21 research outputs found

    Current Opinions on Optimal Management of Basilar Artery Occlusion: After the BEST of BASICS Survey

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    Background The best management of basilar artery occlusion (BAO) remains uncertain. The BASICS (Basilar Artery International Cooperation Study) and the BEST (Basilar Artery Occlusion Endovascular Intervention Versus Standard Medical Treatment) trials reported neutral results. We sought to understand physicians’ approaches to BAOs and whether further BAO randomized controlled trials were warranted. Methods We conducted an online international survey from January to March 2022 to stroke neurologists and neurointerventionalists. Survey questions were designed to examine clinical and imaging parameters under which clinicians would offer (or rescind) a patient with BAO to endovascular therapy (EVT) or best medical management versus enrollment into a randomized clinical trial. Results Of >3002 invited participants, 1245 responded (41.4% response rate) from 73 countries, including 54.7% stroke neurologists and 43.6% neurointerventionalists. More than 95% of respondents would offer EVT to patients with BAO, albeit in various clinical circumstances. There were 70.0% of respondents who indicated that the BASICS and BEST trials did not change their practice. Only 22.1% of respondents would perform EVT according to anterior circulation occlusion criteria. The selection of patients for BAO EVT by clinical severity, timing, and imaging modality differed according to geography, specialty, and country income level. Over 80% of respondents agreed that further randomized clinical trials for BAO were warranted. Moreover, 45.6% of respondents indicated they would find it acceptable to enroll all trial‐eligible patients into the medical arm of a BAO trial, whereas 26.3% would not enroll. Conclusion Most stroke physicians continue to believe in the efficacy of EVT in selected patients with BAO in spite of BEST and BASICS. There is no consensus on which selection criteria to use, and few clinicians would use anterior circulation occlusion criteria for BAOs. Further randomized clinical trials for BAO are warranted

    Data from: A novel mechanism of mixing by pulsing corals

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    The dynamic pulsation of the xeniid corals is one of the most fascinating phenomena observed in coral reefs. We quantify for the first time the flow near the tentacles of these soft corals whose active pulsations are thought to enhance their symbionts' photosynthetic rates by up to an order of magnitude. These polyps are about 1 cm in diameter and pulse at frequencies between about 0.5 and 1 Hz. As a result, the frequency based Reynolds number calculated using the tentacle length and pulse frequency is on the order of 10 and rapidly decays as one moves away from the polyp. This introduces the question of how these corals minimize the reversibility of the flow and bring in new volumes of fluid during each pulse. We estimate that the Peclet number of the bulk flow generated by the coral as being on the order of 100-1000 while the flow between the bristles of the tentacles as being on the order of 10. This illustrates the importance of advective transport in removing oxygen waste. Flow measurements using particle image velocimetry reveal that the individual polyps generate a jet of water with positive vertical velocities that do not go below 1 mm/s and with average volumetric flow rates of about 700 cubic mm per second. Our results show that there is nearly continual flow in the radial direction towards the polyp with only about 3.3 percent back flow. 3D numerical simulations uncover a region of slow mixing between the tentacles during expansion. We estimate that the average flow that moves through the bristles of the tentacles are about 0.3 mm/s. The combination of nearly continual flow towards the polyp, slow mixing between the bristles, and the subsequent ejection of this fluid volume into an upward jet ensures the polyp continually samples new water with sufficient time for exchange to occur

    single_xeniid_polyp

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    This zip file contains raw images of a single xeniid coral polyp pulsing for several cycles. The coral polyp and the particles in the fluid are illuminated with a laser sheet

    four_polyp_xeniid

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    This zip file contains raw images of four xeniid coral polyps pulsing. The corals and particles in the fluid are illuminated with a laser sheet

    Severe bilateral knee osteonecrosis in a young man with human immunodeficiency virus

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    We present a young man with a background Human Immunodeficiency virus (HIV) who presented with bilateral knee pain and reduced mobility. Subsequent imaging of the knees demonstrated florid osteonecrosis (ON), which was managed conservatively. ON is seen more commonly in HIV patients than the general population, however the underlying mechanism for this association is remains unclear. An awareness of this disease is imperative to appropriately identify and manage such patients. Keywords: Osteonecrosis, Musculoskeletal disorders, HIV / AID

    Comparison of Drip‐and‐Ship Versus Mothership Delivery Models of Mechanical Thrombectomy Delivery

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    Background It remains uncertain whether the drip‐and‐ship (DS) strategy (transport to the nearest primary stroke centers) or the mothership (MS) model (direct transportation to the comprehensive stroke center) is the organizational stroke model associated with the best functional outcome in acute stroke patients with large vessel occlusion. In this study, we compared the periprocedural complications and outcomes at 90 days of acute stroke patients with large vessel occlusion of the anterior circulation directly admitted to our comprehensive stroke center compared to those referred from primary stroke centers treated with mechanical thrombectomy. Methods This is a single‐center prospective observational study where patients with DS and MS were compared regarding the disability at 90 days, as assessed by applying the modified Rankin scale, the rate of successful reperfusion, and the rate of immediate complications postprocedure. Results Of 579 patients, 216 (37.30%) were MS, and 363 (62.7%) were DS. There was no difference regarding the modified Rankin scale at 3 months between the MS (36.4%) and DS (39.3%) groups of patients treated with mechanical thrombectomy (P=0.362). There was no significant difference regarding the National Institutes of Health Stroke Scale at 24 hours, mortality at 90 days, and rate of successful recanalization postprocedure between the 2 groups. DS was associated with an increased risk of hemorrhagic transformation and symptomatic intracranial hemorrhage (odds ratio, 5.414 [95% CI, 1.572–18.644]; P=0.007). Conclusion Our single‐center study showed no difference in terms of functional independence between the DS and MS organizational paradigm. DS was associated with an increased risk of hemorrhagic transformation and symptomatic intracranial hemorrhage

