1
|
Dowlati E, Chesney K, Carpenter AB, Rock M, Patel N, Mai JC, Liu AH, Armonda RA, Felbaum DR. Awake transradial middle meningeal artery embolization and twist drill craniostomy for chronic subdural hematomas in the elderly: case series and technical note. J Neurosurg Sci 2023; 67:471-479. [PMID: 34114433 DOI: 10.23736/s0390-5616.21.05335-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Due to prohibitive perioperative risk factors, optimal treatment for chronic subdural hematomas (cSDH) in the elderly remains unclear. Minimally invasive techniques are a viable option and include bedside subdural evacuation port system (SEPS), as well as prevention of recurrence with middle meningeal artery (MMA) embolization. We present a case series of elderly patients undergoing combined transradial MMA embolization and bed-side craniostomy as primary treatment for cSDH. METHODS Patients 70 years and older from 2019 to 2020 that underwent single setting, awake transradial MMA embolization with concurrent SEPS placement under local anesthesia were included. Those with prior treatments, interventions performed under general anesthesia, or with less than 60-day follow-up were excluded. Descriptive analyses of baseline characteristics, radiologic parameters, comorbidities, and outcome measures were completed. RESULTS Twenty elderly patients (mean age of 81.0 years) with multiple comorbidities underwent 28 MMA embolization+SEPS procedures as primary treatment for cSDH. Mean cSDH thickness was 1.8cm±0.6 cm with 7.3±3.9 mm midline shift. All patients tolerated the procedure well. 1/20 (5.0%) patients died within 30 days of the procedure. A majority of patients were discharged to home (12/20; 60.0%). There was an average of 3.6-month follow-up and one patient (5.0%) developed recurrence in the follow-up period requiring further intervention. CONCLUSIONS In select elderly patients with high perioperative risk factors, primary treatment of cSDH using awake transradial MMA embolization+SEPS placement is a minimally invasive, feasible, and safe option. Further comparative studies are warranted to evaluate efficacy of the treatment.
Collapse
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA -
| | - Kelsi Chesney
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Mitchell Rock
- Georgetown University School of Medicine, Washington, DC, USA
| | - Nirali Patel
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ai-Hsi Liu
- Department of Radiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
2
|
Duquette E, Dowlati E, Abdullah T, Felbaum DR, Mai JC, Sur S, Armonda RA, Liu AH. De Novo dural arteriovenous fistulas after endovascular treatment: Case illustration and literature review. Interv Neuroradiol 2022:15910199221118517. [PMID: 35924383 DOI: 10.1177/15910199221118517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intracranial dural arteriovenous fistulas (dAVF) account for nearly 10-15% of all arteriovenous malformations. Although the majority of dAVF are effectively cured after endovascular intervention, there are cases of dAVFs that may recur after radiographic cure. We present the case of a 69-year-old female with de novo formation of three dAVFs in different anatomic locations after successive endovascular treatments. The patient's initial dAVF was identified in the right posterior frontal convexity region and obliterated with transarterial and transvenous embolization. The patient returned eight years later due to left-sided pulsatile tinnitus and a new dAVF in the left greater sphenoid wing region was seen on angiography. This was treated with transvenous embolization with complete resolution. One year later, she developed left sided pulsatile tinnitus again and was found to have a left carotid-cavernous dAVF. This is the first case report to our knowledge of the formation of three de novo dAVFs over multiple years in distinct anatomical locations. We also review the literature regarding de novo dAVFs after endovascular treatment which includes 16 cases. De novo dAVF formation is likely due to numerous factors including changes in venous flow and aberrant vascular development. It is important to further understand the relationship between endovascular treatment and recurrent dAVF formation to prevent subsequent malformations.
Collapse
Affiliation(s)
| | - Ehsan Dowlati
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
| | - Taha Abdullah
- 89013Touro College of Osteopathic Medicine, New York, NY, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Samir Sur
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Ai-Hsi Liu
- Department of Radiology, 8405MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
3
|
Dowlati E, White Y, Sur S, Liu AH, Mai JC, Armonda RA, Felbaum DR. Letter: Middle Meningeal Artery Embolization versus Conventional Treatment of Chronic Subdural Hematomas. Neurosurgery 2022; 90:e93-e96. [PMID: 35049527 DOI: 10.1227/neu.0000000000001844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Yasmine White
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Samir Sur
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ai-Hsi Liu
- Department of Radiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Rocco A Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| |
Collapse
|
4
|
Dowlati E, Mualem W, Carpenter A, Chang JJ, Felbaum DR, Sur S, Liu AH, Mai JC, Armonda RA. Early Fevers and Elevated Neutrophil-to-Lymphocyte Ratio are Associated with Repeat Endovascular Interventions for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2021; 36:916-926. [PMID: 34850332 DOI: 10.1007/s12028-021-01399-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/09/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with aneurysmal subarachnoid hemorrhage (aSAH) may develop refractory arterial cerebral vasospasm requiring multiple endovascular interventions. The aim of our study is to evaluate variables associated with need for repeat endovascular treatments in refractory vasospasm and to identify differences in outcomes following one versus multiple treatments. METHODS We retrospectively reviewed patients treated for aSAH between 2017 and 2020 at two tertiary care centers. We included patients who underwent treatment (intraarterial infusion of vasodilatory agents or mechanical angioplasty) for radiographically diagnosed vasospasm in our analysis. Patients were divided into those who underwent single treatment versus those who underwent multiple endovascular treatments for vasospasm. RESULTS Of the total 418 patients with aSAH, 151 (45.9%) underwent endovascular intervention for vasospasm. Of 151 patients, 95 (62.9%) underwent a single treatment and 56 (37.1%) underwent two or more treatments. Patients were more likely to undergo multiple endovascular treatments if they had a Hunt-Hess score > 2 (odds ratio [OR] 5.10 [95% confidence interval (CI) 1.82-15.84]; p = 0.003), a neutrophil-to-lymphocyte ratio > 8.0 (OR 3.19 [95% CI 1.40-7.62]; p = 0.028), and more than two fevers within the first 5 days of admission (OR 7.03 [95% CI 2.68-20.94]; p < 0.001). Patients with multiple treatments had poorer outcomes, including increased length of stay, delayed cerebral ischemia, in-hospital complications, and higher modified Rankin scores at discharge. CONCLUSIONS A Hunt-Hess score > 2, a neutrophil-to-lymphocyte ratio > 8.0, and early fevers may be predictive of need for multiple endovascular interventions in refractory cerebral vasospasm after aSAH. These patients have poorer functional outcomes at discharge and higher rates of in-hospital complications.
Collapse
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA.
| | - William Mualem
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Austin Carpenter
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Samir Sur
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ai-Hsi Liu
- Department of Radiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
5
|
Dowlati E, Pasko KBD, Liu J, Miller CA, Felbaum DR, Sur S, Chang JJ, Liu AH, Armonda RA, Mai JC. Treatment of In-Stent Stenosis Following Flow Diversion of Intracranial Aneurysms with Cilostazol and Clopidogrel. Neurointervention 2021; 16:285-292. [PMID: 34503310 PMCID: PMC8561031 DOI: 10.5469/neuroint.2021.00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022] Open
Abstract
In-stent stenosis is a feared complication of flow diversion treatment for cerebral aneurysms. We present 2 cases of patients treated with pipeline flow diversion for unruptured cerebral aneurysms. Initial perioperative dual antiplatelet therapy (DAPT) consisted of standard aspirin plus clopidogrel. At 6-month follow-up cerebral angiography, the patients were noted to have developed significant in-stent stenosis (63% and 53%). The patients were treated with cilostazol and clopidogrel for at least 6 months. Subsequent angiography at 1-year post-treatment showed significant improvement of the in-stent stenosis from 63% to 34% and 53% to 21%. The role of cilostazol as treatment of intracranial in-stent stenosis has not been previously described. Cilostazol’s vasodilatory effect and suppression of vascular smooth muscle proliferation provides ideal benefits in this setting. Cilostazol plus clopidogrel may be a safe and effective alternative to standard DAPT for treatment of in-stent stenosis following flow diversion and warrants further consideration and investigation.
Collapse
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Jiaqi Liu
- Georgetown University School of Medicine, Washington, DC, USA
| | - Charles A Miller
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Samir Sur
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ai-Hsi Liu
- Department of Radiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
6
|
Miller CA, Felbaum DR, Liu AH, Mai J, Alfawaz A, Lynes J, Armonda R. Direct Vertebral Artery Access for Coil Embolization of a Partially Thrombosed Mid-Basilar Trunk Aneurysm: Technical Limitations. Oper Neurosurg (Hagerstown) 2021; 21:E381-E385. [PMID: 34133747 DOI: 10.1093/ons/opab186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Partially thrombosed basilar aneurysms have a high morbidity from the rupture risk and mass effect prompting early treatment. Depending on the size and location, they pose a surgical challenge often requiring multiple endovascular treatment modalities. Here we present a partially thrombosed mid-basilar aneurysm successfully coil embolized with direct vertebral artery access and discuss the technical limitations of direct V1 access. CLINICAL PRESENTATION A 70-yr-old woman presented with acute onset headache, nausea, and vomiting. A computed tomography (CT) head demonstrated a hyperdense prepontine mass which was further characterized as a partially thrombosed basilar aneurysm on CT angiography. After multiple failed attempts to access the vertebral artery via femoral and radial access the patient was taken to the operating room (OR) for surgical exposure of the right V1 segment and direct cannulation of the vertebral artery. The aneurysm was successfully coiled and the vertebral artery closed primarily. The patient was discharged home without any neurological deficits. CONCLUSION Partially thrombosed mid-basilar aneurysms are difficult to treat both surgically and endovascularly. We present a case where endovascular access to the aneurysm was very challenging requiring direct exposure and cannulation of the V1 segment to successfully embolize with coils and discuss the technical limitations of this approach.
