Endovascular Therapy for Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis

Recent reports have emerged suggesting that multiple sclerosis (MS) may be due to abnormal venous outflow from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI). These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment

Dissecting Aneurysms of Posterior Cerebral Artery: Clinical Presentation, Angiographic Findings, Treatment, and Outcome

Background: The dissecting posterior cerebral artery (PCA) aneurysms are very rare. These aneurysms pose significant treatment challenge and need careful evaluation to formulate an optimal treatment plan in case of ruptured or un-ruptured presentations. Methods: Retrospective review of a prospectively collected data. Results: Seven patients with dissecting aneurysms of the PCA were identified. Six out of seven presented with subarachnoid hemorrhage (SAH) and one with ischemic stroke. Three out of seven were treated with endovascular coil embolization without sacrifice of the parent artery and the rest had parent artery occlusion (PAO) with coil embolization. None of the patients developed new neurological deficits post-procedure. Aneurysm re-occurred in two patients that were treated without PAO. Conclusion: Endovascular treatment of the dissecting PCA aneurysm is safe and feasible. It can be performed with or without PAO. Recurrence is more common without PAO and close follow-up is warranted

Safety and Feasibility of Simultaneous Ipsilateral Proximal Carotid Artery Stenting and Cerebral Aneurysm Coiling

Coexistence of cerebral aneurysm and carotid artery disease may be encountered in clinical practice. Theoretical increase in aneurysmal blood flow may increase risk of rupture if carotid artery disease is treated first. If aneurysm coiling is performed first, stroke risk may increase while repeatedly crossing the diseased artery. It is controversial which disease to treat first, and whether it is safe to treat both simultaneously via endovascular procedures. We document the safety and feasibility of such an approach. Review of collected neurointerventional database at our institution was performed for patients who underwent both carotid artery stenting (CAS) and aneurysm coil embolization (ACE) simultaneously. All patients underwent carotid stenting followed by aneurysm coiling in the same setting. Demographic, clinical data, and outcome measures including success rate and periprocedural complications were collected. Five hundred and ninety aneurysms coiling were screened for patients who underwent combined CAS and ACE. Ten patients were identified. Mean age was 67.7 years (range 51–89). The success rate for stenting and coiling was 100% with no immediate complications. The coiling procedure time was extended by an average of 45 min for performing both procedures jointly. No stroke, TIAs, or aneurysmal rebleeding was found on their most recent follow up. Our case series demonstrates that it is safe and feasible to perform CAS and ACE simultaneously as one procedure which may avoid unwanted risk of treating either disease at two separate time sessions

Influence of design parameters on the performance of a refractive index sensor based on SPR in plastic optical fibers

We report a refractive-index sensor based on surface plasmon resonance in etched plastic optical-fibers. Impact of fiber residual thickness and sensing length on the sensor's sensitivity is experimentally investigated

Investigation of the performance of an SPR-based optical fiber sensor using finite-difference time domain

Finite-difference time domain (FDTD) method was used to investigate the performance of surface plasmon resonance (SPR)-based optical fiber sensors. The results show that the performance of the fiber sensor can be optimized by choosing a proper combination of metal layer thickness of 40–60 nm and residual cladding thickness of 400–500 nm. Furthermore, the roughness effect of the gold surface layering the fiber sensor is significant in rough surfaces when sigma rms is greater than 5 nm or correlation length is lower than 100 nm

Drivers of farmers’ intention to adopt integrated pest management: a case study of vegetable farmers in Pakistan

Abstract: Integrated pest management adoption is quite low around the globe, particularly in developing countries, due to different factors. Here, we examine the factors affecting the intention of Pakistani farmers to adopt integrated pest management practices in vegetable production using a structured questionnaire. We interviewed 301 vegetable growers in Multan, Pakistan. The reliability and validity of the data, along with the underlying relationship between the observed variables, were identified through exploratory factor analysis. The majority of the farmers (79.4%) relied on pesticides for pest control. More than four out of 10 of the respondents (43.8%) reported that okra received the highest application of pesticides followed by potato (24.5%) and cauliflower (17.9%). Integrated pest management was currently non‐existent among the vegetable growers of the study area. The latent factors—“knowledge of the adverse effects of pesticide,” “belief in the efficacy of non‐chemical pest control measures,” “perceived barriers to the adoption of integrated pest management,” “progressive farming approach,” and “intention to adopt integrated pest management”—were subsequently confirmed using confirmatory factor analysis. The structural equation model suggested that the intention to adopt integrated pest management is significantly affected by farmers’ knowledge of the adverse effects of pesticides (β = 0.274, z‐value = 3.082, P = 0.002). An increase in farmers’ awareness of the harmful effects of pesticides could lead to integrated pest management adoption for pest control. The scale for intention to adopt integrated pest management developed in this study can be used in future studies and provide valuable insights to the policymakers for devising integrated pest management adoption campaigns in the study area

In silico transcriptional regulation and functional analysis of dengue shock syndrome associated SNPs in PLCE1 and MICB genes

YesSingle nucleotide polymorphisms (SNPs) in PLCE1 and MICB genes increase risk for the development of dengue shock syndrome (DSS). We used Bioinformatics tools to predict alterations at the transcriptional and posttranslational levels driven by PLCE1 and MICB SNPs associated with DSS. Functional and phenotypic analysis conducted to determine deleterious SNPs and impact of amino acid substitution on the structure and function of proteins identified rs2274223 (H1619R) as deleterious to protein coding as it induces structural change in the C2 domain of PLCε, with the mutant residue more positively charged than the wild-type residue (RMSD score, 1.75 Å).Moreover, rs2274223 condenses the chromatinrepressing PLCε expression in DSS. Briefly, this study presents the impact of a single nucleotide transition at SNPs associated with DSS on differential protein binding patterns with PLCE1 and MICB genes and on protein structure modification and their possible role in the pathogenesis of DSS

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke).

BACKGROUND: Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-dependent. We hypothesized that interhospital transfer to endovascular-capable centers would result in treatment delays and worse clinical outcomes compared with direct presentation. METHODS: STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter, observational, single-arm study of real-world MT for acute stroke because of anterior-circulation large-vessel occlusion performed at 55 sites over 2 years, including 1000 patients with severe stroke and treated within 8 hours. Patients underwent MT with or without intravenous tissue plasminogen activator and were admitted to endovascular-capable centers via either interhospital transfer or direct presentation. The primary clinical outcome was functional independence (modified Rankin Score 0-2) at 90 days. We assessed (1) real-world time metrics of stroke care delivery, (2) outcome differences between direct and transfer patients undergoing MT, and (3) the potential impact of local hospital bypass. RESULTS: A total of 984 patients were analyzed. Median onset-to-revascularization time was 202.0 minutes for direct versus 311.5 minutes for transfer patients ( CONCLUSIONS: In this large, real-world study, interhospital transfer was associated with significant treatment delays and lower chance of good outcome. Strategies to facilitate more rapid identification of large-vessel occlusion and direct routing to endovascular-capable centers for patients with severe stroke may improve outcomes. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02239640