Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

BACKGROUND: There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS: We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS: From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS: The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS: Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits

Genome analysis and physiological comparison of Alicycliphilus denitrificans strains BC and K601T

The genomes of the Betaproteobacteria Alicycliphilus denitrificans strains BC and K601T have been sequenced to get insight into the physiology of the two strains. Strain BC degrades benzene with chlorate as electron acceptor. The cyclohexanol-degrading denitrifying strain K601T is not able to use chlorate as electron acceptor, while strain BC cannot degrade cyclohexanol. The 16S rRNA sequences of strains BC and K601T are identical and the fatty acid methyl ester patterns of the strains are similar. Basic Local Alignment Search Tool (BLAST) analysis of predicted open reading frames of both strains showed most hits with Acidovorax sp. JS42, a bacterium that degrades nitro-aromatics. The genomes include strain-specific plasmids (pAlide201 in strain K601T and pAlide01 and pAlide02 in strain BC). Key genes of chlorate reduction in strain BC were located on a 120 kb megaplasmid (pAlide01), which was absent in strain K601T. Genes involved in cyclohexanol degradation were only found in strain K601T. Benzene and toluene are degraded via oxygenase-mediated pathways in both strains. Genes involved in the meta-cleavage pathway of catechol are present in the genomes of both strains. Strain BC also contains all genes of the ortho-cleavage pathway. The large number of mono- and dioxygenase genes in the genomes suggests that the two strains have a broader substrate range than known thus far.This research was supported by the Technology Foundation, the Applied Science Division (STW) of the Netherlands Organization for Scientific Research (NWO), project number 08053, the graduate school WIMEK (Wageningen Institute for Environment and Climate Research, which is part of SENSE Research School for Socio-Economic and Natural Sciences of the Environment, www.wimek-new.wur.nl and www.sense.nl), SKB (Dutch Centre for Soil Quality Management and Knowledge Transfer, www.skbodem.nl) and the Consolider project CSD-2007-00055. The research was incorporated in the TRIAS (TRIpartite Approaches 469 toward Soil systems processes) program (http://www.nwo.nl/en/research-and-results/programmes/alw/trias-tripartite-approach-to-soil-system-processes/index. html). Flávia Talarico Saia was supported by a FAPESP (the State of São Paulo Research Foundation) scholarship (2006-01997/5). The work conducted by the DOE JGI is supported by the Office of Science of the United States Department of Energy under contract number DE-AC02-05CH11231. Alfons Stams acknowledges support by an ERC (European Research Counsil) advanced grant (project 323009). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Safety of boneless reconstruction of the mandible with a CAD/CAM designed titanium device: The replica cohort study

Objective: We evaluated the safety of REPLICA, a CAD/CAM-designed patient-specific titanium mandible, in patients with mandibular defects not suitable for reconstruction with traditional techniques. Patients and methods: We performed a cohort study with a composite primary outcome assigned at the end of a 1-year follow-up. The outcome was assigned in the presence of all the following: 1) absence of intraoral or skin extrusion of REPLICA; 2) decrease or cessation of oral pain; 3) stability or increase in mouth opening; 4) resumption of oral feeding without the need of nasogastric tube; 5) absence of fracture at multidetector computer tomography (MDCT); 6) absence of displacement (MDCT); 7) absence of screw loosening (MDCT). The secondary outcome was the patient-reported QOL at 6 months of follow-up as detected by the EORTC QLQ-C30 and QLQ-H&amp;N35 questionnaires. Results: Between March 2012 and June 2017, 18 consecutive patients, with a median (IQR) age of 67 (65;74) underwent reconstruction of mandibular defects with REPLICA at our Unit. The primary outcome was reached by 14 of the 18 patients. QOL data were available for 15 patients at the 6-month follow-up, showing a good profile of general and disease-specific QOL. Conclusion: REPLICA offered a safe solution at 1-year for the treatment of mandibular defects not suitable for reconstruction with traditional techniques, and was associated with subjective well-being and satisfaction. Further studies are needed to assess the full range of indications of REPLICA

Mediterranean forage legumes grown alone or in mixture with annual ryegrass: biomass production, N2 fixation, and indices of intercrop efficiency

