bluuebunny/crossref_metadata_2025 huggingface dataset:
Seizures in Cerebral Arteriovenous Malformations: Type, Clinical Course, and Medical Management
Authors: Osipov A. , Koennecke H.-C. , Hartmann A. , Young W.L. , Pile-Spellman J. , Hacein-Bey L. , Mohr J.P. , Mast H.
Published: January 2017

We investigated the type and early clinical course of seizure disorders in cerebral arteriovenous malformations (AVMs). Decisions on invasive treatment for AVMs depend on detailed knowledge of the natural course and prognosis of neurologic sequelae.

Among 328 patients of a prospective cerebral AVM databank 92 (28%) presented with seizures unrelated to haemorrhage. Under a median observation time of 2.2 years (mean 3.8 years) the 92 patients received 454 follow-up examinations (median time interval 4.6 months). All patients were treated with anticonvulsant medication. During the observation period sixty (65%) patients received staged endovascular glue embolisation. The effect of staged embolisation on seizure recurrence was tested univariately by comparing patients undergoing embolisation versus those without endovascular treatment.

At the time of enrolment in the database, elementary (motor or sensory) and partial complex seizures were described in twenty (22%) and one (1%) patients, respectively. Generalized seizures without focal initiation were reported in sixty (65%) and with focal initiation in 11 (12%) patients. 57 (62%) cases had suffered a seizure as a first single event, ten (11%) had weekly, 17 (19%) monthly, and eight (9%) patients had seizures once per year. In the following clinical course, complete cessation of seizure activity was seen in 69 (75%). Ten (11%) patients continued to have seizures at a rate of once per year or less. 13 (14%) cases continued to have weekly to monthly events with only four (4%) of them showing (monthly) grand mal. An early beneficial effect of staged embolisation on seizure recurrence was not observed.

Seizure disorders in cerebral AVMs show a benign early course, leaving few patients with insufficient seizure control. The differential long-term effect of invasive AVM treatment on seizure control should be subject to clinical trials.
Endovascular Approach to a Ligated External Carotid Artery
Authors: Kurata A. , Miyasaka Y. , Kunii M. , Morishima H. , Fujii K. , Kan S.
Published: January 2017

A 37-year-old female with left sided multiple congenital haemangiomata presented with repeated haemorrhage. The haemorrhagic origin was from the angiomatous lesion with arteriovenous (AV) shunting in the tongue and pharynx. The patient had already undergone ligation of the external carotid artery. Vascularization was mainly from the portion of the external carotid artery distal to the occlusion. Our first approach via the collateral channels to the haemangioma failed. Through direct puncture of the distal end of the external carotid artery with the use of two dimensional road mapping, we succeeded in catheterizing the distal end of the external carotid artery at the first attempt without placing any pressure on the neck, and carried out selective embolisation without mishap.
Large Haemangiopericytoma of the Posterior Cervical Space
Authors: Horky J.K. , Chaloupka J.C. , Putman C.M. , Roth T.C. , Sasaki C.T.
Published: January 2017

We report a case of a 39-year old woman who upon developing a rapidly enlarging posterior cervical space tumour, underwent incisional biopsy prior to diagnostic imaging that resulted in nearly catastrophic haemorrhage.

Subsequently, MR imaging showed evidence of marked hypervascularity, prompting diagnostic angiography and endovascular microembolization prior to surgical resection.

The tumour turned out to be a large haemangiopericytoma arising from the paravertebral musculature.

The case is instructive by highlighting the need for considering rare locations of hypervascular tumours in the head and neck region before attempting biopsy, which can be predicted by cross-sectional imaging studies, and the benefits of pre-operative devascularization with modern superselective microembolisation techniques.
Broad Neck Basilar Tip Aneurysm Treated by Neck Plastic Intra-Aneurysmal GDC Embolisation with Protective Balloon
Authors: Takahashi A. , Ezura M. , Yoshimoto T.
Published: January 2017

A 56-year-old male was found to have a basilar artery aneurysm by magnetic resonance imaging. Angiography demonstrated a broad neck basilar tip aneurysm.

He refused surgical clipping but accepted intravascular embolisation. Introducing catheters were inserted into each of the bilateral vertebral arteries.

A microcatheter was introduced into the aneurysm through one of the introducing catheters and a double lumen balloon catheter was introduced into the left posterior cerebral artery (PCA) through the other.

The balloon was located from the left PCA to the basilar artery across the aneurysmal neck with the aid of a guidewire passed through the inner lumen of the balloon catheter. The balloon was inflated, and a Guglielmi detachable coil (GDC) was inserted until the platinum part was placed inside the aneurysm. The balloon was deflated to confirm the stability of the GDC, and then the GDC was electrically detached. This procedure was repeated until nine GDCs were successfully inserted.

The aneurysm was tightly embolised despite its broad neck. Angiography comfirmed complete neck closure and stable preservation of the basilar artery and bilateral PCAs immediately, 1 week, 3 months, 6 months, and 12 months after embolisation without evidence of thrombo-embolic complications.

Neck plastic intra-aneurysmal GDC embolisation using a protective balloon can be used to treat broad-neck aneurysms.
Usefulness of MRA in the Treatment of Dural AVM
Authors: Kurokawa S. , Tanaka Y. , Ikeya F. , Maruki C. , Ebato M. , Ohtomo T.
Published: January 2017

We report 5 cases of dural AVMs, in which MRA images were considered very useful for evaluating the effectiveness of treatments, such as transvenous embolization therapy.

