Bilateral cavernous carotid aneurysms treated by two-stage extracranial-intracranial bypass followed by parent artery occlusion: case report and literature review

Bilateral cavernous carotid aneurysms (CCAs) are often not amenable to neurosurgical clipping or endovascular coiling. Here, we report the case of a 50-year-old female who presented with a 1-year history of gradual severe headache. Preoperative angiograms revealed bilateral CCAs. Among these findings, the right giant CCA had been trapped after the external carotid artery-saphenous vein-middle cerebral artery (ECA-SV-MCA) bypass 8 years prior. Additionally, the left CCA was again trapped after the internal maxillary artery-radial artery-middle cerebral artery (IMA-RA-MCA) bypass, followed by parent artery occlusion (PAO), because of the enlargement of a 0.4-cm aneurysm to a 1.3-cm aneurysm during the 5th to 8th years following surgery. Postoperative radiologic findings proved that the aneurysms disappeared with good graft patency of the bilateral anastomoses and excellent filling of the bilateral MCA territories. This is the first case of bilateral CCAs treated with two stages of bilateral high-flow extracranial-intracranial (EC-IC) bypass, including an IMA-RA-MCA bypass.

Wilted cucumber plants infected by Fusarium oxysporum f. sp. cucumerinum do not suffer from water shortage

Background and Aims

Fusarium wilt is primarily a soil-borne disease and results in yield loss and quality decline in cucumber (Cucumis sativus). The main symptom of fusarium wilt is the wilting of entire plant, which could be caused by a fungal toxin(s) or blockage of water transport. To investigate whether this wilt arises from water shortage, the physiological responses of hydroponically grown cucumber plants subjected to water stress using polyethylene glycol (PEG, 6000) were compared with those of plants infected with Fusarium oxysporum f. sp. cucumerinum (FOC).

Methods

Parameters reflecting plant water status were measured 8d after the start of treatment. Leaf gas exchange parameters and temperature were measured with a LI-COR portable open photosynthesis system and by thermal imaging. Chlorophyll fluorescence and chloroplast structures were assessed by imaging pulse amplitude-modulated fluorometry and transmission electron microscopy, respectively.

Key Results

Cucumber water balance was altered after FOC infection, with decreased water absorption and hydraulic conductivity. However, the responses of cucumber leaves to FOC and PEG differed in leaf regions. Under water stress, measures of lipid peroxidation (malondialdehyde) and chlorophyll fluorescence indicated that the leaf edge was more seriously injured, with a higher leaf temperature and disrupted leaf water status compared with the centre. Here, abscisic acid (ABA) and proline were negatively correlated with water potential. In contrast, under FOC infection, membrane damage and a higher temperature were observed in the leaf centre while ABA and proline did not vary with water potential. Cytologically, FOC-infected cucumber leaves exhibited circular chloroplasts and swelled starch grains in the leaf centre, in which they again differed from PEG-stressed cucumber leaves.

Conclusions

This study illustrates the non-causal relationship between fusarium wilt and water transport blockage. Although leaf wilt occurred in both water stress and FOC infection, the physiological responses were different, especially in leaf spatial distribution.

[New advances in the diagnosis of liver fibrosis]

Various chronic liver diseases may progress to liver fibrosis or liver cirrhosis. Assessment of the degree of liver fibrosis helps with clinical decision-making, prognosis prediction, and evaluation of therapeutic effect, and therefore, accurate diagnosis and evaluation of the degree of liver fibrosis is a research hotspot at present. The advances in the diagnosis of liver fibrosis in recent years include the publication of international consensuses and guidelines, evaluation of the outcome of liver fibrosis after antiviral therapy, development of the diagnosis of liver fibrosis in patients with non-viral hepatitis, and constant update of noninvasive diagnostic techniques.

[Distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015: results from a multicenter, retrospective study]

Objective: To describe the distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015 to provide reference for empirical anti-infection treatment. Methods: Pathogens were from hematology department of 26 tertiary hospitals in Jiangsu Province from 2014 to 2015. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or agar dilution method. Collection of drug susceptibility results and corresponding patient data were analyzed. Results: The separated pathogens amounted to 4 306. Gram-negative bacteria accounted for 64.26%, while the proportions of gram-positive bacteria and funguses were 26.99% and 8.75% respectively. Common gram-negative bacteria were Escherichia coli (20.48%) , Klebsiella pneumonia (15.40%) , Pseudomonas aeruginosa (8.50%) , Acinetobacter baumannii (5.04%) and Stenotropho-monas maltophilia (3.41%) respectively. CRE amounted to 123 (6.68%) . Common gram-positive bacteria were Staphylococcus aureus (4.92%) , Staphylococcus hominis (4.88%) and Staphylococcus epidermidis (4.71%) respectively. Candida albicans were the main fungus which accounted for 5.43%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were 3.5%-6.1% and 5.0%-6.3% respectively. The rates of Pseudomonas aeruginosa resistant to tobramycin and amikacin were 3.2% and 3.3% respectively. The resistant rates of Acinetobacter baumannii towards tobramycin and cefoperazone/sulbactam were both 19.2%. The rates of Stenotrophomonas maltophilia resistant to minocycline and sulfamethoxazole were 3.5% and 9.3% respectively. The rates of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis resistant wards vancomycin were 0, 6.4% and 1.4% respectively; also, the rates of them resistant to linezolid were 1.2%, 0 and 1.6% respectively; in addition, the rates of them resistant to teicoplanin were 2.8%, 14.3% and 8.0% respectively. Furthermore, MRSA accounted for 39.15% (83/212) . Conclusions: Pathogens were mainly gram-negative bacteria. CRE accounted for 6.68%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were lower compared with other antibacterial agents. The rates of gram-positive bacteria resistant to vancomycin, linezolid and teicoplanin were still low. MRSA accounted for 39.15%.

Role of Silicon on Plant-Pathogen Interactions

Although silicon (Si) is not recognized as an essential element for general higher plants, it has beneficial effects on the growth and production of a wide range of plant species. Si is known to effectively mitigate various environmental stresses and enhance plant resistance against both fungal and bacterial pathogens. In this review, the effects of Si on plant-pathogen interactions are analyzed, mainly on physical, biochemical, and molecular aspects. In most cases, the Si-induced biochemical/molecular resistance during plant-pathogen interactions were dominated as joint resistance, involving activating defense-related enzymes activates, stimulating antimicrobial compound production, regulating the complex network of signal pathways, and activating of the expression of defense-related genes. The most previous studies described an independent process, however, the whole plant resistances were rarely considered, especially the interaction of different process in higher plants. Si can act as a modulator influencing plant defense responses and interacting with key components of plant stress signaling systems leading to induced resistance. Priming of plant defense responses, alterations in phytohormone homeostasis, and networking by defense signaling components are all potential mechanisms involved in Si-triggered resistance responses. This review summarizes the roles of Si in plant-microbe interactions, evaluates the potential for improving plant resistance by modifying Si fertilizer inputs, and highlights future research concerning the role of Si in agriculture.

Development of a Prolonged-Release Pramipexole Transdermal Patch: In Vitro and In Vivo Evaluation

