Correlation between ASPECTS and Core Volume on CT Perfusion: Impact of Time since Stroke Onset and Presence of Large-Vessel Occlusion

BACKGROUND AND PURPOSE: Both ASPECTS and core volume on CTP are used to estimate infarct volume in acute ischemic stroke. To evaluate the potential role of ASPECTS for acute endovascular treatment decisions, we studied the correlation between ASPECTS and CTP core, depending on the timing and the presence of large-vessel occlusion. MATERIALS AND METHODS: We retrospectively reviewed all MCA acute ischemic strokes with standardized reconstructions of CTP maps entered in the Acute STroke Registry and Analysis of Lausanne (ASTRAL) registry. Correlation between ASPECTS and CTP core was determined for early (,6 hours) versus late (6–24 hours) times from stroke onset and in the presence versus absence of large-vessel occlusion. We used correlation coefficients and adjusted multiple linear regression models. RESULTS: We included 1046 patients with a median age of 71.4 years (interquartile range, IQR ¼ 59.8–79.4 years), an NIHSS score of 12 (IQR, 6–18), an ASPECTS of 9 (IQR, 7–10), and a CTP core of 13.6 mL (IQR, 0.6–52.8 mL). The overall correlation between ASPECTS and CTP core was moderate (r ¼ –0.49, P , .01) but significantly stronger in the late-versus-early window (r ¼ –0.56 and r ¼ – 0.48, respectively; P ¼ .05) and in the presence versus absence of large-vessel occlusion (r ¼ –0.40 and r ¼ –0.20, respectively; P , .01). In the regression model, the independent association between ASPECTS and CTP core was confirmed and was twice as strong in late-arriving patients with large-vessel occlusion (b ¼ –0.21 per 10 mL; 95% CI, 0.27 to –0.15; P , .01) than in the overall population (b ¼ –0.10; 95% CI, 0.14 to –0.07; P , .01). CONCLUSIONS: In a large cohort of patients with acute ischemic stroke, we found a moderate correlation between ASPECTS and CTP core. However, this was stronger in patients with large-vessel occlusion and longer delay from stroke onset. Our results could support the use of ASPECTS as a surrogate marker of CTP core in late-arriving patients with acute ischemic stroke with large-vessel occlusion

Procedural Complications During Early Versus Late Endovascular Treatment in Acute Stroke: Frequency and Clinical Impact

BACKGROUND AND PURPOSE: Endovascular treatment (EVT) in acute ischemic stroke is effective in the late time window in selected patients. However, the frequency and clinical impact of procedural complications in the early versus late time window has received little attention. METHODS: We retrospectively studied all acute ischemic strokes from 2015 to 2019 receiving EVT in the Acute Stroke Registry and Analysis of Lausanne. We compared the procedural EVT complications in the early (<6 hours) versus late (6-24 hours) window and correlated them with short-term clinical outcome. RESULTS: Among 695 acute ischemic strokes receiving EVT (of which 202 were in the late window), 113 (16.3%) had at least one procedural complication. The frequency of each single, and for overall procedural complications was similar for early versus late EVT (16.2% versus 16.3%, Padj=0.90). Procedural complications lead to a significantly less favorable short-term outcome, reflected by the absence of National Institutes of Health Stroke Scale improvement in late EVT (delta-National Institutes of Health Stroke Scale-24 hours, -2.5 versus 2, Padj=0.01). CONCLUSIONS: In this retrospective analysis of consecutive EVT, the frequency of procedural complications was similar for early and late EVT patients but very short-term outcome seemed less favorable in late EVT patients with complications

Early-versus-Late Endovascular Stroke Treatment: Similar Frequencies of Nonrevascularization and Postprocedural Cerebrovascular Complications in a Large Single-Center Cohort Study.

