution with conjunctival injection, raised intraocular pressures (IOP) and mild exophthalmos of her left eye. A digital subtraction angiography (DSA) demonstrated a Type-D CCF draining into the left superior ophthalmic vein (SOV). The patient declined endovascular treatment. She presented 15 months later with acute exacerbation of her orbital signs and symptoms. A DSA showed no evidence of arteriovenous fistula, and a brain MRI was consistent with spontaneous thrombosis of the SOV. At her 2-week clinical assessment, the patient showed clinical improvement and her IOP were within normal limits. Spontaneous thrombosis of the SOV can trigger the obliteration of a CCF with possible paradoxical worsening of orbital symptoms. DSA is the gold standard of diagnosis and management is directed toward decreasing IOP. Introduction We present an interesting case of a type-D carotid cavernous fistula (CCF) that closed spontaneously with a paradoxical worsening of the symptoms due to thrombosis of the superior ophthalmic vein (SOV). The authors also give directives for the management of these extremely rare cases

Acute Stroke Intervention In Young Patients

Purpose: Stroke is a disease of the elderly, however it can affect the younger patients. We present a retrospective review of our series of young patients (55 years old and younger), treated at our institution from 2007 to 2012, to assess the safety, efficacy and patient outcome of multimodal endovascular treatment in this patient population. Methods: A total of 42 patients underwent multimodal endovascular revascularization for acute ischemic events. Recanalization rates were assessed using the Thrombolysis in Myocardial Infarction (TIMI)and clinical outcomes were assessed using the Modified Rankin Scale (mRS) obtained at discharge and follow-up visits. Patient demographics, medical co-morbidities, treatment complications and mortality data were collected and analyzed. Results: Of 42 patients, an improvement in Thrombolysis in Myocardial Infarction score (TIMI score) was noted in 38 patients (90.47%). The average modified Rankin Scale score on discharge was 3.2 with 25 patients (60%) having a favorable score of 0-3. All 21 patients (100%) with available clinical follow-up had a favorable mRS score (mean follow-up of 10.4 months). Symptomatic intracranial hemorrhage occurred in four patients (9.5%); none required surgery. Three fatalities resulted from intraoperative vessel rupture (7.14%). Conclusion: We observed good recanalization rates and favorable clinical outcomes after endovascular stroke intervention in young patients. Also, there was a low morbidity and mortality rate overall. Therefore multimodal endovascular recanalization of acute ischemic stroke is an effective treatment in younger patients, which justifies aggressive management of those patients

GiC Master e GiC Player: Aplicativos para Apoiar a Gamificação em Sala de Aula

This extended abstract presents two mobile applications using hybrid technologies, still under development, as part of a web platform to support the implementation of classroom gamification. Since most of the work related to gamification in education concentrates on the current decade, we believe that the existence of a tool that facilitates its use in the classroom, is of great relevance for the accomplishment of studies, seeking the understanding of positive and negative points about the use of gamification in teaching and learning

The inferior intercavernous sinus : an anatomical study with application to trans-sphenoidal approaches to the pituitary gland

CITATION: Wahl, L. et al. 2020. The inferior intercavernous sinus: An anatomical study with application to trans-sphenoidal approaches to the pituitary gland. Clinical Neurology and Neurosurgery, 196, doi:10.1016/j.clineuro.2020.106000.The original publication is available at https://www.sciencedirect.com/journal/clinical-neurology-and-neurosurgeryObjectives: The inferior intercavernous sinus is located below the pituitary gland in the sella turcica. Its presence has been controversial among anatomists because it is not always found on radiological imaging or during cadaveric dissections; however, it is becoming a better-known structure in the neurosurgical and radiological fields, specifically with respect to transsphenoidal surgery. Therefore, the present study was performed to better elucidate this structure at the skull base. Patients and methods: Fifty adult, latex injected cadavers underwent dissection. The presence or absence of the inferior cavernous sinus was evaluated and when present, measurements of its width and length were made. Its connections with other intradural venous sinuses were also documented. Results: An inferior intercavernous sinus was identified in 26 % of specimens. In all specimens, it communicated with the left and right cavernous sinus. The average width and length were 3 mm and 9.5 mm, respectively. In the sagittal plane, the inferior intercavernous sinus was positioned anteriorly in 31 %, at the nadir of the sella turcica in 38 %, and slightly posterior to the nadir of the sella turcica in 31 %. In two specimens (15.4 %), the sinus was plexiform in its shape. In one specimen a diploic vein connected the basilar venous plexus to the inferior intercavernous sinus on its deep surface. Conclusion: An improved understanding of the variable anatomy of the inferior intercavernous sinus is important in pathological, surgical, and radiological cases.https://www.sciencedirect.com/science/article/pii/S0303846720303437?via%3DihubPublishers versio