MRA by time of flight method (TOF) with contrast medium for dural AVMs involving the cavernous sinus (dural CCFs) is necessary to assess the caliber of superior ophthalmic veins (SOVs) prior to treatment as well as immediately after treatment and during follow-up.

MRA for dural AVM at the transverse-sigmoid sinus is useful for verifying thrombosed sinus in the dural AVM prior to transvenous embolization therapy and necessary to determine the approach to the nidus of the dural AVM2.
De Novo Appearance of Three Cavernomas in an Infant with Dural AV Shunts
Authors: Janz C. , Meisel J. , Brock M. , Lasjaunias P.
Published: January 2017

Cavernomas of the brain and spinal cord are malformations which are generally considered congenital and often found in young adults. Although the distinction of a sporadic and a hereditary type is discussed, the natural history is still poorly understood.

We present the unusual case of an infant first submitted to CT scan, MRI and MR-angiography at the age of three months, revealing multiple AV shunts of the superior sagittal and the sigmoid sinus, with a small pial supply. A second angiogram at the age of six months showed an additional parietal pial AVM. At this time, partial embolisation of the dural AV shunts was performed. At the age of three, the child was restudied by MRI and three formerly invisible cavernomas were detected.
Percutaneous Treatment of Herniated Lumbar Disc by Intradiscal Oxygen-Ozone Injection
Authors: Muto M. , Avella F.
Published: January 2017

We report our experience of treating lumbar herniated disc by intradiscal injection of an oxygen-ozone mixture. Ozone (03, MW = 48) is a triatomic molecule, having antiviral, disinfectant and antiseptic properties. Several mechanisms of action have been proposed to explain the efficacy of the treatment:

analgesic action; anti-inflammatory action; oxidant action on the proteoglycan in the nucleus pulposus.

We treated 93 patients (50 women, 43 men) aged from 24 to 45 yrs (average age 38 yrs) from June 1996 to April 1998.

All patients presented sciatica and/or low back pain, lasting two or more months; patients had in the mean time received both medical and physical therapy with mild or no benefit.

Diagnostic tests in all patients included plain film x-ray, CT and/or MR at the level of the lumbar spine disclasing a herniated or protruded disc with nerve root or thecal sac compression.

We divided patients to be treated in to two groups: the first one group included 35 patients already selected for surgery who presented herniated or protruded disc with radicular pain with associated neurological deficit (hypoesthesia and partial loss of reflex). Those patients had already had medical and physical therapy for two or more months and agreed to try the percutaneous treatment before surgery. CT or MR in this group demonstrated the presence of intraforaminal, extra or sub-ligamentary and sequestrated herniated disc. The second group included 58 patients with radicular pain but without neurological deficit; patients in this group had received medical and/or physical therapy for two or more months and CT showed the presence of a small subligamentary herniated or protruded disc.

We considered the results according to the modified MacNab method.

In the first group we had “failure” in all patients; in seven cases the symptoms improved for one month, but recurred later on. In the second group 45 patients had “success” showing complete clinical recovery within five to six days after treatment, all remained without symptoms up to six months or more of follow-up. The remaining 13 patients presented the same symptoms again within three months after a temporary clinical recovery. The goal of this study was to present this new technique that can also be compared with a previous study of different percutaneous treatment. Clinical and neuroradiological indications and the contraindications are well known, and must be followed to achieve good results and avoid complications.
Six Cases of Ruptured Aneurysm, Treated with Cellulose Acetate Polymer
Authors: Matsunaga M. , Kinugasa K. , Mandai S. , Ohmoto T.
Published: January 2017

We review 6 cases of ruptured aneurysm which were elderly, poor-grade SAH or requiring high-risk surgery treated with Cellulose Acetate Polymer (CAP). A 76-year-old female with A-com aneurysm was comatose. Heart failure was her complication (case 1). An 81-year-old female with A-com aneurysm was semicomatose (case 2). An 89-year-old female with MCA aneurysm was semicomatose and had right hemiplegia (case 3), An 88-year-old female with MCA aneurysm was comatose (case 4). A 55-year-old male with IC-PC aneurysm had a small intracerebral hematoma and was semicomatose (case 5). A 52-year-old female with IC-Ach aneurysm was somnolent (case 6).

All cases had no rebleeding after embolization. CAP embolization was complete in all cases but case 1. Case 4 died from primary brain damage on the day 7. Three cases stayed in a severely disabled state and died after 3 months (case 1), 2 months (case 2) and 4 months (case 3) from onset respectively. Case 5 remains in a moderately disabled state after 2 years, Case 6 had a anterior choroidal artery which was hard to spare on aneurysmal clipping. She is free from neurological deficits after CAP embolization. Angiography after 2 years demonstrated complete obstruction of the aneurysm.

CAP is good for cases which are elderly, poor-grade SAH or difficult to treat with surgery. CAP embolization has some advantages over GDC coil obstruction for aneurysm treatment.
Application of Three Dimensional Angiography for Diagnosis of Patients and Intravascular Surgery
Authors: Konishi Y. , Sato E. , Tomita Y. , Isamu S.
Published: January 2017

We examined newly developed three-dimensional angiography to understand the anatomy for surgery and for intravascular surgery in order to decide when treatment should be stopped. The subjects were 23 patients chosen randomly (angiography, 22). The diagnoses in these patients included aneurysm (5), arteriovenous malformation (6), meningioma, glioma, vascular tumours of the brain and the neck (5), and vascular diseases (6) including carotid artery stenosis, Moya-Moya disease, middle cerebral artery occlusion, and megadolico-ectasia (6).

