Endovascular reperfusion techniques are a promising intervention for acute ischemic stroke (AIS). Prior studies have identified markers of initial injury (arrival NIH stroke scale (NIHSS) or infarct ...volume) as predictive of outcome after these procedures. We sought to define the role of collateral flow at the time of presentation in determining the extent of initial ischemic injury and its influence on final outcome.
Demographic, clinical, laboratory, and radiographic data were prospectively collected on a consecutive cohort of patients who received endovascular therapy for acute cerebral ischemia at a single tertiary referral center from September 2004 to August 2010.
Higher collateral grade as assessed by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading scheme on angiography at the time of presentation was associated with improved reperfusion rates after endovascular intervention, decreased post-procedural hemorrhage, smaller infarcts on presentation and discharge, as well as improved neurological function on arrival to the hospital, discharge, and 90 days later. Patients matched by vessel occlusion, age, and time of onset demonstrated smaller strokes on presentation and better functional and radiographic outcome if found to have superior collateral flow. In multivariate analysis, lower collateral grade independently predicted higher NIHSS on arrival.
Improved collateral flow in patients with AIS undergoing endovascular therapy was associated with improved radiographic and clinical outcomes. Independent of age, vessel occlusion and time, in patients with comparable ischemic burdens, changes in collateral grade alone led to significant differences in initial stroke severity as well as ultimate clinical outcome.
We investigated clinical characteristics and demographics of brain death in patients from a single center in Korea to identify possible changes in organ procurement by comparing early and late ...periods.
Potential donors diagnosed as brain dead and who had provided organ donation consent from May 2000 to May 2020 were considered. Donors were divided into 2 categories: early period (2000-2010) and late period (2011-2020).Demographic data, clinicalrisk factors, cause of death, use ofinotropic and vasoconstrictor agents, laboratory findings, intensive care unit stay data, loss of donors, and number of donated organs were analyzed.
Mean age of donors significantly increased in the late period (36.0 ± 12.0 vs 46.0 ± 15.1 years), but there were no significant differences in the proportion of females and the number of pediatric donors (<18 years). The number of donors who smoked decreased (61% vs 41%), but hypertension rate increased significantly in the late period (17.4% vs 31.0%). In the late period, fewer brain dead donors were lost (19.0% vs 7.59%) and use of vasoconstrictor agents was more frequent (25.3% vs 64.5%) than use of inotropic agents (73.1% vs 49.3%). In the late period, heart(19.0% vs 37.3%) and lung (0% vs 18.3%) procurement rates increased and the number of transplanted organs per donorincreased (2.58 ± 1.6 vs 3.14 ± 1.50; P = .016). Causes of death were primarily from head traumas (34.4%), cerebral aneurysms (21.7%), spontaneous intracerebral hemorrhage (21.3%), and asphyxia/hanging (16.3%). Head trauma decreased in the late period (46% vs 29.7%; P = .021) but still constituted the most common cause of death.
We found no definite demographic changes in brain dead donors. Donors with cerebrovascular disease increased annually, but trauma was still the most common cause of brain death, with suicides being highly frequent.
Probiotics can be used as a nutritional strategy to improve gut homeostasis. We aimed to evaluate the intestinal microbiota profile of 18 subjects after ingestion of probiotic yogurt powder (PYP) ...based on enterotype. The subjects were classified into three enterotypes according to their microbial community:
(
= 9, type B),
(
= 3, type P), and
(
= 6, type R). We performed controlled termination in a transient series that included a control period of three weeks before probiotic intake, PYP intake for three weeks, and a three-week washout period. Fecal microbiota composition was analyzed by sequencing the V3-V4 super variable region of 16S rRNA. Based on the Bristol stool shape scale, abnormal stool shape improved with PYP intake, and bowel movements were activated. The abundance of
,
, and
, which ferment and metabolize glucose, showed a strong correlation with type B
, and glucose metabolism improvement was observed in all type B subjects. Alkaline phosphatase was significantly improved only in type B. In addition, the abundance of type B
showed a negative correlation with that of
. The abundance of
,
, and
, which are involved in lipid metabolism, showed a strong correlation with that of type P
, and triglyceride metabolism improvement was observed in all type P subjects. The gut microbiota showed only short-term changes after PYP intake and showed resilience by returning to its original state when PYP intake was interrupted. In summary, the different responses to PYP intake may result from the different enterotypes and associated strains; therefore, the probiotic composition should be adjusted based on the individual enterotype.
