bluuebunny/crossref_metadata_2025 huggingface dataset:
An improved reversible image watermarking algorithm based on difference expansion
Authors: Zhang Zhengwei , Wu Lifa , Yan Yunyang , Xiao Shaozhang , Sun He
Published: January 2017

To improve the visual quality and the embedding rate of the existing reversible image watermarking algorithm, an improved reversible image watermarking algorithm based on difference expansion is proposed. First, the watermark information is divided into groups, and the information value of each group is calculated. The watermark group number and the corresponding carrier image block number are mapped, and the corresponding coefficient position of each corresponding carrier block is identified according to the value of the watermark information in each group. Second, the identified location map is compressed and embedded in the original image through the difference expansion. Through circular searching the suitable pixel position, the embedding rate can be effectively improved without sacrificing any visual quality. The experimental results show that the proposed algorithm not only has high embedding rate but also has a high visual quality and can achieve full recovery of the original image. Compared with other algorithms, the algorithm has certain advantages.
Acute Pure Spontaneous Subdural Haematoma from Ruptured Intracranial Aneurysms
Authors: Nozar A. , Philippe D. , Fabrice P. , Silvia M. , Marc T.
Published: January 2017

Acute subdural haematoma (ASDH) is rarely caused by an aneurysmal rupture. We report four cases of pure acute subdural haematomas caused by ruptured intracranial aneurysms. Aneurysms were localized in the posterior communicating artery in two cases, in the anterior communicating artery in one case and in the middle cerebral artery in one other case. Possible mechanisms for this type of aneurysmal bleeding are discussed. A good prognosis for these patients can be expected with rapid evacuation of the haematoma (in case of high intracranial pressure and midline structure shift), and treatment of the aneurysm (surgical clipping or endovascular treatment).

Our report demonstrates the utility of angiography in the evaluation of nontraumatic acute subdural haematomas. Angiography has to be performed before haematoma evacuation or just after if the patient requires urgent surgery in case of intracranial hypertension. Aneurysms may require surgical clipping or endovascular treatment.
Growing Dural Sinus Malformation with Associated Developmental Venous Anomaly, Multiple Cavernomas and Facial Venous Malformation in an Infant
Authors: Mohamed Z. , Batista LL , Sachet M. , Mahadevan J. , Alvarez H. , Lasjaunias P.
Published: January 2017

This is an unusual case report of an infant, who initially presented with a facial haemangioma and was later diagnosed to have a dural sinus malformation (DSM) involving the torcula. The DSM increased in size lateralising to the right transverse sinus at three months of age. Postnatal enlargement of the dural sinus has not been described before suggesting a delay in the maturation of the dural sinus which normally would occur antenatally.

There was a further association with a complex developmental venous anomaly (DVA) draining the right cerebral hemisphere into the deep cerebral vein and multiple cavernous malformations. The DVA was not clearly demonstrated at age one month but was more obvious at age three months. This would be the first reported case of DSM associated with a DVA. Increasing venous hypertension probably contributed to the poor opacification of the DVA on follow-up angiography at age six months and to the haemorrhagic changes within the cavernomas on magnetic resonance imaging (MRI).

The therapeutic goal was to correct venous hypertension by partially embolising the dural shunts to remodel the cerebral vasculature and preserve the patent sinus. The treatment strategy and possible link between the complex disease entities presented in this infant are discussed. Despite these attemps, the lesion continued to grow compressing the posterior fossa structures. The infant died at nine months of age.
Hydroxyapatite and bFGF Coating of Detachable Coils for Endovascular Occlusion of Experimental Aneurysm
Authors: Shimozuru T. , Kamezawa T. , Kuratsu J. , Sakai N. , Nagata I. , Kishida A. , Akashi M. , Matsusaki M.
Published: January 2017

The purpose of this study was to evaluate the effect of hydroxyapatite (HAp) and fibroblast growth factor-basic (bFGF) coating on Guglielmi detachable coils (GDCs) in an experimental aneurysm model. A total of 18 aneurysms were experimentally made in the common carotid arteries of swine. Embolization was done on these aneurysms using standard GDCs and coated GDCs with HAp (GDC-HAp) and with bFGF (GDC-HAp-bFGF). The animals were then killed 14 days after embolization. The development of tissue scarring and coverage the aneurysm's orifice were evaluated macroscopically. No significant difference of volume ratio of the coils exited in each groups. Macroscopically, covering ratio of fibrous membrane at the neck of aneurysms were 88.3 ± 14.7% in a group with GDC-HAp-bFGF, while it were 26.7 ± 15.3% in a group with standard GDC and it was 41.7 ± 31.7% in a group with GDC-HAp. These results indicated that coating by hydroxyapatite and bFGF might facilitate a wound healing in an experimental aneurysm model.
Clinical and Angiographic Results of Intra-Aneurysmal Embolization for Cerebral Aneurysms and Histopathological Findings in an Aneurysm Treated with GDC
Authors: Kaku Y. , Yoshimura S. , Kokuzawa J. , Sakai N.
Published: January 2017

We describe follow-up clinical and angiographic results in patients with cerebral aneurysms treated with IDC or GDC. In 175 patients, 116 patients with ruptured aneurysm and 59 patients with non-ruptured aneurysm who underwent endovascular occlusion of aneurysms, there was no mortality and nine cases (4.7%) with morbidity in the periprocedural period. During follow up period, four cases (2.3%) experienced bleeding, and three cases (1.7%) experienced thromboembolic events. On the follow-up angiograms (median angiographic follow-up period 24.8 months), 12.5% of incompletely obliterated aneurysms exhibited progressive thrombosis, 20% remained unchanged and 67.5% showed aneurysmal recanalization or regrowth. Histological examination of a small ruptured A-com aneurysm treated seven months before harvesting, demonstrated that formation of an incomplete endothelium-lined layer of connective tissue at the orifice, and no complete fibrous obliteration of the aneurysm lumen could be detected, various amounts of unorganized clot were still present in the center of the aneurysm.

