Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono-institutional case series

Background Since its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retreatment rates rather high compared to other treatment methods. For initially ruptured aneurysms, a retreatment rate of 13 % has been reported. A variety of retreatment strategies has been proposed; however, there is a paucity of data concerning microsurgical clipping of WEB-pretreated aneurysms, especially previously ruptured ones. Thus, we present a single-center series of five ruptured aneurysms treated with the WEB device and retreated with microsurgical clipping. Methods A retrospective study including all patients presenting with a ruptured aneurysm undergoing WEB treatment at our institution between 2019 and 2021 was performed. Subsequently, all patients with an aneurysm remnant or recurrence of the target aneurysm retreated with microsurgical clipping were identified. Results Overall, five patients with a ruptured aneurysm treated with WEB and retreated with microsurgical clipping were included. Besides one basilar apex aneurysm, all aneurysms were located at the anterior communicating artery (AComA) complex. All aneurysms were wide-necked with a mean dome-to-neck ratio of 1.5. Clipping was feasible and safe in all aneurysms, and complete occlusion was achieved in 4 of 5 aneurysms. Conclusions Microsurgical clipping for initially ruptured WEB-treated aneurysms is a feasible, safe, and effective treatment method in well-selected patients

Morphology of the myenteric plexus and nanc transmission in therat colorectal region

The enteric nervous system exerts local control on the gastrointestinal motility, exocrine and endocrine secretions, ensures proper blood supply, and modulates the immune and inflammatory processes in the gut. The aim of this paper is to give insights into current advances and present knowledge about morphology of the myenteric plexus and the neurochemical coding of adult rat myenteric neurons in the large intestine with a special emphasis on non-adrenergic, non-cholinergic (NANC) transmitters. Major neuroactive substances involved in the NANC transmission include nitric oxide (NO), tachykinins, mostly substance P (SP), and adenosine triphosphate (ATP), co-localized in variable proportions with other neuroactive substances. After applying NADPH-diaphorase enzyme histochemistry and neuronal NO synthase (nNOS) immunohistochemistry, we were able to dem-onstrate numerous nitrergic somata of myenteric neurons with Dogiel type I morphology. In addition to the observed nitrergic distributional patterns, significant variations were registered in the staining intensity of myenteric structures in the colon and anorectal area. Immunohistochemistry for SP revealed an abundance of intensely stained SP-immunoreactive varicose fibers, ensheathing the immunonegative myenteric neuronal cell bodies in a basket-like manner. ATPergic structures were mostly limited to fiber bundles surrounding unstained myenteric neurons and penetrating the two muscle layers. An important finding was the notable presence of purinergic immunoreactive nerve fiber bundles in the longitudinal muscle layer. In conclusion, our results show that the cytoarchitecture and morphometric properties appeared to mimic their equivalent in the more proximal parts of the rat digestive tract and in other experimental animals

Light microscopic immunocytochemical identification of leucine enkephalin

Leucine-enkephalin is a potent and naturally-occurring opioid peptide which serves to inhibit other neurotransmitters involved with pain perception, thereby reducing its emotional and physical impact. Nevertheless, there is little data in the literature concerning leucine-enkephalin-immunoreactivity (Leu-enk-ir) in the human claustrum. The objectives of this study were to confirm the existence of leucine-enkephalin immunoreactive neurons and fibers in the human claustrum. Light microscopy was used to describe their morphology and distribution. Samples of claustrum were obtained from the brains of two females (39 and 48 years of age) and two males (27 and 42 years of age). The brains did not show any overt signs of pathology or trauma. Immunoreactivity to Leuenk was assessed via the Avidin-Biotin Complex Method. Light-microscopic analysis confirmed the presence of Leu-enk-ir neurons and fibres in all areas of the human claustrum. The cell bodies varied in shape and size, and were divided into three groups: small, medium and large. The density of immunostaining varied both within and between the cell types, with some neurons, staining more darkly or lightly than others. The large and medium sized cells most likely correspond to claustrocortical projection neurons while the small-sized cells appear to be inhibitory interneurons. It is our hope that these results will be contributed to a better understanding the functions of claustrum, in both health and disease, given its relationship with the development of autism, schizophrenia, Alzheimer disease, Parkinson disease and Huntington disease

Familial atrial fibrillation mutation M1875T-SCN5A increases early sodium current and dampens the effect of flecainide

