Effect of Retrievable Stent Size on Endovascular Treatment of Acute Ischemic Stroke: A Multicenter Study

BACKGROUND AND PURPOSE

In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes.

MATERIALS AND METHODS

Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device. We matched patients treated with the 2 stent sizes using propensity score analysis. The successful outcome was reperfusion as measured by the modified Thrombolysis in Cerebral Infarction score immediately postprocedure and the dichotomized modified Rankin Scale score at 90 days. Symptomatic intracerebral hemorrhage and in-hospital mortality were also recorded.

RESULTS

After propensity score analysis, group outcomes did not differ. In addition, in patients with atherosclerosis-related occlusion, a higher reperfusion rate (P = .021) was observed in the Solitaire 4 group, as well as a shorter time interval (P = .002) and fewer passes (P = .025). Independent predictors of successful reperfusion in patients with atherosclerotic disease on logistic analysis were the small stent (OR, 3.217; 95% CI, 1.129-9.162; P = .029) and the propensity score acting as a covariate (OR, 52.84; 95% CI, 3.468-805.018; P = .004).

CONCLUSIONS

We found no evidence of a differential effect of intra-arterial therapy based on the size of Solitaire retrievers. In patients with atherosclerotic disease, favorable reperfusion was associated with deployment of a small stent.

Enhancement of anaerobic digestion of grass by pretreatment with imidazolium-based ionic liquids

In this work, the toxicity of imidazolium-based ionic liquids (ILs) and the enhancement of high-solid anaerobic digestion by pretreatment were studied. Compared with [Bmim]Cl, [Bmim]OAc and [Bmim]BF₄, [Bmim]PF₆ had the highest toxicity. When the mass ratio of [Bmim]PF₆ to grass was higher than 1:10, biogas was not produced within 30 days. The ability to remove lignin and hemicellulose followed the sequence of [Bmim]OAc, [Bmim]Cl, [Bmim]BF₄ and [Bmim]PF₆. The crystallinity index of grass pretreated with [Bmim]OAc, [Bmim]Cl, [Bmim]BF₄ and [Bmim]PF₆ reduced by 73.83%, 54.44%, 17.52% and 7.47%, respectively. The pretreatment with ILs enhanced the methane yield of grass by reducing crystallinity and particle size. The grass pretreated with [Bmim]OAc had the highest methane yield, about 221 mL/g volatile solids, due to its good lignin removal ability and relative low toxicity. After 10 times recycling, the cumulative methane yield of grass pretreated by recycled [Bmim]OAc decreased by 11.95%.

[The understanding of Epstein-Barr virus associated lymphoproliferative disorder]

In recent years, there are increasing articles concerning Epstein-Barr virus associated lymphoproliferative disorder (EBV+ LPD), and the name of EBV+ LPD is used widely. However, the meaning of EBV+ LPD used is not the same, which triggered confusion of the understanding and obstacles of the communication. In order to solve this problem. Literature was reviewed with combination of our cases to clarify the concept of EBV+ LPD and to expound our understanding about it. In general, it is currently accepted that EBV+ LPD refers to a spectrum of lymphoid tissue diseases with EBV infection, including hyperplasia, borderline lesions, and neoplastic diseases. According to this concept, EBV+ LPD should not include infectious mononucleosis (IM) and severe acute EBV infection (EBV+ hemophagocytic lymphohistiocytosis, fatal IM, fulminant IM, fulminant T-cell LPD), and should not include the explicitly named EBV+ lymphomas (such as extranodal NK/T cell lymphoma, aggressive NK cell leukemia, Burkitt lymphoma, and Hodgkin lymphoma, etc.) either. EBV+ LPD should currently include: (1) EBV+ B cell-LPD: lymphomatoid granulomatosis, EBV + immunodeficiency related LPD, chronic active EBV infection-B cell type, senile EBV+ LPD, etc. (2) EBV+ T/NK cell-LPD: CAEBV-T/NK cell type, hydroa vacciniforme, hypersensitivity of mosquito bite, etc. In addition, EBV+ LPD is classified, based on the disease process, pathological and molecular data, as 3 grades: grade1, hyperplasia (polymorphic lesions with polyclonal cells); grade 2, borderline (polymorphic lesions with clonality); grade 3, neoplasm (monomorphic lesions with clonality). There are overlaps between EBV+ LPD and typical hyperplasia, as well as EBV+ LPD and typical lymphomas. However, the most important tasks are clinical vigilance, early identification of potential severe complications, and treating the patients in a timely manner to avoid serious complications, as well as the active treatment to save lives when the complications happened.

