Recanalization of the Chronically Occluded Internal Carotid Artery: Review of the Literature.

Introduction: We reviewed the literature on interventions for patients with medically refractory chronically occluded internal carotid artery (COICA) to assess the risks and/or benefits after recanalization via an endovascular technique (ET) or hybrid surgery (HS, i.e., ET plus carotid endarterectomy). Methods: A systematic search of the electronic databases was performed. Patients with COICA were classified into 4 different categories according to Hasan et al classification. Results: Eighteen studies satisfied the inclusion criteria. Only 6 studies involved an HS procedure. We identified 389 patients with COICA who underwent ET or HS; 91% were males. The overall perioperative complication rate was 10.1% (95% confidence interval [CI]: 7.4%-13.1%). For types A and B, the successful recanalization rate was 95.4% (95% CI: 86.5%-100%), with a 13.7% (95% CI: 2.3%-27.4%) complication rate. For type C, the success rate for ET was 45.7% (95% CI: 17.8%-70.7%), with a complication rate of 46.0% (95% CI: 20.0%-71.4%) for ET and for the HS technique 87.6% (95% CI: 80.9%-94.4%), with a complication rate of 14.0% (95% CI: 7.0%-21.8%). For type D, the success rate of recanalization was 29.8% (95% CI: 7.8%-52.8%), with a 29.8% (95% CI: 6.1%-56.3%) complication rate. Successful recanalization resulted in a symmetrical perfusion between both cerebral hemispheres, resolution of penumbra, normalization of the mean transit time, and improvement in Montreal Cognitive Assessment (MoCA) score (ΔMoCA = 9.80 points; P = 0.004). Conclusions: Type A and B occlusions benefit from ET, especially in the presence of a large penumbra. Type C occlusions can benefit from HS. Unfortunately, we did not identify an intervention to help patients with type D occlusions. A phase 2b randomized controlled trial is needed to confirm these findings

Sex Differential in 15-Hydroxyprostaglandin Dehydrogenase Levels in the Lumen of Human Intracranial Aneurysms.

BACKGROUND: Aspirin is a promising medical therapy for the prevention of intracranial aneurysm (IA) rupture. Recently, we found that men have a better response to aspirin than women. The purpose of this study was to determine whether a sex differential exists in the level of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) in the lumen of human IAs. METHODS AND RESULTS: Consecutive patients undergoing coiling or stent-assisted coiling for a saccular IA at our institution were enrolled. Two samples (A and B) were collected from IA lumens, and the plasma level of 15-PGDH was measured using an ELISA-based method. The study included 38 patients, with 20 women and 18 men. Women and men were comparable on baseline characteristics. The mean plasma concentration of 15-PGDH did not differ statistically between sample A (62.8±16.2 ng/mL) and sample B (61.8±17.9 ng/mL; 95% confidence interval -6.6 to 9.4). The mean plasma concentration of 15-PGDH in IA lumens of samples A and B was significantly higher in men (73.8±13.5 ng/mL) than women (49.6±7.8 ng/mL; P\u3c0.0001). CONCLUSIONS: Higher enzyme levels of 15-PGDH exist in the lumen of IAs of men compared with women. This observation could explain why aspirin confers better protection against IA rupture in men than in women. The susceptibility of an individual to aspirin may differ according to the level of 15-PGDH

Plasma and intracellular (platelet) zinc levels in chronic renal failure (CRF) patients under different treatment modalities