The new technique was used for intravascular surgery in six cases, which allowed the neck of the aneurysm and the bifurcation to be revealed. This method is useful for determining whether another coil should be inserted. In patients with basilar top aneurysm using this technique during coil embolization the intra-aneurysmal blood flow disappeared because complete embolization was performed. This technique was more useful during coil embolization, especially to decide the timing of withdrawal in intravascular surgery compared with conventional DSA.
Embolization Method for Cavernous Sinus Fistula within the Cavernous Sinus
Authors: Usami S. , Abe T. , Hata Y.
Published: January 2017

The complications of dural and direct cavernous sinus fistula (CCF) arise mainly from the specific venous route. However, embolization at an inappropriate site within the cavernous sinus (CS) is also a major factor. Therefore, we first diagrammed the surrounding structures of the CS to elucidate the specificity of the venous routes. Next, we divided the inside structure of the CS into four compartments, to examine orifices at which part we can start embolization with the least danger of causing complications when we have to embolize them within the CS. We obtained findings which will be useful to prevent complications such as subarachnoid haemorrhage, glaucoma, central retinal vein thrombosis and marked neurological impairment.
Stereotactic Transcerebellar Approach to Pontine Lesions through the Middle Cerebellar Peduncle
Authors: Parker F. , Levesque M.F. , Bittoun J. , Doyon D. , Tadie M.
Published: January 2017

A stereotactic approach to the pons through the middle cerebellar peduncle based on MR studies was used to biopsy 18 patients. The stereotactic coordinates and angles were defined with reference to three orthogonal planes (mid-sagittal, IVth ventricular floor and pontomedullary junction).

The pathological diagnoses were in keeping with clinical outcome and comprised five high-grade astrocytomas, three low-grade astrocytomas, two glioblastomas multiforme, two oligodendrogliomas, two primitive neuroectodermic tumours, two lymphomas, one medulloblastoma, and one tuberculosis. This approach provides a high yield of positive histological diagnoses with little morbidity (transient neurological deficits in two cases) and thereby avoids inappropriate therapy.
Extracavernous Arteriovenous Fistulae
Authors: Sedat J. , Kominami S. , Siriwimonmas S. , Pongpech S. , Suthipongchai S. , Alvarez H.
Published: January 2017

We report five cases of arteriovenous fistulae (AVFs) of the carotid system. Two were traumatic non penetrating injuries and involved the subarachnoid, extracavernous part of the intracranial internal carotid artery; two were spontaneous and involved the internal carotid artery in its extracranial portion; one was a spontaneous AVF of the ascending pharyngeal artery.

All the symptoms due to these AVFs were not related to the location of the fistula, but to the congestive venous drainage.

The revealing symptoms regressed and/or improved after transarterial detachable balloon embolisation that led to complete occlusion of the AVFs.
How to Embolize Wide-Necked Aneurysms?
Authors: Kazekawa K. , Oka K. , Aikawa H. , Tomonaga M. , Yoshimura S. , Yoshioka T. , Hosoda H.
Published: January 2017

Novel endovascular approaches are needed for safer and more definitive treatment of wide-necked aneurysms, to overcome the limitations of the Guglielmi detachable coil (GDC) system and further, the application of this technique.

The double GDC technique (DGT), for embolization of wide-necked aneurysms, and the combination of stent placement and coil deposition (CTSC) for management of fusiform aneurysms have been developed and their usefulness is reviewed. The DGT involves scaffolding of a GDC coil to form a stabilizing frame inside the aneurysmal neck and then positioning of a second coil to reinforce the first coil. After confirming the absence of coil herniation in the parent artery, both coils are released together. A patient with a wide-necked large aneurysm of the left internal carotid artery was treated using this technique, and followed up angiographically and clinically for a period of three months. The follow-up angiograms revealed complete embolization of the aneurysm.

The patient had no neurological changes or adverse events during the procedure. The CTSC involves reconstructing the artery with a stent and packing the aneurysm lumen with GDCs through the stent interstices. A patient with a dissecting fusiform aneurysm of the vertebral artery associated with hypoplasia of the contralateral vertebral artery was treated using this technique to prevent rebleeding. His clinical course was uneventful over a six-month follow-up period. Angiography performed two months after the procedure confirmed excellent flow through the right vertebral artery and absence of filling of the daughter aneurysm.
Angioarchitecture Predicting Hemorrhage in Cerebral Arteriovenous Malformations
Authors: Hirai S. , Mine S. , Kobayashi E. , Yamakami I. , Yamaura A.
Published: January 2017

To find out lesions responsible for hemorrhage in arteriovenous malformations (AVMs), a retrospective study of angioarchitecture around the nidus was conducted in 27 patients who underwent conservative treatment. Comparison of angiograms revealed disappearance of an intranidal aneurysmal dilatation after the hemorrhagic events in two cases. The hematomas were adjacent to the dilatation, and no subarachnoid hemorrhage was evident. Obstruction of venous drainage, noticed in a case of spontaneous regression of AVM, was not demonstrated in the cases of hemorrhage.