Collapse
Affiliation(s)
- Charles A Miller
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ai-Hsi Liu
- Department of Neurosurgery, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - Jeffrey Mai
- Department of Neurosurgery, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - Abdullah Alfawaz
- Department of Vascular Surgery, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - John Lynes
- Department of Neurosurgery, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - Rocco Armonda
- Department of Neurosurgery, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| |
Collapse
|
7
|
Carpenter A, Rock M, Dowlati E, Miller C, Mai JC, Liu AH, Armonda RA, Felbaum DR. Middle meningeal artery embolization with subdural evacuating port system for primary management of chronic subdural hematomas. Neurosurg Rev 2021; 45:439-449. [PMID: 33893872 DOI: 10.1007/s10143-021-01553-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/14/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
Optimal treatment for chronic subdural hematomas remains controversial and perioperative risks and comorbidities may affect management strategies. Minimally invasive procedures are emerging as alternatives to the standard operative treatments. We evaluate our experience with middle meningeal artery (MMA) embolization combined with Subdural Evacuating Port System (SEPS) placement as a first-line treatment for patients with cSDH. A single institution retrospective review was performed of all patients undergoing intervention. Patients were stratified by treatment with MMA embolization and SEPS placement, MMA embolization and surgery, SEPS placement only, and surgery only for cSDH from 2017 to 2020, and cohorts were compared against each other. Patients treated with MMA/SEPS were more likely to be older, be on anticoagulation, have significant comorbidities, have shorter length of stay, and less likely to have symptomatic recurrence compared to SEPS only cohort. Thus, MMA/SEPS appears to be a safe and equally effective minimally invasive treatment for cSDH patients with significant comorbidities who are poor surgical candidates.
Collapse
Affiliation(s)
- Austin Carpenter
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, USA
| | - Mitchell Rock
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, PHC7, Washington, DC, USA.
| | - Charles Miller
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, PHC7, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC, USA
| | - Ai-Hsi Liu
- Department of Radiology, MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, PHC7, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, PHC7, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC, USA
| |
Collapse
|
8
|
Triano M, Corbin MJ, Desale S, Liu AH, Felbaum DR, Mai JC, Armonda RA, Aulisi EF, Chang JJ. Abstract P350: Early Transcranial Doppler Velocity Changes as a Predictor for Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Although transcranial Doppler (TCD) evaluation for vasospasm remains an important study in aneurysmal subarachnoid hemorrhage (aSAH) management, its precise role in predicting delayed cerebral ischemia (DCI) remains unclear.
Hypothesis:
We evaluated optimal measures for evaluating TCD velocities and hypothesized that TCD velocity change would be the best predictor for DCI in patients with aSAH.
Methods:
Patients with aSAH over a two-year period were retrospectively analyzed. Baseline characteristics, outcomes, and TCD velocities in bilateral middle cerebral arteries (MCA) for hospital days 2 to14 were recorded. TCD variables, including absolute velocity and change in velocity, were obtained by creating a smoothing curve. A variable representing change in TCD velocity was then created through a linear regression model that confirmed greatest change in velocity associated with DCI occurred at days 2-7. Multivariate logistic regression analysis using DCI as outcome was then completed.
Results:
95 patients with aSAH were evaluated. Increased TCD velocity at days 2-7 proved to be a better predictor for DCI than absolute velocity with an optimal cutoff of 8.9 cm/sec/day (
p
= 0.019) and AUC 0.651. Multivariate logistic analysis using DCI as the outcome showed that poor admission Hunt-Hess scores (OR 5.02, 95%CI 1.22-22.67,
p
= 0.028) and increase in TCD velocity during days 2-7 (OR 5.32, 95%CI 1.41-23.33,
p
= 0.018) were independently associated with DCI.
Conclusions:
We found that relative increases in TCD velocities in the MCAs during the first 7 days (threshold increase of 8.9 cm/sec/day or 53.4 cm/sec from days 2-7) after aSAH were independently associated with DCI. Our findings suggest that vasospasm should be confirmed and treated aggressively when detected via increased TCD velocities during the first seven days in order to minimize DCI. This association requires independent confirmation.
Collapse
Affiliation(s)
- Matthew Triano
- Critical Care Medicine, Georgetown Univ Sch of Medicine, Washington, DC
| | - Maite J Corbin
- Critical Care Medicine, MedStar Washington Hosp Cntr, Washington, DC
| | - Sameer Desale
- Biostatistics and Biomedical Informatics, MedStar Washington Hosp Cntr, Washington, DC
| | - Ai-Hsi Liu
- Radiology, MedStar Washington Hosp Cntr, Washington, DC
| | | | - Jeffrey C Mai
- Neurosurgery, MedStar Washington Hosp Cntr, Washington, DC
| | | | | | - Jason J Chang
- Critical Care Medicine, MedStar Washington Hosp Cntr, Washington, DC
| |
Collapse
|
9
|
Dowlati E, Armonda RA, Liu AH, Felbaum DR. Letter: Access-Site Complications in Transfemoral Neuroendovascular Procedures: A Systematic Review of Incidence Rates and Management Strategies. Oper Neurosurg (Hagerstown) 2020; 19:E616-E619. [PMID: 32895695 DOI: 10.1093/ons/opaa279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
| | - Rocco A Armonda
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia.,Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| | - Ai-Hsi Liu
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia.,Department of Radiology MedStar Washington Hospital Center Washington, District of Columbia
| | - Daniel R Felbaum
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia.,Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| |
Collapse
|
10
|
Felbaum DR, Dowlati E, Mai JC, Liu AH, Schuette AJ, Bell R, Armonda RA. Letter: Realistic Expectations for Incorporating Dual-Trained Neurosurgeons in a Call Schedule. Neurosurgery 2020; 87:E615-E616. [PMID: 32860029 DOI: 10.1093/neuros/nyaa375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Daniel R Felbaum
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| | - Ehsan Dowlati
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
| | - Jeffrey C Mai
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| | - Ai-Hsi Liu
- Department of Radiology MedStar Washington Hospital Center Washington, District of Columbia
| | - A Jesse Schuette
- Division of Neurosurgery Walter Reed National Military Medical Center Bethesda, Maryland
| | - Randy Bell
- Division of Neurosurgery Walter Reed National Military Medical Center Bethesda, Maryland
| | - Rocco A Armonda
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| |
Collapse
|
11
|
Altshuler M, Liu AH, Armonda RA. Spontaneous Occlusion of a Complex Brain Arteriovenous Malformation Following Partial Embolization. World Neurosurg 2020; 144:136-139. [PMID: 32841794 DOI: 10.1016/j.wneu.2020.08.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Curative embolization for cerebral arteriovenous malformation (AVM) cannot always be achieved. Rather, embolization plays a role in AVM treatment as an adjuvant therapy before radiosurgery and microsurgery. Curative embolization for large, complex AVMs is not commonly seen. CASE DESCRIPTION A man in his 30s with an unruptured left cerebral AVM underwent radiosurgery in 2014 and was lost to follow-up. He presented with intracerebral hemorrhage in 2019, and diagnostic cerebral angiography demonstrated a large, complex AVM. The patient was scheduled for 2-stage embolization in preparation for microsurgical resection. Initial embolization targeted and occluded 20% of the AVM nidus involving primarily the anteroinferior portion. A cerebral angiogram obtained 5 weeks following initial embolization revealed spontaneous occlusion of the remaining AVM. CONCLUSIONS There are few reported cases of spontaneous occlusion of a large, complex AVM following embolization with previous radiation therapy. The spontaneous occlusion in this case suggests that at least some AVMs that receive embolization after radiation, rather than before, may have a potential for spontaneous, curative thrombosis.
Collapse
Affiliation(s)
- Marcelle Altshuler
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ai-Hsi Liu
- Department of Neurointerventional Radiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, Medstar Washington Hospital Center, Washington, DC, USA.
| |
Collapse
|
12
|
Chang JJ, Triano M, Corbin MJ, Desale S, Liu AH, Felbaum DR, Mai JC, Armonda RA, Aulisi EF. Transcranial Doppler velocity and associations with delayed cerebral ischemia in aneurysmal subarachnoid Hemorrhage. J Neurol Sci 2020; 415:116934. [DOI: 10.1016/j.jns.2020.116934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 10/24/2022]
|
13
|
Dowlati E, Zhou T, Stewart J, Felbaum DR, Liu AH, Mai JC, Armonda RA. Head Repositioning during Neurointerventional Procedures to Optimize Biplanar Imaging. J Neuroimaging 2020; 30:603-608. [PMID: 32639646 DOI: 10.1111/jon.12750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Head positioning is an important aspect for surgical planning in any cranial procedure. However, in neurointerventional cases, this is an afterthought due to advances in biplane imaging. We aim to present that the concept of head positioning may be applied to neurointerventional procedures to obtain optimal working projections to aide in the treatment of neurovascular pathology. METHODS The operative log of the senior author was reviewed between 2016 and 2019. Seventeen patients were identified who required readjustment of head position to allow for ideal working projection during treatment. The reports and imaging of these patients were reviewed and categorized based on repositioning adjustments applied. RESULTS Three specific head adjustments were performed to obtain working projections using biplanar angiography: head flexed position, head extended position, or extended-tilt positioning. All patients underwent endovascular coiling treatment for a variety of intracranial aneurysms. CONCLUSION In select cases, ideal views of vascular pathology can be difficult to obtain due to limitations of biplane rotation or patient-specific anatomy. Simple maneuvers in head positioning can be done to achieve better working projections for optimized endovascular treatment.