The causes and degree of zinc (Zn) deficiency in uraemia are still controversial. The effect of different treatment modalities are still unsettled. Plasma Zn represents only a small part of the total body Zn (about 0.5%). Thus determination of intracellular Zn in the peripheral blood cells might be more reliable. The present study was designed to assess the actual Zn status in uraemia and to find whether the treatment modalities of CRF (conservative and dialytic) could influence Zn status. Also to determine the elfeet of single dialysis session, type of dialysis and dialysate buffer on the Zn status.This study included ten healthy controls and fourty CRF patients divided in three subgroups on different treatment modalities (10 conservative treatment, 15 on intermittent perioneal dialysis ((IPD) and 15 on haemedialysis (HD). Zinc was measured by atomic absorption spectrophotometry in plasma and platelets. Statistically significant decrease of plasma Zn and significant increase of platelet Zn were found in CRF patients on different treatment modalities as compared to controls (P<0.01), but there was no significant difference in this respect hetween the three uraemic subgroups. There was no difference as regard serum protein and albunun levels in uraemic subgroups compared to controls. Moreover plasma Zn was significantly increased (still less than control) and platelet Zn was significantly decreased (P<0.01) after a single dialysis session in both IPD and HD subgroups, but the changes of both parameters (before and after dialysis) were insignificant in IPD patients compared to HD patients.Significant negative correlation was found between platelet Zn and creatinine clearance in the three uraemic subgroups (r = -0.81 P<0.01 in conservative patients, r= -0.72 P<0.01 in IPD and r= -0.76 P<0.01 in HD) while no correlation could be detected between the duration of dialysis and each of platelet & plasma Zn and between plasma Zn and each of platelet Zn, serum creatinine and clearance. Plasma Zn showed transient significant rise in HD patients using bicarbonate (11.6 ± 1.1 umol/L) as compared to those using acetate buffer (9.1 ± 1.3 umol/L), P<0.01. We can conclude that intracellular measurements of Zn (platelet) is of value in diagnosis and monitoring of Zn status in uraemics. Different treatment modalities does not influence Zn haernostasis. with no superiority of particular type of dialysis in this respect. The effect of a single dialysis session and the use of bicarbonate versus acetate buffer was just a transient rise of plasma Zn due to haemoconcentration and better correction of acidosis during dialysis

Plasma Soluble Human Elastin Fragments as an Intra-Aneurysmal Localized Biomarker for Ruptured Intracranial Aneurysm

Background—Fragmentation of the tunica media is a hallmark of intracranial aneurysm formation, often leading to aneurysmal progression and subsequent rupture. The objective of this study is to determine the plasma level of elastin fragments in the lumen of ruptured versus unruptured human intracranial aneurysms. Methods and Results—One hundred consecutive patients with/without ruptured saccular intracranial aneurysms undergoing endovascular coiling or stent-assisted coiling were recruited. Blood samples were collected from the lumen of intracranial aneurysm using a microcatheter. The tip of the microcatheter was placed inside the aneurysm’s sac in close proximity to the inner wall of the dome. Plasma levels of elastin fragments were measured using an ELISA-based method. Mean plasma level of soluble human elastin fragments was significantly greater in ruptured aneurysms when compared with nonruptured aneurysms (102.0±15.5 versus 39.3±9.6 ng/mL; P\u3c0.001). Mean plasma level of soluble human elastin fragments did not have significant correlation with age, sex, size, or aneurysm location. Conclusions—The present study revealed that a significantly higher concentration of soluble human elastin fragments in the lumen of ruptured intracranial aneurysms when compared with nonruptured ones. © 2018 The Authors

THE EFFECTS OF DIABETES MELLITUS ON THE RESPONSE TO PEGINTERFERON-ALPHA IN COMBINATION WITH RIBAVIRIN THERAPY IN EGYPTIAN CHRONIC HEPATITIS C PATIENTS

Objective:The present study aimed to determine whether type 2 diabetes mellitus influences the response to antiviral therapy with peg-interferon alpha plus ribavirin in Egyptian patients with chronic hepatitis C. Methods:All patients were treated with peginterferon alpha 2 b (1.5 μg/Kg/body weight) subcutaneously plus oral ribavirin application in a dose ranging from 800-1200 mg/day and followed after 12 w of therapy. Results: The present study indicated that, non-significant changes were observed in liver function, kidney function, thyroid function tests, tumor marker, immunological analysis, hematological parameters, viral load and degree of cirrhosis between both groups’ baselines, while the only significant difference was regarded in glucose level. However, diabetic group showed a significant decrease in response to antiviral therapy as compared to non-diabetic hepatitis C virus (HCV) patients. Furthermore, significant decrease in serum liver enzymes activity and total bilirubin level as compared to baseline levels in both groups, while there were a significant increase in alanine transaminase (ALT) activity and total bilirubin level in diabetic group as compared to non-diabetic HCV group after treatment. Also, significant decreases in hemoglobin concentration, white blood cells and platelet counts, in both groups after treatment as compared to there before treatment while diabetic group showed significant decreases in hemoglobin concentration and white blood cells count when compared with non-diabetic HCV group after treatment. Conclusion: Type 2 diabetes mellitus influence the response to antiviral therapy with peginterferon plus ribavirin in Egyptian patients with chronic hepatitis C

Cerebral Arteriovenous Malformations: Evaluation and Management.