The current study aimed to develop a prolonged-release pramipexole (PPX) transdermal patch for the treatment of Parkinson's disease. Permeation parameters of PPX were investigated using human cadaver skin. Pramipexole patches were prepared using DURO-TAK^® pressure-sensitive-adhesive (PSA) and evaluated for drug stability, drug loading, in vitro drug release, and in vitro permeation through mouse skin. The results indicated that blends of DURO-TAK^® 87-2852 and DURO-TAK^® 87-2510 were suitable for creating a prolonged-release PPX patch due to their advantages in drug release, drug loading, and stability. The final formulation consisted of 87-2852/87-2510 (70:30), 10% PG, and 15% PPX and showed a cumulative permeation amount of 1497.19 ± 102.90 μg/cm² with a continuous flux over 6.0 μg/(cm²·h) across human cadaver skin for 7 days. In vivo studies in rats indicated that PPX patch produced a significantly longer (p < 0.001) half-life (t _1/2, 75.16 ± 17.37 h) and mean residence time (MRT, 135.89 ± 24.12 h) relative to oral tablets (Sifrol^®) and had a relative bioavailability of 51.64 ± 21.32%. Therefore, this study demonstrated the feasibility of developing a prolonged-release PPX patch, which proposed the potential to serve as an alternate to conventional oral tablets and may therefore improve patient compliance.

Nitrate Increased Cucumber Tolerance to Fusarium Wilt by Regulating Fungal Toxin Production and Distribution

Cucumber Fusarium wilt, induced by Fusarium oxysporum f. sp. cucumerinum (FOC), causes severe losses in cucumber yield and quality. Nitrogen (N), as the most important mineral nutrient for plants, plays a critical role in plant-pathogen interactions. Hydroponic assays were conducted to investigate the effects of different N forms (NH₄⁺ vs. NO₃‒) and supply levels (low, 1 mM; high, 5 mM) on cucumber Fusarium wilt. The NO₃‒-fed cucumber plants were more tolerant to Fusarium wilt compared with NH₄⁺-fed plants, and accompanied by lower leaf temperature after FOC infection. The disease index decreased as the NO₃‒ supply increased but increased with the NH₄⁺ level supplied. Although the FOC grew better under high NO₃- in vitro, FOC colonization and fusaric acid (FA) production decreased in cucumber plants under high NO₃- supply, associated with lower leaf membrane injury. There was a positive correlation between the FA content and the FOC number or relative membrane injury. After the exogenous application of FA, less FA accumulated in the leaves under NO₃- feeding, accompanied with a lower leaf membrane injury. In conclusion, higher NO₃- supply protected cucumber plants against Fusarium wilt by suppressing FOC colonization and FA production in plants, and increasing the plant tolerance to FA.

Immunohistochemical localization of sex hormone receptors in two Raillietina tapeworms

Sex hormone receptors play critical roles in development and reproduction. However, it is not known whether they exist in Raillietina tapeworms, and if they do, whether they have a similar function to that in vertebrates. We examined the immunohistochemical distributions of androgen receptors (ARs), estrogen receptors (ERs), and progesterone receptors (PRs) in the tissues of two tapeworm species: Raillietina echinobothrida and Raillietina tetragona. Immunopositive ARs were found in the entire reproductive system of R. echinobothrida, including the testes, ovaries, and oocysts, and weakly immunopositive ERs and PRs were found in the testes, ovaries, and oocysts. Immunopositive ARs were also found throughout the entire reproductive system of R. tetragona, including the testes, ovaries, and oocysts, and weakly immunopositive ERs were in the testes and oocysts; the PRs were distributed in an immunonegative manner. The results show that androgens and their receptors play critical roles in reproductive system development in the two tapeworms. The immunoreactivity and tissue localizations of the sex hormone receptors suggest that, in both species, they have similar functions as in vertebrates, and modulate reproduction.

Outcome of Radical Surgical Resection for Craniopharyngioma with Hypothalamic Preservation: A Single-Center Retrospective Study of 1054 Patients

OBJECTIVE

A retrospective review of the surgical outcome for patients with craniopharyngioma (CP) treated in a single neurosurgical center with surgical resection using visualization to ensure hypothalamic preservation.

METHODS

The study included 1054 patients. Before 2003, a pterional cranial approach was preferred for 78% of patients; after 2004, the unifrontal basal interhemispheric approach was performed in 79.1% of patients.

