Ultra-distal access of the M1 segment with the 5 Fr Navien distal access catheter in acute (anterior circulation) stroke: is it safe and efficient?

Background and aim The importance of mechanical thrombectomy in acute stroke treatment has grown over recent years. Mechanical thrombectomy comprises many different techniques. Technical improvements in the catheter material have led to the development of large-bore distal access catheters which can enter tortuous intracranial vessels. This has promising applications for endovascular stroke treatment. This study evaluated the safety and success rate of ultra-distal access of the middle cerebral artery (MCA) M1 segment with the 5 Fr Navien 58 distal access catheter in the treatment of acute stroke in combination with stent retrievers. Methods We retrospectively analyzed 81 patients with an acute stroke of the anterior circulation in whom ultra-distal access to the M1 segment was carried out using the Navien 58 catheter with an anchoring technique with a stent retriever for mechanical thrombectomy. Technical complications, success rates of catheter placement, success rates of thrombectomy using the modified Thrombolysis In Cerebral Infarction (mTICI) score, and the procedure times were evaluated. Results Ultra-distal access with the Navien 58 was successful in 75% (61/81) of cases. Recanalization success with a mTICI score of 2b and better was achieved in 83% overall (67/81), in 90% (55/61) of cases with successful ultra-distal access and in 60% (12/20) of cases without ultra-distal access. No severe adverse effects such as dissections or perforations occurred as a result of the ultra-distal catheter placement in the M1 segment. In 4% (3/81) of the cases a reversible MCA vasospasm occurred. Conclusions Ultra-distal placement of the Navien 58 distal access catheter into the M1 segment in acute anterior circulation stroke can be achieved consistently, is safe in practice, and results in good recanalization success rates

Phosphate/Silicate Ratio Allows for Fine-Tuning of Bioactive Glass Crystallisation and Glass-Ceramic Microstructure

A combination of XRD, solid-state NMR and state-of-the-art imaging techniques were used to investigate how the calcium orthophosphate/calcium silicate ratio affects the crystallisation of bioactive glasses in the system SiO2-P2O5-CaO-CaF2. In the phosphate-free glass, xonotlite, wollastonite and cuspidine crystallised. From 2.4 mol% P2O5, fluorapatite also formed, while the amount of wollastonite decreased. Crystallisation tendency was low for low phosphate contents, while above 3 mol% P2O5 it increased. The phosphate-free glass showed a volume crystallisation mechanism with constant activation energy. By contrast, the glass with the largest phosphate to silicate ratio showed both volume and surface crystallisation, causing a pronounced decrease in activation energy with crystallisation degree. This work shows that by changing the phosphate/silicate ratio we can determine which crystal phases form, obtaining for example fluorapatite-free or wollastonite-free glass-ceramics, depending on the desired application and properties such as mechanical strength or activity in contact with physiological solutions

A single gene defect causing claustrophobia

Claustrophobia, the well-known fear of being trapped in narrow/closed spaces, is often considered a conditioned response to traumatic experience. Surprisingly, we found that mutations affecting a single gene, encoding a stress-regulated neuronal protein, can cause claustrophobia. Gpm6a-deficient mice develop normally and lack obvious behavioral abnormalities. However, when mildly stressed by single-housing, these mice develop a striking claustrophobia-like phenotype, which is not inducible in wild-type controls, even by severe stress. The human GPM6A gene is located on chromosome 4q32-q34, a region linked to panic disorder. Sequence analysis of 115 claustrophobic and non-claustrophobic subjects identified nine variants in the noncoding region of the gene that are more frequent in affected individuals (P=0.028). One variant in the 3′untranslated region was linked to claustrophobia in two small pedigrees. This mutant mRNA is functional but cannot be silenced by neuronal miR124 derived itself from a stress-regulated transcript. We suggest that loosing dynamic regulation of neuronal GPM6A expression poses a genetic risk for claustrophobia

Antirealism and the Roles of Truth

Geschiedenis van Antieke en Middeleeuwse Semantie

Pflanzenbaulehre

von C. H. PatzigIn Fraktu