[Application of voice acoustic analysis of surgical effect in children with benign hyperplastic vocal cord disease]

Objective:To evaluate the use of voice acoustic analysis in children with hyperplasia diseases of vocal cords. Method:The software developed by Dr.Speech was used to do acoustic analysis for 93 children patients with vocal cords hyperplasia diseases before the operation, 15 and 30 days after the operation, and 76 normal subjects were also analyzed as the controls. Result:The Jitter, Shimmer and NNE parameters were higher, and HNR, SNR parameters were significant lower in vocal cords hyperplasia diseases group than in normal controls (P<0.01). The Jitter, Shimmer and NNE decreased, HNR, SNR increased 15 days and 30 days after the operation in vocal cords hyperplasia diseases group. Compared with preoperative group, there was a highly statistically significant at 15 and 30 days after the operation (P<0.01). All the data returned to normal levels 30 days after surgery. Conclusion:Voice acoustic analysis can evaluate the quality of children voice and the surgical effect objectively and quantitatively.

Salvage therapy with lenalidomide containing regimen for relapsed/refractory Castleman disease: a report of three cases

Castleman disease (CD) is uncommon non-clonal lymphoproliferative disorder with unknown etiology. No standard therapy is recommended for relapsed/refractory CD patients, thus requiring development of novel experimental approaches. Our cohort of three adult patients with multicentric CD (MCD) were treated with refractory to traditional chemotherapy lenalidomide-containing regimens (10-25 mg lenalidomide perorally administered on days 1-21 in 28-day cycle) as second- to fourth-line treatment. Partial remission was achieved in first plasma-cell CD patient, who relapsed seven months after autologous hematopoietic stem cell transplantation and then failed to respond to four cycles of chemotherapy. Partial remission was obtained in second patient with CD and polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. Third case showed complete remission with complete disappearance of pleural effusion and ascites and normalization of platelet count. To conclude, encouraging clinical responses were achieved in cohort of three patients with lenalidomide-based regimen, though long-term efficacy remains to be observed.We propose further investigation of therapeutic potential of this drug in treating MCD.

Structure similarity-guided image binarization for automatic segmentation of epidermis surface microstructure images

Partitioning epidermis surface microstructure (ESM) images into skin ridge and skin furrow regions is an important preprocessing step before quantitative analyses on ESM images. Binarization segmentation is a potential technique for partitioning ESM images because of its computational simplicity and ease of implementation. However, even for some state-of-the-art binarization methods, it remains a challenge to automatically segment ESM images, because the grey-level histograms of ESM images have no obvious external features to guide automatic assessment of appropriate thresholds. Inspired by human visual perceptual functions of structural feature extraction and comparison, we propose a structure similarity-guided image binarization method. The proposed method seeks for the binary image that best approximates the input ESM image in terms of structural features. The proposed method is validated by comparing it with two recently developed automatic binarization techniques as well as a manual binarization method on 20 synthetic noisy images and 30 ESM images. The experimental results show: (1) the proposed method possesses self-adaption ability to cope with different images with same grey-level histogram; (2) compared to two automatic binarization techniques, the proposed method significantly improves average accuracy in segmenting ESM images with an acceptable decrease in computational efficiency; (3) and the proposed method is applicable for segmenting practical EMS images. (Matlab code of the proposed method can be obtained by contacting with the corresponding author.).