The intranidal aneurysmal dilatation is likely to have caused the hemorrhage in our cases. Careful endavascular embolization using proper materials should be indicated for an intranidal aneurysmal dilatation to prevent subsequent hemorrhage.
Efficacy of Diluted NBCA Mixture for Embolization of Arteriovenous Malformations
Authors: Tamatani S. , Ito Y. , Koike T. , Abe H. , Kumagai T. , Kurashima A. , Koizumi T. , Takeuchi S. , Tanaka R.
Published: January 2017

The purpose of this study is to evaluate the efficacy and problems of the embolization for cerebral arteriovenous malformations (AVMs) with diluted cyanoacrylate adhesives.

Twelve consecutive AVM cases were treated with N-butyl-2-cyanoacrylate (NBCA) glues between January 1997 and July 1998. The mean age of the patients was 37 years old. Intracerebral hemorrhage was the presenting symptom in seven cases, seizure in three, headache in one and mental deterioration in one. According to the classification of Spetzler and Martin, seven were Grade 11, five were Grade III. We used a mixture of NBCA (normally 25% Histoacryl, 75% Ethidol) for embolization. Microcatheter was navigated into the nidus and the tip of the catheter was set in a wedged position. Then the glue was injected using complete column technique.

Nineteen sessions of embolization were performed in 12 patients. The mean volume of each nidus was reduced from 22.5 ml to 3.4 ml (85%) after embolization. Four cases were cured by embolization alone. Surgical resection was performed after embolization without any residual nidus in three cases. Five were treated with stereotactic radiosurgery following embolization. One was completely cured in 18 months after and the other four have been decreasing their sizes of nidus. One case was suffered from delayed intracerebral hemorrhage three days after embolization, and resulted in mild hemiparesis and memory disturbance. The others had no complications and were clinically improved or unchanged after embolization.

It is possible to embolize the nidus of AVMs more accurately and safely with diluted mixture of NBCA, compared with the method using relatively higher concentration of NBCA glues. This technique is useful and effective method for the treatment of AVMs.
Coil Embolization for Ruptured Dissection on the Vertebral Artery Distal to the Origin of Posterior Inferior Cerebellar Artery
Authors: Manabe H. , Fujita S. , Hatayama T. , Suzuki S.
Published: January 2017

Although many surgical or endovascular treatments for ruptured vertebral dissection have been reported, the best treatment remains controversial. Recently endovascular vertebral occlusion using coils has been reported, the appropriate occlusion site has not yet been fully discussed.

Five cases of ruptured vertebral dissection located distally to the origin of posterior inferior cerebellar artery were occluded by platinum coil packing in the angiographical “pearl” portion or “fusiform dilatation” together with its proximal vertebral artery. All dissections were occluded completely together with occlusion of distal portion of vertebral artery to PICA's origin. No complications related to procedure were seen in this series.

Occlusion of rupture point with preserving tiny perforators arising from vertebral artery would be an ideal method for this lesion. The present cases suggest that the short segment occlusion by coil packing in the angiographical “pearl” portion or “fusiform dilatation” together with its proximal vertebral artery would be near to the ideal.
The Embolization of Ruptured Aneurysms in Acute Stage with Guglielmi Detachable Coils
Authors: Matsumaru Y. , Sonobe M. , Masuda R. , Yasuda M. , Hori E. , Sugita K. , Takahashi S.
Published: January 2017

We have treated 43 ruptured aneurysms in 42 patients with Guglielmi Detachable Coils (GDC) in acute period. Thirty-one patients (74%) were independent on discharge. Among the patients of Hunt and Hess Grade I, II and III, 27 patients (84%) were independent. Acute rerupture occurred in two elderly patients with insufficient embolization and another patient experienced rerupture 45 days after the embolization. Symptomatic vasospasm was reported in 16% of patients and its permanent morbidity rate resulted in 3.1%. Although the long term results remain to be determined, embolization with GDC is a safe and promising treatment for acutely ruptured aneurysms.
Long-Term Histopathology of Intracranial Aneurysms after Endovascular Treatment with Coils
Authors: Suda Y. , Kikuchi K. , Shioya H. , Shindo K. , Nanjo H. , Masuda H.
Published: January 2017

We describe the results of electron microscopic examination in two patients with ruptured intracranial aneurysms who were successfully treated by endovascular coil embolization. The aneurysms were seen completely occluded on the follow-up angiograms. Autopsies of these patients were performed five and 26 months after endovascular treatment when they died of pneumonia and thalamic hemorrhage, respectively. The aneurysms were densely filled with the coils, which were readily identified through the thin and transparent wall of the aneurysmal dome. The orifice of the aneurysm was completely occluded so that macroscopically the coils were not directly visualized through the orifice.

To examine any evidence of endothelialization across the orifice of the aneurysms, scanning electron microscopic examination was performed. In both cases, evidence of well regenerative endothelialization was observed across the aneurysmal orifice, being contiguous with the endothelial layer of the adjacent parent vessels. These ultrastructural findings indicate that the aneurysms are completely isolated from the lumen of the parent artery by a continuous lining of the regenerated endothelial cells following the endovascular treatment with coils, and further suggest that aneurysms have a potential of being cured permanently by this treatment modality. This is, to the best of our knowledge, the first report in humans verifying a complete endothelialization of the luminal surface at the aneurysmal neck after coil embolization, as evidenced by scanning electron microscopy.
Endothelial Dysfunction in Rheumatoid Arthritis is Improved by Anti-Tumor Necrosis Factorα Treatment
Authors: Capria A. , De Nardo D. , De Sanctis G. , Simonelli A.R. , Kroegler B. , Silvestri F. , Franconi G. , Fontana L.
Published: January 2017

Rheumatoid arthritis (RA) is associated with excess cardiovascular morbidity and mortality. TNFα plays a pivotal role in causing both RA synovial damage and atherosclerosis, also by inducing endothelial dysfunction. The aim of the present study was to assess the occurrence of endothelial dysfunction and the effects of anti-TNFα antagonism on endothelial function in RA. Ten RA women with Disease Activity Score (DAS) ≥ 3.7 despite treatment with at least two disease-modifying antirheumatic drugs for 4 months underwent anti-TNFα treatment with infliximab or etanercept.