There has been increased detection of incidental AVMs as result of the frequent use of advanced imaging techniques. The natural history of AVM is poorly understood and its management is controversial. This review provides an overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management of AVMs. The authors discussed the imaging techniques available for detecting AVMs with regard to the advantages and disadvantages of each imaging modality. Furthermore, this review paper discusses the factors that must be considered for the most appropriate management strategy (based on the current evidence in the literature) and the risks and benefits of each management option

Combining Evolutionary Algorithms and Average Overlap Metric Rules for Medical Image Segmentation

Abstract: In this paper, we explore a new algorithm based on evolutionary algorithms and fusion concepts for improving medical image segmentation. The proposed approach starts by finding seeds that cover the image using genetic algorithm (GA). This initial partition is used as the seed to a computationally efficient region growing method to produce the closed regions. The average overlap metric (AOM) is used to classify these regions into groups based on the similarity criterion. The fusion modules are applied to each group to find the points that label the suite membership values. The different fusion rules will be applied to these groups to produce a set of chromosomes to select the best data in each chromosome to represent the final segment. To prove the efficiency of the proposed algorithm, the proposed algorithm will be applied to challenging applications: MRI datasets, 3D simulated MRIs, and gray matter/white matter of brain segmentations

Endovascular Treatment of Cerebral Mycotic Aneurysm: A Review of the Literature and Single Center Experience

The management of mycotic aneurysm has always been subject to controversy. The aim of this paper is to review the literature on the intracranial infected aneurysm from pathogenesis till management while focusing mainly on the endovascular interventions. This novel solution seems to provide additional benefits and long-term favorable outcomes

Condiciones óptimas para la degradación enzimática de proteínas de semillas oleaginosas

Soybean, sesame seed, and rice bran meal proteins were hydrolyzed with two enzymes, namely, papain and bromelain. Experiments were carried out to elucidate the optimum condition for each enzyme when acting on each substrate seperately. Results revealed that the highest relative activities for papain were achieved with E/S 0.06 , 0.29, 0.19 and pH 7.2, 7.0, 7.0 for soybean, sesame,and rice bran meal proteins, respectively. Optimum temperature for papain while hydrolysing the three substrates was 50 ºC. When using bromelain optimum E/S resulting in highest relative activities were 0.067, 0.058 and 0.21 for soybean, sesame,and rice bran meal protein, respectively. Optimum pH was 6.0 and optimum temperature was 45 ºC for bromelain when hydrolysing the protein of the three substrates. A numerical correlation of enzymatic behaviour for the different substrates was calculated.Proteínas de haba de soja, semilla de sésamo y harina de germen de arroz se hidrolizaron con dos enzimas, denominadas, papaina y bromelaina. Se han llevado a cabo experimentos para determinar las condiciones óptimas de cada enzima cuando actúan separadamente sobre cada sustrato. Los resultados mostraron que las mayores actividades relativas para la papaina se consiguieron con una E/S 0,06, 0,29, 0,19 y un pH 7.2, 7.0, 7.0 para las proteínas de haba de soja, sésamo y harina de germen de arroz, respectivamente. La temperatura óptima para la papaina durante la hidrólisis de los tres sustratos fue de 50 ºC. Cuando se usa bromelaina las relaciones E/S óptimas que proporcionaron mayor actividad relativa fueron 0.067, 0.058 y 0.21 para las proteínas de habas de soja, sésamo y harina de germen de arroz respectivamente. El pH óptimo fue 6.0 y la temperatura óptima 45 ºC para la bromelaina cuando se hidroliza la proteína de los tres sustratos. Con estos datos se hizo una correlación numérica del comportamiento enzimático para los diferentes sustratos

Management of head and neck pseudoaneurysms: a review of 33 consecutive cases.

Background. Endosaccular coiling, vessel occlusion, stenting, stent-assisted coiling, and flow diversion are all endovascular treatment options for pseudoaneurysms (PAs) of the head and neck. We explore different clinical situations in which these were selected for PA management at a single institution. Methods. Over a period of ten years, 33 patients presented to our hospital with PAs of the head and neck. Their outcomes and procedural complications are discussed. Results. We observed a complication rate of 18.2% (6 of 33), consisting predominantly of infarcts following vessel occlusion. As measured by the modified Rankin Scale, 25 (75.8%) patients had achieved favorable outcomes on discharge. A single patient who was treated with stent-assisted coiling expired following procedural complications. Conclusions. In our series, most patients with traumatic/iatrogenic PAs were successfully treated with parent vessel sacrifice. When parent vessel occlusion is not an option, stenting with or without coiling, or flow diversion, may also be safe and effective alternatives