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Cureus Mar 2024Guidelines for the treatment and management of ischemic strokes triggered by stenosis versus dissection are well established. However, the presence of both entities in...
Guidelines for the treatment and management of ischemic strokes triggered by stenosis versus dissection are well established. However, the presence of both entities in the same patient, although rare, poses challenges for short- and long-term treatment. Here, we describe the case of a 55-year-old man who presented to the emergency department with a 72-hour history of headache, dizziness, unbalanced gait, nausea, and two episodes of vomiting. Stroke was initially suspected, but the computerized tomography (CT) scan showed no hemorrhage. His magnetic resonance imaging (MRI) showed right inferior cerebellar acute ischemia in the territory of the right posterior inferior cerebellar artery (PICA), with smaller foci of early acute infarcts in the bilateral inferior cerebellum. Furthermore, magnetic resonance angiography (MRA) and CT angiography revealed right vertebral artery stenosis and left cervical internal carotid artery dissection (ICAD). This clinical report describes a rare case of stroke secondary to vertebral artery stenosis with concomitant carotid artery dissection. The treatment course and evolution are presented.
PubMed: 38586807
DOI: 10.7759/cureus.55598 -
Journal of Korean Neurosurgical Society Apr 2024Microscopic microvascular decompression (MVD) has been considered to be a useful treatment modality for medically refractory hemifacial spasm (HFS) and trigeminal...
OBJECTIVE
Microscopic microvascular decompression (MVD) has been considered to be a useful treatment modality for medically refractory hemifacial spasm (HFS) and trigeminal neuralgia (TN). But, the advent of the endoscopic era has presented new possibilities to MVD surgery. While the microscope remains a valuable tool, the endoscope offers several advantages with comparable clinical outcomes. Thus, fully endoscopic MVD (E-MVD) could be a reasonable alternative to microscopic MVD. This paper explores the safety and efficacy of the fully E-MVD technique.
METHODS
A single-center retrospective study was conducted in 25 patients diagnosed with HFS between September 2019 and July 2023. All surgeries were performed by a single neurosurgeon using the fully E-MVD technique without any assistance of a microscope. The study reviewed intraoperative brainstem auditory evoked potentials and disappearance of the lateral spread response. Outcomes were assessed based on the patients' clinical status immediately after surgery and at their last follow-up. Complications, including facial palsy, hearing loss, ataxia, dysphagia, palsy of other cranial nerves, and cerebrospinal fluid (CSF) leakage, were also examined.
RESULTS
The most common offending artery was the anterior inferior cerebellar artery (AICA) in 15 cases (60.0%), followed by the posterior inferior cerebellar artery (PICA) in 8 cases (32.0%), vertebral artery (VA) in 1 case (4.0%), tandem lesions involving the AICA and VA in 1 case (4.0%). Ten patients (40.0%) had pre-operative facial palsy on the ipsilateral side, and 8 patients (32.0%) experienced delayed facial palsy on the ipsilateral side, from which they fully recovered by the last follow-up. The median operation time was 105 minutes. All patients were symptom free immediately after surgery and at the last follow-up. One patient experienced a permanent complication, such as high-frequency hearing loss, from which he partially recovered over time.
CONCLUSION
Fully E-MVD demonstrated similar clinical outcomes to microscopic MVD. It offered a similar complication rate, shorter operation time, and a panoramic view with a smaller craniectomy size. Although there is a learning curve associated with fully E-MVD, it presents a viable alternative in the endoscopic era.
PubMed: 38583999
DOI: 10.3340/jkns.2024.0003 -
Neurosurgical Review Apr 2024Vertebrobasilar artery dissecting aneurysms (VBDAs) are the most surgically challenging type of aneurysm. Cerebral revascularization is the ultimate treatment for...
