Strategies to improve spinal cord ischemia in endovascular thoracic aortic repair: Outcomes of a prospective cerebrospinal fluid drainage protocol

PurposeAlthough endovascular repair of thoracic aortic aneurysm has been shown to reduce the morbidity and mortality rates, spinal cord ischemia remains a persistent problem. We evaluated our experience with spinal cord protective measures using a standardized cerebrospinal fluid (CSF) drainage protocol in patients undergoing endovascular thoracic aortic repair.MethodsFrom 2004 to 2006, 121 patients underwent elective (n = 52, 43%) and emergent (n = 69, 57%) endovascular thoracic aortic stent graft placement for thoracic aortic aneurysm (TAA) (n = 94, 78%), symptomatic penetrating ulceration (n = 11, 9%), pseudoaneurysms (n = 5, 4%) and traumatic aortic transactions (n = 11, 9%). In 2005, routine use of a CSF drainage protocol was established to minimize the risks of spinal cord ischemia. The CSF was actively drained to maintain pressures <15 mm Hg and the mean arterial blood pressures were maintained at ≥90 mm Hg. Data was prospectively collected in our vascular registry for elective and emergent endovascular thoracic aortic repair and the patients were divided into 2 groups (+CSF drainage protocol, −CSF drainage protocol). A χ2 statistical analysis was performed and significance was assumed for P < .05.ResultsOf the 121 patients with thoracic stent graft placement, the mean age was 72 years, 62 (51%) were male, and 56 (46%) underwent preoperative placement of a CSF drain, while 65 (54%) did not. Both groups had similar comorbidities of coronary artery disease (24 [43%] vs 27 [41%]), hypertension (44 [79%] vs 50 [77%]), chronic obstructive pulmonary disease (18 [32%] vs 22 [34%]), and chronic renal insufficiency (10 [17%] vs 12 [18%]). None of the patients with CSF drainage developed spinal cord ischemia (SCI), and 5 (8%) of the patients without CSF drainage developed SCI within 24 hours of endovascular repair (P< .05). All patients with clinical symptoms of SCI had CSF drain placement and augmentation of systemic blood pressures to ≥90 mm Hg, and 60% (3 of 5 patients) demonstrated marked clinical improvement.ConclusionPerioperative CSF drainage with augmentation of systemic blood pressures may have a beneficial role in reducing the risk of paraplegia in patients undergoing endovascular thoracic aortic stent graft placement. However, selective CSF drainage may offer the same benefit as mandatory drainage

Radical remodeling of the Y chromosome in a recent radiation of malaria mosquitoes

open28openHall A.B.; Papathanos P.-A.; Sharma A.; Cheng C.; Akbari O.S.; Assour L.; Bergman N.H.; Cagnetti A.; Crisanti A.; Dottorini T.; Fiorentini E.; Galizi R.; Hnath J.; Jiang X.; Koren S.; Nolan T.; Radune D.; Sharakhova M.V.; Steele A.; Timoshevskiy V.A.; Windbichler N.; Zhang S.; Hahn M.W.; Phillippy A.M.; Emrich S.J.; Sharakhov I.V.; Tu Z.J.; Besansky N.J.Hall, A. B.; Papathanos, P. -A.; SHARMA DHAKAL, Apsara; Cheng, C.; Akbari, O. S.; Assour, L.; Bergman, N. H.; Cagnetti, A.; Crisanti, A.; Dottorini, T.; Fiorentini, E.; Galizi, R.; Hnath, J.; Jiang, X.; Koren, S.; Nolan, T.; Radune, D.; Sharakhova, M. V.; Steele, A.; Timoshevskiy, V. A.; Windbichler, N.; Zhang, Shangu; Hahn, M. W.; Phillippy, A. M.; Emrich, S. J.; Sharakhov, I. V.; Tu, Z. J.; Besansky, N. J

Speech and Non-Speech Audio-Visual Illusions: A Developmental Study

It is well known that simultaneous presentation of incongruent audio and visual stimuli can lead to illusory percepts. Recent data suggest that distinct processes underlie non-specific intersensory speech as opposed to non-speech perception. However, the development of both speech and non-speech intersensory perception across childhood and adolescence remains poorly defined. Thirty-eight observers aged 5 to 19 were tested on the McGurk effect (an audio-visual illusion involving speech), the Illusory Flash effect and the Fusion effect (two audio-visual illusions not involving speech) to investigate the development of audio-visual interactions and contrast speech vs. non-speech developmental patterns. Whereas the strength of audio-visual speech illusions varied as a direct function of maturational level, performance on non-speech illusory tasks appeared to be homogeneous across all ages. These data support the existence of independent maturational processes underlying speech and non-speech audio-visual illusory effects

Affinity and structure of complexes of tropomyosin and caldesmon domains.

