Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions

Small vessel disease encompasses lacunar stroke, white matter hyperintensities, lacunes and microbleeds. It causes a quarter of all ischemic strokes, is the commonest cause of vascular dementia, and the cause is incompletely understood. Vascular prophylaxis, as appropriate for large artery disease and cardioembolism, includes antithrombotics, and blood pressure and lipid lowering; however, these strategies may not be effective for small vessel disease, or are already used routinely so precluding further detailed study. Further, intensive antiplatelet therapy is known to be hazardous in small vessel disease through enhanced bleeding. Whether acetylcholinesterase inhibitors, which delay the progression of Alzheimer's dementia, are relevant in small vessel disease remains unclear. Potential prophylactic and treatment strategies might be those that target brain microvascular endothelium and the blood brain barrier, microvascular function and neuroinflammation. Potential interventions include endothelin antagonists, neurotrophins, nitric oxide donors and phosphodiesterase 5 inhibitors, peroxisome proliferator-activated receptor-gamma agonists, and prostacyclin mimics and phosphodiesterase 3 inhibitors. Several drugs that have relevant properties are licensed for other disorders, offering the possibility of drug repurposing. Others are in development. Since influencing multiple targets may be most effective, using multiple agents and/or those that have multiple effects may be preferable. We focus on potential small vessel disease mechanistic targets, summarize drugs that have relevant actions, and review data available from randomized trials on their actions and on the available evidence for their use in lacunar stroke

A computational and experimental investigation of the anchoring of organosilanes on the halloysite silicic surface

In this work, the effect of halloysite nanotubes alkali activation on its grafting efficiency with organosilanes was studied by Density Functional Theory and experimental investigations. In particular, computational analysis allowed to enlight the structural properties of the organic molecules attached to the silanol groups on halloysite outer surface. The energetics of the reactions showed that the pretreatment with a base is crucial for the modification of the surface due to the appearance of a high number of active sites which lead to thermodynamically favored exothermic processes. Experimental evidences are in good agreement with calculation hypothesis. For instance, the coating efficiency is higher after the alkali activation of the inorganic counterpart for both the investigated organosilanes. The findings here reported are important in order to improve any functionalization protocols for aluminosilicates without variations or loss of the hollow nanotubular morphological features and it paves the ground to halloysite based technological applications in many fields, from nanotechnology to catalysis

Salvage surgery for squamous cell carcinoma of the head and neck in the era of immunotherapy: Is it time to clarify our guidelines?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146561/1/cncr31717_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146561/2/cncr31717.pd

TEVAR and periscope graft technique to treatment of huge aneurysm of aortic isthmus: Case report

Introduction: Thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms. Innovative techniques as chimney and periscope grafts can improve the outcomes of procedure. Herein, we report a case in emergency of huge Thoracic aortic aneurism. Presentation of case: An 86-year-old male with hypertension, diabetes mellitus, was referred to our hospital for chest pain. CT-angiography showed a huge aneurysm of aortic isthmus with signs of rupture. The patient was considered unfit for open surgery and an endovascular approach was chosen. This patient underwent endovascular repair with TEVAR, using the periscope graft technique to preserve patency in left subclavian artery (LSA). Discussion: Symptomatic ischemia from LSA coverage has been reported to occur in only a modest 6–10% of patients and is often sacrificed with impunity given coverage rates between 10 and 50%. In this case reported the lack of revascularization of LSA increased the risk of neurological manifestations or stroke. Periscope technique is feasible and safe to maintain perfusion to the subclavian artery, with a 93% primary patency at 2 years. Conclusions: Our experience using TEVAR with periscope graft technique as solution to address thoracic aneurysm of aortic isthmus was feasible and safe

Staged acute mesenteric and peripheral ischemia treatment in COVID-19 patient: Case report

Introduction: COVID-19 is an infectious disease that has been associated not only with respiratory complications. The COVID-19 disease includes, also damage to other organ systems as well as coagulopathy. The present report describes a case of COVID-19 presenting with acute mesenteric ischemia (AMI) and subsequent acute limb ischemia (ALI). Presentation of case: An 84-years old hospitalized female patient presenting diabetes and recent COVID-19 reported acute onset of abdominal pain and typical findings of AMI. The CT-angiography confirmed the AMI secondary to a superior mesenteric artery (SMA) occlusion. The patient was managed through an endovascular approach using a SMA mechanical thrombectomy and stenting with a good result. Discussion: Treatment of this life-threatening condition includes surgical resection of the necrotic bowel, restoration of blood flow to the ischemic intestine and supportive measure - gastrointestinal decompression, fluid resuscitation, hemodynamic support. Endovascular management of AMI is preferred over the standard surgical approach due to a reduced mortality and morbidity rates. Imaging findings of intestinal necrosis, however, represent an indication for AMI surgical treatment with explorative laparotomy. Different endovascular solutions have been employed to address AMI including mechanical thrombectomy, local thrombolysis, and PTA-stenting. Conclusion: COVID-19 clinical presentation can be atypical, including gastrointestinal symptoms. If a first embolic event occurs, an aggressive anticoagulation treatment could be inefficient to reduce the risk of subsequent embolization events. The limited life expectancy of such revascularization procedures should orientate towards less invasive treatments

Responses of four winegrape varieties to managed water stress and partial defoliation in an arid environment

In viticulture, the imposition of managed water deficits is a strategy which has been used to increase both water use efficiency and winemaking quality in arid climates. Partial defoliation early in the season is another innovative practice that may also be used as an aid in regulating yield components and improving fruit quality. The aim of this work was to evaluate the effects of managed water stress and early season partial defoliation on crop yield and quality in two autochthonous (‘Frappato’ and ‘Nero d’Avola’) and two international varieties (‘Syrah’ and ‘Cabernet Sauvignon’) growing in an arid environment. The four treatments were: (i) no leaf removal, un-irrigated, (ii) no leaf removal, irrigated at 30 % of estimated crop evapotranspiration (ETc), (iii) partial leaf removal, un-irrigated, and (iv) partial leaf removal, irrigated at 30 % of estimated ETc. The results confirm the effectiveness of partial defoliation in yield management which leads to smaller clusters. Managed water stress was also an effective strategy for reducing berry size, improving must quality and generally enhancing anthocyanin accumulation.