Endothelium-dependent vasodilation was significantly lower than normal (3.8±3.7 % vs. 13.7 ±5.1, p≤0.05), thus demonstrating the presence of endothelial dysfunction in our RA patient population. Anti-TNF- treatment significantly improved flow-mediated vasodilation, which increased from baseline values of 3.8±3.7% to 10.9±6.6% (p<0.05) at day 1, to 13.4±5.4 % (p < 0.05) at week 1, to 12.7±5.3 % (p<0.05) at week 2 and to 15.5±5.2 % at week 6 (p≤0.05). There was no significant difference between two anti-TNFα treatments regarding mean percentage increase of flow-mediated vasodilation during treatment. RA clinical improvement was demonstrated by a significant decrease in the DAS score (from 6.26±1.6 to 5.26 1.38, p < 0.05) associated to a marked decrease of acute phase reactants serum levels. The present study supports the hypothesis of the pivotal role for TNFα as a mediator of systemic and vascular wall inflammation in RA.
A Retrospective Evaluation of the Inflammatory Marker C-Reactive Protein (CRP), Cholesterol and High-Density Lipoproteins in Patients with Major Depression: Preliminary Findings
Authors: Gambi F. , De Berardis D. , Campanella D. , Carano A. , Sepede G. , Salini G. , Scorrano B. , Spinella S. , Conti C.M. , La Rovere R. , Valchera A. , Mancini E. , Ceddia D. , Marchionni L. , Calcagni E. , Cotellessa C. , Salerno R.M. , Ferro F.M.
Published: January 2017

The aim of this study was to retrospectively evaluate the role of C-reactive protein, total cholesterol and high-density lipoprotein cholesterol in patients suffering from Major Depression (MD). Data of C-reactive protein, total cholesterol (TC) and high-density lipoprotein cholesterol of 37 adult outpatients (17 men, 20 women) with a DSM-IV diagnosis of MD were analyzed. Depression was measured with the 17-item Hamilton Depression Rating Scale (HAM-D) and with the Beck Depression Inventory (BDI). Suicide risk was evaluated with the Scale of Suicide Ideation (SSI). Patients with a lifetime history of attempted suicide were categorized as having higher suicide risk. Higher suicide risk patients showed higher C-reactive protein levels and lower high-density lipoprotein cholesterol levels than lower suicide risk patients whereas total cholesterol levels were not statistically different. C-reactive protein positively correlated with BDI, HAM-D, SSI scores and with number of previous depressive episodes. High-density lipoprotein cholesterol correlated inversely with BDI, HAM-D and SSI scores, whereas, no significant correlations were found between Total Cholesterol and other variables including C-reactive protein. In linear regression models, C-reactive protein was predictor of more severe depression and increased suicide risk. Lower high-density lipoprotein cholesterol levels were significantly predictive of increased suicide risk.
Stress Characteristics in Different Work Conditions: Is it Possible to Identify Specificity of Risk Factors by the Questionnaire Method?
Authors: Sancini A. , Tomei F. , Schifano M.P. , Di Giorgio V. , Caciari T. , Fiaschetti M. , Scimitto L. , Cetica C. , Fioravanti M. , Tomei G.
Published: January 2017

The aim of this study is to identify, by a brief ad hoc questionnaire, specific dimensions of perceived occupational stress that could be relevant in two different work conditions of female workers: visual display unit (VDU) operators, for whom the risk of work-related stress is already known in literature, and kindergarten teachers, for whom very few studies have examined this risk. A questionnaire, prepared specifically for workers, was filled in by 70 all-female kindergarten teachers and 70 all-female VDU operators. The two groups were matched for age and length of service. The questionnaire was examined by factor analysis and questionnaire single item scores. Total score and factor scores were examined between group comparison of means analysis. The level of significance was established at p<0.05. Kindergarten teachers show significantly higher values of the questionnaire total score than VDU operators, indicating a higher level of perceived stress related to their occupation. In particular, the factor scores concerning perceived load of work responsibilities, the first of the three factors accounting for the structure of the questionnaire (1. perceived load of work-responsibility; 2. independence and autonomy in performing work-duties; 3. negative features of work interfering with psycho-physical wellbeing) are significant between groups. Compared to VDU operators, kindergarten teachers perceive a more stressful condition of responsibility in taking independent decisions and autonomously managing their work. When appropriate comparisons are performed between groups of workers operating under different occupational conditions, it is possible to identify, using an ad hoc questionnaire, different sources of occupational stress which are effective in the work environment of different categories of female workers.
Rituximab Rescue Therapy for Refractory Early Acute Rejection after Liver Transplantation
Authors: Vogel T. , Wolters H.H. , Hölzen J. , Schmidt H.H. , August C. , Dahrenmöller C. , Senninger N. , Brockmann J.G.
Published: January 2017