RESULTS

Complete tumor resection was achieved in 89.6% of patients; vision improved in 47.1% of patients who had preoperative vision impairment. However, diabetes insipidus worsened in 70.4% of patients and new-onset diabetes insipidus occurred in 29.7% of the remaining patients. Pituitary stalk preservation occurred in 48.9% of cases. There were 89.6% of patients with total tumor removal; 13.3% of patients showed tumor recurrence within an average of 2.8 years. Of 69 follow-up patients with a subtotal or partial resection, 94.2% showed tumor recurrence within an average of 4.3 months. Of the total patients, 82.3% fully recovered.

CONCLUSIONS

This study has shown that radical surgical resection of CP using microsurgical excision can be effective with a good patient outcome without more limitations on each individual tumor of distinct features despite the impact of recent endoscopic techniques on CP surgery. The surgical approach depends on a direct and wider visualization of CP located in the midline with preserving hypothalamic structures by identifying some hypothalamic landmark structures. After surgery, most patients can resume their normal activities even after aggressive tumor removal, although patients require postoperative hormonal replacement.

[A discussion of the methods for the assessment of chronic hepatitis B-related liver fibrosis regression]

Antiviral therapy could reverse hepatitis B-related liver fibrosis and early-stage cirrhosis. However, the assessment of fibrosis regression remains controversial. As the gold standard for assessment, liver biopsy has its own limitations. In terms of non-invasive assessment, there are many interfering factors for transient elastography and less clinical evidence for the use of serum markers. Therefore, further evidence from clinical studies is still needed to determine the role of non-invasive methods in evaluating fibrosis regression.

[In-Vivo Noninvasive Measurement of Human Blood Glucose Levels by Mid-Infrared Spectrograph with External CO(2) Laser Source]

Diabetes is a kind of diseases which does harm to people’s health, and the detection of human blood glucose levels utilizing blood samples will result in pain even infection for patients. Thus the in-vivo noninvasive measurement of human blood glucose levels has vital value in clinical diagnosis, detection and therapy, and it also is a very hot research topic with challenging. At present, as to various noninvasive detection methods, the technology based on mid-infrared absorption spectrophotometry with ATR has been gaining increasing attention. However, when carrying out noninvasive measurement of human blood glucose levels by means of the spectrophotometry equipped with routine light sources, the penetration depth of probe light in human tissues is low and thus it is very difficult to reach the stromal layer containing body fluids and especially dermis layer containing blood for probe light, which resulting in low relativity between experimental data and real human blood glucose levels and thus limiting the clinical application. Generally, not only the mid-infrared laser with high strength and high purity can deeper penetrate the human tissues, but also the output wavelengths at 1 035 cm(-1) of CO2 laser very coincide with the fundamental frequency characteristic absorption at 1 029 cm(-1) of glucose. Thus, in this work, a novel noninvasive mid-infrared measurement system to detect human blood glucose levels has been successfully assembled, in which a CO2 laser was used a self-defined external light source of the new mid-infrared absorption spectrophotometry with ATR. In this system, the absorbance of human fingertip at 1 035 cm(-1) has been measured when external CO2 laser source was used as probe light, at the same time, the mid-infrared absorption spectra of fingertip have been also obtained and absorbance at 1 492 cm(-1) has been recorded. The human blood glucose levels were determined synchronously by means of the routine medical method. The experimental results showed that the ratio in fingertip between absorbance at 1 035 cm(-1) from the laser source and one at 1 492 cm(-1) from mid-infrared absorption spectrophotometry could synchronously change with the human blood glucose levels, and the ratio presents certain positive relativity with the real human blood glucose levels(R=0. 812 5). Thus the measurement data could be used as a new index of blood glucose level in human body, which showed the potential in clinical diagnosis of the ATR mid-infrared absorption spectrophotometry with external CO(2) laser source in noninvasive measurement of human blood glucose levels.