Coil embolization is a safe treatment for cerebral aneurysms with a lower incidence of periprocedural morbidity, wheareas follow-up results are less satisfactory in cases involving incompletely obliterated lesions.
Post-Mortem Pathological Examination of Two Patients after Intraaneurysmal Embolization Using Guglielmi Detachable Coils
Authors: Nakahara T. , Sakamoto S. , Hamasaki O. , Sakoda K.
Published: January 2017

We report the histological findings in two patients treated using Guglielmi detachable coils with almost complete occlusion of the aneurysms. Autopsies of these patients were performed one week and one year after GDC embolization respectively. In one aneurysm that was obtained at autopsy one week after embolization, the histological findings revealed coils and an unorganized thrombus-filled aneurysm sac; an incomplete cell-lining on the luminal side of fibrin thrombi in the region of the neck of the aneurysm was recognized. In the other aneurysm in which autopsy was performed one year after embolization, an organized fibrous tissue at the margin of the aneurysmal wall and vascular granulation tissue at the center of the aneurysm were observed. There is a single layer of endothelium covering fibrous tissue in the neck of the aneurysm. We discuss the healing process after GDC treatment.
Endovascular Surgery for Intracranial Aneurysm
Authors: Konishi Y. , Sato E. , Shimada M. , Hino K. , Fujitsuka M. , Saito I.
Published: January 2017

Recently, endovascular surgery became common approach for management of intracranial aneurysms. Though its efficacy, this approach is still new and under development. Here, we report our clinical experience in patients treated with two methods - balloon or Gugliemi detachable coil.

In addition, to understand better the mechanisms underlying postoperative complications, we studied them in histopathological specimens of patients and in a model of experimental aneurysm. From our data we conclude that choice of appropriate therapeutic method should respect specific conditions of patients as well as of facility.

Careful postoperative studies including examination of intravascular surface by endovascular scope examination would be useful for prediction of possible complications.
Histological Evaluation of Endothelial Reactions after Endovascular Coil Embolization for Intracranial Aneurysm
Authors: Ozawa T. , Tamatani S. , Koike T. , Abe H. , Ito Y. , Soga Y. , Hasegawa H. , Morita K. , Tanaka R.
Published: January 2017

The purpose of this study was to evaluate the role of the endothelial cell reaction after endovascular coil embolization for the treatment of intracranial aneurysms. A scanning electron microscopic (SEM) study of the platinum coil, embolized into a middle cerebral aneurysm in a 35-year-old woman and subsequently removed surgically eight months later, revealed no endothelial coverage on the coil.

This finding prompted us to perform experimental studies. In the first in vitro study, endothelial cells from gerbil brain microvessels and canine carotid arteries were co-cultured with either bare-form platinum coils or type-1 collagen-coated coils for up to three weeks, and the endothelial cell population on the coils was ascertained. In the second in vivo study, platinum coils coated with type-1 collagen were delivered endovascularly into canine carotid arteries, while the contralateral side was treated with bare-form coils, and endothelialization over the coil was investigated.

SEM studies revealed that no endothelial cells, either from gerbil brain microvessels or from canine carotid artery, were found on the uncoated coils, whereas gerbil endothelial cells began to proliferate on the collagen-coated coils in three days, covering extensively in one week and reaching confluence in two weeks in vitro. The in vivo canine study demonstrated that bare-form platinum coils did not show endothelial coverage until two weeks, but endothelial cells proliferated directly on the collagen-coated coils in three days, and coils were completely covered in two weeks.

These results supported the SEM study of our case and several human histopathological reports in the literature in that endothelial cell coverage in the orifice of the intracranial aneurysm is exceptional after endovascular treatment. But if some extracellular matrix, like collagen in our study, is prepared, coverage could be possible, as is seen in a few human cases. Biological modification of the platinum coils, such as collagen coating, is awaited for the better long-term results of endovascular coil embolization without recanalization of the treated intracranial aneurysms.
Radiological and Pathological Changesin the Sinus of an Experimental Arteriovenous Fistula of the Rat
Authors: Sahara Y. , Miyachi S. , Nagasaka T. , Negoro M. , Suzuki O. , Hattori K. , Kobayashi N. , Kojima T. , Yoshida J.
Published: January 2017

The object of this study is to evaluate the radiological and pathological changes in the sinus of an experimental arteriovenous fistula of the rat.

Twenty-five male Sprague-Dawley rats, including two control rats, were used for this study. A venous hypertension model in the transverse sinus was induced by means of anastomosis of a common carotid artery (CCA) to the ipsilateral external jugular vein (EJV). Rats were sacrificed 11 to 42 weeks after the procedure, then histopathological and immunohistopathological examinations were performed for the resected transverse sinus. Follow-up angiography was performed two to three weeks after the anastomosis in every case, and five months later in two rats.

Patency of the anastomosed portion was confirmed in 12 of the 23 anastomosed rats. An ipsilateral carotid angiogram demonstrated a high-flow arteriovenous (AV) shunt from the CCA to the sigmoid-to-transverse sinus and draining into the contralateral juglar vein. A contralateral angiogram displayed a steal phenomenon via the communicating artery.