Rejection of a liver transplant is a rare but serious event which can be life threatening. T-cells were supposed to be the major, if not the only key player in allograft rejection. However, during recent years B-cell function has regained attention. A chimeric monoclonal antibody against CD20 protein (rituximab) successfully reversed a multi-drug resistant rejection in a liver transplant recipient. Following an uncomplicated postoperative course, the patient showed biopsy-confirmed acute rejection on postoperative day 28. Despite treatment with steroids, increased tacrolimus doses and anti-thymocyte globulin (ATG) the rejection could not be resolved. Repeated biopsies confirmed ongoing acute cellular rejection; however, a humoral component of rejection could not be fully excluded and rituximab treatment was initiated. Liver function showed a subsequent melioration accompanied by convalescence of the patient. No adverse side effects associated to rituximab administration were observed. Promising results with rituximab were reported for heart and kidney transplant recipients suffering from humoral rejection. To our knowledge this is the first report of a successful rescue therapy of a multi-drug-resistant liver allograft rejection with rituximab. The addition of rituximab might be a valuable option to overcome severe, multi-drug-resistant rejection, although humoral nature of rejection is not proven by histology.
Inhibitor Effect of Antioxidant Flavonoids Quercitin, and Capsaicin in Mast Cell Inflammation
Authors: Shaik-Dasthagirisaheb Y.B. , Varvara G. , Murmura G. , Saggini A. , Caraffa A. , Antinolfi P. , Tetè S. , Rosati M. , Cianchetti E. , Toniato E. , Speranza L. , Pantalone A. , Saggini R. , Di Tommaso L.M. , Conti P. , Theoharides T.C. , Pandolfi F.
Published: January 2017

Mast cells are essential not only for allergies but also for innate and acquired immunity, autoimmunity and inflammation, and they are recognized as a new type of immunoregulatory cells capable of producing different cytokines. Natural compounds have long been recognized to possess anti-inflammatory, antioxidant and anticancergenic activity. Quercitin is an inhibitor for mast cells and is a potent antioxidant, cytoprotective and anti-inflammatory compound and has a negative effect on intracellular regulator signal events initiated by FceRI receptor cross-linking and other activating receptors on mast cells. These observations candidate quercitin as a therapeutic compound in association with other therapeutic molecules. Capsaicin is a compound derived from peppers, especially capsicum, and is involved in stimulating circulation aiding digestion and relieving pain. Capsaicin receptor sub type I (VRI) is expressing in neurons and is present in a number of brain nuclei and in non-neuronal tissues, mediating inflammatory response. Capsaicin is involved in migraine, allergic symptoms, arthritis pain and gastric secretion. In this paper we review the biological effects of quercitin and capsaicin.
Chlamydia Pneumoniae and Cardiovascular Disease in End-Stage Renal Disease Patients: An Update
Authors: Rassu M. , Filardo S. , Mastromarino P.
Published: January 2017

Cardiovascular diseases (CVD), due to accelerated atherosclerosis, are responsible for approximately 50% of mortality in End Stage Renal Disease (ESRD) patients undergoing haemodialysis (HD). Over the last decade, Chlamydia pneumoniae, a respiratory pathogen, has been involved in the pathogenesis of atherosclerosis and several reports have suggested the association between C. pneumoniae infection and CVD in HD patients. This report reviews the contribution of C. pneumoniae infection in cardiovascular diseases in ESRD patients, in light of recent studies on cardiovascular risk factors; we hypothesize that C. pneumoniae-infection may contribute to mineral bone disorder and, consequently, vascular calcification. However, further studies are needed to define the relationship between C pneumoniae and bone and vascular disorders in HD patients.
Essential Oil Extracted from Rhizoma of Atractylode Lancea Induces Oncosis in Human MKN-45 Cancer Cells
Authors: Chen H-N. , Shao C. , Zhao J-Z. , Guan X-W. , Ding J. , Shao S-H.
Published: January 2017

The aim of this study was to examine whether the essential oil extracted from rhizoma of Atractylode lancea has cytotoxicity to human MKN-45 cancer cells and its underlying mechanisms. The cytotoxicity of essential oil to cancer cells was examined by MTT assay. The effects of essential oil and disruption were monitored using whole-cell, time-lapse recording by microscopy. The effects of essential oil on cytoskeletal systems were detected by Western blotting and immunofluorescence. The effects of essential oil on cytokine secretion were measured by ELISA. The result showed that the cytotoxicity of essential oil was triggered rapidly by 2 μl/ml (1 h caused 50% maximum cytotoxicity) and involved secretion function perturbation. In addition, essential oil could induce membrane blebbing within 1 h of sustained application, which was blocked by polyethylene glycols (PEG) with molecular weights £3350, but not prevented by PEG with molecular weight34000 and extracellular calcium chelator EGTA. Moreover, essential oil did not disrupt cytoskeletal systems as demonstrated with no degradation of microtubules and actin. In conclusion, essential oil extracted from rhizoma of Atractylode lancea can rapidly initiate acute injury and burst via oncosis and may offer a novel therapeutic strategy for cancer treatment.
Chronic Periodontitis and Cardiovascular Disease: A Controlled Clinical Trial
Authors: Mariotti G. , Quaranta A. , Merli M. , Holtzman L. Paternò , Piemontese M.
Published: January 2017