Family member-based supervision of patients with hypertension: a cluster randomized trial in rural China

Empirical evidence has suggested that social support from family can help patients take their medicines correctly. This study aims to evaluate the role of a family member-based supervision package in the management of hypertension using a cluster randomized trial in rural China. We recruited patients with hypertension from four villages in Yangzhong and randomly allocated them to the control group (n=288) and the intervention group (n=266). A family member-based supervision package was applied to the intervention group, while the usual service was applied to the controls. Patients were followed for 12 months and completed face-to-face interviews at the end of 6 and 12 months. The primary outcomes were patients' medication adherence and frequency of blood pressure measurement. Secondary outcomes included changes in blood pressure, altered risk behaviours and occurrence of hypertension-related complications. To control for the effects of cluster randomization, multilevel mixed-effects regression models were used to compare group changes. We observed that the intervention improved patients' blood pressure measurement frequency (OR: 9.00, 95% CI: 4.52-17.91) and adherence to antihypertensive treatment (OR: 1.74, 95% CI: 0.91-3.32). Its effect on the blood pressure control rate was significant at the mid-term investigation (OR: 0.67, 95% CI: 0.40-0.93), but the long-term effect was not significant (OR: 0.89, 95% CI: 0.64-1.26). After 6 months of intervention, either systolic or diastolic blood pressure was significantly decreased in the intervention group. However, this difference was not significant at the final investigation. Findings from this study revealed that the family member-based supervised therapy may have positive effects on patients' adherence to blood monitoring and hypertensive medications.

Detection of Chlamydia trachomatis and Neisseria gonorrhoeae based on cross-priming amplification

Rapid, sensitive and specific isothermal nucleic acid amplification methods of Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) have been developed based on cross-priming amplification (CPA). The amplicon of CPA can be detected by a disposable amplicon cross-contamination proof device. The whole assay takes 1-1·5 h from amplification to read out. Ten fold serial dilutions of quantified plasmids were used to test the CPA assay sensitivities, with the detection limits of 45 copies per reaction and 65 copies per reaction for C. trachomatis and N. gonorrhoeae respectively. The specificities of CPA assays for C. trachomatis and N. gonorrhoeae were tested by using total DNA extracted from nine other bacterial strains, and no cross-reactivity was detected. Eighty clinical cervical or vaginal swab specimens were tested by both CPA and real-time polymerase chain reaction (PCR) with the consistencies of 98·75% (79/80) and 97·5% (78/80) for C. trachomatis and N. gonorrhoeae respectively. Using real-time PCR as a reference standard, the clinical sensitivity (positive) and specificity (negative) of CPA was found to be 98·15% (53/54) and 100% (26/26) for C. trachomatis, and 93·75% (30/32) and 100% (48/48) for N. gonorrhoeae. Eight swab specimens tested positive for both C. trachomatis and N. gonorrhoeae simultaneously by real-time PCR and CPA assay. This study demonstrated that CPA is an affordable and accessible assay for C. trachomatis and N. gonorrhoeae detection, with high sensitivity and specificity.

SIGNIFICANCE AND IMPACT OF THE STUDY

Rapid and specific detection of the sexually transmitted pathogens Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) would enable early treatment and management of their spread. Here, for the first time, a user friendly DNA isothermal amplification method named cross-priming amplification (CPA), was used to test C. trachomatis and N. gonorrhoeae with high sensitivity and specificity. The results indicate that CPA has great potential for improving C. trachomatis and N. gonorrhoeae diagnostics which could be particularly advantageous in resource-limited areas.

Liver and Muscle Contribute Differently to the Plasma Acylcarnitine Pool During Fasting and Exercise in Humans

BACKGROUND

Plasma acylcarnitine levels are elevated by physiological conditions such as fasting and exercise but also in states of insulin resistance and obesity.

AIM

To elucidate the contribution of liver and skeletal muscle to plasma acylcarnitines in the fasting state and during exercise in humans.

METHODS

In 2 independent studies, young healthy males were fasted overnight and performed an acute bout of exercise to investigate either acylcarnitines in skeletal muscle biopsies and arterial-to-venous plasma differences over the exercising and resting leg (n = 9) or the flux over the hepato-splanchnic bed (n = 10).

RESULTS

In the fasting state, a pronounced release of C2- and C3-carnitines from the hepato-splanchnic bed and an uptake of free carnitine by the legs were detected. Exercise further increased the release of C3-carnitine from the hepato-splanchnic bed and the uptake of free carnitine in the exercising leg. In plasma and in the exercising muscle, exercise induced an increase of most acylcarnitines followed by a rapid decline to preexercise values during recovery. In contrast, free carnitine was decreased in the exercising muscle and quickly restored thereafter. C8-, C10-, C10:1-, C12-, and C12:1-carnitines were released from the exercising leg and simultaneously; C6, C8, C10, C10:1, C14, and C16:1 were taken up by the hepato-splanchnic.