Nitrate Protects Cucumber Plants Against Fusarium oxysporum by Regulating Citrate Exudation

Fusarium wilt causes severe yield losses in cash crops. Nitrogen plays a critical role in the management of plant disease; however, the regulating mechanism is poorly understood. Using biochemical, physiological, bioinformatic and transcriptome approaches, we analyzed how nitrogen forms regulate the interactions between cucumber plants and Fusarium oxysporum f. sp. cucumerinum (FOC). Nitrate significantly suppressed Fusarium wilt compared with ammonium in both pot and hydroponic experiments. Fewer FOC colonized the roots and stems under nitrate compared with ammonium supply. Cucumber grown with nitrate accumulated less fusaric acid (FA) after FOC infection and exhibited increased tolerance to chemical FA by decreasing FA absorption and transportation in shoots. A lower citrate concentration was observed in nitrate-grown cucumbers, which was associated with lower MATE (multidrug and toxin compound extrusion) family gene and citrate synthase (CS) gene expression, as well as lower CS activity. Citrate enhanced FOC spore germination and infection, and increased disease incidence and the FOC population in ammonium-treated plants. Our study provides evidence that nitrate protects cucumber plants against F. oxysporum by decreasing root citrate exudation and FOC infection. Citrate exudation is essential for regulating disease development of Fusarium wilt in cucumber plants.

Pharmacokinetics and pharmacodynamics of glycyrrhetinic acid with Paeoniflorin after transdermal administration in dysmenorrhea model mice

BACKGROUND

Glycyrrhetinic acid (GA) and paeoniflorin (PF) are the main active ingredients in Chinese peony- Liquorice Decoction, a widely used Traditional Chinese Medicine.

HYPOTHESIS/PURPOSE

The aim of this work was to investigate the combinatory analgesic effect of GA and PF after percutaneous administration and to define their pharmacokinetic/pharmacodynamic (PK/PD) characteristics.

STUDY DESIGN AND METHODS

GA and PF were produced to transdermal patches based on previous research, and the permeation parameters of GA and PF in the patches were investigated with in vitro experiments. Dysmenorrhea model mice were then produced to compare the analgesic effects of the patches with different proportions of GA-PF. In the in vivo assessment, the number of writhes exhibited by the dysmenorrhea mice was recorded at designated time points, and skin, muscle under skin and plasma samples were collected, for assessments of drug distribution, pharmacokinetics parameters and PK/PD characteristics.

RESULTS AND CONCLUSION

In dysmenorrhea mice, GA-PF and meloxicam (the positive control drug) could relieve pain to equal degrees. Specifically, a single dose of the optimized patches (10%GA-10%PF, wt) exerted a steady analgesic effect for 48h in dysmenorrhea mice, but this effect lagged behind the changes in the plasma concentration. Evaluation with the Bliss Independence criterion revealed that the two ingredients displayed a synergistic effect. Then the PK/PD relationship of GA in this compound preparation was defined with this synergistic effect. The preparation might be suitable for topical spasmolysis and anti-inflammatory therapy.

Internal maxillary artery to intracranial artery bypass: a case series of 31 patients with chronic internal carotid/middle cerebral arterial-sclerotic steno-occlusive disease

OBJECTIVE

To evaluate the effectiveness of internal maxillary artery (IMA) - radial artery graft (RAG) - middle cerebral artery (MCA) bypass surgery for chronic arterial-sclerotic severe stenosis or occlusion of the internal carotid artery (ICA) or MCA.

METHODS

A retrospective study was conducted in 31 patients with ischemic cerebrovascular disease who underwent bypass surgery of the IMA with a RAG of the MCA. Twenty-seven patients had complete occlusion of the ICA or MCA, and four patients had severe stenosis of the M1 segment of the MCA.

