bluuebunny/crossref_metadata_2025 huggingface dataset:
P-019 Preoperative embolization of intracranial tumors using Onyx
Authors: Dashti S , Yao T
Published: July 2011

Introduction

Tumor surgery in the central nervous system is often filled with complexities. Some tumors are particularly hypervascular and may pose an added level of difficulty to surgical resection; in these cases preoperative embolization may assist the surgeon in accomplishing better resection with lower surgical blood loss. With the refinement of endovascular techniques, embolization of tumors has become more efficacious and safe. Liquid embolic agents are particularly appealing, as they allow greater control and penetration into the tumor mass. In this series, the authors report their experience with patients undergoing preoperative intracranial tumor embolization with Onyx liquid embolic agent.

Methods

We retrospectively reviewed the records of all patients undergoing preoperative intracranial tumor embolization at our institution between 2009 and 2011. Transarterial Onyx embolization was used in all cases.

Results

11 patients underwent preoperative embolization in the last year: eight meningiomas and three glomus tumors. All meningiomas were embolized through the middle meningeal artery. Extensive penetration was achieved in all glomus tumors, but in none of the meningiomas. Meningioma onyx penetration was moderate in 2, mild in 3, and proximal in 2. There was one major procedure-related morbidity: optic nerve ischemia secondary to non-target embolization of the ophthalmic artery through anastomotic channels with the meningeal artery. This resulted in near-complete vision loss in the affected eye. There was no procedure-related mortality. Median estimated blood loss from subsequent surgery was 300 ml.

Conclusion

Preoperative embolization of central nervous system tumors with Onyx liquid embolic agent can be performed relatively safely and effectively in selected patients. The main advantage of Onyx over other embolizates is the superior control and extensive penetration that can be achieved in hyper-vascular tumors such as glomus tumors. This converts a very bloody lesion to an avascular Onyx cast that allows surgical resection with significantly reduced blood loss. Non-target vessel embolization remains the main complication. There may be a decreased risk of hemorrhagic complications when compared to particle embolization.
P-020 SILK flow diverter-beginner's perspective
Authors: Shankar J , Vandorpe R , Pickett G , Fleetwood I , Schmidt M , Maloney W
Published: July 2011

Purpose

Flow diverters are the latest technology in the treatment of difficult/so far untreatable aneurysms. As with all new technologies, there is lots of “hype” factor for flow diverters as well. For a beginner in the field of interventional neuroradiology, it is usually not advisable to venture into the difficult cases in the beginning of the carrier. However for a new technology, every body is a beginner. The purpose of this presentation is to discuss important points that a beginner in the field should know about how to proceed for the SILK flow diverter technology.

Materials and Method

We treated a total of seven patients with aneurysms which were branded as non-treatables or extremely difficult to treat with the conventional treatment techniques. Before actually starting the treatment, the most important point is to educate and make a consensus among the vascular neurosurgeons and interventional neuroradiology. Organizing an in-service with the company is helpful in this. Getting approval from healthcare regulatory agency (Health Canada) and proctorship are the next steps. The most important part for a new technology is proper case selection. Management of the patient per se starts with talking with the patient about the technology, the rationale for its use and lack of its long term outcome. This is followed by the periprocedural management most important being the anti-platelet medications and steroids. Eventually the follow-up is the most important step to maintain the credibility of both the new treatment and the new operator.

Result

The aneurysms in our patient group were located at cavernous/ophthalimic segment of internal carotid artery (n=5), basilar trunk (n=1) and A2 segment of anterior cerebral artery (n=1). Five of these patients were done under the guidance of the proctor and last two patients were done independently. We had 100% technical success. No technical complications. One patient had mild hemiparesis which improved over a period of next 5 days. Another patient had spontaneous occlusion of her parent artery 2 months after the treatment as she stopped taking antiplatelet drugs. Other patient had no complications. All patients were followed up using CEMRA to begin with and the confirmation of complete occlusion was validated using DSA. We had an average follow-up of 3 months (0 to 7 months). One patient had confirmed exclusion of his aneurysm on MRI 3 months after the initial treatment and other patient had occlusion of her parent artery 2 months after the initial treatment.

Conclusion

Education, proper training, proper case selection, patience and team support are the most important factors to consider when venturing into a relatively new territory in the first year of your carrier.
P-021 Safety and efficacy of balloon-assisted coil embolization of intracranial aneurysms: a single institution experience
Authors: Santillan A , Mazura J , Riina H , Gobin Y , Patsalides A
Published: July 2011

Purpose

The safety of the balloon remodeling technique remains a matter of debate. In this report we analyze the safety of the balloon remodeling technique compared with coil embolization alone for the treatment of ruptured and unruptured intracranial aneurysms.

Material and Methods

We retrospectively reviewed the medical records, procedures notes, and angiograms of 491 patients treated with coil embolization alone and the balloon remodeling technique from March 2002 to March 2010 at the Division of Interventional Neuroradiology at NYPH/Weill Cornell Medical Center. The aneurysms were classified in two groups according to the size of the aneurysm dome: 7 mm or less and larger than 7 mm. A wide-necked aneurysm was defined as a neck diameter >4 mm or a dome-to-neck ratio <1.5 mm. The adverse events were classified in three groups: thromboembolic events, intraprocedural ruptures, and device-related problems. Clinical outcomes of these adverse events were classified as none, transient or permanent neurologic deficit and death.