Endovascular treatment of acute ischemic stroke is now performed more frequently in the late window in radiologically selected patients. However, little is known about whether the frequency and clinical impact of incomplete recanalization and postprocedural cerebrovascular complications differ between early and late windows in the real world. We retrospectively reviewed all patients with acute ischemic stroke receiving endovascular treatment within 24 hours from 2015 to 2019 and included in the Acute STroke Registry and Analysis of Lausanne. We compared rates of incomplete recanalization and postprocedural cerebrovascular complications (parenchymal hematoma, ischemic mass effect, and 24-hour re-occlusion) in the early (&lt;6 hours) versus late window (6-24 hours, including patients with unknown onset) populations and correlated them with the 3-month clinical outcome. Among 701 patients with acute ischemic stroke receiving endovascular treatment, 29.2% had late endovascular treatment. Overall, incomplete recanalization occurred in 56 patients (8%), and 126 patients (18%) had at least 1 postprocedural cerebrovascular complication. The frequency of incomplete recanalization was similar in early and late endovascular treatment (7.5% versus 9.3%, adjusted P =.66), as was the occurrence of any postprocedural cerebrovascular complication (16.9% versus 20.5%, adjusted P = .36). When analyzing single postprocedural cerebrovascular complications, rates of parenchymal hematoma and ischemic mass effect were similar (adjusted P = .71, adjusted P = .79, respectively), but 24-hour re-occlusion seemed somewhat more frequent in late endovascular treatment (4% versus 8.3%, unadjusted P = .02, adjusted P = .40). The adjusted 3-month clinical outcome in patients with incomplete recanalization or postprocedural cerebrovascular complications was comparable between early and late groups (adjusted P = .67, adjusted P = .23, respectively). The frequency of incomplete recanalization and of cerebrovascular complications occurring after endovascular treatment is similar in early and well-selected late patients receiving endovascular treatment. Our results demonstrate the technical success and safety of endovascular treatment in well-selected late patients with acute ischemic stroke

Bioaccumulation of total mercury in the earthworm Eisenia andrei

Earthworms are a major part of the total biomass of soil fauna and play a vital role in soil maintenance. They process large amounts of plant and soil material and can accumulate many pollutants that may be present in the soil. Earthworms have been explored as bioaccumulators for many heavy metal species such as Pb, Cu and Zn but limited information is available for mercury uptake and bioaccumulation in earth- worms and very few report on the factors that influence the kinetics of Hg uptake by earthworms. It is known however that the uptake of Hg is strongly influenced by the presence of organic matter, hence the influence of ligands are a major factor contribut - ing to the kinetics of mercury uptake in biosystems. In this work we have focused on the uptake of mercury by earthworms ( Eisenia andrei ) in the presence of humic acid (HA) under varying physical conditions of pH and temperature, done to assess the role of humic acid in the bioaccumulation of mercury by earthworms from soils. The study was conducted over a 5-day uptake period and all earthworm samples were analysed by direct mercury analysis. Mercury distribution profiles as a function of time, bioac- cumulation factors (BAFs), first order rate constants and body burden constants for mercury uptake under selected conditions of temperature, pH as well as via the dermal and gut route were evaluated in one comprehensive approach. The results showed that the uptake of Hg was influenced by pH, temperature and the presence of HA. Uptake of Hg 2 + was improved at low pH and temperature when the earthworms in soil were in contact with a saturating aqueous phase. The total amount of Hg 2 + uptake decreased from 75 to 48 % as a function of pH. For earthworms in dry soil, the uptake was strongly influenced by the presence of the ligand. Calculated BAF values ranged from 0.1 to 0.8. Mercury uptake typically followed first order kinetics with rate constants determined as 0.2 to 1 h ? 1 .Scopus 201

Reperfusion Injury after ischemic Stroke Study (RISKS): single-centre (Florence, Italy), prospective observational protocol study

Introduction Treatments aiming at reperfusion of the acutely ischaemic brain tissue may result futile or even detrimental because of the so-called reperfusion injury. The processes contributing to reperfusion injury involve a number of factors, ranging from blood\u2013brain barrier (BBB) disruption to circulating biomarkers. Our aim is to evaluate the relative effect of imaging and circulating biomarkers in relation to reperfusion injury. Methods and analysis Observational hospital-based study that will include 140 patients who had ischaemic stroke, treated with systemic thrombolysis, endovascular treatment or both. BBB disruption will be assessed with CT perfusion (CTP) before treatment, and levels of a large panel of biomarkers will be measured before intervention and after 24 hours. Relevant outcomes will include: (1) reperfusion injury, defined as radiologically relevant haemorrhagic transformation at 24 hours and (2) clinical status 3 months after the index stroke. We will investigate the separate and combined effect of pretreatment BBB disruption and circulating biomarkers on reperfusion injury and clinical status at 3 months. Study protocol is registered at http://www. clinicaltrials. gov ( ClinicalTrials. gov ID: NCT03041753). Ethics and dissemination The study protocol has been approved by ethics committee of the Azienda Ospedaliero Universitaria Careggi (Universit\ue0 degli Studi di Firenze). Informed consent is obtained by each patient at time of enrolment or deferred when the participant lacks the capacity to provide consent during the acute phase. Researchers interested in testing hypotheses with the data are encouraged to contact the corresponding author. Results from the study will be disseminated at national and international conferences and in medical thesis. Trial registration number NCT03041753