Histopathologically, the vein of the anastomosed portion and the transverse sinus were markedly dilated in with cases. There was a thickening the connecting tissue and a proliferation of fibroblast in four (50%) of the eight cases. Thrombus formation in the transverse sinus was found in one case. VEGF stained strongly in the endothelial hypertrophied area and in fibrous connective tissue around the transverse sinus compared to the control sinuses.

Our results from this long-term observation of the radiological and pathological changes in the sinus exposed to hypertension resembled the clinical findings of a dural AV fistula.
Cerebral Diagnostic and Therapeutic Angiography for Neonatal Arteriovenous Fistulas
Authors: Komiyama M. , Honnda Y. , Matsusaka Y. , Morikawa T. , Kitano S. , Sakamoto H.
Published: January 2017

Cerebral diagnostic and therapeutic angiography for neonatal arteriovenous fistulas is reported. Three neonatal boys with vein of Galen aneurysmal malformation (1 patient) and dural arteriovenous fistulas (2 patients) presented severe congestive heart failure soon after birth, and were treated by transarterial and/or transvenous embolization using various access routes. In the neonatal period, umbilical approach and direct cervical approach provide unique access routes in addition to the usual transfemoral route. Characteristics of neonatal angiography are discussed.
Analysis of Complications Related to Endovascular Therapy for Dural Arteriovenous Fistulae
Authors: Tsumoto T. , Terada T. , Tsuura M. , Matsumoto H. , Yamaga H. , Masuo O. , Itakura T.
Published: January 2017

In this paper, we reviewed our cases of dural arteriovenous fistulae (dural AVFs) and analyzed periprocedural complications. In 157 procedures, we encountered 14 complications. Overall, complication rate of 9% was seen. We divided these complications into five subgroups such as cranial nerve palsy, coil-related trouble, thromboembolic complication, vessel perforation, and radiation-related trouble.

There were five transient abducent nerve palsies in cases with cavernous sinus dural AVFs. There were two cases of coil unraveling and two cases of coil migration. In two cases, direct puncture of the internal jugular vein was performed to retrieve the unraveled coil by using dual microcatheter and guidewire snare technique. We encountered two thromboembolic complications. In one case, venous infarction was recognized after polyvinyl alcohol particle embolization. In two cases of vessel perforations, there were no new neurological deficits except one case with transient Gerstmann syndrome. In endovascular treatment of dural AVF, serious complications are rare and can be prevented if maximum attention is paid during the procedure.
Treatment for Intracranial Cerebral Artery Stenosis
Authors: Kawaguchi K. , Kubo T. , Takeuchi H. , Nemoto S.
Published: January 2017

Symptomatic intracranial cerebral artery stenosis is largely resistant to drug treatment. Regardless of their locations, lesions may cause cerebral infarction with a frequency of 7–10% in a year, but the natural history of asymptomatic intracranial cerebral artery stenosis remains unclear. Revascularization is indicated for symptomatic lesions which show resistance to drug treatment, while bypass surgery is the accepted therapeutic indication for haemodynamic ischemia. Endovascular treatment is effective in haemodynamic ischemia, and is also expected to be effective against embolic symptoms.

Bypass surgery for anterior circulation cases is safe because of its low incidence of complications, whereas bypass surgery for posterior circulation cases is technically difficult and has a high associated complication rate. Hence, endovascular treatment is currently favored for posterior circulation cases, and has also been introduced for anterior circulation cases.

Endovascular treatment has become a widespread modality for intracranial cerebral artery stenosis, but there are many unsolved problems associated with complications, technology and devices. Therefore, in practice, endovascular treatment should be used only with a strict indication, and should be performed only after considerable thought and with appropriate informed consent.
Simulation Study of Distal Balloon Protection Systems during Carotid Artery Stenting
Authors: Kuroiwa T. , Sakai N. , Sakaguchi M. , Adachi H. , Imamura H. , Sakai C. , Morizane A. , Ishihara H. , Yano T. , Nakao S. , Kikuchi H.
Published: January 2017

The purpose of our experimental study was to assess the pitfalls of distal balloon protection systems and to learn any technique tips to increase safety.

Silicone carotid artery models were connected to a circulatory system to simulate arterial flow. A distal balloon protection device, PercuSurge GuardWire Plus (GWP, Medtronic Vascular) was delivered to the internal carotid artery (ICA), then was inflated to occlude ICA flow temporarily. A debris aspiration catheter (Export catheter) was delivered just proximal to the GuardWire Plus balloon coaxially, in order to introduce and diffuse particulate debris (200–500 micro meter in diameter) in the ICA stump. Then, after debris in the stump was aspirated, the GWP balloon was deflated. We recorded all the processes of our simulation experiments on a digital video and observed the movements of debris during these experiments.

Exp 1) We simulated the movements of debris in the ICA stump when the GWP balloon was gradually deflated to produce a crevice between the balloon and vessel wall, simulating accidental movement of the GWP balloon during the procedure.

Exp 2) In order to assess the optimal placement of the tip of aspiration catheter, the debris in the ICA stump was aspirated from three different sites (from just below the GuardWire balloon, from 2 cm below it, and from 5 cm below it).

Exp 1) When the crevice appeared between GuardWire balloon and silicone tube, simulated debris began to concentrate just below the balloon. Then, some debris migrated distally from the crevice, and another part crowded in the crevice so that was impossible to aspirate and migrated in the end.