Results

A total of 491 aneurysms (371 women, 120 men; mean age, 55.36±12.35 [SD]; range, 11–92 years) were embolized. 236 aneurysms were treated using the balloon remodeling technique, however; in 8 cases (3.4%) the balloon placement failed. Of the 491 treated aneurysms, 274 aneurysms (55.8%) presented with a previously ruptured aneurysm. 303 aneurysms (61.8%) measured 7 mm or less and 187 (38.2%) were larger than 7 mm. Dome-to-neck ratio was 1.5 or less in 169 (34.4%) and >1.5 in 322 patients (65.6%). Thromboembolic events, intraprocedural rupture, and device-related problems were encountered in 12 (2.4%), 19 (3.9%) and 16 (3.3%) patients respectively, for both treatment modalities. The rate of adverse events related to the balloon remodeling technique was seen in 26 cases (5.3%) compared to coil embolization alone that was 21 cases (4.3%). Patients treated with coil embolization alone were more likely to have a previously ruptured aneurysm compared to the balloon remodeling group (67.8% vs 42.8%). There was no statistical difference between both groups after treatment of aneurysms with a dome to neck ratio <1.5 (p=0.88, χ2test). The risk of thromboembolic events was the same in both groups (OR=0.92; 95% CI 0.29 to 2.91; p=0.89). A trend toward a lower risk of intraprocedural rupture was observed in the coil embolization group, but the results were not significant (OR=0.53; 95% CI 0.20 to 1.36; p=0.19). There was no statistical difference detected for the risk of device-related problems in both groups (OR=0.92; 95% CI 0.34 to 2.50; p=0.88).

Conclusions

The balloon remodeling technique does not increase the risks of periprocedural complications associated with endovascular embolization of intracranial aneurysms.
O-006 Pharmaco-mechanical clot disruption using a balloon infusion wire in an acute rabbit common carotid artery thromboembolic occlusion model
Authors: Gounis M , Nogueira R , Mehra M , Finol E , Yang Y , Jahrmarkt S , Migliuolo M , Wakhloo A
Published: July 2011

Purpose

Recanalization using intra-arterial fibrinolytic therapy in combination with mechanical clot disruption may be a more effective strategy for early reestablishment of cerebral blood flow in acute ischemic stroke. To validate our hypothesis, we evaluated a prototype balloon infusion wire (NeuroInterventions, Pittsburgh Pa) for delivering rtPA directly within the clot and compared its performance with the HyperGlide compliant balloon (eV3 Neurovascular, Irvine, CA) and microcatheter directed rtPA infusion in a rabbit common carotid artery (CCA) thromboembolic occlusion model.

Materials and Methods

New Zealand white rabbits (n=7) were selected for this work due to their similar response to rtPA as in humans. They were anesthetized and >50% luminal stenosis of the CCA was created bilaterally with 3-0 silk suture. Allogenic clot was injected through a 6F guide catheter and lodged consistently in the CCA proximal to the stenosis (arrows, A). The stenosis was released one hour post clot injection allowing sufficient time for clot-vessel lumen interaction. DSA was performed bilaterally to confirm the occlusion and assess the Thrombolysis in Cerebral Infarction (TICI) score. Each vessel was assigned to receive the device, balloon angioplasty, or microcatheter directed rtPA. The negative control group received no therapy. The primary endpoint was flow restoration. The secondary endpoint was time to recanalization and vascular safety, which was assessed by histological response on luminal scanning electron microscopy (SEM) and H&E staining. An assessment of the vascular safety from controlled operation of the infusion device and balloon occlusion in unembolized rabbit CCA was also made.

Results

We successfully created consistent thromboembolic occlusions with TICI 0 flow at the predetermined location within the CCA. The balloon infusion wire achieved an earlier recanalization with a TICI 2B score (B, 2D perfusion post MTT) in 14 min requiring 2.8 mg rtPA. In comparison, microcatheter directed rtPA achieved TICI 2B score in 29 min requiring 4 mg rtPA. Balloon angioplasty, when used alone, achieved an inferior TICI 2A final recanalization score in 20 min post treatment and often failed to recanalize the CCA. Histomorphometry and luminal SEM evaluation revealed that the operation of the infusion device is comparable to balloon angioplasty with endothelial cell denudation and an exposure of the internal elastic lamina, an acceptable level of disruption for mechanical revascularization devices.

Conclusion

Combined pharmaco-mechanical disruption achieves a high recanalization grade with a lower thombolytic dose more rapidly in comparison to either therapy (balloon angioplasty and thrombolysis) used alone.

Abstract O-006 Figure 1
P-026 Avoiding perils during endovascular embolization of skull base tumors: a pictorial review
Authors: Cho A , Pakbaz R , Green D
Published: July 2011

Introduction

Endovascular embolization in the external carotid artery territory has become a widely accepted treatment for preoperative embolization of head and neck tumors. Tumors about the skull base present a difficult task to the endovascular surgeon because of extent of disease at presentation, and proximity to foramina with transiting cranial nerves and important blood vessels. External carotid to intracranial artery communications present potential for disastrous complications during embolization procedures. Understanding embryology and regular review of high quality images clearly demonstrating these communications are key to real time recognition during embolization and thus avoiding potential complications.

Methods

Retrospective institutional review of endovascular embolization for tumors and vascular malformations about the skull base. Illustrative cases demonstrating dangerous extracranial-intracranial anastamoses and cranial nerve blood supply were identified are presented for review.