RESULTS

Patent IMA-RAG-MCA in 30 (96.8%) patients was confirmed by angiography after surgery. One case developed a new motor aphasia due to unsuccessful bypass. Eleven transient ischemic attacks (TIA) and five ischemic strokes resolved following surgery. The other 14 cases showed some improvement without ischemic events at one month following surgery. Prior to surgery, mean ± SD National Institute of Health Stroke Scale (NIHSS) score was 5.4 ± 1.1 in the ischemic stroke group. In the first month post-procedure, the NIHSS score decreased significantly to 3.8 ± 1.2, (p < 0.01). Perfusion weighted imaging (PWI) or computed tomography perfusion (CTP) indicated improved hemodynamics in 30 patients. In addition, seven patients demonstrated improved glucose metabolism on 18-fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography (PET) postoperatively. No new neurological deficit occurred in the 30 patients during a 2.19 ± 1.59 years of follow-up.

CONCLUSIONS

By supplying an adequate flow to a larger flow territory of chronically stenotic/occlusive major cerebral arteries, IMA bypass surgery is efficient for restoring hemodynamics in selected patients and improving their neurological deficits.

An Engineered Endomorphin-2 Gene for Morphine Withdrawal Syndrome

An optimal therapeutics to manage opioid withdrawal syndrome is desired for opioid addiction treatment. Down-regulation of endogenous endomorphin-2 (EM2) level in the central nervous system after continuous morphine exposure was observed, which suggested that increase of EM2 could be an alternative novel method for opioid dependence. As a short peptide, the short half-life of EM2 limits its clinical usage through conventional administration. In the present study, we engineered an EM2 gene using a signal peptide of mouse growth factor for an out-secretory expression of EM2 and an adenovirus as a vector, which ultimately sustained the release of EM-2. After administration of the adenovirus in central nervous system, a sustained increase of EM2 level in the cerebral spinal fluid (CSF) was observed along with a reduction of morphine withdrawal syndrome. These findings suggest that the engineered EM2 gene delivered to the central nervous system could be a novel therapeutics for withdrawal syndrome in opioid dependent subjects.

Effect of glycyrrhizic acid on the oral absorption of paeoniflorin in rats in vivo

The effect of glycyrrhizic acid (GL) on the absorption of paeoniflorin (PF) was GL dosage dependent in rats. The C_max of PF decreased significantly when GL at the dosage of 300 mg kg⁻¹ BW, while it increased with the increase of the dosage of GL.

A membrane-permeable dye for living cells with large two-photon excited fluorescence action cross-sections for bioimaging

The development of two-photon fluorophores remains an important issue. Dyes that possess both large two-photon excited fluorescence action cross-sections and cell membrane permeability are especially in demand to maximize the underlying virtue of two-photon microscopy for bioimaging. Herein, a novel two-photon excited fluorescence dye has been synthesized. This V-shaped dye exhibited large two-photon excited fluorescence action cross-sections and high plasma membrane permeability. Cell imaging experiments demonstrated that the dye could stain living cells with bright two-photon excited fluorescence. All the results have indicated the potential of the dye as a basic platform for the development of two-photon excited fluorescence probes.

Water balance altered in cucumber plants infected with Fusarium oxysporum f. sp. cucumerinum

Fusarium wilt is caused by the infection and growth of the fungus Fusarium oxysporum in the xylem of host plants. The physiological responses of cucumbers that are infected with Fusarium oxysporum f. sp. cucumerinum (FOC) was studied in pot and hydroponic experiments in a greenhouse. The results showed that although water absorption and stem hydraulic conductance decreased markedly in infected plants, large amounts of red ink accumulated in the leaves of infected cucumber plants. The transpiration rate (E) and stomatal conductance (gs) of the infected plants were significantly reduced, but the E/gs was higher than healthy plants. We further found that there was a positive correlation between leaf membrane injury and E/gs, indicating that the leaf cell membrane injury increased the non-stomatal water loss from infected plants. The fusaric acid (FA), which was detected in the infected plant, resulted in damage to the leaf cell membranes and an increase in E/gs, suggesting that FA plays an important role in non-stomatal water loss. In conclusion, leaf cell membrane injury in the soil-borne Fusarium wilt of cucumber plants induced uncontrolled water loss from damaged cells. FA plays a critical role in accelerating the development of Fusarium wilt in cucumber plants.