Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines

A New Insight into the Physiological Role of Bile Salt Hydrolase among Intestinal Bacteria from the Genus <i>Bifidobacterium</i>

<div><p>This study analyzes the occurrence of bile salt hydrolase in fourteen strains belonging to the genus <i>Bifidobacterium</i>. Deconjugation activity was detected using a plate test, two-step enzymatic reaction and activity staining on a native polyacrylamide gel. Subsequently, bile salt hydrolases from <i>B. pseudocatenulatum</i> and <i>B. longum</i> subsp. <i>suis</i> were purified using a two-step chromatographic procedure. Biochemical characterization of the bile salt hydrolases showed that the purified enzymes hydrolyzed all of the six major human bile salts under the pH and temperature conditions commonly found in the human gastrointestinal tract. Next, the dynamic rheometry was applied to monitor the gelation process of deoxycholic acid under different conditions. The results showed that bile acids displayed aqueous media gelating properties. Finally, gel-forming abilities of bifidobacteria exhibiting bile salt hydrolase activity were analyzed. Our investigations have demonstrated that the release of deconjugated bile acids led to the gelation phenomenon of the enzymatic reaction solution containing purified BSH. The presented results suggest that bile salt hydrolase activity commonly found among intestinal microbiota increases hydrogel-forming abilities of certain bile salts. To our knowledge, this is the first report showing that bile salt hydrolase activity among <i>Bifidobacterium</i> is directly connected with the gelation process of bile salts. In our opinion, if such a phenomenon occurs in physiological conditions of human gut, it may improve bacterial ability to colonize the gastrointestinal tract and their survival in this specific ecological niche.</p></div

Coexistence of Ehlers–Danlos Syndrome with Coronary–Pulmonary Arterial Fistula and Other Multiple Coronary Artery Anomalies

This case report presents a 34-year-old male with Ehlers–Danlos syndrome, type 2 diabetes mellitus, aortic valve regurgitation, and aortic bulb aneurysm. Following spine surgery for thoracic–lumbar stabilization, the patient underwent assessment for aortic bulb aneurysm and aortic valve replacement surgeries. Five months post spinal surgery, a coronary computed tomography angiography was performed. The coronary computed tomography angiography revealed unique findings, including the absence of the left main coronary artery, right coronary artery dominance, ectopic origin of the left circumflex artery from the right sinus of the valsalva, a coronary–pulmonary arterial fistula originating from the right sinus of the valsalva, and an additional right pulmonary vein. The patient was qualified for surgical treatment for an aortic bulb aneurysm, was informed about the high surgical risk, and is awaiting surgery. This case underscores the rarity of Ehlers–Danlos syndrome coexisting with multiple coronary artery anomalies. The presence of a coronary–pulmonary arterial fistula further emphasizes the need for specialized patient monitoring when Ehlers–Danlos syndrome and coronary anomalies converge

Effect of pH on the activity of the purified bile salt hydrolase from <i>B. pseudocatenulatum</i> (A) and <i>B. suis</i> (B).

<p>Relative deconjugation activity at various pH was calculated using results obtained for pH 5 as a standard at 100%. Values are expressed as the means of three independent replicates. Error bars represent standard deviation.</p

Detection of bile salt hydrolase in <i>Bifidobacterium</i> using the plate test.

<p>Analysis of colony morphologies of <i>Bifidobacterium</i> was performed on solidified MRS (A) and Garche's medium (B) containing bile salts on the example of <i>Bifidobacterium bifidum</i> DSM 20456.</p

Effect of various chemicals on BSH activity.

<p>Effect of various chemicals on BSH activity.</p

Substrate specificity of the purified BSH from <i>B. suis</i> (A) and <i>B. pseudocatenulatum</i> (B).

<p>Six major bile salts are shown: taurocholic acid (TCA), taurodeoxycholic acid (TDCA), taurochenodeoxycholic (TCDCA), glycocholic acid (GCA), glycodeoxycholic acid (GDCA) and glycochenodeoxycholic acid (GCDCA). Relative deconjugation activity in the presence of six major human bile salts was calculated using GCDCA as a standard at 100%. Values are expressed as the mean of three independent replicates. Different lower case letters indicate statistically significant differences (p<0.05).</p

Rheological analysis of the gelation process of deoxycholic acid under different conditions.

<p>The effect of various pH (6–7) on viscoelastic behavior of the samples containing 10 mM deoxycholate (A). Analysis of gel formation in the samples containing various concentrations of DCA (from 5 to 15 mM) (B). The bservation of hydrogel-forming abilities of <i>B. animalis</i> subsp. <i>lactis</i> and <i>B. asteroides</i> (BSH-negative reference strain) in the presence of 10 mM TDCA (C). At least three replicates of each experiment were performed with little variation only one example is displayed.</p

Phylogenetic tree based on amino acid sequence of BSHs from different bifidobacteria.

<p>The phylogenetic tree was calculated using neighbor joining method from 1000 bootstrapping replicates with software package MEGA version 4.0. Amino acid sequences used for phylogenetic tree calculation are present in the NCBI database under the following accession numbers: YP_909719.1, KFI89881.1, EFE89535.1, YP_002322914.1, YP_004220577.1, KFI71781.1, AAT11513.1, ETY71513.1, KFI75916.1, EEB21828.1, EDT46256.1, EEP21498.1, KFJ07027.1, KFI79764.1, KFI78707.1, KFI67852.1, EFA23638.1, KFI70893.1, KFI67645.1, KFI47755.1, KFJ00339.1, KFJ02268.1, KFI57613.1, KFI65994.1, YP_006280029.1, YP_002969854.1.</p