Findings

Pre-embolization identification and or exclusion of dangerous extracranial to intracranial anastamoses and blood supply to cranial nerves was possible in all cases. Angiographic identification of these vessels facilitated appropriate vessel selection and catheter positioning for safe embolization.

Conclusion

Real time ability to identify external carotid territory artery to intracranial artery anastamoses and blood supply to cranial nerves about the skull base allows for effective embolization and avoidance of associated complications from inadvertent vessel embolization.
E-004 Safety and efficacy of transluminal balloon angioplasty using a compliant balloon for severe cerebral vasospasm after an aneurysmal subarachnoid hemorrhage
Authors: Lee T , Sung S , Choi C
Published: July 2011

Purpose

Vasospasm of cerebral vessels remains a major source of morbidity and mortality after an aneurysmal subarachnoid hemorrhage. The purpose of this study was to evaluate the safety and efficacy of transluminal balloon angioplasty (TBA) for subarachnoid hemorrhage-induced vasospasm.

Materials and Methods

11 patients with an angiographically confirmed significant vasospasm (>50% vessel narrowing and clinical deterioration) were studied. A total of 54 vessel segments with significant vasospasm were treated by TBA. Digital subtraction angiography was used to confirm the presence of vasospasm, and TBA was performed to dilate vasospastic arteries. Medical and angiographic reports were reviewed to determine technical efficacy and for procedural complications.

Results

Balloon angioplasty using Hyper-Glide or Hyper-Form balloons (MicroTherapeutics, Irvine, California, USA) was successfully accomplished in 88.9% vasospastic segments (48 of 54), namely, in the distal internal carotid artery (100%, n=7), the middle cerebral artery (100%), including the M1 (n=10), M2 (n=10), and M3 segments (n=4), in the vertebral artery (100%, n=2), basilar artery (100%, n=1), and in the anterior cerebral artery, including the A1 (66%), A2 (66%), and A3 segments (100%). Vessel diameters significantly increased after TBA. No vessel rupture or thromboembolic complications occurred. GCS at 1st day after TBA is improved in all patients except one.

Conclusion

This study suggests that TBA using Hyper-Glide or Hyper-Form balloons is a safe and effective treatment for subarachnoid hemorrhage-induced cerebral vasospasm.
E-008 Novel approach to endovascular repair of complex iatrogenic V3 vertebral AVF using amplatzer II plug and PGLA- coated coils: a case report
Authors: Whapham J , Asiri A , Ahmed H
Published: July 2011

The concomitant vertebral artery injury as a complication during posterior C1&2 screw fixation has been described before and found to occur in approximately 3% of cases and may remain asymptomatic (30%) or cause sequelae that include an arterial steal phenomenon with cerebral hypoperfusion, increased flow in cerebral veins resulting in intracranial venous congestion or hemorrhage, headaches, a bruit, tinnitus or vertigo. The nature of the fistula and its associated symptoms, the onset and nature of the injury and the concurrent clinical status of the patient, and the necessity of treatment, these factors influence choosing the treatment modality and approach which range between conservative management, endovascular techniques to occlude the fistula, and/or on rare occasions direct surgical clipping could be used also, see Abstract E-008 table 2 in (Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils. 1999), E-008 tables 1 and 2 in (Herreraet al., 2008). Variable endovascular techniques have been described in many publications, (Kattner, Roth, Nardone, & Giannotta, 2004), (Gonzalezet al., 2001), (Leeet al., 2007), (Beaujeuxet al), (Feyyaz Baltacıoğlu, 2009), (Chuhan Jiang, Xianli Lv, Youxiang Li, Jingbo Zhang, Zhongxue Wu, 2009), (Macdonald, Millar, & Barker, 2010), (Andreou, Ioannidis, & Nasis, 2008), (Liet al., 2007), (Guoet al., 1998). In this case, we are first to report the practical use of Amplatzer Vascular Plug (II), which has been only known to be used in treating peripheral vascular AVF, and it has never been reported to be used in treating AVFs until the time of submitting this case-report. Amplatzer Vascular Plug Family, are designed to provide optimal embolization of peripheral veins and arteries through single device occlusion, full cross-sectional vessel coverage, controlled and precise deployment. Using the Amplatzer Vascular plug is a very efficient and cost-effective alternative to coils or surgery. It can also be repositioned or recaptured, if necessary. The Amplatzer Vascular Plug (II), is a unique multi-segmented, multilayered device, that reduces the time to occlusion for transcatheter embolization procedures. Its adjustable lobes are designed to better conform to vessel landing zone. (AGA medical corporation, 2010), (Cil B, Peynircioğlu B, Canyiğlit M, Geyik S, Ciftçi T., 2008).

Conclusion

Using Amplatzer Vascular Plug (II) in treating vertebral AVFs has never been previously reported. In this case; the large size of the AVF and the and the altered and complicated vertebral vascular anatomy secondary to the previous cervical surgeries were strong indications to choose a larger vascular plug in attempt to cause a complete occlusion of the AVF and attempt complete cure of its clinical sequelae on our patient.
E-010 Features of dissections on high resolution MRI
Authors: Hui F , Mahmoud S , Toth G , Ken U , Hajj-Ali R , Jones S
Published: July 2011

Introduction

High resolution MR imaging has been used to evaluate vessel walls in atherosclerotic disease as well as vasculitides in order to characterize wall thickness and enhancement. High resolution MRI may also be useful in characterizing dissections and may offer additional information not available from catheter angiography.