Cardiovascular disease is one of the leading causes of death worldwide. Controlled prospective studies and randomized clinical studies have shown that inflammation plays a major role in the pathogenesis of atherosclerosis, and that a chronic inflammatory systemic reaction increases the risk of cardiovascular, and cerebrovascular attacks. In recent years, many researchers have focused on defining a correlation between cardiovascular and periodontal diseases. The aim of the present study was to observe the effects of periodontal causal therapy on the level of specific inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6) levels, before and after non-surgical periodontal therapy. A total of 64 patients were enrolled in the present study. Among these, 26 patients were affected by cardiovascular disease and periodontal disease, (MCV-Perio test group), whereas 38 patients were only affected by cardiovascular disease, without periodontal disease, (MCV control group). The MCV-Perio group was then sub-divided into two additional groups: Treated MCV-Perio test group, treated with non-surgical phase I periodontal therapy; Not-Treated MCV-Perio test group, not treated with any periodontal therapy. A comprehensive periodontal treatment was carried out at baseline. The non-surgical therapy treatment was conceived according to Full Mouth Therapy (FMT) treatment protocol, consisting of various phases delivered in a very short time. Blood samples were collected at baseline and re-evaluated in order to assess periodontal and inflammation marker changes. All values were registered as an average ± standard deviation (x ± SD) and Wilcoxon-Mann-Whitney test was used. It is interesting to observe that the serum concentrations of IL-6 and hs-CRP were higher in the group with cardiovascular and periodontal disease compared to the group with cardiovascular disease alone. Non-surgical periodontal treatment determined a dramatic improvement in the levels of the systemic inflammatory markers. The results of the present study show that non-surgical periodontal therapy performed according to the Full Mouth Therapy protocol may prove beneficial in reducing the levels of inflammatory markers typically associated with heart disease. Because the two pathologies share a certain number of common risk factors, this may be a hindrance in the correct interpretation of the results. Therefore, further evidence, represented preferably with a randomized controlled clinical design is necessary to interpret the results correctly.
Effects of Plasma from Patients Affected by Mild Cognitive Impairment and Alzheimer's Disease on Cultured Endothelial Cells
Authors: Salvolini E. , Vignini A. , Nanetti L. , Luzzi S. , Provinciali L. , Di Primio R. , Mazzanti L.
Published: January 2017

There is accumulating evidence that Alzheimer's disease (AD) can have vascular contribution. In particular, endothelial dysfunction may impair nitric oxide (NO) production and cause cerebral hypoperfusion. Blood flow impairment can be provoked also by an increased production of reactive oxygen species (ROS). The present study was performed in order to investigate the effect of plasma from subjects affected by AD and mild cognitive impairment (MCI) on human aortic endothelial cells (HAECs) in vitro, since endothelial dysfunction has been suggested to be an early event in patients affected by AD. Plasma samples were obtained from 27 AD patients, 15 MCI subjects, and 19 age-and sex-matched healthy subjects. After a short incubation period the following parameters were evaluated: NO release, superoxide dismutase (SOD) and Na+/K+-ATPase activities, membrane fluidity, and thiobarbituric acid-reactive substance (TBARS) production. Exposure to MCI plasma provoked a decrease in NO release, more pronounced in the presence of AD plasma. Our data on SOD and Na+/K+-ATPase activities showed a similar trend, since the lowest values were recorded after incubation with AD plasma. Endothelial membrane fluidity was deeply affected by the exposure to MCI plasma, and even more following incubation with AD plasma. Finally, enhanced TBARS production after incubation with MCI and AD plasma was observed. In conclusion, our results showed that MCI and AD plasma affects endothelial cells, thus highlighting the need for early treatment aimed at protecting the endothelium.
Orbital Metastases in a Female Patient with Breast Cancer
Authors: Fini G. , Grippaudo F.R. , Fenicia V. , Ricotta F. , Virciglio P. , Mici E. , Bozzao A. , Belli E.
Published: January 2017

Breast cancer is the most common malignant disease among women, with a lifetime risk of approximately 10%. Frequent and well-known locations of metastases are bone, liver, lung, skin and brain, but tumour repetition has been seen in almost any anatomic site. Orbital involvement is quite rare, or perhaps underestimated. Orbit metastases (OMs) represent 1–13% of all orbital cancers, and are difficult to discriminate with other differential diagnoses, such as a simple blepharitis, or orbital pseudotumor, up to more complex forms of cancer such as lymphoma. The prevalence of OMs is calculated to occur in 2–4.7% of primitive cancer patients. Typical manifestations of orbital metastases include overall regional inflammation, mass effect causing displacement or ocular globe proptosis, pain, bone infiltration, chemosis and eyelid swelling. Infiltration of soft tissue leads to ptosis, diplopia or enophthalmos. We report the case of a 70-year-old female patient who developed chronic inflammatory process of both orbital regions due to orbital metastases, without evidence of other systemic disease after 8 years from primary breast cancer diagnosis. The diagnostic pathway as well as the differential diagnosis are discussed.
Use of platelet rich fibrin and Bio-OSS/SINT-Oss for implant-prosthetic rehabilitation in maxillary atrophy with sinus pathology: A 48-month follow-up
Authors: Inchingolo F , Ballini A , Mura SA , Farronato D , Cirulli N , Pettini F , Gheno E , Vermesan D , Pederzoli P , Resta G , Caprio M , Muollo F , Marinelli G , Inchingolo AD , Malcangi G , Cantore S , Del Corso M , De Benedittis M , Inchingolo AM , Serafini M , Diteodoro S , Schinco F , Cagiano R , De Vito D , Cortelazzi R , Dipalma G
Published: January 2017

