Mild hypothermia alone or in combination with anesthetic post-conditioning reduces expression of inflammatory cytokines in the cerebral cortex of pigs after cardiopulmonary resuscitation

Introduction: Hypothermia improves survival and neurological recovery after cardiac arrest. Pro-inflammatory cytokines have been implicated in focal cerebral ischemia/reperfusion in-jury. It is unknown whether cardiac arrest also triggers the release of cerebral inflammatory molecules, and whether therapeutic hypothermia alters this inflammatory response. This study sought to examine whether hypothermia or the combination of hypothermia with anes-thetic postconditioning with sevoflurane affect cerebral inflammatory response after cardio-pulmonary resuscitation. Methods: Thirty pigs (28 - 34kg) were subjected to cardiac arrest following temporary coro-nary artery occlusion. After 7 minutes of ventricular fibrillation and 2 minutes of basic life support, advanced cardiac life support was started according to the current AHA guidelines. Return of spontaneous circulation was achieved in 21 animals who were randomized to ei-ther normothermia at 38degreesC, hypothermia at 33degreesC or hypothermia at 33degreesC combined with se-voflurane (each group: n = 7) for 24 hours. The effects of hypothermia and the combination of hypothermia with sevoflurane on cerebral inflammatory response after cardiopulmonary resuscitation were studied using tissue samples from the cerebral cortex of pigs euthanized after 24 hours and employing quantitative RT-PCR and ELISA techniques. Results: Global cerebral ischemia following resuscitation resulted in significant upregulation of cerebral tissue inflammatory cytokine mRNA expression (mean +/- SD; interleukin (IL)-1beta 8.7 +/- 4.0, IL-6 4.3 +/- 2.6, IL-10 2.5 +/- 1.6, tumor necrosis factor (TNF)alpha 2.8 +/- 1.8, intercellular adhesion molecule-1 (ICAM-1) 4.0 +/- 1.9-fold compared with sham control) and IL-1beta protein concentration (1.9 +/- 0.6-fold compared with sham control). Hypothermia was associated with a significant (P <0.05 versus normothermia) reduction in cerebral inflammatory cytokine mRNA expression (IL-1beta 1.7 +/- 1.0, IL-6 2.2 +/- 1.1, IL-10 0.8 +/- 0.4, TNFalpha 1.1 +/- 0.6, ICAM-1 1.9 +/- 0.7-fold compared with sham control). These results were also confirmed for IL-1beta on protein level. Experimental settings employing hypothermia in combination with sevoflurane showed that the volatile anesthetic did not confer additional anti-inflammatory effects com-pared with hypothermia alone. Conclusions: Mild therapeutic hypothermia resulted in decreased expression of typical ce-rebral inflammatory mediators after cardiopulmonary resuscitation. This may confer, at least in part, neuroprotection following global cerebral ischemia and resuscitation

Low pain, more gain : the effect of country risk on the mode of market entry on the example of U.S. companies for over four decades

Includes bibliographical references (p. 100-111).This thesis discusses the effect of country risk of seven developing countries on the behavior of ten American multinational corporations (MNC) over four decades. It shows that country risk has the explanatory power to significantly determine the corporate behavior when entering a foreign, developing country. Aside from country risk only a few other factors could prove to have contributed to the MNCs choices how to enter the new market. Further the thesis will explains that enterprises which did choose the right combination of country risk and mode of entry were in general quite successful. The framework for the analysis is built upon the eclectic model of Hill, Hwang, and Kim; a holistic model based on several managerial theories, specific transaction-cost theory, resource-based theory and bargaining power theory. Due to this comprehensive approach the model has higher explanatory power than models based only on one of the mentioned theories. The other parts of the framework are qualitative and quantitative country risk data and 51 cases of company entries into one of the seven developing markets. The thesis shows that a pure transaction cost-model or resource-based model is insufficient to explain the choice of market entry mode and, therefore the holistic eclectic model is chosen. At the same time a resource-based view provides the hypothesis, that country risk does significantly explain the behavior of the MNCs in the last four decades. In opposition to a transaction cost-model I assume that companies will tend to choose a mode of low resource-commitment for developing markets with a high country risk and vice versa. In cases where this hypothesis does not hold true the other forces of the eclectic model will be tested to determine, which the minor significant factors are. The thesis uses the PRS Group's International Country Risk Score (ICRS) in combination with qualitative data to determine country risk for each relevant period of time during the four decades. The cases are built by a mixture of corporate data and reports on the MNCs and then combined with the found risk data, to test the hypothesis

Meaning in Life in Patients With Progressive Supranuclear Palsy

Background: Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are characterized by rapid deterioration and a fatal outcome. Objectives: Admission triggers, treatment efficacy, and care patterns. Methods: Retrospective analysis of patients with PSP/CBD admitted to an inpatient specialized palliative care service. Results: In 38 patients, there were 63 admissions for swallowing difficulties, falls, pain, impaired communication, cognitive/mood disturbances, respiratory symptoms, and infection. Mean length of stay was 11.6 days. Treatment response was variable. In 68%, of admission episodes there was stabilization or improvement, 75% were discharged home. In case of readmission, the mean interval has been 9.7 months. Time since diagnosis and admission triggers were not associated with outcome or death. Conclusion: Patients showed high symptom load contrasting with discharge rates and subsequent health care utilization. Brief multidisciplinary interventions might be helpful to preserve autonomy

Choosing an Effective and Safe Direct Aspiration Setup for Tortuous Anatomy in Acute Ischemic Stroke: In vitro Study in a Physiological Flow Model