Methods

This is a retrospective review of 75 patients who underwent high resolution contrast enhanced imaging of the neurovasculature. Four patients with a history of dissection were included in this retrospective review. Re analysis of the exams was performed by two attending neuroradiologists with comparison to other relevant imaging modalities including cerebral angiography, conventional magnetic resonance and CT.

Results

Images from the high resolution magnetic resonance examinations demonstrate wall enhancement in dissected vessels as well as the dissection flap. The dissected vessel walls demonstrate robust enhancement even in the early phases. Static or slow flowing blood may interfere with the nulling effect of the saturation pulse, so high signal of intravascular components should be interpreted with care. Intravascular thrombus was identifiable in one case that was not detectable on cerebral angiogram. Wall thickness and outer diameter can be assessed on HRMR.

Conclusion

High Resolution MRI of intracranial dissections may yield information about angioarchitecture not discernible by conventional imaging. Further investigation is warranted.
E-012 Direct transcrainal puncture of a hemangiopericytoma and successful embolization with Onyx
Authors: Kreitel D , Conant P , Liu K , Jensen M , Evans A
Published: July 2011

Introduction

Hemangiopericytomas (HPC) comprise 1% of intracranial neoplasms and are traditionally treated with preoperative embolization and resection. This is a case of direct transcranial puncture and Onyx embolization of a right extra-axial tentorial HPC.

Materials and Methods

A 61-year-old woman presented to the University of Virginia Medical Center following an aborted resection at an outside hospital of what was believed a meningioma. During the operation significant bleeding occurred. Frozen section identified it as a HPC. Angiography was performed for preoperative embolization of the lesion. The tumor was highly vascular and had arterial feeders from the right ECA and parasitized vessels from the right MCA, PCA, and SCA. The only appropriate branch for embolization was a small tortuous branch of the middle meningeal artery. Attempts to select this vessel using 0.014 and 0.010 microguidewires were unsuccessful. The vessel proved to be too small to catheterize. The team opted to attempt to treat the tumor by a direct stick embolization through the gap in the craniotomy defect. The scalp was surgically prepped and a diagnostic angiographic catheter was placed into the right ECA trunk to perform control angiograms and to monitor embolization. This was used to puncture the center of the supratentorial component. Embolization was performed with Onyx 34 (eV3, Irvine, California, USA) with continuous fluoroscopic monitoring using a negative roadmap technique. The needle was repositioned five times and a total of five cc's of Onyx was injected into the supratentorial component. The infratentorial component was not treated because it was small and less accessible. Surgical resection was performed the following day. The supratentorial section was completely necrotic and avascular. The infratentorial tumor was very vascular but resected with acceptable blood loss.

Discussion

Transarterial embolization of vascular tumors of the head and neck is a standard procedure; direct stick embolization is rare. Direct puncture embolization with NBCA of vascular tumors has been reported. Onyx has been used for direct stick embolization of carotid body tumors. In this case, the crainotomy defect allowed for direct access to a tumor which could not have been embolized with transarterial techniques. In principle, otherwise inaccessible intracranial tumors would be embolized via small burr holes.

Conclusion

Successful Onyx embolization of intracranial vascular tumors can be achieved via unique accesses.

Abstract E-012 Figure 1
E-017 Treatment of a complicated ICA vein graft aneurysm using covered stent assisted coiling
Authors: Sandhu D , Nanda A
Published: July 2011

Purpose

To demonstrate the safety and efficacy of stent assisted, coil embolization for a large fusiform aneurysm that developed in a previously placed saphenous venous graft in the distal CCA and proximal ICA.

Clinical Presentation

A 44-year-old male presented with sudden onset of left hemiplegia, dysarthria and left hemianopia. An MRI brain revealed a large acute ischemic stroke the right temporo-parietal cortex and basal ganglia. A subsequent diagnostic angiogram revealed a large fusiform vein graft aneurysm measuring 3 cm by 2.5 cm engulfing the distal CCA and the origin of the ICA. A decision was made to perform covered stent assisted coiling of the aneurysm after vascular surgery deemed the procedure to carry too high a risk for intraoperative stroke. Treatment was delayed by 4 weeks due to the increased risk of hemorrhagic conversion of the large ischemic stroke.

Technique

Procedure was performed under conscious sedation. Two Precise stents were deployed across the aneurysm neck after jailing a Prowler 14 microcatheter inside the aneurysm sac to prevent coil herniation into the parent vessel. After filling the sac with coils, a covered Viabahn stent was successfully deployed across the aneurysm neck thereby achieving complete occlusion of the aneurysm while maintaining patency of the vessel lumen.

Conclusion

Covered stent assisted coiling for treatment of carotid artery vein graft aneurysms is a safe and effective treatment for a difficult vascular lesion. The patient was discharged home with complete resolution of the presenting symptoms and a NIH stroke scale of 0. This is the first reported case of successful endovascular treatment of an aneurysm developing in a vein graft in the carotid artery.

Abstract E-017 Figure 1
E-021 Endovascular management strategies for anterior cerebral artery aneurysms: a single low volume center experience
Authors: Gordhan A
Published: July 2011

Purpose

To evaluate management strategies, efficacy and clinical outcomes of anterior cerebral artery aneurysm endovascular treatment at a low volume community hospital.