Collapse
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Tianzan Zhou
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jeffrey Stewart
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC
| | - Ai-Hsi Liu
- Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC.,Department of Radiology, MedStar Washington Hospital Center, Washington, DC
| | - Jeffrey C Mai
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC
| | - Rocco A Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC
| |
Collapse
|
14
|
Felbaum DR, Dowlati E, Liu AH, Armonda RA. Shared discussion of transradial approach complications may help broaden use. J Neurointerv Surg 2020; 13:e11. [PMID: 32499389 DOI: 10.1136/neurintsurg-2020-016189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Daniel R Felbaum
- Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA .,Neurosurgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ehsan Dowlati
- Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Ai-Hsi Liu
- Neurosurgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Rocco A Armonda
- Neurosurgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| |
Collapse
|
15
|
Wang LM, Dong LJ, Liu X, Huang LY, Liu W, Lyu YJ, Li XR, Liu AH. [Proteomic analysis of aqueous humor in acute primary angle-closure glaucoma]. Zhonghua Yan Ke Za Zhi 2019; 55:687-694. [PMID: 31495154 DOI: 10.3760/cma.j.issn.0412-4081.2019.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the difference among expression of aqueous humor proteins in acute primary angle-closure glaucoma (APACG). Methods: Case-control study. The patients with APACG combined cataract (APACG with cataract group) and patients with cataract (cataract group), who had undertaken surgical treatment at the Tianjin Medical University Eye Hospital from October 2016 to June2017 were collected. Upon receipt of patient's consent, 50 μl of aqueous humor were collected with 1 ml syringe and No.1 needle through the surgical access during the surgery, and then injected into a sterile collection tube to be stored at -80 ℃. Those proteins extracted from aqueous humor were analyzed by quantitative proteomic mass spectrometry. The differential significance test was performed by Maxquant significances A approach. The differential proteins of the two groups were screened and determined with the conditions of P<0.05 and difference multiple>2. The functions and signal pathway of differential proteins in aqueous humor were annotated in biological big data, on the basis gene ontology (GO) and the Kyoto gene and genomic encyclopedia (KEGG) analyses. Results: There were 3 males and 7 females with an average age of (68±6) years in the APACG group. The cataract group included 2 males and 8 females with an average age of (71±8) years. There were no statistical differences in gender ratio and age between the two groups (both P>0.05). A total of 91 differential proteins were detected in this experiment, including 50 up-regulated proteins (annexinA1, vimentin, S100 calcium binding protein A8, interleukin 6, C reactive protein, laminin β2, etc.) and 41 down-regulated (keratin 85, γ-crystallin D, syntaxin-binding protein 5, semaphoring 4B, matrilin 2, cathepsin O, cadherin 4, semaphoring 3B, platelet-derived growth factor D, transforming growth factor β, etc.). On one hand, the functions of differential proteins involved in many aspects. AnnexinA1, CD163, S100 calcium-binding protein A8, C reactive protein, interleukin 6 are involved in the inflammatory reaction, cadherin 4 and laminin β2 regulate cell adhesion, matrilin 2, vimentin and laminin β2 participate in tissue fibrosis; on the other hand, KEGG analysis showed that the differential proteins participate diverse signaling pathways such as phosphatidylinositol-3-kinase-protein kinase B signaling pathway, transformation growth factor β signaling pathway, mitogen activated protein kinase signaling pathway, Toll-like receptor signaling pathway, the nuclear factor κ-light chain enhancer of the activated B cells signaling pathway, focal adhension and extracellular matrix receptor interaction pathway and so on. Conclusions: The expression of annexin A1 is significantly up-regulated in the aqueous humor in APACG, while some other factors such as transformation growth factor β, cadherin-4, and matrilin 2 are down-regulated. The change of proteins in aqueous humor is related with the outbreak of APACG. (Chin J Ophthalmol, 2019, 55: 687-694).
Collapse
Affiliation(s)
- L M Wang
- Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Zhang BR, Liu AH, Mo DP, Huo XC, Liu P, Jin HW, Miao ZR. [Endovascular thrombectomy in patients with intracranial large artery occlusion and atrial fibrillation]. Zhonghua Yi Xue Za Zhi 2019; 99:3068-3072. [PMID: 31648448 DOI: 10.3760/cma.j.issn.0376-2491.2019.39.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the safety and efficacy of mechanical thrombectomy in patients with atrial fibrillation complicated with acute intracranial arterial occlusion. Methods: Fifty-eight patients with atrial fibrillation complicated with acute intracranial arterial occlusion in the intervention group of East (Endovascular Therapy for Acute ischemic Stroke Trial) were analyzed. According to the TOAST (Trial of Org 10 172 in Acute Stroke Treatment) classification, patients were divided into ICAS (Intracranial Atherosclerotic Stenosis) group and cardiogenic embolism group. Clinical characteristics, treatment methods and clinical prognosis were compared between ICAS group and cardiogenic embolism group. Results: A total of 58 patients with atrial fibrillation complicated with acute intracranial arterial occlusion were included in this study, including 46 patients in the cardiogenic embolism group (79%) and 12 patients in the ICAS group (21%). The pre-hospital transport time in ICAS group was longer than that in cardiogenic embolism group (P<0.05).Patency rate in patients with atrial fibrillation complicated with acute intracranial arterial occlusion was 98.3% (57/58), The rate of patients with the 90-day function independent (mRS 0-2) was 51.7% (30/58). There were no statistically significant differences in functional independence, mortality rate, ICH and sICH at 90 days between the cardiogenic embolism group and the ICAS group. Conclusions: Mechanical thrombectomy is an effective method to treat patients with atrial fibrillation complicated with acute intracranial arterial occlusion.
Collapse
Affiliation(s)
- B R Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - A H Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - D P Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - X C Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - P Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - H W Jin
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Z R Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| |
Collapse
|
17
|
Li MY, Ye J, Huang ZY, Lin YC, Liu AH, Li LP, Chen J, Wang YP. [Clinical analysis of five cases of autism spectrum disorder complicated with epilepsy with chromosome copy number variation]. Zhonghua Yi Xue Za Zhi 2019; 99:2615-2618. [PMID: 31510723 DOI: 10.3760/cma.j.issn.0376-2491.2019.33.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical features and genetic causes of autism spectrum disorder (ASD) patients with epilepsy. Methods: The clinical data of five patients with ASD and epilepsy admitted to Xuanwu Hospital between September 2017 and September 2018 were collected, including medical history, intelligence level, developmental level, physical examination, neuroimaging and electroencephalogram. High-throughput whole-genome sequencing was applied to five patients and their parents. Results: Of five patients, four were male and one was female. All five patients had mild mental retardation, and one patient had significant growth retardation and craniofacial deformity. The average epilepsy onset age was 6.3 years old (7 months to 16 years). The main epileptic type was tonic-clonic seizure with abnormal EEG results. All patients have a favorable response to anti-epileptic drugs. Whole-exome sequencing (WES) revealed copy number variation in all 5 patients. Among them, 3 cases were reported to be pathogenic, and 2 cases were not reported (chromosome 16p13.3 duplication and chromosome 21q22.3 deletion). Conclusions: The results of current study support that autism spectrum disorders with seizures is often associated with copy number variations, such as Williams-Beuren region duplication syndrome, chromosome 15q11.2 duplication syndrome and chromosome 15q11.2 deletion syndrome. We reported two novel copy number variations (chromosome 16p13.3 duplication and chromosome 21q22.3 deletion) in two autism spectrum disorder patients with epileptic seizures.
Collapse
Affiliation(s)
- M Y Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Hsia AW, Luby M, Cullison K, Burton S, Armonda R, Liu AH, Leigh R, Nadareishvili Z, Benson RT, Lynch JK, Latour LL. Rapid Apparent Diffusion Coefficient Evolution After Early Revascularization. Stroke 2019; 50:2086-2092. [PMID: 31238830 DOI: 10.1161/strokeaha.119.025784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- In this era of endovascular therapy (EVT) with early, complete recanalization and reperfusion, we have observed an even more rapid apparent diffusion coefficient (ADC) normalization within the acute ischemic lesion compared with the natural history or IV-tPA-treated patient. In this study, we aimed to evaluate the effect of revascularization on ADC evolution within the core lesion in the first 24 hours in acute ischemic stroke patients. Methods- This retrospective study included anterior circulation acute ischemic stroke patients treated with EVT with or without intravenous tPA (IVT) from 2015 to 2017 compared with a consecutive cohort of IVT-only patients treated before 2015. Diffusion-weighted imaging and ADC maps were used to quantify baseline core lesions. Median ADC value change and core reversal were determined at 24 hours. Diffusion-weighted imaging lesion growth was measured at 24 hours and 5 days. Good clinical outcome was defined as modified Rankin Scale score of 0 to 2 at 90 days. Results- Twenty-five patients (50%) received IVT while the other 25 patients received EVT (50%) with or without IVT. Between these patient groups, there were no differences in age, sex, baseline National Institutes of Health Stroke Scale, interhospital transfer, or IVT rates. Thirty-two patients (64%) revascularized with 69% receiving EVT. There was a significant increase in median ADC value of the core lesion at 24 hours in patients who revascularized compared with further ADC reduction in nonrevascularization patients. Revascularization patients had a significantly higher rate of good clinical outcome at 90 days, 63% versus 9% (P=0.003). Core reversal at 24 hours was significantly higher in revascularization patients, 69% versus 22% (P=0.002). Conclusions- ADC evolution in acute ischemic stroke patients with early, complete revascularization, now more commonly seen with EVT, is strikingly different from our historical understanding. The early ADC normalization we have observed in this setting may include a component of secondary injury and serve as a potential imaging biomarker for the development of future adjunctive therapies. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00009243.