PURPOSE  A direct aspiration first pass technique (ADAPT) is an effective thrombectomy option in patients with acute ischemic stroke. Balloon guide catheters (BGC) seem to improve the efficacy of stent retrievers and ADAPT. The last generation 6F aspiration catheters require 9F BGCs, which are rigid devices that are challenging to position in a tortuous anatomy. In this experimental study the efficacy of 6F ADAPT alone and 5F ADAPT combined with 8F BGC was evaluated. MATERIALS AND METHODS  Either a fibrin rich (white) clot or an RBC rich (red) clot was placed in the M1 segment of a transparent silicon phantom. Physiological hemodynamic conditions were maintained. The clots were retrieved by 6F aspiration catheter via 8F long sheath or 5F aspiration catheter via a flexible 8F BGC. Thrombectomy was performed under direct visual control. The primary endpoints were the number of passes and the number of distal emboli. RESULTS  Ten experiments were made with each clot model and thrombectomy technique (n = 40). Full recanalization could be achieved in every experiment. First pass mTICI 3 could be achieved by 6F ADAPT in 80 % of red clots and 90 % of white clots. Distal emboli were caused in 10 % and 20 %, respectively. When using 5F ADAPT combined with BGC, a first pass mTICI 3 rate of 90 % in red clots and 100 % in white clots could be achieved. A 10 % rate of distal emboli occurred in both groups. In almost all experiments (both techniques), the thrombi clogged the aspiration catheter. No statistically significant differences could be found between the techniques and clot models. CONCLUSION  6F ADAPT without BGC was as effective as 5F ADAPT combined with a flexible 8F BGC, with both techniques showing high first-pass recanalization rates and low distal emboli rates. Especially in the case of a tortuous anatomy, these setups should be considered as alternatives to a rigid 9F BGC. The thrombus compositions seemed to be irrelevant in this setting. KEY POINTS   · 6F ADAPT with no BGC and 5F ADAPT with BGC were very effective and performed equally.. · Both techniques should be considered in tortuous anatomy.. · In this setting the clot composition showed no effect on the recanalization rate.. CITATION FORMAT · Madjidyar J, Nerkada L, Larsen N et al. Choosing an Effective and Safe Direct Aspiration Setup for Tortuous Anatomy in Acute Ischemic Stroke: In vitro Study in a Physiological Flow Model. Fortschr Röntgenstr 2021; 193: 544 - 550

The “Shiny and Thick High Heel Sign”

Purpose!#!Together with the foramen ovale, the middle meningeal artery (MMA) looks like a high heel shoe print on axial time-of-flight magnetic resonance angiography (TOF-MRA) images, with the MMA resembling the heel. Cranial dural arteriovenous fistulas (DAVF) are often fed by the MMA, which can lead to an increase of signal intensity and diameter of this vessel, resulting in a more 'shiny' and 'thick' high heel print appearance than on the contralateral side. We describe this finding as a novel radiologic sign and provide cut-off values for the ratios of MMA signal intensities and diameters for predicting the presence of a DAVF.!##!Methods!#!A total of 84 TOF-MRA examinations of 44 patients with DAVFs (40 with unilateral MMA feeders, 4 with bilateral feeders) and of 40 patients without DAVFs were included. Diameters and signal intensities of both MMAs were measured by two raters and evaluated using receiver operating characteristic analysis.!##!Results!#!The diameters of feeding and non-feeding MMAs differed significantly, as did the ratios of signal intensities and of diameters of DAVF and control patients (P &amp;lt; 0.0001). Cut-off values were 1.25 for average signal intensity ratio (shiny high heel sign) and 1.21 for diameter ratio (thick high heel sign). The combination of the 'shiny' and the 'thick' high heel sign resulted in the highest sensitivity (92.5%) and positive predictive value (95%).!##!Conclusion!#!The described sign seems promising for the detection of DAVFs with noncontrast-enhanced MRI. The TOF-MRA source images should be reviewed with special attention to the MMA

Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions

International audiencePurpose To evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent. Methods Multicenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries. Results Overall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9–18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), respectively, this occurred during the procedure. No statistically significant difference was observed between patients with and without thrombus formation with regard to pre-existing long term medication with anticoagulants or intraprocedural administration of heparin, acetylsalicylic acid (ASA), or heparin and ASA. Favorable early neurological outcome was similar in patients with (n=15; 45.5%) and without (n=63; 49.6%) thrombus formation at the CASPER stent. Conclusion Acute thrombosis or occlusion of CASPER stents in thrombectomy patients receiving emergent extracranial internal carotid artery stenting for tandem occlusions were observed more often during the procedure than within 72 hours of follow-up, were less frequent then previously reported, and showed no impact on early neurological outcome

sj-docx-1-ine-10.1177_15910199221145985 - Supplemental material for The effect of the size of the new contour neurovascular device for altering intraaneurysmal flow

Supplemental material, sj-docx-1-ine-10.1177_15910199221145985 for The effect of the size of the new contour neurovascular device for altering intraaneurysmal flow by Mariya S Pravdivtseva, Andrey N Pravdivtsev, Sönke Peters, Johannes Hensler, Naomi Larsen, Jan-Bernd Hövener, Olav Jansen and Fritz Wodarg in Interventional Neuroradiology</p

The life and letters of Barthold Georg Niebuhr. : With essays on his character and influence /

Founded upon and translated from the "Lebensnachrichten über Barthold Georg Niebuhr", ed. by Madame Hensler.Edited and translated by Susanna Winkworth.Mode of access: Internet

The life and letters of Barthold Georg Niebuhr. With essays on his character and influence, by the chevalier Bunson, and Professors Brandis and Lorbell [!]

1 p. L., [v]-xxiii, [25]-563 p. 21 cm.Edited and translated by Susanna Winkworth.Founded upon and translated from the "Lebensnachrichten über Barthold Georg Niebuhr", ed. by Madame Hensler