Aims Atrial fibrillation (AF) is the most common cardiac arrhythmia. Pathogenic variants in genes encoding ion channels are associated with familial AF. The point mutation M1875T in the SCN5A gene, which encodes the α-subunit of the cardiac sodium channel Nav1.5, has been associated with increased atrial excitability and familial AF in patients. Methods and results We designed a new murine model carrying the Scn5a-M1875T mutation enabling us to study the effects of the Nav1.5 mutation in detail in vivo and in vitro using patch clamp and microelectrode recording of atrial cardiomyocytes, optical mapping, electrocardiogram, echocardiography, gravimetry, histology, and biochemistry. Atrial cardiomyocytes from newly generated adult Scn5a-M1875T+/− mice showed a selective increase in the early (peak) cardiac sodium current, larger action potential amplitude, and a faster peak upstroke velocity. Conduction slowing caused by the sodium channel blocker flecainide was less pronounced in Scn5a-M1875T+/− compared to wildtype atria. Overt hypertrophy or heart failure in Scn5a-M1875T+/− mice could be excluded. Conclusion The Scn5a-M1875T point mutation causes gain-of-function of the cardiac sodium channel. Our results suggest increased atrial peak sodium current as a potential trigger for increased atrial excitability

Functional abilities, respiratory and cardiac function in a large cohort of adults with Duchenne muscular dystrophy treated with glucocorticoids

\ua9 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.Background and purpose: The transition to adult services, and subsequent glucocorticoid management, is critical in adults with Duchenne muscular dystrophy. This study aims (1) to describe treatment, functional abilities, respiratory and cardiac status during transition to adulthood and adult stages; and (2) to explore the association between glucocorticoid treatment after loss of ambulation (LOA) and late-stage clinical outcomes. Methods: This was a retrospective single-centre study on individuals with Duchenne muscular dystrophy (≥16 years old) between 1986 and 2022. Logistic regression, Cox proportional hazards models and survival analyses were conducted utilizing data from clinical records. Results: In all, 112 individuals were included. Mean age was 23.4 \ub1 5.2 years and mean follow-up was 18.5 \ub1 5.5 years. At last assessment, 47.2% were on glucocorticoids; the mean dose of prednisone was 0.38 \ub1 0.13 mg/kg/day and of deflazacort 0.43 \ub1 0.16 mg/kg/day. At age 16 years, motor function limitations included using a manual wheelchair (89.7%), standing (87.9%), transferring from a wheelchair (86.2%) and turning in bed (53.4%); 77.5% had a peak cough flow <270 L/min, 53.3% a forced vital capacity percentage of predicted <50% and 40.3% a left ventricular ejection fraction <50%. Glucocorticoids after LOA reduced the risk and delayed the time to difficulties balancing in the wheelchair, loss of hand to mouth function, forced vital capacity percentage of predicted <30% and forced vital capacity <1 L and were associated with lower frequency of left ventricular ejection fraction <50%, without differences between prednisone and deflazacort. Glucocorticoid dose did not differ by functional, respiratory or cardiac status. Conclusion: Glucocorticoids after LOA preserve late-stage functional abilities, respiratory and cardiac function. It is suggested using functional abilities, respiratory and cardiac status at transition stages for adult services planning

Soil Contamination Interpretation by the Use of Monitoring Data Analysis

The presented study deals with the interpretation of soil quality monitoring data using hierarchical cluster analysis (HCA) and principal components analysis (PCA). Both statistical methods contributed to the correct data classification and projection of the surface (0–20 cm) and subsurface (20–40 cm) soil layers of 36 sampling sites in the region of Burgas, Bulgaria. Clustering of the variables led to formation of four significant clusters corresponding to possible sources defining the soil quality like agricultural activity, industrial impact, fertilizing, etc. Two major clusters were found to explain the sampling site locations according to soil composition—one cluster for coastal and mountain sites and another—for typical rural and industrial sites. Analogous results were obtained by the use of PCA. The advantage of the latter was the opportunity to offer more quantitative interpretation of the role of identified soil quality sources by the level of explained total variance. The score plots and the dendrogram of the sampling sites indicated a relative spatial homogeneity according to geographical location and soil layer depth. The high-risk areas and pollution profiles were detected and visualized using surface maps based on Kriging algorithm

Stable or improved neurological manifestations during miglustat therapy in patients from the international disease registry for Niemann-Pick disease type C: an observational cohort study