Exp. 2) Debris aspiration was most effective from immediately below the GuardWire balloon, and the aspiration ability declined as the distance between the balloon and aspiration catheter became longer. According to our simulation studies, when the GWP balloon was moved accidentally during CAS procedures, or when the aspiration catheter was not delivered all the way to the GuardWire Plus balloon, distal embolization might still occur, even under protection.
Impact of Stent Design on Intra-Aneurysmal Flow
Authors: Ohta M. , Hirabayashi M. , Wetzel S. , Lylyk P. , Wata H. , Tsutsumi S. , Rüfenacht D.A.
Published: January 2017

In addition to providing a skeleton for vessel reconstruction, stent implantation as used for cerebral aneurysm treatment can induce flow redirection, thus reducing vortical flow velocities within the aneurysm cavity. Further, stent characteristics such as strut size, porosity and cell shape influence the changes in intra-aneurysmal flow by analog simulations. The purpose of this computer simulation study was to visualize the flow pattern over the entire neck area of a side wall aneurysm while changing the stent parameters.

A 3-D computer model aneurysm was constructed to have a parent artery of 5 mm diameter and an aneurysm of 10 mm diameter. The distance between the midline of main artery and center point of the aneurysm was 6.8 mm, providing a neck length of 5 mm, a width of 3.6 mm, and a neck area of 14 mm 2. The simulations were carried out with a Finite Element Method based flow simulation package. The incompressible Navier -Stokes equation was solved for a steady flow with a mean speed of 290 mm/s, steady viscosity of 3.83 cp, and density of 1.0 g/cm3. Two parallel stent struts (dimensions: 100 μm m 100 μm m 2.0 mm) were introduced into the plane of the aneurysm neck.

The fraction of the aneurysm neck cross-section occupied by the stent was 2.83% in all cases.

The velocity distribution through the neck of the aneurysm was calculated for three different choices of separation between the struts for each of two orientations of the struts (parallel and perpendicular) relative to the vessel axis.

The flow pattern in the aneurysm was composed of an inflow zone at the distal neck and of an outflow zone at the proximal neck. The placement of stent struts at the aneurysm neck resulted in a decrease in the mean speed in the aneurysm. The degree of reduction and the distribution of flow through the neck did depend on the orientation of the stent struts. The struts, when placed parallel or perpendicular to the parent vessel axis affected the mean speed through the aneurysm neck differently.
Feasibility of Photocrosslinkable Chitosan as an Embolization Material for Aneurysms
Authors: Nakai K. , Kojima T. , Hattori K. , Miyachi S. , Ishihara M. , Kobayashi N. , Okamoto T. , Yoshida J.
Published: January 2017

The purpose of this study was to evaluate the feasibility of photocrosslinkable chitosan as an embolization material for aneurysms. Three experimental aneurysms were created in three Japanese white rabbits. All of the aneurysms were packed with chitosan hydrogel.

Histopathologic data were analyzed on two, seven, and 30 days after embolization. Unorganized clots and minimal inflammation around the applied chitosan hydrogel were observed two days after implantation. After seven days, the chitosan was reduced and inflammatory response appeared. At 30 days, most of the aneurysm lumen was replaced with inflammatory cells, and the remaining chitosan was not observed. Severe complications such as anaphylaxis did not occur after the embolization with the chitosan. These results suggest that photocrosslinkable chitosan might be a candidate for an embolization material for endovascular treatment of cerebral aneurysms.
Computational Fluid Dynamics for Brain Circulation and Aneurysm with Therapeutic Devices
Authors: Fukasaku K. , Negoro M. , Iwase H. , Yokoi K. , Himeno R.
Published: January 2017

We analysed fluid dynamics at brain arteries having multiple inflow and out flow like Willis ring based on clinical imaging modalities. In addition, we analysed fluid dynamics with therapeutic devices like coils and stents to simulate their influences to blood flow.

3D CTA and MRA obtained three-dimensional structures of the brain vessels. The centreline was obtained from the three dimensional structure. Diameter of the blood vessels was measured by 3D CTA/MRA then smooth surfaced blood vessel models were created. For the fluid analysis, we developed a home brew software which can display parameters such as streamline, etc.

In addition, our CFD (computational fluid dynamics) software can work in collaboration with a CAD (computer aided design) software which we also developed (VCAD: Volume CAD). So, therapeutic devices such as coils, balloons and stents could be placed in the models and CFD analysis could be performed placing devices in the models.

The flow pattern in the complicated vascular structure could be calculated such as Willis ring which has multiple inputs like ICA, VA and multiple outlets like MCA and PCA with communicating arteries. CFD with therapeutic devices could also analysed with our system.
Traumatic Carotid Cavernous Fistula: Failure of Endovascular Treatment with Two Stent-Grafts
Authors: La Tessa G. , Pasqualetto L. , Catalano G. , Marino M. , Gargano C. , Cirillo L. , Zenna L. , Montemarano E. , Sirabella G.
Published: January 2017

We describe an unconventional endovascular approach in a young patient with large high-flow traumatic carotid cavernous fistula that could not be treated by detachable balloon procedure. Two coronary stent-grafts were used to close the large tear of internal carotid artery.

