Radiological predictors of final infarct volume in patients with proximal vascular occlusion

INTRODUCTION

Various clinical and radiologic variables impact the neurologic prognosis of patients with ischemic cerebrovascular accidents. About 30% of ischemic cerebrovascular accidents are caused by proximal obstruction of the anterior circulation; in these cases, systemic thrombolysis is of limited usefulness. CT angiography is indicated in candidates for endovascular treatment. Various radiologic factors, including the grade of leptomeningeal collateral circulation, as well as the length, density, and extension of the thrombus, have been identified as predictors of neurologic prognosis after anterior ischemic cerebrovascular accidents due to proximal vascular obstruction. Final infarct volume correlations with mortality and long-term functional outcome in these patients. This study aimed to determine the best predictors of final infarct volume on CT angiography in patients with ischemic cerebral accidents due to proximal occlusion.

MATERIALS AND METHODS

This retrospective observational study included adults with ischemic cerebrovascular accidents due to obstruction of the anterior circulation diagnosed by CT angiography in the period comprising June 2009 through December 2019. We measured the length and density of the thrombus in unenhanced CT images, and we used the clot burden score to record the grade of leptomeningeal collateral circulation and the extension of the thrombus. Then we measured the final infarct volume on follow-up CT and analyzed the correlations among these radiologic factors in the infarct volume.

RESULTS

We included 54 patients [mean age, 82 y; 41 (75%) women] with ischemic cerebrovascular accidents due to proximal occlusion. About 60% of the cerebrovascular accidents affected the right cerebral hemisphere, and the most commonly affected vessel was the M1 segment of the medial cerebral artery (40.7%). Final infarct volume correlated with the grade of leptomeningeal collateral circulation (p=0.03) and with the clot burden score (p=0.01). Neither the length nor the density of the thrombus correlated with final infarct volume.

CONCLUSION

The final infarct volume can be estimated on the initial CT angiogram. Nevertheless, we found no useful predictive factors in unenhanced CT images. The best independent radiologic predictors of the final infarct volume are the grade of collateral circulation and the clot burden score, especially in patients who did not undergo mechanical thrombectomy, because mechanical thrombectomy improves outcomes. These factors are important for decision making in the management of patients with ischemic cerebrovascular accidents due to proximal occlusion.

Consumer perception of situational appropriateness for fresh, dehydrated and fresh-cut fruits

In recent years, a decreasing trend in fruit consumption has been detected in Mediterranean countries, with the consequent risk for the population's health. The objective of this study was to obtain consumer knowledge that can be useful to promote fruit consumption by designing specific interventions. This study was conducted in Spain as its inhabitants have traditionally adhered to the Mediterranean diet. Firstly, four fresh fruit types were identified based on the consumer perception of the fruit characteristics that condition the eating process (fruit size, the need for cutlery to peel/eat fruit, and susceptibility to be spoiled during transportation). Then consumer perception of situational appropriateness of six different fruit types (the 4 types of fresh fruit previously identified, dehydrated non-traditional fruit (DF), and fresh-cut fruit ready to eat on the go (FCF)) was investigated by the Item-By-Use method using Check-All-That Apply (CATA) questions. The potential of DF and FCF to broaden fruit consumption situations, and barriers for their consumption, were evaluated. Fresh fruits, particularly 'easy-to-peel' ones like mandarins or bananas, were those preferred by consumers in most evaluated contexts. DF were considered mainly appropriate to be consumed 'As an ingredient' and 'As a healthy snack', while FCF were more suitable 'To be included in school lunchboxes' and 'To eat immediately'. According to our results, these two processed fruit types can help to increase the fruit consumption of a non-negligible percentage of the population (38% of participants), but it is necessary to overcome the barriers related mostly to sensory properties, plastic packaging and consumer misperception of fewer healthy properties compared to fresh fruit.

Impact of ethylene degreening treatment on sensory properties and consumer response to citrus fruits