Collapse
Affiliation(s)
- Amie W Hsia
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.).,MedStar Washington Hospital Center Comprehensive Stroke Center, Washington, DC (A.W.H., S.B., R.T.B.)
| | - Marie Luby
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - Kaylie Cullison
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - Shannon Burton
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.).,MedStar Washington Hospital Center Comprehensive Stroke Center, Washington, DC (A.W.H., S.B., R.T.B.)
| | - Rocco Armonda
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | | | - Richard Leigh
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - Zurab Nadareishvili
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.).,MedStar Washington Hospital Center Comprehensive Stroke Center, Washington, DC (A.W.H., S.B., R.T.B.)
| | - Richard T Benson
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - John K Lynch
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - Lawrence L Latour
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| |
Collapse
|
19
|
Mao D, Liu AH, Wang ZP, Zhang XW, Lu H. Cucurbitacin B inhibits cell proliferation and induces cell apoptosis in colorectal cancer by modulating methylation status of BTG3. Neoplasma 2019; 66:593-602. [PMID: 31058532 DOI: 10.4149/neo_2018_180929n729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 02/27/2019] [Indexed: 11/08/2022]
Abstract
A previous report has revealed that cucurbitacin B (CuB) inhibits cancer cell proliferation and tumorigenesis in non-small cell lung cancer (NSCLC) through epigenetic modifications of several genes. However, whether CuB regulates cell proliferation and apoptosis by altering methylation status of BTG3 in colorectal cancer (CRC) remains unknown. In the present study, the results showed that BTG3 was downregulated in CRC tissues compared with adjacent normal tissues. CuB significantly increased BTG3 levels, induced promoter demethylation, and decreased the levels of DNA methyltransferases (DNMT1, DNMT3a and DNMT3b) in both CRC cell lines (SW480 and Caco-2), and the effects of CuB were comparable with those of 5-Aza-dC. We also found that CuB inhibited cell proliferation, accompanied with decreased expression of Ki67. Furthermore, CuB treatment induced cell cycle arrest at G1 phase in SW480 and Caco-2 cells, as well as decreased levels of Cyclin D1 and Cyclin E1. Incubation with CuB promoted cell apoptosis in both CRC cell lines in vitro, accompanied with elevation of cleaved caspase-3 and cleaved PARP. BTG3 knockdown abolished the effects of CuB in CRC cells. In summary, CuB-induced proliferation inhibition and cell apoptosis may be due to the reactivation of BTG3 by promoter demethylation. CuB may be a promising agent for CRC therapy.
Collapse
Affiliation(s)
- D Mao
- Department of Colorectal Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - A H Liu
- Department of Colorectal Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Z P Wang
- Department of Colorectal Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - X W Zhang
- Department of Colorectal Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - H Lu
- Department of Colorectal Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| |
Collapse
|
20
|
Wang LY, Feng X, Zhang BR, Ma N, Guo EK, Peng F, Tong X, Liu AH. [Efficacy analysis of LVIS and Enterprise stent assisted coil in the treatment of vertebral artery dissection aneurysm]. Zhonghua Yi Xue Za Zhi 2019; 99:685-689. [PMID: 30831618 DOI: 10.3760/cma.j.issn.0376-2491.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe and evaluate the therapeutic efficacy of LVIS stent and Enterprise stent assisted coil in embolization of vertebral artery dissection aneurysm (VDA). Methods: Clinical data of 96 patients with VDAs treated by LVIS stent and Enterprise stent assisted coil were analyzed retrospectively between January, 2013 and June, 2017.Of all, the LVIS stent assisted coil was performed in 28 patients (LVIS-stent group) and Enterprise in 68 patients (Enterprise-stent group). The clinical and imaging follow-up were performed. The instant embolization rate, complications, and recurrence rate were analyzed and compared between the two groups. Results: Instant angiographic results:in the LVIS stent group, complete occlusion was achieved in 17 VDAs (60.7%), near-complete occlusion in 10VDAs (35.7%), and partial occlusion in 1 VDA (3.6%). In the Enterprise stent group, complete occlusion was achieved in 27 VDAs (39.7%), near-complete occlusion in 34VDAs(50.0%), partial occlusion in 7VDAs (10.3%). Procedure-related complications occurred in 3 patients (10.7%) in LVIS stent group and 3 patients (4.4%) in Enterprise stent group. DSA follow-up was performed during 6 to 12 months after surgery, and 10 patients with vertebral artery dissection aneurysm recurred, 2 in the LVIS group and 8 in the Enterprise stent group. The latest modified Rankin Scale score was 0 in 55 patients,1 in 13, 2 in 1, 3 in 1, and 6 in 1. Among them, all follow-up patients in the LVIS stent group had good prognosis, while in the Enterprise stent group, 50 patients (94.4%) had a good prognosis. Conclusions: The stent-assisted coils have a higher degree of embolization in the vertebral artery dissection aneurysms, a higher rate of near-total embolization, a lower incidence of neurological complications, and a good prognosis. The complete andnear-complete occlusion rates and the incidence of neurological complicationsin the LVIS group was higher than that in the Enterprise groupand the recurrence ratesin the LVIS group was lower than that in the Enterprise group,both with no statistically significant difference.
Collapse
Affiliation(s)
- L Y Wang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070 Chian
| | - X Feng
- Beijing Hospital Neurosurgery Beijing100005 Chian
| | - B R Zhang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070 Chian
| | - N Ma
- The Neurosurgery Department, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - E K Guo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070 Chian
| | - F Peng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070 Chian
| | - X Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070 Chian
| | - A H Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070 Chian
| |
Collapse
|
21
|
Affiliation(s)
- Saeed A Alqahtani
- Department of Neurosurgery, MedStar Georgetown University Hospital, Pasquerilla Healthcare Center, Washington, DC
| | | | - Ai-Hsi Liu
- Department of Interventional Neuroradiology, MedStar Washington Hospital Center, Washington, DC
| |
Collapse
|
22
|
Ma N, Zhang BR, Feng X, Wang LY, Peng F, Liu AH. [Efficacy analysis of the endovascular treatment for 175 unruptured vertebrobasilar dissecting aneurysms]. Zhonghua Yi Xue Za Zhi 2018; 98:2176-2179. [PMID: 30032521 DOI: 10.3760/cma.j.issn.0376-2491.2018.27.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the clinical characteristics, clinical effect and follow-up outcome of the different endovascular treatment techniques in the treatment of unruptured vertebrobasilar dissecting aneurysms (VBDAs). Methods: The clinical data of 160 consecutive patients (175VBDAs) from January 2012 to December 2016 in Beijing Tiantan hospital were retrospectively analyzed.All of the 175 aneurysms were treated with endovascular embolization, including 115 stent-assisted coils, 27 simple stents, 21 blood flow diverting devices, and 12 parent arteries occlusion.The imaging and clinical follow-up were performed after the operation. Results: Headache including cervical-occipital pain(43.1%)was the most common clinical manifestation.The incidence of perioperative complications was 3.75%, no intraoperative bleeding and no deaths.The imaging findings of 113 aneurysms were followed up for (9.9±7.3) months.Of the 71 stent-assisted coils, 62 recovered well and 9 relapsed; of the 19 aneurysms treated with simple stent, 4 recovered well, 11 improved, 2 stable and 2 relapsed; of the 15 aneurysms treated by the blood flow diverting devices, 4 recovered and 11 improved; all of the 8 aneurysms with parent arteries occlusion recovered well.A total of 144 patients were follow-up (17.3±16.6) months by the Modified Rankin Scale(mRS) score: 140 patients were 0-2 score and 4 patients were 3-6 score. Conclusions: The clinical manifestations of the unruptured VBDAs are complex, and the headache is the most common clinical symptom.Endovascular treatment for the treatment of unruptured VBDAs is safe and feasible.The principle of individualization should be followed during embolization.
Collapse
Affiliation(s)
- N Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | | | | | | | | | | |
Collapse
|
23
|
Kalidasan V, Liu XL, Li Y, Sugumaran PJ, Liu AH, Ren L, Ding J. Examining the effect of ions and proteins on the heat dissipation of iron oxide nanocrystals. RSC Adv 2018; 8:1443-1450. [PMID: 35540917 PMCID: PMC9077098 DOI: 10.1039/c7ra11472a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/29/2017] [Indexed: 01/05/2023] Open
Abstract
In this paper, the effect and contribution of physiological components like ions and proteins under an applied alternating magnetic field (AMF) towards heat dissipation of superparamagnetic iron oxide nanoparticles (SPIONs) are discussed. Our results have shown that under an applied AMF, magnetic hyperthermia efficiency could be significantly enhanced if SPIONs were suspended in 1× phosphate buffered saline (PBS) compared to a suspension in de-ionized (DI) water. However, no heat enhancement was found when SPIONs were suspended in blood which is an amalgamation of physiological ions and proteins. Closer investigations have revealed that the presence of physiological ions can contribute positively to heating efficiency, and the heating efficiency increases with concentration of ions, ionic mass and solubility. However, the heating efficiency of ions can be suppressed to an insignificant level (comparable with measurement error), in the presence of physiological proteins in 1×PBS. Our electrochemical studies also showed that ionic mobility can be reduced significantly if proteins were present in the solution, thus retarding the heating efficiency.