Material and Methods

Prospective data entry and retrospective review of endovascular anterior cerebral artery aneurysms (ACA) treatment was performed from September 2004 to November 2009. Endovascular treatment of 17 anterior ACA (7 ruptured and 10 unruptured) was performed for 17 consecutive patients (6 males, 11 female; mean age 65.2 years). Procedural adverse events, morbidity, mortality, hospital length of stay and angiographic outcomes were analyzed.

Results

Three aneurysms were treated with Neuroform stent placement and two aneurysms were treated with balloon support. Complete occlusion was achieved in 64.7% (11/17) aneurysms. A residual neck was present in 35.2% (6/17). None showed aneurysm filling. Permanent procedure related morbidity and mortality was 0% and 5.2% (1/17), respectively. The single death occurred in a Fisher and Hunt and Hess Grade 4 patient with a procedural aneurysm perforation. Procedural adverse events occurred in 4 (21%) patients. This included 2 (10.5%) aneurysm perforations, 1 (5.8%) thromboembolic event and 1 (5.85%) stretched coil. At a mean 6 months angiographic follow-up, persistent complete occlusion was identified in 58.3% (7/12) of aneurysms. 16.6% (2/12) demonstrated a residual neck and 25% (3/12) aneurysm refilling. Two aneurysms were retreated with subsequent complete occlusion. Mean hospital length of stay was 2 days.

Conclusion

Endovascular coil embolization of anterior cerebral artery aneurysms at a low community hospital is feasible with acceptable clinical outcomes.
The isomerase Rrd1 mediates rapid loss of the Sgs1 helicase in response to rapamycin
Authors: Marrakchi Rim , Chouchani Chedly , Cherif Mohamed , Boudabbous Abdellatif , Ramotar Dindial
Published: July 2011

In Saccharomyces cerevisiae , rapamycin exposure inhibits the target of rapamycin (TOR) signaling pathway, causing a profound alteration in the transcription pattern of many genes, including those involved in ribosome biogenesis and nutritional changes. Deletion of the RRD1 gene encoding a peptidyl prolyl isomerase resulted in mutants that are resistant to rapamycin. These rrd1Δ mutants are unable to efficiently downregulate genes such as ribosomal protein genes, or to upregulate genes involved in diauxic shift. It is believed that the isomerase function of Rrd1 plays a role in changing the transcriptional profile upon rapamycin exposure. Herein, we set out to search for genes that when deleted in the rrd1Δ mutant would suppress the rapamycin-resistant phenotype. The analysis revealed that deletion of the SGS1 gene in the rrd1Δ mutant partially suppresses the rapamycin-resistant phenotype of the single rrd1Δ mutant. SGS1 encodes a helicase that functions in many biological processes, including transcriptional regulation. We further show, and for the first time, that Sgs1 is rapidly lost in the parent cells in response to rapamycin, but not by other agents. Interestingly, Sgs1 reduction was completely blocked in the rrd1Δ mutant, suggesting that Rrd1 is required to mediate this process. Genes such as PUT4 and HSP42, known to be upregulated in the parent in response to rapamycin, were not induced in the rrd1Δ mutant if the SGS1 gene was deleted. Since Sgs1 plays a role in transcriptional regulation, we propose that it acts as a repressor of a subset of rapamycin responsive genes. Thus, the observed Rrd1-dependent reduction in Sgs1 level may promote expression of specific classes of genes in response to rapamycin.
Multiple Dural Tuberculomas Presenting as Leptomeningeal Carcinomatosis
Authors: Kocaeli Hasan , Taşkapılıoğlu Özgür , Başaran Elif , Karaoğlu Ahmet , Bekar Ahmet
Published: July 2011

Objective and Importance. We present the rare occurrence of multiple dural-based tuberculomas mimicking leptomeningeal carcinomatosis in a young immunocompetent patient.Clinical Presentation. A 36-year-old man presented with a 2-month history of generalized epileptic activity and altered perception. Neurological examination was remarkable for bilateral Babinski's sign. Cranial magnetic resonance imaging (MRI) revealed multiple dural-based enhancing lesions with cerebral edema.Intervention. A right frontal craniotomy was performed for diagnosis. Histological examination revealed multiple confluent necrotizing and nonnecrotizing granulomas with giant cells which was consistent with tuberculosis (TB), and the patient was placed on anti-TB therapy for 24 months.Conclusion. To the best of our knowledge isolated diffuse involvement of the dura mater by TB, mimicking leptomeningeal carcinomatosis, as the sole manifestation of disease has not been reported before. Since pachymeningeal TB is rarely suspected when atypical radiological appearance is combined with the absence of systemic disease, biopsy is inevitably required for diagnosis.
Nerve Growth Factor Links Oral Cancer Progression, Pain, and Cachexia
Authors: Ye Yi , Dang Dongmin , Zhang Jianan , Viet Chi T. , Lam David K. , Dolan John C. , Gibbs Jennifer L. , Schmidt Brian L.
Published: July 2011