CONCLUSION

These data provide novel insight to the organo-specific release/uptake of acylcarnitines. The liver is a major contributor to systemic short chain acylcarnitines, whereas the muscle tissue releases mostly medium chain acylcarnitines during exercise, indicating that other tissues are contributing to the systemic increase in long chain acylcarnitines.

Comparison of clinicopathological features and prognosis of gastric cancer located in the lesser and greater curve

PURPOSE

Little is known about the features of gastric cancer located in the lesser and greater curve. This study aims to investigate the clinicopathological features and prognosis of gastric cancer located in the lesser and greater curve.

PATIENTS

From September 2008 to March 2015, 780 gastric cancer patients were enrolled in the present study. The associations between locations and features of patients were analyzed.

RESULTS

There were 571 male (73.2 %) and 209 female (26.8 %) patients. The median age was 56 years (ranged 21-86). There were 684 tumors located in the lesser curve (87.7 %) and 96 located in the greater curve (12.3 %). The incidence of melena was significantly lower in patients with tumors located in the lesser curve than that in the greater curve (8.5 vs 15.6 %, P = 0.024). The median size of tumors in the lesser curve was significantly larger than that in the greater curve (5.0 (0.3-15) vs 4.0 cm (0.5-15), P = 0.001). The remaining clinicopathological features were comparable between the two groups (all P > 0.05). Tumor location was not a risk factor for the prognosis of gastric cancer by univariate and multivariate analysis (both P > 0.05). The postoperative complications (all P > 0.05) and prognoses (P = 0.279) were comparable between tumors located in the lesser and greater curve.

CONCLUSIONS

The ratio of gastric cancer located in the lesser to greater curve was 7.1:1. Compared with tumors located in the greater curve, the incidence of melena was significantly lower and the tumor size was significantly larger in tumors located in the lesser curve. The prognoses were comparable between tumors located in the lesser and greater curve.

Decoupled polarization dynamics of incoherent waves and bimodal spectral incoherent solitons

We consider the propagation of strongly incoherent waves in optical fibers in the framework of the vector nonlinear Schrödinger equation (VNLSE) accounting for the Raman effect. On the basis of the wave turbulence theory, we derive a kinetic equation that greatly simplifies the VNLSE and provides deep physical insight into incoherent wave dynamics. When applied to the study of polarization effects, the theory unexpectedly reveals that the linear polarization components of the incoherent wave evolve independently from each other, even in the presence of weak fiber birefringence. When applied to light propagation in bimodal fibers, the theory reveals that the incoherent modal components can be strongly coupled. After a complex transient, the modal components self-organize into a vector spectral incoherent soliton: The two solitons self-trap and propagate with a common velocity in frequency space.

Autologous hematopoietic stem cell transplantation in patients with end-stage liver disease: a 5-year follow-up study of 48 patients

OBJECTIVE

To investigate the long-term therapeutic effect of autologous hematopoietic stem cell transplantation in patients with End-stage Liver Disease (ESLD).

PATIENTS AND METHODS

Forty-eight ESLD patients underwent autologous CD34+ stem cell transplantation were retrospectively reviewed. Changes in clinical and biochemical data, complications, and quality of life were monitored at 3, 6, 12, 36, and 60 months following the stem cell transplantation. Liver biopsies were obtained for histopathological analysis using Ishak system.

RESULTS

Marked improvement in clinical and biochemical data was observed during the long-term follow-up. Serum albumin was significantly increased (p<0.001), while total serum bilirubin, prothrombin time (PT), and international normalized ratio (INR) were all significantly decreased (p<0.001). Ishak inflammation and fibrosis scores were significantly decreased with the increased time (p<0.001). The number of patients with ascites, model of end-stage liver disease (MELD) score, Child-Pugh class, and indocyanine green (ICG) score were all markedly reduced with increased time. Meanwhile, the quality of life score of the patients was significantly increased (p<0.001). Six patients died during the 5-years follow-up, and complications occurred in 17 patients. The incidence of complications was significantly associated with mortality of the patients (p<0.05).