Degreening treatment is normally applied to early-season citrus varieties grown in the Mediterranean area in order to enhance the external colour when fruits have already reached internal maturity. Despite profound knowledge about the effect of ethylene on the physico-chemical quality of citrus fruit, less is known about its effect on consumers' expectations in the supermarket or consumer quality perceptions when they eat such fruit. In this study, three mandarin cultivars ('Owari', 'Clemenules' and 'Oronules') with two initial colours at harvest, and one orange cultivar, 'Navelina', were submitted to the degreening treatment under commercial conditions. The effect of treatment on both external and internal qualities perceived by consumers was evaluated. The main physico-chemical parameters were also determined. The degreening treatment slightly affected firmness, total soluble solids or acidity level in 'Owari' and 'Navelina'. However, sensory triangle tests, in which 100-122 consumers compared the internal quality of degreened fruit and control fruit, did not show significant differences between treatments for any of the studied cultivars. A survey based on images of citrus fruit was responded by 340 consumers; it showed that the degreening treatment strongly affected consumers' maturity expectations, which resulted in improved fruit liking expectations and increased the number of consumers willing to buy. The extent of this effect depended on the initial colour of the fruit submitted to degreening. In order to improve liking expectations, fruit should arrive on the market with an external colour index (CI = 1000a/Lb) between +10 and +20. We conclude that the ethylene degreening treatment, which did not have any effect on the internal quality that consumers perceive, is a potent postharvest tool to increase citrus fruit sales at the beginning of the season.

Volatile metabolite profiling reveals the changes in the volatile compounds of new spontaneously generated loquat cultivars

In recent years, the advantageous traits of three new loquat cultivars have drawn the attention of breeders and growers. All three have spontaneously arisen from the 'Algerie' cultivar: the new 'Xirlero' cultivar is a bud mutant of 'Algerie', while 'Amadeo' and 'Raúl' arose as chance seedlings. Following a non-targeted approach based on HS-SPME-GC-MS, the volatile compounds profile of the fruits from the new cultivars were obtained and compared to the original 'Algerie' cultivar. Carboxylic acids clearly dominated the volatile profile of all the loquat cultivars, but esters, aldehydes, ketones and alcohols were also predominant compounds. Interestingly when the bud mutant event did not lead to marked changes in the volatile compounds complement, pronounced changes in the volatile composition of chance seedling-generated cultivars 'Amadeo' and 'Raúl' were observed. 'Amadeo' fruits showed lower levels of 2-methyl butanoic acid and much higher levels of methylhexanoate, methylbutanoate and 2-hydroxy-5-methylacetophenone. The 'Raúl' cultivar also had a distinctive volatile profile characterised by high levels of C6-aldehydes, (E)-2-hexanal, 2-hexenal, (Z)-3-hexenal and hexanal, and several carotenoid-derived volatiles; e.g. 2-pentene-1,4-dione 1-(1,2,2-trimethylcyclopentyl), (S)-dihydroactinidiolide, isodurene, cis-geranyl acetone, β-damascenone, β-ionone, α-ionone and 3,4-dehydro-β-ionone. These changes in volatiles were associated with a more intense flavour in cultivars 'Amadeo' and 'Raúl', according to the sensory evaluation of the flavour intensity carried out by a semi-trained panel. A metabolomic correlation network analysis provided insights as to how volatiles were regulated, and revealed that the compounds modified in 'Amadeo' were uncoupled from the rest of the volatilome, while the volatiles modified in 'Raul' changed according to specific groups. To conclude, this work provides a holistic view of how the loquat volatilome was affected, and this information was integrated with the physical-chemical-sensory attributes to understand the changes that occur in the new cultivars.

[Brain atrophy in clinically isolated syndrome]

INTRODUCTION

Previous reports have shown that brain atrophy appears early in the course of multiple sclerosis (MS). The aim of the present study was to evaluate whether brain atrophy already exists in clinically isolated syndrome (CIS) by comparing with a control sample.

METHODS

Patients with CIS were included prospectively from June 2008 to June 2009. A control group of healthy persons, matched by age and gender with CIS, was also included during the same period of time. An automated analysis tool, SIENAX, was used to obtain total brain volume (TBV), gray matter volume (GMV) and white matter volume (WMV). Mann-Whitney U test was used to analyze the data.

RESULTS

Twenty CIS patients and 30 healthy controls were included (8 vs. 17 females, p=0.11). Mean age for CIS was 35 ± 6 years vs. 34.4±5 in controls (p=0.61). Mean EDSS in CIS was 1.1 ± 0.5. Eighteen patients with CIS (90%) had abnormal baseline MRI. The TBV in CIS was 1.6.l ± 0.22.l × 106 vs.1.65 ± 0.15 × 106 in controls (p=0.005), the GMV in CIS was 0.58 ± 0.05 × 106 vs. 0.67 ± 0.03 × 106 in controls (p ≤ 0.001) and the WMV in CIS was 1 ± 0.1 × 106 vs. 1.12 ± 0.02 × 106 in controls (p=0.03).

CONCLUSIONS

This is the first study dealing with brain atrophy in a CIS sample from Latin America in which brain atrophy, mainly grey matter atrophy, was shown in early stages of the disease compared with healthy individuals.