After the failure of stenting procedure, the fistula was successfully treated by trapping with two detachable balloons.
Carotid-Cavernous Fistula in Ehlers-Danlos Syndrome by Pure Transvenous Approach
Authors: Van Overmeire O. , De Keukeleire K. , Van Langenhove P. , Defreyne L.
Published: January 2017

We describe a carotid-cavernous fistula (CCF) in a middle aged woman with Ehlers-Danlos syndrome (EDS) type IV, which manifested with a left-sided ophthalmoplegia. The CCF was diagnosed on magnetic resonance imaging. To prevent potential lethal arterial wall injury, the CCF was treated endovascularly under local anesthesia and exclusively by a transvenous approach. The fistula was successfully closed with Guglielmi Detachable Coils. Notwithstanding these precautionary measures, the patient suffered an intraperitoneal and a small retroperitoneal bleed during the procedure and died suddenly ten days after intervention in hemorrhagic shock. A review of recent literature focussing on the technique of transvenous approach and the catheterization risks of CCF in Ehlers-Danlos syndrome is presented.
Exclusion of a Cavernous Aneurysm by Leo Stent
Authors: Pumar J.M. , Castiñeira J.A. , Vazquez F. , Blanco M. , Lylyk P.
Published: January 2017

The Leo stent is a cranial self-expanding stent recently developed for the treatment of wide-neck aneurysms. We report the first case with total occlusion of a cavernous aneurysm nine months after stent placement without complementary coiling.
Lumbosacral Liposuction. A New Tool for the Treatment of Low Back Pain
Authors: Théron J. , Guimaraens L. , Casasco A. , Coellar H. , Sola T.
Published: January 2017

To obtain a better active contention of the lumbosacral spine, a new technique of liposuction of the fat surrounding the atrophied paraspinal muscles is described. A preliminary series of 40 patients presenting low back pain symptoms is presented. The technique, performed on an out patient basis is well tolerated. The MR follow-up controls regularly showed an expansion of the paraspinal muscles. The overall results obtained on this preliminary non uniform series showed encouraging results with 77.5% of very good or good results.
Covered Stent Application of a Repeatedly Regrowing Iatrogenic Subclavian Artery Pseudoaneurysm at the Origin of the Vertebral Artery
Authors: Xu G.F. , Suh D.C. , Pyun H.W. , Yoo H. , Lee S.W. , Huh M.O. , Kwon T. , Kim S.J.
Published: January 2017

Formation of an iatrogenic subclavian artery pseudoaneurysm while attempting central venous access through the internal jugular vein is relatively uncommon. However, management of a subclavian artery pseudoaneurysm remains a challenge because of its growing tendency and its relation to the origin of the vertebral artery (VA). We report a strategy for using a covered stent as for the endovascular treatment of a patient with a repeatedly regrowing subclavian artery pseudoaneurysm at the origin of the VA.
Outcome in Acute Stroke with Different Intra-Arterial Infusion Rate of Urokinase on Thrombolysis
Authors: Gan X. , Luo Y. , Ling F. , Ji X. , Chen J. , Ding Y.
Published: January 2017

Intra-arterial infusion of urokinase (UK) has been widely used. However, the optimal infusion rate of the reagent has never been determined. This was investigated in the acute stage of middle cerebral artery (MCA) embolism in the present study.

Sprague Dawley male rats (n=43) were randomly divided into sham-operation and five ischemic groups with urokinase administration at different infusion rates or without urokinase administration. Ischemia was induced with MCA embolism. Two hours after embolism, total urokinase (urokinase, 170,000U/kg) was given in groups A,B,C and D (n=8 each) at different rates: 1,000 U (0.03 ml/min) per minute, 4,000U (0.12 ml/min), 10,000U (0.30 ml/min), and 16,000U (0.48 ml/min), respectively. Group E received normal saline at a rate of 0.48 ml/min. The sham-operation group (no embolism) received urokinase at (170,000U/kg, 1.5 ml, 16,000 U/min). During ischemia and thrombolysis, regional cerebral blood flow (CBF) was monitored by laser Doppler flowmetry. The neurological deficits, infarct volumes and mortalities in each group were determined.

The CBF in ischemic hemisphere were significantly (p<0.05) decreased after embolism in groups A!E at similar levels (27.32±8.20% to 34.71±6.84%). After different treatments, in group B 4,000U/min infusion of UK induced the best reperfusion, the least neurological deficits and infarct volume, as well as the least mortality and lowest incidence of hemorrhage.

The effect of intra-artery thrombolysis of urokinase was related to the infusion rate. Our study demonstrated an optimal infusion rate at 4,000U/min, suggesting relatively low levels of infusion are better able to improve brain reperfusion and reduce brain injury after stroke.
Outcome Evaluation of Carotid Stenting in High-Risk Patients with Symptomatic Carotid near Occlusion
Authors: Choi B.S. , Park J.W. , Shin J.E. , Lü P-H. , Kim J.K. , Kim S.J. , Lee D.H. , Kim J.S. , Kim H.J. , Suh D.C.
Published: January 2017

Management of symptomatic carotid near occlusion especially in high-risk patients is different from outcome analysis of NASCET. We evaluated outcome in high-risk patients with symptomatic near occlusion.

For 48 patients with near occlusion out of 166 symptomatic high-risk patients who underwent carotid stenting, we assessed the procedural success defined as residual stenosis <30%, modified Rankin Scale (mRS) at one and six months following stenting, and the 13 cerebrovascular factors related to the outcome. Initial National Institutes of Health Stroke Scale (NIHSS) ≥4, 1–3 and 0 were 13, 14 and 21 patients each. We compared the outcome with patients who underwent CAS (n=118) due to symptomatic stenosis without near occlusion during the same period.

Our procedural success rate was 98%. A good outcome (mRS ≤2) was achieved in 44 patients (92%) at six months. There were five events (10%) within six months, i.e. three minor strokes, one major stroke caused by hemorrhage, and one death excluding two deaths not related to stroke. Hyperperfusion (n=4) was the most common cause of events leading to two minor strokes and a major stroke. Although initial NIHSS (P = .012) was related to poor outcome (mRS >2) compared to the CAS group, there was no statistical significance between two groups in the event rate of stroke, death or restenosis.