The maxillary sinus floor elevation procedure has gained popularity with predictable results, and is a safe, acceptable technique for bone augmentation, providing a base for dental implant treatment. Faint radiopaque lesions at the base of the maxillary sinus are frequent diagnoses on radiographs and must be identified during dental implant planning. The use of autografts, xenografts, allografts, and alloplasts or a combination between them has been demonstrated to be effective for increasing bone height and bone volume in maxillary sinus. The objective of this study was to evaluate the outcome of subjects with considerable sinus membrane pathology (test group) undergoing maxillary sinus floor augmentation using Platelet Rich Fibrin (PRF) as a filling material, in association with the Bio-Oss and Sint-Oss and simultaneous implant placement in a one-stage surgical procedure. All patients reported no pain to percussion, no sign of tissue suffering to the soft peri-implant tissues, the presence of an optimal primary stability of the inserted implants, and the increase in the peri-implant bone density. No complications were encountered during follow-up periods in these patients, including no negative evolution in the sinusitis and all implants are functioning successfully. In conclusion, the use of PRF and Piezosurgery reduced the healing time, favoring optimal bone regeneration and allowing sinus membrane integrity to be maintained during surgical procedures, according to evidence-based dentistry.
Management of uncommon disorders in pregnancy: Von Hippel–Lindau disease, Gitelman syndrome, and Nutcracker syndrome
Authors: Merhi Basma , Miller Margaret , Lanis Aviya , Katz Brittany , Hsu Tiffany , Tong Iris
Published: January 2017

Uncommon renal disorders in pregnancy can be challenging to manage given limited evidence in the literature to guide management. We present a series of three uncommon renal disorders in pregnancy: Von Hippel–Lindau disease, Gitelman syndrome, and Nutcracker syndrome. Previously published case reports with differing outcomes offer some guidance to the management of these disorders in pregnancy. In this case series, we address the management of these syndromes during pregnancy and discuss the maternal and fetal outcomes. All three of our patients had good maternal and fetal outcomes, which will contribute to current data on maternal and fetal outcomes in these rare diseases, which is limited.
Evidence-Based Design Features Improve Sleep Quality Among Psychiatric Inpatients
Authors: Pyrke Ryan J. L. , McKinnon Margaret C. , McNeely Heather E. , Ahern Catherine , Langstaff Karen L. , Bieling Peter J.
Published: January 2017

Objective:

The primary aim of the present study was to compare sleep characteristics pre- and post-move into a state-of-the-art mental health facility, which offered private sleeping quarters.

Background:

Significant evidence points toward sleep disruption among psychiatric inpatients. It is unclear, however, how environmental factors (e.g., dorm-style rooms) impact sleep quality in this population.

Methods:

To assess sleep quality, a novel objective technology, actigraphy, was used before and after a facility move. Subjective daily interviews were also administered, along with the Horne–Ostberg Morningness–Eveningness Questionnaire and the Pittsburgh Sleep Quality Index.

Results:

Actigraphy revealed significant improvements in objective sleep quality following the facility move. Interestingly, subjective report of sleep quality did not correlate with the objective measures. Circadian sleep type appeared to play a role in influencing subjective attitudes toward sleep quality.

Conclusions:

Built environment has a significant effect on the sleep quality of psychiatric inpatients. Given well-documented disruptions in sleep quality present among psychiatric patients undergoing hospitalization, design elements like single patient bedrooms are highly desirable.
The efficacy of a shared-care surveillance protocol for asymptomatic renal calculi
Authors: Ravindra P , Voss J , Hall S , Stanford RJ , Scriven SD , Ratan HL
Published: January 2017

Objective:

Patients at our institution with asymptomatic calyceal stones (<11 mm) are discharged to their GPs with a request for 12- and 24-month X-ray KUBs with specific re-referral criteria. We aimed to assess the effectiveness of this shared care protocol as well as to investigate long-term outcomes.

Patients and methods:

All patients satisfying the above criteria discharged during October 2009–June 2011 were reviewed for protocol compliance, symptomatic events and/or surgical intervention up to July 2015.

Results:

A total of 134 patients were identified. Out of 115 patients eligible for their first X-ray, and 100 patients eligible for their second X-ray, 43% and 26% respectively were performed. Of these, 75% demonstrated no progression. No patients were treated surgically solely on the basis of radiographic progression. Over a mean five-year follow-up, patients had a 39% chance of experiencing a symptomatic event and a 24% chance of requiring surgical intervention (ESWL, ureteroscopy and/or PCNL). Risk factors included a previous stone history and having a total stone size >10 mm.

Conclusion:

There was poor adherence to this protocol. Despite this, only symptomatic patients were treated surgically, challenging the value of indefinite surveillance of asymptomatic patients. Longitudinal studies are needed to determine a cost-effective manner in which these patients can be safely followed up.
An Empirical Investigation of the Effect of Customer Orientation on the Business Performance of French Firms: A Firm-Level Analysis of Direct and Moderation Effects
Authors: Pekovic Sanja , Rolland Sylvie
Published: January 2017

Is customer orientation a driver of better firm performance? To answer this question, we examine the impact of customer orientation on the business performance of more than 7,500 French firms. Our findings show that customer orientation significantly improves business performance, as measured by the logarithm of the profit per employee and the logarithm of EBITDA (earnings before interest, taxes and depreciation) per employee. Additionally, there is an indirect impact that varies according to the market environment. The findings imply that the positive influence of customer orientation on firm profitability per employee and EBITDA per employee increases in growing, highly competitive and uncertain markets.