Collapse
Affiliation(s)
- V Kalidasan
- Department of Materials Science & Engineering, Faculty of Engineering, National University of Singapore 7 Engineering Drive 1 117574 Singapore
| | - X L Liu
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology Beijing 100190 People's Republic of China
| | - Y Li
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology Beijing 100190 People's Republic of China .,Department of Biomaterials, Fujian Provincial Key Laboratory of Fire Retardant Materials, College of Materials, Xiamen University Xiamen 361005 People's Republic of China
| | - P J Sugumaran
- Department of Materials Science & Engineering, Faculty of Engineering, National University of Singapore 7 Engineering Drive 1 117574 Singapore
| | - A H Liu
- Department of Materials Science & Engineering, Faculty of Engineering, National University of Singapore 7 Engineering Drive 1 117574 Singapore
| | - L Ren
- Department of Biomaterials, Fujian Provincial Key Laboratory of Fire Retardant Materials, College of Materials, Xiamen University Xiamen 361005 People's Republic of China
| | - J Ding
- Department of Materials Science & Engineering, Faculty of Engineering, National University of Singapore 7 Engineering Drive 1 117574 Singapore
| |
Collapse
|
24
|
Tai A, Felbaum D, Liu AH, Mason RB, Armonda R, Sava J, Aulisi EF. 336 Civilian Penetrating Craniocerebral Gunshot Injuries. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx417.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
25
|
Alqahtani SA, Stemer AB, McCullough MF, Bell RS, Mai J, Liu AH, Armonda RA. Endovascular Management of Stroke Patients with Large Vessel Occlusion and Minor Stroke Symptoms. Cureus 2017; 9:e1355. [PMID: 28721323 PMCID: PMC5510978 DOI: 10.7759/cureus.1355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Endovascular mechanical thrombectomy for stroke patients with large vessel occlusion (LVO) in the anterior circulation has become the standard of care based on several major randomized clinical trials. The successful result reported by these trials constitutes what may be the largest achievement in the history of neurological sciences. However, most of these mechanical thrombectomy trials (except for the multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands, i.e., MR CLEAN and Extending the Time for Thrombolysis in Emergency Neurological Deficits–Intra-Arterial, i.e., EXTEND-IA) excluded stroke patients with minor to mild stroke symptoms with National Institutes of Health Stroke Scale (NIHSS) scores of six to eight or lower. The median NIHSS score for patients who underwent acute endovascular thrombectomy was approximately 15 to 17 in all trials. To date, the evidence is lacking to support the mechanical thrombectomy in patients with acute stroke and LVO with minor to mild severity on NIHSS score. The purpose of this review was to assess the current data, safety and clinical outcomes in stroke patients with minor to mild symptoms who were treated with endovascular thrombectomy.
Collapse
Affiliation(s)
| | | | | | - Randy S Bell
- Department of Neurosurgery, Walter Reed Army Medical Center, Washington D.C
| | - Jeffrey Mai
- Neurosurgery, Medstar Georgetown University Hospital
| | - Ai-Hsi Liu
- Neurointerventional Radiology, Medstar Washington Hospital Center
| | | |
Collapse
|
26
|
Abstract
Fenestrated vertebrobasilar junction aneurysms are rare vascular lesions. Microsurgical intervention is extremely difficult due to the complex anatomy in the vicinity of these aneurysms. Endovascular neurosurgery appears to be safe and should be considered as the first modality of treatment. This case study details the treatment of an unruptured fusiform fenestrated vertebrobasilar junction aneurysm with endovascular occlusion with stent-assisted coiling. The optimal angiographic exposure and selective microcatheterization of the aneurysm were challenging due to the patient’s body habitus, and the aneurysm was large with one dominant fenestrated limb.
Collapse
Affiliation(s)
| | | | - Alex Tai
- Neurosurgery, Medstar Georgetown University Hospital
| | - Ai-Hsi Liu
- Neurointerventional Radiology, Medstar Washington Hospital Center
| | | |
Collapse
|
27
|
Li XN, Liu AH, Tang X, Ren Y. [Urothelial carcinoma-associated 1 enhances tamoxifen resistance in breast cancer cells through competitively inhibiting miR-18a]. Beijing Da Xue Xue Bao Yi Xue Ban 2017; 49:295-302. [PMID: 28416841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate how urothelial carcinoma-associated 1 (UCA1) and miR-18a modulates acquired tamoxifen resistance and the relevant mechanisms in estrogen receptor (ER) positive cancer cells. METHODS qRT-PCR was performed to detect UCA1 and miR-18a expression in breast cancer cells. Dual luciferase assay was performed to detect the binding between miR-18a and UCA1 3'UTR. Tamoxifen sensitive MCF-7 cells were transfected with UCA1 expression vector or miR-18a inhibitors. Tamoxifen resistant LCC9 and BT474 cells were transfected with UCA1 siRNA or miR-18a mimics. CCK-8 assay was performed to detect cell viability. Soft agar assay was performed to assess cell colony formation. Flow cytometric analysis was performed to check cell cycle distribution. RESULTS UCA1 was significantly upregulated in tamoxifen resistant LCC2, LCC9, and BT474 cells than in tamoxifen sensitive MCF-7 cells. UCA1 expression was significantly upregulated in MCF-7 cells after treatment with 0.1 μmol/L tamoxifen. UCA1 overexpression enhanced cell viability of MCF-7 cells after tamoxifen treatment, while UCA1 siRNA significantly suppressed viability of LCC9 and BT474 cells after tamoxifen treatment. In MCF-7 cells, compared with vector control+tamoxifen group, the average cell colony number and colony size of the UCA1+tamoxifen group was 19.0% more and 29.0% larger respectively, while the proportions of the cells in G1 phase and in S phase were 7.3% lower and 6.7% higher respectively. In BT474 cells, compared with siRNA control+tamoxifen group, the average cell colony number and colony size of the si-UCA1+tamoxifen group were 54.0% less and 42.0% smaller respectively, while the proportions of the cells in G1 phase and in S phase were 9.0% higher and 6.2% lower respectively. UCA1 directly interacted with miR-18a and reduced its expression in ER positive breast cancer cells. Knockdown of miR-18a increased viability of MCF-7 cells after tamoxifen treatment, while miR-18a overexpression significantly reduced viability of BT474 cells after tamoxifen treatment. In MCF-7 cells, compared with miRNA inhibitor control+tamoxifen group, the average cell colony number and colony size of the miR-18a inhibitor+tamoxifen group were 15.0% more and 33.0% larger respectively, while the proportions of the cells in G1 phase and in S phase were 8.8% lower and 5.3% higher respectively. In BT474 cells, compared with miRNA control+tamoxifen group, the average cell colony number and colony size of the miR-18a mimics+tamoxifen group were 47.0% less and 25.0% smaller respectively, while the proportions of the cells in G1 phase and in S phase were 13.3% higher and 7.9% lower respectively. CONCLUSION UCA1 can increase tamoxifen resistance of ER positive breast cancer cells via competitively inhibiting of miR-18a.
Collapse
Affiliation(s)
- X N Li
- Department of Breast Surgery, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
| | - A H Liu
- Department of Breast Surgery, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
| | - X Tang
- Department of Breast Surgery, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
| | - Y Ren
- Department of Breast Surgery, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
| |
Collapse
|
28
|
Ge LL, Han ZY, Liu AH, Zhu L, Meng JH. [Antibiotic resistance analysis of Streptococcus pneumoniae isolates from the hospitalized children in Shanxi Children's Hospital from 2012 to 2014]. Zhonghua Er Ke Za Zhi 2017; 55:109-114. [PMID: 28173648 DOI: 10.3760/cma.j.issn.0578-1310.2017.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: To investigate the antibiotic resistance status of Streptococcus pneumoniae isolates from hospitalized children in Shanxi Children's Hospital. Method: E-test and Kirby-Bauer methods were applied to determine drug sensitivity of the isolates collected from the body fluid specimens of hospitalized children in Shanxi Children's Hospital from January 2012 to December 2014. The antimicrobial sensitivity and minimum inhibitory concentration (MIC) of Streptococcus pneumoniae to the conventional antibiotics were analyzed, in order to compare the annual trends of non-invasive isolates, while the differentiation of sensitivity from specimens. The comparison of rates was performed by Chi-squared test and Fisher's exact test. Result: A total of 671 isolates of streptococcus pneumoniae were obtained, which could be divided as non-invasive isolates(607), invasive isolates from non-cerebrospinal fluid(non-CSF)(40) and invasive isolates from cerebrospinal fluid(CSF)(24). The antimicrobial sensitivity(isolates(%)) of the 671 isolates were respectively vancomycin 671(100.0%), linezolid 671(100.0%), levofloxacin 665(99.1%), penicillin 595(88.7%), ceftriaxone 516(76.9%), cefotaxime 512(76.3%), sulfamethoxazole-trimethoprin(SMZ-TMP) 103(15.4%), clindamycin 28(4.2%), tetracycline 26(3.9%), erythromycin 12(1.8%). From 2012 to 2014, the susceptibility rates of non-invasive isolates to penicillin every year were 95.0%(96/101), 97.3%(110/113), 87.3%(343/393), respectively, and there was significant difference among the three years(χ(2)=13.266, P<0.05), and the values of MIC(50, )MIC(90) and the maximum values of MIC(mg/L) of penicillin were 0.064, 2.000, 6.000 in 2012, which grew up to 1.000, 3.000, 16.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to ceftriaxone and cefotaxime during these three years, (χ(2)=1.172, 1.198, both P>0.05). On the other hand, the values of MIC(50, )MIC(90) and the maximum value of MIC(mg/L) of ceftriaxone and cefotaxime both increased from 0.500, 2.000, 8.000 in 2012 to 0.750, 4.000, 32.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to the rest antibiotic. Based on the same examining standard of CSF, the antimicrobial sensitivity(isolates(%)) of the non-invasive isolates to ceftriaxone, cefotaxime, SMZ-TMP were respectively 281(46.3%), 278(45.8%), 78(12.9%), were significantly lower than the susceptibility rate of the invasive isolates from non-CSF (28(70%), 28(70%), 14(35%), χ(2)=8.453, 8.817, 15.094, all P<0.012 5), and lower than the invasive isolates from CSF (18(75%), 18(75%), χ(2)=7.631, 7.905, P<0.012 5; 11(45.8%), P=0.001). The sensitivity of the isolates to the rest antibiotics were similar(P>0.05). Conclusion: More than 95.0% strains of the streptococcus pneumoniae isolates from the hospitalized children in Shanxi Children's Hospital were sensitive to vancomycin, linezolid, levofloxacin, and the susceptibility rate of penicillin, ceftriaxone, cefotaxime were 88.7%, 76.9%, 76.3%. However, less than 20.0% of streptococcus pneumoniae were sensitive to erythromycin, clindamycin, SMZ-TMP and tetracycline. The susceptibility rate of penicillin of non-invasive Streptococcus pneumoniae declined by these years, and the differences to ceftriaxone and cefotaxime can be neglected, but the values of MIC(50, )MIC(90) and the maximum value of MIC of all were linearly rising. The susceptibility rate of antibiotics to ceftriaxone and cefotaxime of the non-invasive isolates was lower than the invasive isolates.