Aims: To evaluate the productivity and N2 fixation of a range of Mediterranean forage legume species as well as their ability to be grown in mixture with a forage grass, and to verify whether N transfer occurs from the legume to the non-legume component of the mixtures and, if so, to what extent this process is affected by legume species. Methods: Seven legume species (Hedysarum coronarium L., Medicago scutellata L., Trifolium resupinatum L., Trifolium squarrosum L., Trigonella foenum-graecum L., Vicia sativa L., Vicia villosa Roth) were grown alone or in mixture with annual ryegrass (Lolium multiflorum L.). Biomass and N yields and biological N2 fixation (15N dilution technique) were measured. N transfer from legume to the non-legume component was also assessed. The efficiency of the intercrops was evaluated using the land equivalent ratio (LER), aggressivity index, and competitive ratio. Results: Differences were observed among the monocropped legumes for biomass yield, N2 fixation, and ability to utilize inorganic soil N. Moreover, the proportion of legume species to the total biomass yield of the intercrop varied from 30 % (T. resupinatum) to 69 % (T. foenum-graecum). All intercrops showed an advantage over monocrops in terms of biomass and N yields (LER and NLER values always >1). No N transfer occurred from legume to ryegrass in any of the mixtures. Conclusions: The large differences observed among the studied legumes must be taken into account when trying to develop cropping systems with more efficient N use. Moreover, as all legume\u2013ryegrass intercrops used natural resources more efficiently than pure crops, intercropping is a relevant cropping strategy for sustainable agricultural systems in Mediterranean environments

Sulla (Hedysarum coronarium L.) as Potential Feedstock for Biofuel and Protein

Although sulla (Hedysarum coronarium L.) has many interesting features that could support the production of biofuels (e.g., a high yield and soluble sugar content, N-fixation capacity, low input requirements for its cultivation), no study has assessed the possibility of its use for that purpose. Our objective was to evaluate the potential value for energy production of sulla cut at various stages of growth. Furthermore, the potential of sulla as a dual purpose crop (energy and feed) was investigated. The crop was grown in rainfed conditions in a typical Mediterranean environment (over two complete 2-year crop cycles) and was cut at four different phenological stages. The biomass was divided into two fractions (stems and leaves), weighed, and analyzed to estimate the theoretical production of bioethanol and biomethane and the feed value of the whole biomass and of the two fractions. The total dry matter yield in the 2-year crop cycle was about 18 Mg ha 121; this level of production is similar to or higher than that of most other crops grown in the same environment in rainfed conditions. The stems had a high content of total soluble sugars (even higher than 200 g kg 121) and cell wall polysaccharides, markedly higher than the leaves. The leaves contained most of the protein of the plant, representing an actual protein concentrate. Thus, the crop seems particularly suitable for dual purpose use if stems are allocated to the production of biofuels and leaves to the production of livestock feed. Moreover, the results showed that the early seed set stage is the most appropriate cutting time for maximizing yield both for energy and for livestock use

The critical period of weed control in faba bean and chickpea in mediterranean areas

Weeds are ofte. The major biological constraint to growing legume crops successfully, and an understanding of the critical period of weed control (CPWC) is important for developing environmentally sustainable weed management practices to prevent unacceptable yield loss. Therefore, we carried out two field experiments to identif. The CPWC for two grain legume crops traditionally grown in Mediterranean areas: chickpea and faba bean. The experiments were conducted at two sites both located I. The Sicilian inland (Italy). In chickpea, when weeds were left to compete wit. The crop fo. The whole cycle. The grain yield reduction was on average about 85% of the weed-free yield, whereas in faba bea. The reduction was less severe (on average about 60% of the weed-free yield). The onset of the CPWC at a 5% yield loss level varied by species, occurring later in faba bean than in chickpea (on average, 261 and 428 growing degree days after emergence for chickpea and faba bean, respectively). In both species. The end of the CPWC occurred a. The early full-flowering stage whe. The canopy of each crop enclose. The interrow space. of the whole. The CPWC at a 5% yield loss level ranged from 50 to 69 d in chickpea and from 28 to 33 d in faba bean. The results highligh. The fact that faba bean has a higher competitive ability against weeds than chickpea. This could be attributable both to more vigorous early growth and t. The plant's greater height, both factors related to a greater shading ability and, consequently, to a better ability to suppress weeds. Nomenclature: Faba bean, Vicia faba L. var. minor; chickpea, Cicer arietinum L. © Weed Science Society of America