The outcome of carotid stenting in high-risk patients with symptomatic near occlusion did not reveal any difference compared with CAS. Poor outcome was related to the initial NIHSS (≥4). Hyperperfusion tended to be more commonly related to an event occurring after stenting.
Cervical Automated Discectomy
Authors: Theron J. , Huet H. , Coskun O.
Published: January 2017

The lumbar automated discectomy system described by Onik has been used in the treatment of cervical disk herniations whose symptomatology resisted medical treatment. Experience on 150 patients is reported showing a 74.5% success rate.

This series performed in most cases on an outpatient basis had no complications. Up to 1992 failure cases were treated by intradiscal injections of triamcinolone with 62% of success. This complementary technique was abandonned after the description of epidural calcifications secondary to this type of injections in the lumbar area.

Since 1992, failure cases have been managed differently with injections of steroids in the cervical joints, especially when a hypertrophy of the ligamentum flavum supposedly a sign of an inflammatory posterior component of the pain was demonstrated on the CT. Nine patients received intradiscal injections of microdoses (600 IU) of chymopapaine with excellent results. No patient has had open surgery since 1992.

It is concluded that percutaneous automated discectomy is a very promising and safe technique which can be used as a first choice technique for most cervical disk herniations resisting medical treatment.
Spinal Cord Arteriovenous Fistula Associated with a Giant Venous Pouch in a Three-Year-Old Child
Authors: Gaikwad S.B. , Mishra N.K. , Goyal M. , Padma M.V. , Sharma A.
Published: January 2017

An unusual case of direct spinal cord arteriovenous fistula (SCAVF) associated with a large venous pouch in a three-year-old child is presented.

Features of this rare vascular lesion on MRI and selective angiography are described.
Allergic Rhinitis: Natural History. A Twenty Years Follow up Study
Authors: Passàli D. , Damiani V. , Passàli G.C. , Passàli F.M. , Bellussi L.
Published: January 2017

Although there is an agreement on the increase of the prevalence of allergic rhinitis in last decades, data emerging from various studies appear to be widely dishomogeneous. Another point that needs a clarification is the relationship between allergic rhinitis and lower airways pathologies such as asthma or bronchitis.

In this study, we followed the evolution of allergic rhinitis in a group of patients in the last 20 years to highlight the efficacy of different treatments in the prevention of complications, specifically asthma. Patients who didn't receive any kind of treatment experimented a remission of symptoms in 4 cases, a stability of the disease in 6 and the development of complications in 11. In the group treated with symptomatic drugs we highlighted a recovery in 11 patients, a stability of symptoms in 2 and complications in 2. At last, patients undergone immunotherapy considered their symptoms improved in 60 % and stable in 40 % of cases.

In conclusion, Immunotherapy guarantees, in a large number of patients, remission of local symptoms and valid protection against district and bronchial complications. Symptomatic treatment with antihistamines and/or cortisones represents a valid alternative, and it's always to be preferred to abstention from any treatment.
Serological Follow-up of Patients with Erythema Migrans: Persistence of Antibody Response to Borrelia Burgdorferi in Lyme Disease Patients
Authors: Christova I. , Komitova R.
Published: January 2017

The rate of seroconversion before treatment and antibody kinetics after treatment were analyzed and possible interpretations of serologic findings was proposed. Serum samples from 219 patients with Erythema migrans were tested by ELISA for antibodies against B. burgdorferi. Twenty-eight (28 %) to 55 % of the patients showed isolated IgM antibody response, 3–5 % showed isolated IgG response, 6–16 % showed concomitant IgM and IgG responses, and 24–63 % tested seronegative depending on number of days passed after the onset of Lyme borreliosis. One year after treatment, 38 % of the patients still had IgG response and 10% had IgM antibodies against B. burgdorferi. Furthermore, 4 of 106 seronegative patients revealed IgM response three months after treatment despite lack of signs or symptoms of active Lyme borreliosis. We concluded that persistence of antibody response is not indicative of treatment failure, although regular clinical and laboratory examinations, including PCR, should follow successful treatment.
Bisphosphonates Treatment in Metastatic Prostate Cancer
Authors: Berardinelli F. , Iannucci M. , Verratti V. , Fusco W. , Nicolai M. , Tenaglia R.L.
Published: January 2017

The skeleton is the third most common site for cancer to spread after the liver and lungs. Malignancies that can cause destruction of skeletal bones include multiple myeloma and metastatic diseases of the lung, prostate and other solid cancers. The clinical complications include pain, fractures, compression of the spinal cord and hypercalcemia of malignancy. Bisphosphonates are bone-seeking agents originally designed to treat loss of bone density. Accumulating data show that they are effective in diseases in which there is upregulation of osteoclastic or osteolytic activity. Bisphosphonates can reduce skeletal-related events and bone pain, as well as reduce the adverse effects of androgen deprivation therapy on skeletal integrity. However, it is clear that bisphosphonates do not represent a decisive treatment in the care of metastases but a therapeutic choice in synergy with regular anti-tumor drugs. The preclinical and clinical data to support this are reviewed here.
RT-PCR Based Mutation Detection of the Inflammatory Molecules Elastase II Gene Encoding Neutrophil Elastase in Cyclic Neutropenia Patients by Capillary Sequencing
Authors: Ahangari G. , Farhoudi A. , Chavoshzadeh Z. , Ramyar A. , Jamshidi S.H.
Published: January 2017