    Axonal marker neurofilament light predicts long-term outcomes and progressive neurodegeneration after traumatic brain injury

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    Axonal injury is a key determinant of long-term outcomes after traumatic brain injury (TBI) but has been difficult to measure clinically. Fluid biomarker assays can now sensitively quantify neuronal proteins in blood. Axonal components such as neurofilament light (NfL) potentially provide a diagnostic measure of injury. In the multicenter BIO-AX-TBI study of moderate-severe TBI, we investigated relationships between fluid biomarkers, advanced neuroimaging, and clinical outcomes. Cerebral microdialysis was used to assess biomarker concentrations in brain extracellular fluid aligned with plasma measurement. An experimental injury model was used to validate biomarkers against histopathology. Plasma NfL increased after TBI, peaking at 10 days to 6 weeks but remaining abnormal at 1 year. Concentrations were around 10 times higher early after TBI than in controls (patients with extracranial injuries). NfL concentrations correlated with diffusion MRI measures of axonal injury and predicted white matter neurodegeneration. Plasma TAU predicted early gray matter atrophy. NfL was the strongest predictor of functional outcomes at 1 year. Cerebral microdialysis showed that NfL concentrations in plasma and brain extracellular fluid were highly correlated. An experimental injury model confirmed a dose-response relationship of histopathologically defined axonal injury to plasma NfL. In conclusion, plasma NfL provides a sensitive and clinically meaningful measure of axonal injury produced by TBI. This reflects the extent of underlying damage, validated using advanced MRI, cerebral microdialysis, and an experimental model. The results support the incorporation of NfL sampling subacutely after injury into clinical practice to assist with the diagnosis of axonal injury and to improve prognostication.</p

    Multiparametric analysis of mutants impaired for intracellular growth identified subsets with shared complex phenotypes.

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    <p>(A) Schematic diagram of the approach to analyzing the mutants. Bacterial attenuation was analyzed based on three imaging parameters (<i>Mtb</i> fluorescence intensity, percent infected, and macrophage count) and host response was analyzed based on multiplexed cytokine analysis for each mutant. The phenotypes for each mutant were then combined into a multiparametric analysis as described in B. (B) Unsupervised 2-D clustering of mutants based on a multiparametric representation of their phenotypes. This analysis combines the four host response clusters (top 4 rows) and three bacterial imaging clusters (bottom 3 rows). Each column represents one of the 113 mutants included in the analysis. Colors indicate low (blue) to high (red) normalized values for each phenotype. Mutants cluster into five groups (Clusters I-V). Mutants in the PDIM locus (labels in orange) and ESX-1 locus (labels in green) group together in Cluster V. (C) Contribution of each bacterial imaging phenotype (bacterial replication, host survival, and % infected: orange vectors) and clustered cytokine response phenotype (cyt-1, cyt-2, cyt-3, and cyt-4: black vectors) to principal component 1 (PC1) and principal component 2 (PC2) of the principal component analysis. PC1 is comprised almost entirely of cytokine phenotypes while PC2 is comprised almost entirely of bacterial imaging features, suggesting that the two sets of features represent orthogonal and complementary information. (D) The 113 mutants included in the multiparametric analysis separate when plotted by PC1 and PC2. Included mutants were those that induced macrophage responses most distinct from the response to wild-type <i>Mtb</i>. Coloring of mutant clusters reflects mapping of the analysis performed in 2D back to the PC1/PC2 graph.</p

    ï»żCitizen scientists track a charismatic carnivore: Mapping the spread and impact of the South African Mantis (Miomantidae, Miomantis caffra) in Australia

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    The recent integration of citizen science with modern technology has greatly increased its applications and has allowed more people than ever to contribute to research across all areas of science. In particular, citizen science has been instrumental in the detection and monitoring of novel introduced species across the globe. This study provides the first records of Miomantis caffra Saussure, 1871, the South African Mantis, from the Australian mainland and uses records from four different citizen science and social media platforms in conjunction with museum records to track the spread of the species through the country. A total of 153 wild mantises and oothecae were observed across four states and territories (New South Wales, Norfolk Island, Victoria, and Western Australia) between 2009 and 2021. The large number of observations of the species in Victoria and the more recent isolated observations in other states and territories suggest that the species initially arrived in Geelong via oothecae attached to plants or equipment, likely from the invasive population in New Zealand. From there it established and spread outwards to Melbourne and eventually to other states and territories, both naturally and with the aid of human transport. We also provide a comparison of M. caffra to similar native mantises, specifically Pseudomantis albofimbriata (StÄl, 1860), and comment on the potential impact and further spread of the species within Australia. Finally, we reiterate the many benefits of engaging directly with citizen scientists in biodiversity research and comment on the decision to include them in all levels of this research investigation
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