Cancers often cause excruciating pain and rapid weight loss, severely reducing quality of life in cancer patients. Cancer-induced pain and cachexia are often studied and treated independently, although both symptoms are strongly linked with chronic inflammation and sustained production of proinflammatory cytokines. Because nerve growth factor (NGF) plays a cardinal role in inflammation and pain, and because it interacts with multiple proinflammatory cytokines, we hypothesized that NGF acts as a key endogenous molecule involved in the orchestration of cancer-related inflammation. NGF might be a molecule common to the mechanisms responsible for clinically distinctive cancer symptoms such as pain and cachexia as well as cancer progression. Here we reported that NGF was highly elevated in human oral squamous cell carcinoma tumors and cell cultures. Using two validated mouse cancer models, we further showed that NGF blockade decreased tumor proliferation, nociception, and weight loss by orchestrating proinflammatory cytokines and leptin production. NGF blockade also decreased expression levels of nociceptive receptors TRPV1, TRPA1, and PAR-2. Together, these results identified NGF as a common link among proliferation, pain, and cachexia in oral cancer. Anti-NGF could be an important mechanism-based therapy for oral cancer and its related symptoms. Mol Cancer Ther; 10(9); 1667–76. ©2011 AACR.
The EU Policy on Return of Illegally Staying Third-Country Nationals
Authors: Canetta Emanuela
Published: July 2011

The purpose of this article is to analyse the EU policy on return of illegally staying third-country nationals, focusing in particular on the draft EU legislation: the Proposal for a Directive on common standards and procedures in Member States for returning illegally staying third-country nationals (COM/2005/391). This paper studies the context, the objectives and the most relevant measures of the proposed Directive in order to identify its critical juridical aspects as regards the fundamental rights of third-country nationals. It analyses the on-going negotiations for its adoption, considering in particular the exercise of co-decision procedure, which is new in this policy domain, and the link with the EU Return Fund, to see how the EU inter-institutional dynamics influence the establishment of provisions regulating the rights and status of immigrants subject to a return procedure. The current findings show that the adoption of the proposed Directive is not an easy exercise: the issue is very sensitive and the on-going negotiations are long and difficult. Other institutions and various NGOs support the harmonisation process but criticise a number of provisions of the draft measure. EU institutions urgently need to find a strategy that could lead to the necessary agreement for the adoption of a 'clear, fair and transparent common procedure respecting fundamental rights'.
“She Had Made a Beginning Too”:Beka Lamband the Caribbean Feminist Bildungsroman
Authors: Smyth Heather
Published: July 2011

This article explores how the Belizean writer Zee Edgell's novel Beka Lamb uses the bildungsroman to point to contradictions in both colonial discourse and narratives of nationalist decolonization. The bildungsroman is a genre that provokes unsettling and valuable insights when found in Caribbean women's literature. It brings with it assumptions about individual subjectivity, progress, and socialization that underlie modes of justification for colonialist and misogynist practice and yet can be used to expose the shortcomings of models of development and to foreground the priorities of Caribbean women's literature. In Beka Lamb Edgell uses the bildungsroman to engage a debate between discourses of identity, Creolization, and relationality in the Caribbean by juxtaposing a young girl's maturation and her diverse nation's decolonization. In the process of adapting this genre for new ideological and cultural purposes, Edgell reveals the creativity and flexibility of the genre.
Stimulated association of STIM1 and Orai1 is regulated by the balance of PtdIns(4,5)P2 between distinct membrane pools
Authors: Calloway Nathaniel , Owens Tristan , Corwith Kathryn , Rodgers William , Holowka David , Baird Barbara
Published: July 2011

We have previously shown that PIP5KIβ and PIP5KIγ generate functionally distinct pools of phosphatidylinositol 4,5-bisphosphate [PtdIns(4,5)P2] important for antigen-stimulated Ca2+ entry in mast cells. In the present study, we find that association of the endoplasmic reticulum (ER) Ca2+ sensor, STIM1, and the store-operated Ca2+ channel, Orai1, stimulated by thapsigargin-mediated ER store depletion, is enhanced by overexpression of PIP5KIβ and inhibited by overexpression of PIP5KIγ. These different PIP5KI isoforms cause differential enhancement of PtdIns(4,5)P2 in detergent-resistant membrane (DRM) fractions, which comprise ordered lipid regions, and detergent-solubilized membrane (DSM) fractions, which comprise disordered lipid regions. Consistent with these results, the inositol 5-phosphatase L10-Inp54p, which is targeted to ordered lipids, decreases PtdIns(4,5)P2 in the DRM fraction and inhibits thapsigargin-stimulated STIM1–Orai1 association and store-operated Ca2+ entry, whereas the inositol 5-phosphatase S15-Inp54p, which is targeted to disordered lipids, decreases PtdIns(4,5)P2 in the DSM fraction and enhances STIM1–Orai1 association. Removal of either the STIM1 C-terminal polylysine sequence (amino acids 677–685) or an N-terminal polyarginine sequence in Orai1 (amino acids 28–33) eliminates this differential sensitivity of STIM1–Orai1 association to PtdIns(4,5)P2 in the distinctive membrane domains. Our results are consistent with a model of PtdIns(4,5)P2 balance, in which store-depletion-stimulated STIM1–Orai1 association is positively regulated by the ordered lipid pool of PtdIns(4,5)P2 and negatively regulated by PtdIns(4,5)P2 in disordered lipid domains.
Locomotor loading mechanics in the hindlimbs of tegu lizards (Tupinambis merianae): comparative and evolutionary implications
Authors: Sheffield K. Megan , Butcher Michael T. , Shugart S. Katherine , Gander Jennifer C. , Blob Richard W.
Published: July 2011