Cyclic neutropenia is characterized by the maturation arrest of myeloid cells at the promyelocyte stage of hematopoiesis. In cyclic neutropenia, due to the disorder of neutrophil production, patients are predisposed to recurrent bacterial infections. Detected mutations in neutrophil elastase (ELA2) gene in genomic DNA of cyclic neutropenia were recently reported. Peripheral blood was obtained from 18 patients with cyclic neutropenia and 20 healthy individuals. Total RNA was isolated using RNA standard techniques from fresh separated cells by polymorphoprep. Elastase II mRNA expression was analyzed by employing reverse transcription PCR amplification using a total of ten specific primers. We amplified five exon of ELA2 gene separately and sequenced each exon. Mutational analysis was performed by directed capillary sequencing method. We found mutations in 15 out of 18 cyclic neutropenia patients (83%) and no mutation in 20 healthy individuals. Most of the mutations were in exon 4 and fewer mutation were found in exon 1.
Morphological Modifications in Osteoarthritis: A Scanning Electron Microscopy Study
Authors: Scaramuzzo L. , Manicone P.F. , Graci C. , Muratori F. , Spinelli M.S. , Damis G. , Raffaelli L. , Maccauro G.
Published: January 2017

The chondrocyte, the only cellular component of adult articular cartilage, plays a key role in the pathogenesis of osteoarthritis (OA). The evolution of this process is very slow: the first changes involve the cell-matrix morphofunctional unit known as chondron. In this study we analyzed the cartilage of 10 patients with primary osteoarthritis. The cartilage was retrieved during total knee replacement (TKR) and maxillofacial surgery procedures. All patients presented an osteoarthritis of at least grade III. The preparation of the specimens was made by taking cartilage from both well-preserved and macroscopically degenerated areas. Specimens underwent histological evaluation with conventional staining and ultrastructural analysis. Age appeared to be a high risk factor in the development of articular cartilage damages. Depth of injury was also found to be age-related as more extensive lesions were found in the elderly, either in the knee or in the mandibular condyle. Whatever the cause of possible damage, Scanning Electron Microscopy (SEM) observations showed that at the beginning most degenerative changes in articular cartilage involved the chondron unit, a concept first introduced by Benninghoff. These changes generally go through three phases. During OA progression all degenerative changes begin from the chondron, which is why it is extremely important to understand the molecular anatomy and physiology of this pericellular microenvironment and its form, function and failure in adult articular cartilage. It is also fundamental to understand the mechanism of adaptation of the cartilage and bone disruptions, given the physiological relationship between these tissues, essential to maintain normal joint structure and function.
Rapid CCL2 Release by Membrane Stromal Cells Initiates Monosodium Urate Crystal-Induced Monocyte Recruitment in a Peritoneal Model of Gouty Inflammation
Authors: Liu X. , Chia E. , Shaw O.M. , Martin W-J. , Harper J.L.
Published: January 2017

Monocyte recruitment is a characteristic feature of the inflammatory response to monosodium urate (MSU) crystals in gout, however the specific cell population(s) responsible for initiating this event is unclear. We therefore investigated the contribution of resident and stromal cell populations to the initiation of MSU crystal-induced inflammatory cytokine and chemokine production in a peritoneal murine model of gout. Depletion of resident macrophages decreased neutrophil infiltration but did not affect MSU crystal-induced monocyte recruitment in vivo despite a significant decrease in overall CCL2 production. Activation of isolated resident peritoneal cells and peritoneal membrane with MSU crystals in vitro indicated that resident peritoneal cells, more specifically resident macrophages, were primarily responsible for the production of the neutrophil chemokine CXCL1, whereas CCL2 was exclusively produced in membrane cultures. Primary culture of membrane mesothelial cells followed by MSU crystal stimulation resulted in CD14-independent CCL2 release from intracellular stores. These findings confirm that MSU crystal-induced neutrophil recruitment is dependent on CXCL1 production by resident macrophages. Conversely, monocyte infiltration may be primarily initiated by the release of low level CCL2 by stromal cells in the surrounding tissue. As such, the synovial tissue in the joint may play a direct role in regulating inflammation in gout.
Kmup-1 Protects Kidney from Streptozotocin-Induced Pro-Inflammation in Early Diabetic Nephropathy by Restoring Enos/Pparγ and Inhibiting MMP-9
Authors: Hong T.Y. , Guh J.Y. , Wu B.N. , Chai C.Y. , Huang H.T. , Chen I.J.
Published: January 2017