CONCLUSIONS

The study provided the evidence that autologous CD34+ stem cell transplantation could offer a long-term therapeutic benefit to patients with ESLD. The complications occurred during the process was significantly associated with survival of the patients. Future studies on a large cohort of patients are needed to confirm the long-term effect of stem cell therapy on ESLD.

Coexistence of intracranial aneurysm and hemangioblastoma: A case report and literature review

The association of intracranial aneurysm and hemangioblastoma is extremely rare. This report regards a patient affected by Von Hippel-Lindau syndrome with multiple hemangioblastoma and two intracranial aneurysms, of which one was on a hemangioblastoma feeder vessel and the other on an unrelated vessel. Review of the literature revealed 13 other previously reported cases. Possible mechanisms to explain the association are discussed.

[Outcomes of total deafness type of idiopathic suddendeafness in different ages]

Objective:This retrospective study was aimed to investigate the characteristics of hearing recovery in the complete deafness type of SSNHL(≥81 dBHL) in patients with different ages.Method:Clinical outcomes of 179 total deafness type of idiopathic sudden deafness were compared.Patients were divided into 5 groups according to age,they were,pediatric group(13 years or less),youthful group(14-44 years),middle-aged group(45-59 years),presenium group(60-74 years),senectitude group(75 years or higher).Patients were divided into 3 groups according to the initial degree of hearing loss: 81 dB group (81-89 dBHL),90 dB group(90- 99 dBHL),100 dB group(100 dBHL or higher).Routine comprehensive treatment including corticosteroids,the inner ear microcirculation improvement drugs,neurotrophic drugs,saturationoxygen and hyperbaric oxygen therapy,etc.was applied.Patients were treated in accordance with the age and body weight.Result:The percentage of youthful group(83/179,46.4%) was highest(P<0.05),middle-aged group(57/179,31.8%)followed(P<0.05),presenium group(26/179,14.5%)was lower(P<0.05),pediatric group(8/179,4.5%) and senectitude group(5/179,2.8%)were the lowest.No a complete recovery in either pediatric group or senectitude group.A complete recovery was rare in the other groups.Recovery rate of the different aged groups was similar(P>0.05).The percentage of 100 dB group(108/179,60.3%) was highest(P<0.05).The percentage of 81 dB group(39/179,21.8%)was similar to 90 dB group(32/179,17.9%)(P>0.05).Recovery rate was similar in 81 dB group(25/39,64.1%)and 90 dB group(18/32,56.2%)(P>0.05).Recovery rate of both 81 dB group and 90 dB group were greater than 100 dB group(24/108,22.2%)(P<0.05).The 100 dB group reduced the satisfactory recovery effects.There were no differences in the proportion of the patients with dizziness(95/179,53.1%)and without dizziness(84/179,46.9%)(P>0.05).Recovery rate of patients without dizziness(43/84,51.2%) was greater than with dizziness(24/95,25.3%)(P<0.05).The percentage of the patients without dizziness(31/39,79.5%)in 81 dB group was the highest(P<0.05),90 dB group(18/32,56.2%)followed(P<0.05).The percentage of the patients with dizziness in 100 dB group(73/108,67.6%)was highest(P<0.05).Recovery rate was similar in the patients without dizziness of 81 dB group(21/31,67.7%)and 90 dB group(11/18,61.1%)(P>0.05).Recovery rate of the above two groups was greater than that of 100 dB group(11/35,31.4%)(P<0.05).Conclusion:Recovery rate of the different aged groups was similar.The percentage of the patients with dizziness in 100 dB group was highest.Initial hearing threshold in excess of 100 dB reduced the satisfactory recovery in patients with total deafness type of SSNHL.Our results provided a good reference for other clinicians.

Shock wave generation triggered by a weak background in optical fibers

We experimentally report the observation of dispersive shock waves from a short pulse superimposed onto a small continuous wave background in optical fibers. We show that the background allows us to strongly enhance the extension and contrast of the oscillatory wave train inherent to the dispersive shock. More than seven periods of oscillations with high contrast are observed experimentally and confirmed with numerical simulations. The dynamics of the process are simply explained from spectro-temporal representations.