Collapse
Affiliation(s)
- L L Ge
- Department of Respiratory Medicine, Shanxi Children's Hospital, Taiyuan 030000, China
| | | | | | | | | |
Collapse
|
29
|
Liu J, Wang HX, Li LP, Hong X, Liu AH, Ye J, Song L, Zhang J, Li J, Hu NN, Sun ZC, Li SR, Yang YH, Dong HQ, Wang YP. [Myoclonus and it's associated factors in Creutzfeldt-Jakob disease]. Zhonghua Yi Xue Za Zhi 2016; 96:3656-3661. [PMID: 27978902 DOI: 10.3760/cma.j.issn.0376-2491.2016.45.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: To analyze features and the related factors of myoclonus of 47 patients with probable or possible Creutzfeldt-Jakob disease (CJD). Methods: All patients diagnosed with"suspected CJD" and hospitalized in Xuanwu Hospital from January 2013 to November 2015 were included, and their clinical information and myoclonus features were analyzed. Age, clinical, course and manifestation, EEG, MRI, CSF14-3-3 features between myoclonus positive group and negative group were compared, and the correlation between myoclonus features and these factors was analyzed using Spearman correlation analyses. Results: (1) Occurrence rate of extrapyramidal symptoms (P=0.028), visual impairment (P=0.025) and dyssomnia (P=0.004) were higher in myoclonus positive group, the differences were significant. Spearman correlation analysis showed that myoclonus was related to extrapyramidal symptoms (P=0.024), visual impairment (P=0.030) and dyssomnia (P=0.001). (2) EEG features showed no significant difference between myoclonus positive and negative group. The 17 myoclonus positive patients were divided into three subgroups, typical EEG change group 52.94%(9/17), atypical EEG change group 23.53%(4/17) and no EEG change group 23.53%(4/17). Difference of myoclonus and other clinical manifestations were not significant among the three subgroups(P>0.05); correlation analysis also found no statistically significant correlation between myoclonus and EEG (P=0.201). Conclusions: Myoclonus often occurs after the damage of locomotor system (including pyramidal tract, extracorticospinal tract and cerebellum) among CJD patients, and it is related to extrapyramidal symptoms , visual impairment and dyssomnia . There is undefined correlation between myoclonus and periodic sharp wave complexes (PSWC) in EEG.
Collapse
Affiliation(s)
- J Liu
- *Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Wang HX, Liu J, Yang YH, Sun HP, Liu AH, Li LP, Ye J, Hou Y, Sun Y, Dong HQ, Wang YP. [Feature of magnetic resonance imaging in patients with Creutzfeldt-Jakob disease]. Zhonghua Yi Xue Za Zhi 2016; 96:3142-3145. [PMID: 27852412 DOI: 10.3760/cma.j.issn.0376-2491.2016.39.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: To assess the imaging features of 43 patients diagnosed as clinically possible or probable Creutzfeldt-Jakob disease (CJD) for providing referential information and experience on applications of MRI in the clinical diagnosis and treatment of CJD. Method: All patients who were diagnosed with "suspected CJD" and hospitalized in Xuanwu Hospital from January 2013 to November 2015 were collected, and their clinical information and MRI imaging features were analyzed retrospectively. Results: Totally 62 patients with "suspected CJD" were rectruited in this study, and 43 of them were diagnosied as probable and possible CJD when they were discharged.The typical MRI feature of CJD patients was "cortical ribbon" sign in MR DWI sequences and/or high signal in cortex or bilateral basal ganglia.In all patients, the simple coritcal involvement was the highest(76.47%, 26/34), followed by the cortical cortex and basal ganglia(23.53%, 8/34). MRI positive group had more prominent extrapyramidal symptoms than MRI negative group (26/31 vs 9/12, P=0.015), but no statistical difference in clinic feature was found between the group with simple cortex affected and the group with both cortex and bilateral basal ganglia affected (P>0.05). Conclusions: MRI images of patients with CJD have special characteristics and have corresponding changes when the patients are in different stages of disease. In combination with the clinical evaluation of disease progression, brain microscopic pathological changes of CJD patients can be assessed by regularly brain MRI examination.
Collapse
Affiliation(s)
- H X Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
Preoperative embolization of meningiomas can be safely performed using a variety of embolic agents. Most commonly, the vascular supply from branches of the external carotid artery is the target of embolization. In our report, we detail the treatment of a patient with a parafalcine meningioma that received its supply via branches of the anterior cerebral artery. One of the feeder vessels appeared to contain a dysplastic aneurysmal dilatation of the vessel. Due to patient circumstances, embolization was performed using standard microcatheterization techniques to minimize intraoperative blood loss. We report a rare instance of endovascular treatment of a pial vessel to treat an intracranial meningioma using Onyx.
Collapse
Affiliation(s)
| | - Kyle Mueller
- Neurosurgery, Medstar Georgetown University Hospital
| | - Ai-Hsi Liu
- Neurointerventional Radiology, Medstar Washington Hospital Center
| | | |
Collapse
|
32
|
Gruchalla RS, Sampson HA, Liu AH, Shreffler W, Wallace PK, Togias A, David G, Calatroni A, LeBeau P. Effects of omalizumab on T lymphocyte function in inner-city children with asthma. Pediatr Allergy Immunol 2016; 27:328-31. [PMID: 26573086 PMCID: PMC4888877 DOI: 10.1111/pai.12508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
While omalizumab treatment of inner city children and adolescents with asthma results in improvement in clinical parameters, no change in peripheral blood T cell responses could be demonstrated. Thus, omalizumab appears not to affect T cell function.
Collapse
Affiliation(s)
- R S Gruchalla
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - H A Sampson
- Mount Sinai School of Medicine, New York, NY, USA
| | - A H Liu
- National Jewish Health, University of Colorado Denver School of Medicine, Denver, CO, USA
| | | | - P K Wallace
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | - A Togias
- Division of Allergy, Immunology and Transplantation, NIH, Bethesda, MD, USA
| | - G David
- Rho Federal Systems Division Inc., Chapel Hill, NC, USA
| | - A Calatroni
- Rho Federal Systems Division Inc., Chapel Hill, NC, USA
| | - P LeBeau
- Rho Federal Systems Division Inc., Chapel Hill, NC, USA
| | | |
Collapse
|
33
|
Felbaum DR, Syed HR, McCullough MF, Armonda RA, Liu AH, Bell RS. Embolization of Carotid Body Tumors: Revisiting Direct Puncture Technique, Preliminary Experience and Literature Review. Cureus 2016; 8:e483. [PMID: 32175212 PMCID: PMC7053799 DOI: 10.7759/cureus.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Preoperative embolization via transarterial route is an acceptable adjunct to the treatment of carotid body tumors (CBT). Direct tumor puncture for embolization has been previously described as a safe and feasible option. We revisit this technique and present our initial experience treating CBT via direct puncture. We identified six patients that underwent preoperative embolization of CBT using a direct puncture technique embolized with Onyx (EV3 Micro Therapeutics Inc., Irvine, CA, USA). After defining the angioarchitecture via digital subtraction angiography, the tumor was targeted with Onyx. Using a 21-gauge needle, the tumor was punctured using a fluoroscopic road mask. There were no immediate post-procedural complications following embolization. All patients underwent definitive resection within 24 hours. During surgery, the embolization material did not affect surgical maneuvers. In addition, the estimated blood loss was noted to average 50 ml. Although early in our experience, direct percutaneous embolization of CBT appears to be a reproducible and well-tolerated endovascular treatment option. Overall, the reported body of evidence available confirms the safety and efficacy of direct intralesional embolization with Onyx.
Collapse
Affiliation(s)
- Daniel R Felbaum
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Hasan R Syed
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Michael F McCullough
- Neurointerventional Radiology, Medstar Washington Hospital Center, Washington DC, USA
| | - Rocco A Armonda
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Ai-Hsi Liu
- Neurointerventional Radiology, Medstar Washington Hospital Center, Washington DC, USA
| | - Randy S Bell
- Department of Neurosurgery, Walter Reed Army Medical Center, Washington DC, USA
| |
Collapse
|
34
|
Zhang C, Jiang SZ, Huo YY, Liu AH, Xu SC, Liu XY, Sun ZC, Xu YY, Li Z, Man BY. SERS detection of R6G based on a novel graphene oxide/silver nanoparticles/silicon pyramid arrays structure. Opt Express 2015; 23:24811-21. [PMID: 26406681 DOI: 10.1364/oe.23.024811] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We present a novel surface-enhanced Raman scattering (SERS) substrate based on graphene oxide/silver nanoparticles/silicon pyramid arrays structure (GO/Ag/PSi). The SERS behaviors are discussed and compared by the detection of R6G. Based on the contrast experiments with PSi, GO/PSi, Ag/PSi and GO/AgA/PSi as SERS substrate, the perfect bio-compatibility, good homogeneity and chemical stability were confirmed. We also calculated the electric field distributions using Finite-difference time-domain (FDTD) analysis to further understand the GO/Ag/PSi structure as a perfect SERS platform. These experimental and theoretical results imply that the GO/Ag/PSi with regular pyramids array is expected to be an effective substrate for label-free sensitive SERS detections in areas of medicine, food safety and biotechnology.