The interaction of caldesmon domains with tropomyosin has been studied using x-ray crystallography and an optical biosensor. Only whole caldesmon and the carboxyl-terminal domain of caldesmon (CaD-4, chicken gizzard residues 597-756) bound to tropomyosin with greater than millimolar affinity at 100 and 150 microM salt. Under these conditions the affinities of whole caldesmon and CaD-4 were both in the micromolar range. Data from the x-ray studies showed that whole caldesmon bound to tropomyosin in several places, with the region of tightest interaction being at tropomyosin residues 70-100 and/or 230-260. Studies with CaD-4 revealed that this region corresponded to the strong binding site seen with whole caldesmon. Weaker association of other regions of caldesmon to tropomyosin residues 180-210 and 5-50 was also observed. The results suggest that the carboxyl-terminus of caldesmon binds tightly to tropomyosin and that other regions of caldesmon may interact with tropomyosin tightly only when they are held close to tropomyosin by the carboxyl-terminal domain. Four models are presented to show the possible interactions of caldesmon with tropomyosin

The study of activity coefficients of (hydrogen bromide + strontium bromide) (aq) using Pitzer's formalism

Electromotive-force measurements were made on the cell:Pt|H 2(g,p = 101.325 k Pa)|HBr(m A), SrBr 2(m B)|AgBr(s)|Ag(s). Activity coefficients of HBr in (hydrogen bromide + strontium bromide)(aq) were determined from electromotive-force measurements at temperatures ranging from 278.15 K to 318.15 K at 10 K intervals and at constant total ionic strengths of (0.1, 0.25, 0.5, 1.0, 2.0, and 3.0) mol · kg −1. The results have been interpreted using Harned's empirical equations and also the comprehensive treatment of Pitzer. Activity coefficients for HBr in the salt mixture follow Harned's rule only at I = 0.1 mol · kg −1. At higher ionic strengths, the eperimental results are best described by a non-linear equation. The Pitzer mixing parameters SΘ H.Sr and Ψ H.Sr.Br (including higher-order electrostatic effects) and Θ H.Sr and Ψ H.Sr.Br (excluding higher-order effects) as well as the temperature derivatives of the mixing coefficients have been determined and compared with the results for similar mixtures. The activity coefficients and excess enthalpies for HBr and SrBr 2 have also been calculated at the experimental temperatures and compared with the results of other investigators

Genome Sequence of the Attenuated Carbosap Vaccine Strain of \u3ci\u3eBacillus anthracis\u3c/i\u3e

The Bacillus anthracis Carbosap genome, which includes the pXO1 and pXO2 plasmids, has been shown to encode the major B. anthracis virulence factors, yet this strain’s attenuation has not yet been explained. Here we report the draft genome sequence of this strain, and a comparison to fully virulent B. anthracis

A Piecewise Design Approach to Engineering a Miniature ACE2 Mimic to Bind SARS-CoV‑2

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues its global spread, the exploration of novel therapeutic and diagnostic strategies is still needed. The virus enters host cells by binding the angiotensin-converting enzyme 2 (ACE2) receptor through the spike protein. Here, we develop an engineered, small, stable, and catalytically inactive version of ACE2, termed miniature ACE2 (mACE2), designed to bind the spike protein with high affinity. Employing a magnetic nanoparticle-based assay, we harnessed the strong binding affinity of mACE2 to develop a sensitive and specific platform for the detection or neutralization of SARS-CoV-2. Our findings highlight the potential of engineered mACE2 as a valuable tool in the fight against SARS-CoV-2. The success of developing such a small reagent based on a piecewise molecular design serves as a proof-of-concept approach for the rapid deployment of such agents to diagnose and fight other viral diseases