Background: Niemann-Pick disease type C (NP-C) is a rare neurovisceral disease characterised by progressive neurological degeneration, where the rate of neurological disease progression varies depending on age at neurological onset. We report longitudinal data on functional disease progression and safety observations in patients in the international NPC Registry who received continuous treatment with miglustat. Methods: The NPC Registry is a prospective observational cohort of NP-C patients. Enrolled patients who received ≥1 year of continuous miglustat therapy (for ≥90 % of the observation period, with no single treatment interruption >28 days) were included in this analysis. Disability was measured using a scale rating the four domains, ambulation, manipulation, language and swallowing from 0 (normal) to 1 (worst). Neurological disease progression was analysed in all patients based on: 1) annual progression rates between enrolment and last follow up, and; 2) categorical analysis with patients categorised as 'improved/stable' if ≥3/4 domain scores were lower/unchanged, and as 'progressed' if <3 scores were lower/unchanged between enrolment and last follow-up visit. Results: In total, 283 patients were enrolled from 28 centers in 13 European countries, Canada and Australia between September 2009 and October 2013; 92 patients received continuous miglustat therapy. The mean (SD) miglustat exposure during the observation period (enrolment to last follow-up) was 2.0 (0.7) years. Among 84 evaluable patients, 9 (11 %) had early-infantile (<2 years), 27 (32 %) had late-infantile (2 to <6 years), 30 (36 %) had juvenile (6 to <15 years) and 18 (21 %) had adolescent/adult (≥15 years) onset of neurological manifestations. The mean (95%CI) composite disability score among all patients was 0.37 (0.32,0.42) at enrolment and 0.44 (0.38,0.50) at last follow-up visit, and the mean annual progression rate was 0.038 (0.018,0.059). Progression of composite disability scores appeared highest among patients with neurological onset during infancy or childhood and lowest in those with adolescent/adult-onset. Overall, 59/86 evaluable patients (69 %) were categorized as improved/stable and the proportion of improved/stable patients increased with age at neurological onset. Safety findings were consistent with previous data. Conclusions: Disability status was improved/stable in the majority of patients who received continuous miglustat therapy for an average period of 2 years

A new class of glycomimetic drugs to prevent free fatty acid-induced endothelial dysfunction

Background: Carbohydrates play a major role in cell signaling in many biological processes. We have developed a set of glycomimetic drugs that mimic the structure of carbohydrates and represent a novel source of therapeutics for endothelial dysfunction, a key initiating factor in cardiovascular complications. Purpose: Our objective was to determine the protective effects of small molecule glycomimetics against free fatty acid­induced endothelial dysfunction, focusing on nitric oxide (NO) and oxidative stress pathways. Methods: Four glycomimetics were synthesized by the stepwise transformation of 2,5­dihydroxybenzoic acid to a range of 2,5­substituted benzoic acid derivatives, incorporating the key sulfate groups to mimic the interactions of heparan sulfate. Endothelial function was assessed using acetylcholine­induced, endotheliumdependent relaxation in mouse thoracic aortic rings using wire myography. Human umbilical vein endothelial cell (HUVEC) behavior was evaluated in the presence or absence of the free fatty acid, palmitate, with or without glycomimetics (1µM). DAF­2 and H2DCF­DA assays were used to determine nitric oxide (NO) and reactive oxygen species (ROS) production, respectively. Lipid peroxidation colorimetric and antioxidant enzyme activity assays were also carried out. RT­PCR and western blotting were utilized to measure Akt, eNOS, Nrf­2, NQO­1 and HO­1 expression. Results: Ex vivo endothelium­dependent relaxation was significantly improved by the glycomimetics under palmitate­induced oxidative stress. In vitro studies showed that the glycomimetics protected HUVECs against the palmitate­induced oxidative stress and enhanced NO production. We demonstrate that the protective effects of pre­incubation with glycomimetics occurred via upregulation of Akt/eNOS signaling, activation of the Nrf2/ARE pathway, and suppression of ROS­induced lipid peroxidation. Conclusion: We have developed a novel set of small molecule glycomimetics that protect against free fatty acidinduced endothelial dysfunction and thus, represent a new category of therapeutic drugs to target endothelial damage, the first line of defense against cardiovascular disease

Essays on financial market microstructure.

Understanding the forces for price formation and asset trading is the backbone of modern financial economics. In the oldest of adages, people trade because they differ---either informationally or from a risk sharing perspective. My thesis focuses on the former and investigates how asymmetric information affects the behavior of financial market participants, and through it, asset prices and trading volume. It is popular knowledge on Wall Street that volume moves prices. Recent empirical research further establishes an important role of the order imbalance in explaining this positive relation. The first essay of my thesis develops a new trading model that allows us to tractably capture the important relationships between trade volume, net order flow and price formation in models with heterogeneously informed agents. We hope that our setting will prove a workable model for answering a range of future questions about price formation in specialist markets. The second essay proposes a framework that affords a tractable analysis of possibly large economies of informationally heterogeneous individuals. Our model subsumes public and conditionally independent private signals as special cases, but captures far more, such as informational geography or social network effects. We provide and discuss multiple examples of the general structure, including curious paradoxes of the rational expectations equilibrium concept. Our framework is very general and naturally applies to environments that linearly aggregate private information. The third essay utilizes the aforementioned framework to further explore rational expectations equilibria with conditionally correlated information. We find that the behavior of prices and investors substantially differs from that in the world with conditionally independent signals. For instance, an agent's price impact is no longer solely determined by her signal's precision. We are also positioned to study how correlation affects trade. We find, in particular, that for a fixed precision of private information, signal correlation has a non-monotonic effect on price informativeness.Ph.D.Economic theoryFinanceSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/125827/2/3224693.pd