Collapse
|
35
|
Xu JL, Bao LZ, Liu AH, Jin XJ, Tong YX, Luo JM, Zhong ZC, Zheng YF. Microstructure, mechanical properties and superelasticity of biomedical porous NiTi alloy prepared by microwave sintering. Mater Sci Eng C Mater Biol Appl 2015; 46:387-393. [PMID: 25492002 DOI: 10.1016/j.jallcom.2015.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 10/08/2014] [Accepted: 10/21/2014] [Indexed: 05/28/2023]
Abstract
Porous NiTi alloys were prepared by microwave sintering using ammonium hydrogen carbonate (NH4HCO3) as the space holder agent to adjust the porosity in the range of 22-62%. The effects of porosities on the microstructure, hardness, compressive strength, bending strength, elastic modulus, phase transformation temperature and superelasticity of the porous NiTi alloys were investigated. The results showed that the porosities and average pore sizes of the porous NiTi alloys increased with increasing the contents of NH4HCO3. The porous NiTi alloys consisted of nearly single NiTi phase, with a very small amount of two secondary phases (Ni3Ti, NiTi2) when the porosities are lower than 50%. The amount of Ni3Ti and NiTi2 phases increased with further increasing of the porosity proportion. The porosities had few effects on the phase transformation temperatures of the porous NiTi alloys. By increasing the porosities, all of the hardness, compressive strength, elastic modulus, bending strength and superelasticity of the porous NiTi alloys decreased. However, the compressive strength and bending strength were higher or close to those of natural bone and the elastic modulus was close to the natural bone. The superelastic recovery strain of the trained porous NiTi alloys could reach between 3.1 and 4.7% at the pre-strain of 5%, even if the porosity was up to 62%. Moreover, partial shape memory effect was observed for all porosity levels under the experiment conditions. Therefore, the microwave sintered porous NiTi alloys could be a promising candidate for bone implant.
Collapse
Affiliation(s)
- J L Xu
- School of Materials Science and Engineering, Nanchang Hangkong University, Nanchang 330063, PR China; Jiangsu Provincial Key Lab for Interventional Medical Devices, Huaiyin Institute of Technology, Huaian 223003, PR China.
| | - L Z Bao
- School of Materials Science and Engineering, Nanchang Hangkong University, Nanchang 330063, PR China
| | - A H Liu
- Jiangsu Provincial Key Lab for Interventional Medical Devices, Huaiyin Institute of Technology, Huaian 223003, PR China
| | - X J Jin
- School of Materials Science and Engineering, Nanchang Hangkong University, Nanchang 330063, PR China
| | - Y X Tong
- Center for Biomedical Materials and Engineering, Harbin Engineering University, Harbin 150001, PR China
| | - J M Luo
- School of Materials Science and Engineering, Nanchang Hangkong University, Nanchang 330063, PR China
| | - Z C Zhong
- School of Materials Science and Engineering, Nanchang Hangkong University, Nanchang 330063, PR China
| | - Y F Zheng
- State Key Laboratory for Turbulence and Complex System and Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, PR China.
| |
Collapse
|
36
|
Abstract
Stenosis of central veins (brachiocephalic vein [BCV] and superior vena cava) occurs in 30% of hemodialysis patients, rarely producing intracranial pathology. The authors present the first cases of BCV stenosis causing perimesencephalic subarachnoid hemorrhage and myoclonic epilepsy.
In the first case, a 73-year-old man on hemodialysis presented with headache and blurry vision, and was admitted with presumed idiopathic intracranial hypertension after negative CT studies and confirmatory lumbar puncture. The patient mildly improved until hospital Day 3, when he experienced a seizure; emergency CT scans showed perimesencephalic subarachnoid hemorrhage. Cerebral angiography failed to find any vascular abnormality, but demonstrated venous congestion. A fistulogram found left BCV occlusion with jugular reflux. The occlusion could not be reopened percutaneously and required open fistula ligation. Postoperatively, symptoms resolved and the patient remained intact at 7-month follow-up.
In the second case, a 67-year-old woman on hemodialysis presented with right arm weakness and myoclonic jerks. Admission MRI revealed subcortical edema and a possible dural arteriovenous fistula. Cerebral angiography showed venous engorgement, but no vascular malformation. A fistulogram found left BCV stenosis with jugular reflux, which was immediately reversed with angioplasty and stent placement. Postprocedure the patient was seizure free, and her strength improved. Seven months later the patient presented in myoclonic status epilepticus, and a fistulogram revealed stent occlusion. Angioplasty successfully reopened the stent and she returned to baseline; she was seizure free at 4-month follow-up.
Central venous stenosis is common with hemodialysis, but rarely presents with neurological findings. Prompt recognition and endovascular intervention can restore normal venous drainage and resolve symptoms.
Collapse
Affiliation(s)
| | - Andrew B. Stemer
- 2Department of Radiology, Washington Hospital Center, Washington, DC; and
| | - Randy S. Bell
- 3Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Ai-Hsi Liu
- 2Department of Radiology, Washington Hospital Center, Washington, DC; and
| | - Rocco A. Armonda
- 3Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - William O. Bank
- 2Department of Radiology, Washington Hospital Center, Washington, DC; and
| |
Collapse
|
37
|
Wang JM, Ma ML, Liu AH, Ren QY, Li AY, Liu ZJ, Li YQ, Yin H, Luo JX, Guan GQ. A sero-epidemiological survey of Chinese Babesia motasi for small ruminants in China. Parasitol Res 2013; 112:2387-91. [PMID: 23371500 DOI: 10.1007/s00436-013-3310-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/18/2013] [Indexed: 11/26/2022]
Abstract
Babesia motasi BQ1 (Lintan) was first isolated from Haemaphysalis qinghaiensis collected in Gannan Tibet Autonomous Region, Gansu province in April 2000. In this study, a total of 3,204 serum samples from small ruminants in 22 provinces located in different districts of China were tested for antibodies against merozoite antigens from cultured B. motasi BQ1 (Lintan) by enzyme-linked immunosorbent assay. This method can survey the prevalence of low-pathogenic Chinese B. motasi. The results of this survey indicated that the average positive rate was 43.5 %, and the positive rates of investigated provinces were significantly different from 6.1 to 91.0 %, and the infections had been found in all provinces investigated. Our data provide large important information regarding the current sero-prevalence of B. motasi in China.
Collapse
Affiliation(s)
- J M Wang
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Key Laboratory of Grazing Animal Diseases MOA, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Science, Xujiaping 1, Lanzhou, Gansu, 730046, People's Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Papadopoulos NG, Arakawa H, Carlsen KH, Custovic A, Gern J, Lemanske R, Le Souef P, Mäkelä M, Roberts G, Wong G, Zar H, Akdis CA, Bacharier LB, Baraldi E, van Bever HP, de Blic J, Boner A, Burks W, Casale TB, Castro-Rodriguez JA, Chen YZ, El-Gamal YM, Everard ML, Frischer T, Geller M, Gereda J, Goh DY, Guilbert TW, Hedlin G, Heymann PW, Hong SJ, Hossny EM, Huang JL, Jackson DJ, de Jongste JC, Kalayci O, Aït-Khaled N, Kling S, Kuna P, Lau S, Ledford DK, Lee SI, Liu AH, Lockey RF, Lødrup-Carlsen K, Lötvall J, Morikawa A, Nieto A, Paramesh H, Pawankar R, Pohunek P, Pongracic J, Price D, Robertson C, Rosario N, Rossenwasser LJ, Sly PD, Stein R, Stick S, Szefler S, Taussig LM, Valovirta E, Vichyanond P, Wallace D, Weinberg E, Wennergren G, Wildhaber J, Zeiger RS. International consensus on (ICON) pediatric asthma. Allergy 2012; 67:976-97. [PMID: 22702533 PMCID: PMC4442800 DOI: 10.1111/j.1398-9995.2012.02865.x] [Citation(s) in RCA: 259] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 01/08/2023]
Abstract
Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. To achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate and fine-tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype-specific treatment choices; however, this goal has not yet been achieved.
Collapse
Affiliation(s)
- N G Papadopoulos
- Department of Allergy, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Stemer AB, Bank WO, Armonda RA, Liu AH, Herzig DW, Bell RS. Acute embolization of ruptured brain arteriovenous malformations. J Neurointerv Surg 2012; 5:196-200. [DOI: 10.1136/neurintsurg-2011-010214] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
40
|
Matsui EC, Sampson HA, Bahnson HT, Gruchalla RS, Pongracic JA, Teach SJ, Gergen PJ, Bloomberg GR, Chmiel JF, Liu AH, Kattan M, Sorkness CA, Steinbach SF, Story RE, Visness CM. Allergen-specific IgE as a biomarker of exposure plus sensitization in inner-city adolescents with asthma. Allergy 2010; 65:1414-22. [PMID: 20560910 DOI: 10.1111/j.1398-9995.2010.02412.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Relationships among allergen-specific IgE levels, allergen exposure and asthma severity are poorly understood since sensitization has previously been evaluated as a dichotomous, rather than continuous characteristic. METHODS Five hundred and forty-six inner-city adolescents enrolled in the Asthma Control Evaluation study underwent exhaled nitric oxide (FE(NO)) measurement, lung function testing, and completion of a questionnaire. Allergen-specific IgE levels and blood eosinophils were quantified. Dust samples were collected from the participants' bedrooms for quantification of allergen concentrations. Participants were followed for 12 months and clinical outcomes were tracked. RESULTS Among sensitized participants, allergen-specific IgE levels were correlated with the corresponding settled dust allergen levels for cockroach, dust mite, and mouse (r = 0.38, 0.34, 0.19, respectively; P < 0.0001 for cockroach and dust mite and P = 0.03 for mouse), but not cat (r = -0.02, P = 0.71). Higher cockroach-, mite-, mouse-, and cat-specific IgE levels were associated with higher FE(NO) concentrations, poorer lung function, and higher blood eosinophils. Higher cat, dust mite, and mouse allergen-specific IgE levels were also associated with an increasing risk of exacerbations or hospitalization. CONCLUSIONS Allergen-specific IgE levels were correlated with allergen exposure among sensitized participants, except for cat. Allergen-specific IgE levels were also associated with more severe asthma across a range of clinical and biologic markers. Adjusting for exposure did not provide additional predictive value, suggesting that higher allergen-specific IgE levels may be indicative of both higher exposure and a greater degree of sensitization, which in turn may result in greater asthma severity.