Caratterizzazione geochimica dei suoli dell'area urbana di Siena ed utilizzo dei lombrichi come bioindicatori

Nelle aree urbane il traffico veicolare rappresenta una delle principali fonti di contaminazione dell’ambiente di superficie, la cui chimica, in seguito alla variazione qualitativa e quantitativa dei contaminanti immessi, è soggetta ad una continua trasformazione. Nell’area di Siena è in fase di realizzazione una ricerca geochimica finalizzata alla valutazione dell’impatto del traffico veicolare sull’ambiente di superficie attraverso la determinazione dei contenuti di elementi in traccia in differenti comparti di esposizione: aria, suolo, organismi vegetali ed animali. Siena è una città di dimensioni medio-piccole, dove le attività industriali sono limitate; pertanto nell’area urbana la principale fonte di contaminanti è rappresentata dal traffico veicolare a cui, in inverno, si aggiunge l’apporto fornito dal riscaldamento domestico. In questo lavoro sono riportati i risultati preliminari inerenti le concentrazioni di elementi in traccia di interesse ambientale (per es., piombo, antimonio, cadmio, nichel, rame e zinco) in suoli ed esemplari di lombrico della specie Nicodrilus caliginosus (Savigny), campionati in siti urbani, peri-urbani ed extra-urbani di Siena. Nell’ambito della ricerca sono stati determinati i contenuti totali degli elementi: Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Pd, Pt, Rh, Sb, U e Zn, nonché la loro ripartizione nelle principali frazioni del suolo (estraibile, riducibile, ossidabile e residuale) allo scopo di definire la mobilità delle specie chimiche di interesse e stabilire le relazioni che intercorrono con l’assorbimento da parte dei lombrichi. Come bioindicatori della qualità del suolo sono stati utilizzati i lombrichi (Anellidi appartenenti alla famiglia Lumbricidae) poiché in grado di assorbire ed accumulare gli elementi chimici sia attraverso l’assorbimento dermale sia mediante l’ingestione delle particelle di suolo. I dati analitici prodotti hanno indicato che piombo ed antimonio sono gli elementi chimici maggiormente influenzati dalla circolazione veicolare, con le più elevate concentrazioni medie registrate nei suoli urbani (Pb=112.5 mg/kg; Sb=5.6 mg/kg). Per cadmio, manganese, rame e zinco è stato riscontrato nei suoli dei siti interessati dal traffico su strada un minore incremento delle concentrazioni rispetto al background geochimico locale. Per gli altri elementi chimici analizzati (cobalto, cromo, ferro, nichel, uranio e platinoidi) non è stata rilevata nessuna variazione significativa della loro abbondanza nei suoli dell’area di studio. Negli esemplari di lombrico le concentrazioni degli elementi chimici analizzati delineano un modello di distribuzione analogo a quello descritto per i contenuti totali nel suolo. Zinco e cadmio sono risultati gli unici elementi bioconcentrati, con contenuti nel lombrico che superano di un ordine di grandezza quelli del suolo

Soil properties and metal accumulation by earthworms in the Siena urban area (Italy)

This paper reports the results of a study focused on the metal (Cd, Co, Cr, Cu, Ni, Pb, Sb, U and Zn) distri-bution in soils and uptake and accumulation by earthworms Nicodrilus caliginosus (Savigny) from urban,peri-urban, green-urban and non-urban zones of Siena municipality (central Italy). The main goal wasto define the influence of soil properties and metal soil contents on the uptake of these contaminantsby earthworms. Data indicated that Cd, Cu, Pb, Sb and Zn soil contents increased in the following order:non-urban &lt; green-urban &lt; peri-urban &lt; urban soils, suggesting that vehicular traffic affects the distribu-tion of these metals. Pb and Sb were the main soil contaminants and their highest enrichments werefound in urban sites where stop-and-go traffic occurs. Concentrations of these traffic-related metals inearthworms showed a distribution pattern similar to that in soil, suggesting that soil contamination influ-enced the uptake of Cd, Cu, Pb, Sb and Zn by N. caliginosus. There were significant positive correlationsbetween Cd, Pb and Sb earthworm concentrations and their soil contents. The lack of correlation for Cuand Zn could be due to the physiological regulation of these elements by earthworms. Statistical analysispointed out that the uptake and accumulation of Cd, Cu, Pb, Sb and Zn by earthworms were affected bysome soil physicochemical properties such as the organic carbon and carbonate contents that are able torule the bioavailability of metals in soils