The aims of this case series study were to review the 10 patients who were diagnosed with left-sided gallbladder and analyze their anatomic variations in the bile duct, portal vein, and hepatic ...vessels.
In this case series study, 10 patients with left-sided gallbladder were retrospectively analyzed at 2 tertiary referral centers between April 2004 and May 2019.
Mean age was 61.1 years; there were 7 women and 3 men. Ten patients underwent laparoscopic cholecystectomy for acute cholecystitis or symptomatic gallbladder stone. The mean operation time was 77.2 minutes. Three ports were used in laparoscopic cholecystectomy procedures. The mean postoperative hospital stay was 3.5 days, and there were no cases of surgery-related morbidity. Two patients had type 1 bile duct and 3 had type 3 bile duct (2 type 3B and 1 type 3A). The right posterior portal vein as the first branch of the main portal vein was observed in all patients. Segment IV branches of the left portal vein crossing over to the segment VIII territory were observed in 7 of the 10 patients.
Although left-sided gallbladder is a very rare disease, it is possible to diagnose it preoperatively and perform laparoscopic cholecystectomy safely by adjusting port position. The common important features of left-sided gallbladder include distribution of the left portal vein crossing over to the right side of the liver and increased size of the left portal vein. These variations may have important clinical implications in the management of hepatic resection including donor hepatectomy.
Degree of stent retriever engagement with target thrombi may be reflected by (1) immediate reperfusion (IR) on first deployment, indicating displacement of clot toward the vessel wall, and (2) by ...early loss of IR (ELOIR), indicating penetration of retriever struts through the thrombus. The relation of these early findings to final reperfusion and clinical outcomes has not been well delineated.
We investigated IR and ELOIR in patients undergoing stent retriever mechanical thrombectomy at an academic medical center between March 2012 and June 2014.
Among 56 patients, IR itself was not associated with final successful reperfusion, which occurred in 66.7% of IR patients and 71.4% of non-IR patients (P=0.999). However, ELOIR was associated with a higher rate of final successful reperfusion (92% versus 44%; P=0.046). Patients with ELOIR had a higher nominal rate of final favorable outcome (42% versus 22%; P=0.64).
ELOIR during the embedding period after deployment of stent retrievers is associated with successful final reperfusion, likely because of greater thrombus engagement with the stent retriever. ELOIR may be a useful finding to guide duration of embedding time in clinical practice and design of novel stent retrievers.
The ideal population of patients for endovascular therapy (ET) in acute ischemic stroke remains undefined. Recent ET trials have moved towards selecting patients with proximal middle cerebral artery ...(MCA) or internal carotid artery occlusions, which will likely leave a gap in our understanding of the treatment outcomes of M2 occlusions.
To examine the presentation, treatment, and outcomes of M2 compared with M1 MCA occlusions in patients undergoing ET by assessing comprehensive MRI, angiography, and clinical data.
We found that M2 occlusions can lead to massive strokes defined by hypoperfused and infarcted volumes as well as death or moderate to severe disability in nearly 50% of patients at discharge. Compared with M1 occlusions, M2 occlusions achieved similar Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization rates, with significantly less hemorrhage. M2 occlusions presented with smaller infarct and hypoperfused volumes and had smaller final infarct volumes regardless of recanalization. TICI 2b/3 recanalization of M2 occlusions was associated with smaller infarct volumes compared with TICI 0-2a recanalization, as well as less infarct expansion, in patients who received IV tissue plasminogen activator as well as those that did not. Successful reperfusion of M2 occlusions was associated with improved discharge modified Rankin scale.
If suitable as targets of ET, M2 occlusions should be given the same consideration as M1 occlusions.
We propose a novel dark matter (DM) detection strategy for models with a nonminimal dark sector. The main ingredients in the underlying DM scenario are a boosted DM particle and a heavier dark sector ...state. The relativistic DM impinged on target material scatters off inelastically to the heavier state, which subsequently decays into DM along with lighter states including visible (standard model) particles. The expected signal event, therefore, accompanies a visible signature by the secondary cascade process associated with a recoiling of the target particle, differing from the typical neutrino signal not involving the secondary signature. We then discuss various kinematic features followed by DM detection prospects at large-volume neutrino detectors with a model framework where a dark gauge boson is the mediator between the standard model particles and DM.
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