Skeletal elements are usually able to withstand several times their usual load before they yield, and this ratio is known as the bone's safety factor. Limited studies on amphibians and non-avian reptiles have shown that they have much higher limb bone safety factors than birds and mammals. It has been hypothesized that this difference is related to the difference in posture between upright birds and mammals and sprawling ectotherms; however, limb bone loading data from a wider range of sprawling species are needed in order to determine whether the higher safety factors seen in amphibians and non-avian reptiles are ancestral or derived conditions. Tegus (family Teiidae) are an ideal lineage with which to expand sampling of limb bone loading mechanics for sprawling taxa, particularly for lizards, because they are from a different clade than previously sampled iguanas and exhibit different foraging and locomotor habits (actively foraging carnivore versus burst-activity herbivore). We evaluated the mechanics of locomotor loading for the femur of the Argentine black and white tegu (Tupinambus merianae) using three-dimensional measurements of the ground reaction force and hindlimb kinematics, in vivo bone strains and femoral mechanical properties. Peak bending stresses experienced by the femur were low (tensile: 10.4±1.1 MPa; compressive: –17.4±0.9 MPa) and comparable to those in other reptiles, with moderate shear stresses and strains also present. Analyses of peak femoral stresses and strains led to estimated safety factor ranges of 8.8–18.6 in bending and 7.8–17.5 in torsion, both substantially higher than typical for birds and mammals but similar to other sprawling tetrapods. These results broaden the range of reptilian and amphibian taxa in which high femoral safety factors have been evaluated and further indicate a trend for the independent evolution of lower limb bone safety factors in endothermic taxa.
Circulating IGF1 regulates hippocampal IGF1 levels and brain gene expression during adolescence
Authors: Yan Han , Mitschelen Matthew , Bixler Georgina V , Brucklacher Robert M , Farley Julie A , Han Song , Freeman Willard M , Sonntag William E
Published: July 2011

GH and its anabolic mediator, IGF1, are important not only in somatic growth but also in the regulation of brain function. Even though GH treatment has been used clinically to improve body composition and exercise capacity in adults, its influence on central nervous system function has only recently been recognized. This is also the case for children with childhood-onset GH deficiency (GHD) where GH has been used to stimulate bone growth and enhance final adult height. Circulating IGF1 is transported across the blood–brain barrier and IGF1 and its receptors are also synthesized in the brain by neurons and glial and endothelial cells. Nevertheless, the relationship between circulating IGF1 and brain IGF1 remains unclear. This study, using a GH-deficient dwarf rat model and peripheral GH replacement, investigated the effects of circulating IGF1 during adolescence on IGF1 levels in the brain. Our results demonstrated that hippocampal IGF1 protein concentrations during adolescence are highly regulated by circulating IGF1, which were reduced by GHD and restored by systematic GH replacement. Importantly, IGF1 levels in the cerebrospinal fluid were decreased by GHD but not restored by GH replacement. Furthermore, analysis of gene expression using microarrays and RT-PCR indicated that circulating IGF1 levels did not modify the transcription ofIgf1or its receptor in the hippocampus but did regulate genes that are involved in microvascular structure and function, brain development, and synaptic plasticity, which potentially support brain structures involved in cognitive function during this important developmental period.
Biofilm formation on materials commonly used in household drinking water systems
Authors: Morvay A. A. , Decun M. , Scurtu M. , Sala C. , Morar A. , Sarandan M.
Published: July 2011

Biofilms are surface-associated bacterial communities that predominate in natural and pathogenic ecosystems. Their formation in drinking water systems creates potential risks for consumers’ health. Herein we tested biofilm formation on materials commonly used for indoor household drinking water systems (copper, PVC and stainless steel) simulating an average family water usage. Water parameters were determined by standardized methods while biofilm formation was assessed by epifluorescent and laser scanning confocal microscopy, for determining the numbers of attached cells, biofilm thickness, colony size and average colony surface. Results showed a very fast colonization on all materials used, of log 6–7 cm−2 cells disposed on a single layer on copper and PVC. On stainless steel, beginning on the 24th experimental day, there were observed multiple layers of cells and a rapid increase of biofilm thickness. The lowest overall number of attached cells was found on copper. Microorganism colonization and biofilm formation is possible and quite fast on an indoor water system connected to a chlorinated water network. From the tested materials, the greatest risk to consumer health comes from biofilm formation on stainless steel parts which are used in the very large majority of residences.
L’emploi dans les spectacles et les paradoxes de sa croissance. Flexibilité des relations contractuelles et des protections assurantielles
Authors: Menger Pierre-Michel
Published: July 2011

We show how the labor market in the performing arts has expanded along a path of unbalanced growth. The performing arts sector disposes of an employment mechanism, and unemployment compensation scheme which has acted as a lever to accelerate simultaneously workforce growth, functional flexibility, and insurance protection specific to employment in the arts.
Du mélange des genres. Le cirque criollo et le théâtre dans les pays du Río de la Plata (XIXe-XXe siècle)
Authors: Mandressi Rafael
Published: July 2011

Le théâtre populaire peut naître du cirque. C’est ce que montrent nombre d’exemples sudaméricains. Les représentations dramatiques de la fin du XIXe siècle, en Argentine, en Uruguay, naissent insensiblement de la piste. Des personnages nouveaux apparaissent aux côtés des acro- bates ou des clowns. Le prestige du «personnage» sur lequel le peuple focalise son imaginaire vient d’abord d’un lieu où s’épanouissent exploits physiques et surprises acrobatiques.
La démonstration comme élément de pratique mathématique
Authors: Chemla Karine
Published: July 2011