KMUP-1 increases nitric oxide (NO) via endothelium nitric-oxide synthase (eNOS). Deficiency of eNOS and peroxisome proliferator-activated receptor-γ (PPARγ) is the pathogenesis of diabetic nephropathy (DN). This study aims to investigate whether KMUP-1 inhibits streptozotocin (STZ)-induced proinflammation in early DN. In experiments, STZ was used to induce diabetes in Wistar rats. Twenty-four male rats were randomly divided into four groups, including control, STZ (65 mg/kg, i.p.), STZ+KMUP-1(1 mg/kg) and STZ+KMUP-1 (2.5 mg/kg). KMUP-1 HCl was dissolved in distilled water for oral administration. The morphology of renal tissues was evaluated by periodic acid-schiff (PAS) staining and immunohistochemistry of eNOS. The expressions of matrix metalloproteinase-2/-9 (MMP-2/-9), eNOS, B-cell lymphoma 2 (Bcl-2), Bcl-2– associated X protein (Bax) and PPARγ of renal tissues were examined by Western blotting technique. NO production was evaluated by Griess reagent. Oxidative stress was evaluated by measuring reactive oxygen species (ROS). Results indicated that STZ-induced diabetic mellitus (DM) and subsequent DN, including excessive deposition of extracellular matrix (ECM) accompanied by enhanced MMP-2/-9, raised ROS production, increased Bcl-2/Bax ratio and decreased eNOS/PPARy over a period of 4 weeks. KMUP-1 inhibited STZ-induced hyperglycemia, BUN, MMP-2/MMP-9, and restored eNOS-PPARγ expression in renal tissues. Immunohistochemistry (IHC) of eNOS in glomeruli of renal cortical tissue sections indicated that KMUP-1 restored the eNOS caused by STZ. PAS staining of glomeruli indicated that KMUP-1 could not significantly reduce STZ-induced ECM expansion. Moreover, KMUP-1 increased Bcl-2/Bax and decreased ROS. In summary, KMUP-1 inhibits STZ-induced proinflammation in early DN by restoring PPARγ/eNOS and inhibiting MMP-9.
Release of High Mobility Protein Box-1 is Greatly Regulated by Nuclear Factor of Activated T Cell-2 in Human Monocytes
Authors: Liu H. , Zhao Q. , Song Q. , Zhou F-H. , Kang H-J. , Pan L. , Yao Y-M.
Published: January 2017

Close talk between inflammatory mediators and immunological cytokines has been discovered and reported. In this study, the role of nuclear factor of activated T cell-2 (NFAT2) in regulation of high mobility group box-1 (HMGB1) release was investigated. THP-1 cell and HEK293T cell were incubated and stimulated by lipopolysaccharide (LPS). Firstly, binding site between HMGB1 and NFAT2 was identified by co-immunoprecipitation (IP). Box A, Box B and CT domain of HMGB1 were constructed, as well as Rel-homology-domain (RHD), pre-RHD and pro-RHD of NFAT2. THP-1 cell was harvested, cell lysate and culture medium were collected at appointed times. Binding between HMGB1 and NFAT2 was measured, HMGB1 protein level in culture medium was analyzed at the same time. Secondly, the role of NFAT2 in regulating HMGB1 release was investigated. When THP-1 cell was cultured for 24 h, HMGB1 protein level was measured at appointed times with or without siRNA to inhibit NFAT2 expression. Our data show that HMGB1 bound to NFAT2 in THP-1 cell cytoplasm. Further experiments showed that box B domain of HMGB1 could bind to pre-RHD of NFAT2. After stimulation by LPS, interaction between HMGB1 and NFAT2 was discovered decreasing gradually. However, HMGB1 protein level increased in culture medium at the same time. Furthermore, HMGB1 release could be enhanced by NFAT2 inhibition. Taken together, release of HMGB1 could be regulated by NFAT2 in human monocytes.
Caspase-1-Deficient Mice are More Susceptible Than Wild-Type Mice to Pneumonia Induced by Influenza A (H1N1)
Authors: Liew A.A. , Narasaraju T. , Phoon M.C. , Wang S. , Tan K.B. , Chow V.T.
Published: January 2017

Although inflammasome-mediated caspase-1 activity and subsequent maturation of IL-1β are critical in host immune response against influenza, their roles in lung pathogenesis are not completely understood. Enhanced susceptibility of caspase-1-deficient mice to influenza has been attributed to decreased inflammation and augmented epithelial damage, while increased IL-1β release has been shown to exacerbate lung pathology. We challenged caspase-1-knockout and wild-type mice with high doses of influenza A (H1N1) virus (500 pfu). Only 10% mortality occurred in wild-type mice, in contrast to 40% mortality in caspase-1-knockout mice which exhibited severe pathologic manifestations as a result of overwhelming inflammatory and cytokine/chemokine responses. Infected caspase-1 knockout mice revealed neutrophil-dominant recruitment and elevated apoptotic inflammatory cells in the lungs, while 20% of these animals displayed focal lymphocytic infiltrates in the brains suggestive of mild focal encephalitis. In infected caspase-1 knockout mice, cytokine/chemokine levels were reduced at 3 days post-infection, but robust increase in the levels of TNF-α, IL-6, MIP-1α, MCP-1, MIP-1β and RANTES were observed at 6 days post-infection, coinciding with exaggerated neutrophil influx. These results support our previous findings implicating excessive neutrophil infiltration in pathologic complications during influenza pneumonia. In addition, we observed an induction of IL-1β release in caspase-1 knock-out mice at 6 days post-infection, indicating the involvement of caspase-1-independent activation of IL-1β. Microarray analyses of the lungs of infected caspase-1 knockout mice revealed upregulation of immune and inflammatory genes including CCL8, CCL4, IFN-γ, ICOS, PRF-1, KLRA4, KLRA7, KLRA18, NKG7, LTB4R and PTX3. Collectively, our data suggest that caspase-1-mediated effects are critical against severe influenza infection which can also trigger robust caspase-1-independent inflammatory responses, thus alluding to the complexity of innate immune regulation.
Dress Syndrome Induced by Sulphasalazine
Authors: Pałgan K. , Bartuzi Z.
Published: January 2017

DRESS syndrome (Drug rash with eosinophilia and systemic symptoms) is a severe drug-induced hypersensitivity syndrome characterized by diffuse skin rash, fever, eosinophilia, atypical lymphocytes and organ involvement. We report a case of drug reaction with eosinophilia and systemic symptoms (DRESS) to sulphasalazine. A 54-year-old woman developed a widespread papulovesicular rash after treatment with sulphasalazine (1000 mg daily). She was successfully treated with systemic corticosteroids.