The microsurgical management of a brainstem compression resulted from an embolized cerebral tentorial dural arteriovenous fistula

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal connections between an arterial feeder and a dural venous sinus or leptomeningeal vein with the nidus located within the dural leaflets. In this article we report an uncommon event which is a hematoma inside a dilated draining vein formed after embolization of tentorial DAVF causing pressure on the brain stem and removed surgically. A 47 years old male with a history of ventriculoperitonial (V-P) shunt 2 years ago and embolization of arteriovenous malformation 15 years ago, presented to our hospital having symptoms due to tentorial dural arteriovenous fistula (TDAVF) fed from branches of external and internal carotid arteries. Two sessions of transarterial embolization were performed with total occlusion. Six months later, he was admitted to the hospital with gait unsteadiness, swallowing difficulties and confusion. Brain MRI revealed a hyperintense heterogenous mass like a pouch from thrombosed draining veins with a localized hematoma compressing the brainstem and causing these symptoms. A small hematoma was seen and removed microsurgically. The patient was improved clinically and was discharged home after 5 days. Neurointerventionalist must be aware when deciding to occlude TDAVMs as there is a risk of venous varix formation and rupture if incompletely occluded. Surgical intervention is sometimes needed to alleviate the hazardous compression on the brain stem and other vital structures. © 202

Wounding rapidly alters transcription factor expression, hormonal signaling, and phenolic compound metabolism in harvested sugarbeet roots

Injuries sustained by sugarbeet (Beta vulgaris L.) roots during harvest and postharvest operations seriously reduce the yield of white sugar produced from stored roots. Although wound healing is critically important to reduce losses, knowledge of these processes is limited for this crop as well as for roots in other species. To better understand the metabolic signals and changes that occur in wounded roots, dynamic changes in gene expression were determined by RNA sequencing and the activity of products from key genes identified in this analysis were determined in the 0.25 to 24 h following injury. Nearly five thousand differentially expressed genes that contribute to a wide range of cellular and molecular functions were identified in wounded roots. Highly upregulated genes included transcription factor genes, as well as genes involved in ethylene and jasmonic acid (JA) biosynthesis and signaling and phenolic compound biosynthesis and polymerization. Enzyme activities for key genes in ethylene and phenolic compound biosynthesis and polymerization also increased due to wounding. Results indicate that wounding causes a major reallocation of metabolism in sugarbeet taproots. Although both ethylene and JA are likely involved in triggering wound responses, the greater and more sustained upregulation of ethylene biosynthesis and signaling genes relative to those of JA, suggest a preeminence of ethylene signaling in wounded sugarbeet roots. Changes in gene expression and enzymes involved in phenolic compound metabolism additionally indicate that barriers synthesized to seal off wounds, such as suberin or lignin, are initiated within the first 24 h after injury

Effect of adverse childhood experiences on physical health in adulthood: Results of a study conducted in Baghdad city

Background: Studies have revealed a powerful relationship between adverse childhood experiences (ACEs) and physical and mental health in adulthood. Literature documents the conversion of traumatic emotional experiences in childhood into organic disease later in life. Objective: The aim was to estimate the effect of childhood experiences on the physical health of adults in Baghdad city. Subjects and Methods: A cross-sectional study was conducted from January 2013 to January 2014. The study sample was drawn from Baghdad city. Multistage sampling techniques were used in choosing 13 primary health care centers and eight colleges of three universities in Baghdad. In addition, teachers of seven primary schools and two secondary schools were chosen by a convenient method. Childhood experiences were measured by applying a modified standardized ACEs-International Questionnaire form and with questions for bonding to family and parental monitoring. Physical health assessment was measured by a modified questionnaire derived from Health Appraisal Questionnaire of Centers for Disease Control and Prevention. The questionnaire includes questions on cerebrovascular diseases, diabetes mellitus, tumor, respiratory and gastrointestinal diseases. Results: Logistic regression model showed that a higher level of bonding to family (fourth quartile) is expected to reduce the risk of chronic physical diseases by almost the half (odds ratio = 0.57) and exposure to a high level of household dysfunction and abuse (fourth quartile) is expected to increase the risk of chronic physical diseases by 81%. Conclusion: Childhood experiences play a major role in the determination of health outcomes in adulthood, and early prevention of ACEs. Encouraging strong family bonding can promote physical health in later life

Treatment of post-traumatic direct carotid�cavernous fistulas using flow diverting stents: Is it alone satisfactory?

Background: Direct carotid cavernous fistula (CCF) occurs between the internal carotid artery (ICA) and the cavernous sinus. Carotid cavernous fistulas (CCFs) frequently present with chemosis, pulsatile proptosis, ocular bruit, vision loss, and occasionally intracerebral hemorrhage or seizure. In this article, we share our experience in endovascular treatment of six patients having this pathology with intracranial flow diverting stents with review of literatures. Case description: All six patients had posttraumatic direct CCF, most of their signs and symptoms were visual disturbance, chemosis, orbital bruit, headache, paralysis of extraocular muscles. They were treated with flow diversion stents with or without coils or liquid embolizing material; transvenous and transarterial routes were used. Most of them underwent multiple sessions, and their conditions were improved dramatically. Conclusion: The best and most effective method is to start the procedure by coiling to convert the high-flow fistula to an aneurysmal pouch with the smallest possible size in the cavernous sinus, and then close the defect site with one or two flow diversion devices (FDDs). © 2021 Elsevier Lt