L'exercice de démonstration fait en général l'objet de pratiques, il se travaille, se communique, par le biais de types de textes, tous deux - pratiques comme types de textes - mis au point par des collectifs. Les démonstrations ne peuvent donc être identifiées, interprétées, pour pouvoir être ensuite analysées, qu'à condition de se préoccuper de restituer cette pratique et de se pencher sur les modalités de sa mise en texte. Telle est la thèse que je défendrai, en m’appuyant sur un exemple prélevé dans le corpus mathématique de la Chine ancienne.
L’effet Pressac
Authors: Lapierre Nicole
Published: July 2011

Jean-Claude Pressac, parti à Auschwitz en 1980 pour conforter les thèses négationnistes, en est revenu avec des documents techniques jusque-là inexploités qui l’ont convaincu de l’existence des chambres à gaz. Son basculement d’émule en ennemi de Faurisson témoigne jusqu’à l’épure de la force de la preuve. Mais le cas Pressac pose en même temps, de façon troublante, la question d’une science sans conscience.
Construction de la perspective, construction du sens
Authors: Lipsyc Carole
Published: July 2011

Au travers de l’exemple du Récit Variable - genre littéraire crossmédia, interactif et coopératif - il est non seulement possible de vérifier le rôle cognitif de la perspective comme outil d’organisation de l’espace en vue du déplacement et de l’action mais également de définir les perspectives ubiquitaires, dynamiques et tournantes qui apparaissent avec les médias numériques. Ces perspectives s’intègrent dans un nouveau contrat de lecture dans lequel le lecteur accepte la responsabilité finale de la construction du sens.
La perspective, un mythe occidental ?
Authors: Cegarra Michel
Published: July 2011

En parcourant l’histoire de la perspective, il s’agit de se demander si la perspective ne serait pas un mythe occidental. En effet, quelque chose s’est noué de façon très particulière avec la reconnaissance et la théorisation de la perspective à la Renaissance. L’opération s’est soutenue d’une manière de fable ou de mythe, dont l’élaboration - prolongée sur plusieurs décennies et conduite à plusieurs mains - demeure l’une des plus belles opérations de communication de l’Occident. Mais aujourd’hui la ligne d’horizon a disparu. Le guidage satellitaire tourne comme un anneau de Moebius en absorbant le codage dans l’espace illusionniste permanent. Le réel est devenu une sorte de sur-illusion.
Multicomponent reaction access to complex quinolines via oxidation of the Povarov adducts
Authors: Vicente-García Esther , Ramón Rosario , Preciado Sara , Lavilla Rodolfo
Published: July 2011

The tetrahydroquinolines obtained through the Povarov multicomponent reaction have been oxidized to the corresponding quinoline, giving access to a single product through a two-step sequence. Several oxidizing agents were studied and manganese dioxide proved to be the reagent of choice, affording higher yields, cleaner reactions and practical protocols.
Transformative Learning Through a Research Practicum for Undergraduate Nursing Students
Authors: Kirkpatrick Helen , Tweedell Donna , Semogas Dyanne
Published: July 2011

In their final year of a Bachelor of Science in Nursing (BScN) program, students are required to take a research practicum related to clinical practice in a new or ongoing research project, supervised by nursing faculty. This course is designed to enhance students’ understanding of the research process. The student’s potential role as a research collaborator is emphasized. Involvement in an interdisciplinary narrative study with formerly homeless individuals challenged by severe alcohol dependence, in general poor health and living in a harm reduction environment, transformed students’ values, assumptions, and beliefs. Not only did students gain confidence in their beginning skills as potential research collaborators, but they also felt that their future practice would be enhanced by new perspectives gained by studying a marginalized and stigmatized group, thus enabling them to appreciate cultural diversity and improve their competence.
Soil test phosphorus changes and phosphorus runoff losses in incubated soils treated with livestock manures and synthetic fertilizer
Authors: Kumaragamage D. , Flaten D. , Akinremi O. O. , Sawka C. , Zvomuya F.
Published: July 2011

Kumaragamage, D., Flaten, D., Akinremi, O. O., Sawka, C. and Zvomuya, F. 2011. Soil test phosphorus changes and phosphorus runoff losses in incubated soils treated with livestock manures and synthetic fertilizer. Can. J. Soil Sci. 91: 375–384. Source of phosphorus (P) and soil properties influence changes in soil test P (STP) concentrations and P runoff losses in manured and fertilized soils. We compared STP changes and P runoff losses in two soils, a clay loam and a sand, that were either unamended (control), or amended with liquid swine manure (LSM), solid cattle manure (SCM), or monoammonium phosphate (MAP) and incubated for 6 wk. Soil subsamples after incubation were analyzed for STP using Olsen (OP), Modified Kelowna (KP), Mehlich 3 (M3P) and water extraction (WEP) methods. We collected runoff from incubated soils for 60 min under a rainfall simulator, and analyzed for dissolved reactive P (DRP). Magnitude of STP increase in amended soils was greater in sand (19–48%) than in clay loam (7–37%). Increases in STP and DRP runoff concentrations in amended soils generally followed the order; MAP>LSM>SCM. Olsen P, KP and M3P were more accurate than WEP for predicting runoff DRP concentrations and loads, accounting for 43–49% of the variation in P concentrations for the first 30 min of runoff. Olsen P, the currently used STP method for environmental P regulation in Manitoba is sufficiently robust to predict runoff P losses from manure and fertilizer amended soils.