Collapse
Affiliation(s)
- E C Matsui
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Piacentini GL, Peroni DG, Bodini A, Bonafiglia E, Rigotti E, Baraldi E, Liu AH, Boner AL. Childhood Asthma Control Test and airway inflammation evaluation in asthmatic children. Allergy 2009; 64:1753-7. [PMID: 19712122 DOI: 10.1111/j.1398-9995.2009.02068.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Childhood Asthma Control Test (C-ACT) has been proposed as a tool in assessing the level of disease control in asthmatic children. To evaluate the position of C-ACT in the clinical management of asthmatic children, in relationship to the level of airway inflammation as assessed by fractional exhaled nitric oxide (FeNO) and with lung function. METHODS A total of 200 asthmatic children were included in the study: 47 children with newly diagnosed asthma ('New') and without any regular controller therapy; and 153 children with previously diagnosed asthma, treated according to GINA guidelines, and evaluated during a scheduled follow-up visit ('Follow-up'). Childhood Asthma Control Test, FeNO and lung function [forced expiratory volume 1 (FEV1) and forced vital capacity (FVC)] were evaluated. RESULTS In New vs Follow-up participants, C-ACT score (P < 0.001), FVC (P < 0.005) and FEV1 (P < 0.05) were significantly lower, and FeNO (P = 0.011) were significantly higher. In New, but not in Follow-up participants, significant correlations were observed between C-ACT score and FeNO (r = -0.51; P < 0.001), FEV1 (r = 0.34; P = 0.022) and FEV1/FVC (r = 0.32; P = 0.03). This lack of correlation in Follow-up visits seemed attributable to dissociation between inadequately controlled asthma by C-ACT ratings with normalization of other measures such as FeNO levels. CONCLUSIONS This study confirms and expands the concept that C-ACT is complementary to, but not a substitute for, other markers of disease control in asthmatic children, especially in the context of follow-up visits.
Collapse
|
42
|
Slater JE, James R, Pongracic JA, Liu AH, Sarpong S, Sampson HA, Satinover SM, Woodfolk JA, Mitchell HE, Gergen PJ, Eggleston PA. Biological potency of German cockroach allergen extracts determined in an inner city population. Clin Exp Allergy 2007; 37:1033-9. [PMID: 17581196 DOI: 10.1111/j.1365-2222.2007.02751.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cockroach allergy is an important cause of inner city asthma. To perform valid studies on the diagnosis and treatment of cockroach allergy, biological potencies of test extracts need to be established, and a surrogate in vitro test for biological potency should be chosen. METHODS Sixty-two cockroach-allergic adult subjects were recruited for quantitative skin testing with three commercial German cockroach extracts. The intradermal D50 values were determined using linear interpolation, and the biologic potencies were determined from D50 data. The extracts were also analysed for relative potency, using a competition ELISA, and for specific allergen content, using a two-site ELISA. RESULTS Estimates of each extract's D50 were analysable in 48-55 subjects, with D50s between 10.3 and 11.8. All three extracts were bioequivalent using pre-set criteria. The biological potencies of the extracts were 1738-8570 bioequivalent allergy units (BAU)/mL (geometric mean=3300), and these relative potencies were similar to those estimated by competition ELISA and specific allergen content. IgE against cockroach allergens were detected in sera from 34 subjects with analysable D50s, and 17 subjects had IgE directed against specific cockroach allergens. Although the presence of anti-Bla g 5 correlated with the subjects' skin test responses for 2/3 extracts, no single allergen was immunodominant. Antibody responses among the subjects were heterogeneous. CONCLUSIONS Although commercial cockroach extracts are relatively low in potency, immunotherapeutic doses should be achievable. Biological potency may be estimated using D50 testing, a combination of specific allergen determinations, or by an overall potency assay such as the competition ELISA. CAPSULE SUMMARY The biological potency of three German cockroach allergen extracts, determined in an inner city population, was 1738-8570 BAU/mL. No one allergen was immunodominant, and surrogate in vitro testing methods were examined.
Collapse
Affiliation(s)
- J E Slater
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Bethesda, MD, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Liu AH, Yin H, Guan GQ, Schnittger L, Liu ZJ, Ma ML, Dang ZS, Liu JL, Ren QY, Bai Q, Ahmed JS, Luo JX. At least two genetically distinct large Babesia species infective to sheep and goats in China. Vet Parasitol 2007; 147:246-51. [PMID: 17531391 DOI: 10.1016/j.vetpar.2007.03.032] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Revised: 03/15/2007] [Accepted: 03/26/2007] [Indexed: 10/23/2022]
Abstract
A fatal disease of sheep and goats in the northern part of China has been reported to be due to Babesia ovis. However, some characteristics of the causative agent in recent reports are not in accordance with the original attributes ascribed to this parasite. Therefore, the 18S small subunit ribosomal RNA (18S rRNA) genes of a number of Babesia isolates in China were sequenced and compared with that of other Babesia and Theileria species in an attempt to clarify their taxonomic position. In the present study, seven Babesia isolates were collected from distinct areas of northern China, and the 18S rRNA genes were amplified and sequenced. The phylogenetic trees were inferred based on 18S rRNA gene sequences of the Chinese ovine Babesia isolates and some of ovine Babesia and Theileria species available in GenBank. In the phylogenetic tree, Babesia sp. isolates from Madang, Tianzhu, Lintan, Ningxian, Hebei and Liaoning all grouped with B. motasi with 88.2-99.9% identity, while Babesia sp. Xinjiang grouped in a separate clade between B. ovis and B. crassa with 79.7-81.2% identity. The results indicated that there are at least two distinct Babesia species groups-B. motasi and Babesia sp. Xinjiang, the latter was distinctly different from other ovine Babesia isolates from China with less than 86.6% identity.
Collapse
Affiliation(s)
- A H Liu
- State Key Laboratory of Veterinary Etiological Biology & Gansu Provincal Key Laboratory of Veterinary Parasitology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Xujiaping 11, Lanzhou, Gansu 730046, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- N Rabinovitch
- Department of Pediatrics, National Jewish Medical and Research Center, Denver, CO, USA.
| | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Man BY, Dong QL, Liu AH, Wei XQ, Zhang QG, He JL, Wang XT. Line-broadening analysis of plasma emission produced by laser ablation of metal Cu. ACTA ACUST UNITED AC 2003. [DOI: 10.1088/1464-4258/6/1/304] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
47
|
|
48
|
An Y, Zhu ZM, Hu JH, Liu AH. [The characteristic infrared spectra of alpha,alpha'-dioxoketene cyclic dithioacetals]. Guang Pu Xue Yu Guang Pu Fen Xi 2001; 21:775-777. [PMID: 12958892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The characteristic infrared spectra of the five alpha,alpha'-dioxoketene cyclic dithioacetals such as carbonyl, double bond of carbon and carbon, single bond of carbon and sulfur etc have been studied. It is specially important that the changing rules with the change of chemical structure have been discussed.
Collapse
Affiliation(s)
- Y An
- Chemistry Department, Liaoning Teacher University, Dalian 116029, China
| | | | | | | |
Collapse
|
49
|
Liu AH. Allergy and asthma prevention: the cup half full. Allergy Asthma Proc 2001; 22:333-6. [PMID: 11775388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Lack of an effective approach to atopic disease prevention is implicit in the global rise in asthma and allergy prevalence over the last 10-20 years. Indeed, asthma appears to be the most common chronic disease of childhood, allergies seem more common than not, and recent evidence suggests that this atopic disease burden is influencing adult prevalence of these conditions as well. Thus, the time seems right for prevention. Considering our current understanding of asthma and allergy pathogenesis, numerous strategies of atopic disease prevention can be envisioned. These strategies can be organized as follows: (1) allergen avoidance; (2) anti-inflammatory pharmacotherapy; (3) inhibition of Th2-type immune development by Th1-type cytokine induction; and (4) dietary and environmental approaches to atopic disease prevention.
Collapse
Affiliation(s)
- A H Liu
- Division of Pediatric Allergy and Immunology, National Jewish Medical and Research Center, University of Colorado Health Sciences Center, 1400 Jackson Street, Denver, CO 80206, USA
| |
Collapse
|
50
|
Liu AH, Redmon AH. Endotoxin: friend or foe? Allergy Asthma Proc 2001; 22:337-40. [PMID: 11775389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Endotoxin in our living environment has been of increasing interest to our global community of allergists. Initially and largely studied for its capacity to mediate septic shock (and earning its "-toxin" suffix), we have since come to understand that endotoxin in the dust of many occupational settings also is an occult respiratory culprit, inducing airflow obstruction and aggravating asthma and allergies. More recently, environmental endotoxin has been implicated as a microbial exposure in early childhood that may have an atopy-protective effect by augmenting early Th1-type immune development. Although seemingly paradoxical, endotoxin's dual nature ultimately may serve to enlighten our understanding of how such bioactive exposures can interact with and guide our immune systems in both health and disease.
Collapse
Affiliation(s)
- A H Liu
- Division of Pediatric Allergy and Immunology, National Jewish Medical and Research Center, University of Colorado Health Sciences Center, 1400 Jackson Street, Denver, CO 80206, USA
| | | |
Collapse
|