Vertebrobasilar artery dissecting aneurysms (VBDAs) are the most surgically challenging type of aneurysm. Cerebral revascularization is the ultimate treatment for complex VBDAs. We retrospectively analysed the characteristics, surgical outcomes and follow-up data of 21 patients who underwent cerebral revascularization to treat complex VBDAs from 2015 to 2022. According to the location of the aneurysm and the anatomic relationship between the VBDA and the PICA, VBDA patients were classified into four groups: aneurysms located at the VA with PICA involvement (10 patients), aneurysms located at the VA without PICA involvement (1 patient), aneurysms located at the basilar apex segment (1 patient) and aneurysms located at the basilar trunk segment (9 patients). A surgical algorithm for complex VBDAs was determined primarily by the location of the aneurysm, the status of the aneurysm and the ability of retrograde blood flow to reach the proximal vertebrobasilar artery. Surgical modalities for patients with aneurysms in the VA with PICA involvement included low-flow (OA-PICA) bypasses with aneurysm trapping, aneurysm excision or reconstructive clip in 8 patients and STA-PCA bypass combined with PICA preservation and aneurysm trapping in 2 patients. In patients with aneurysms in the VA without PICA involvement, aneurysm excision was performed without cerebral bypass. In patients with aneurysms in the basilar apex segment, high-flow bypass (ECA-RA-P2) with aneurysm trapping was performed. In patients with aneurysms in the basilar trunk segment, surgical modalities included high-flow bypasses (ECA-RA-P2 and LVA-RA-P2) with aneurysm trapping or proximal occlusion in 6 patients, ECA-RA-P2 bypass with partial proximal occlusion in 1 patient, ECA-RA-P2 bypass alone in 1 patient, and STA-PCA bypass with R-VA narrowing in 1 patient. Of the 21 patients, 20 experienced clinical improvement or no change, and 17 of 21 patients achieved favourable functional outcomes (mRS ≤ 2). However, one patient died of infarction and respiratory failure postoperatively. Aneurysms were completely obliterated in 13 patients, shrank in 5 patients and stabilized in 2 patients. The median follow-up period was 32.5 months. During the follow-up period, all bypasses were patent, and further clinical improvement was observed in 11 patients. Cerebral revascularization appears to be safe and effective for the treatment of complex VBDAs, and cerebral revascularization could act as a complementary treatment strategy.
Topics: Humans; Cerebral Revascularization; Intracranial Aneurysm; Retrospective Studies; Neurosurgical Procedures; Arteries; Treatment Outcome
PubMed: 38578572
DOI: 10.1007/s10143-024-02365-5 -
Global Pediatric Health 2024To assess levels of 25(OH)D among adolescents with symptoms of pica in northern Sudan. A cross-sectional study was conducted in North Sudan. Questionaries were used to...
To assess levels of 25(OH)D among adolescents with symptoms of pica in northern Sudan. A cross-sectional study was conducted in North Sudan. Questionaries were used to collect adolescents' sociodemographics. The enzyme-linked immunosorbent assay was used to measure 25(OH)D level. Of the 344 adolescents enrolled, 161 (46.8%) and 183 (53.2%) were male and female, respectively and 103 (29.9%) had symptoms of pica. The median (IQR) of 25(OH)D level was significantly lower in adolescents with symptoms of pica. Multiple linear regression analysis showed that while age (coefficient = 1.1, = .023) was positively associated with 25(OH)D level, female sex (coefficient = -7.5, P < .001), and pica symptoms (coefficient = -3.5, = .032) were negatively associated with 25(OH)D level. Adolescents with symptoms of pica had lower 25(OH)D levels. Adolescents with symptoms of pica have to be assessed for vitamin D status.
PubMed: 38577659
DOI: 10.1177/2333794X241242564 -
BioRxiv : the Preprint Server For... Mar 2024Targeting proteins to specific subcellular destinations is essential in prokaryotes, eukaryotes, and the viruses that infect them. Chimalliviridae phages encapsulate...
UNLABELLED
Targeting proteins to specific subcellular destinations is essential in prokaryotes, eukaryotes, and the viruses that infect them. Chimalliviridae phages encapsulate their genomes in a nucleus-like replication compartment composed of the protein chimallin (ChmA) that excludes ribosomes and decouples transcription from translation. These phages selectively partition proteins between the phage nucleus and the bacterial cytoplasm. Currently, the genes and signals that govern selective protein import into the phage nucleus are unknown. Here we identify two components of this novel protein import pathway: a species-specific surface-exposed region of a phage intranuclear protein required for nuclear entry and a conserved protein, PicA, that facilitates cargo protein trafficking across the phage nuclear shell. We also identify a defective cargo protein that is targeted to PicA on the nuclear periphery but fails to enter the nucleus, providing insight into the mechanism of nuclear protein trafficking. Using CRISPRi-ART protein expression knockdown of PicA, we show that PicA is essential early in the chimallivirus replication cycle. Together our results allow us to propose a multistep model for the Protein Import Chimallivirus (PIC) pathway, where proteins are targeted to PicA by amino acids on their surface, and then licensed by PicA for nuclear entry. The divergence in the selectivity of this pathway between closely-related chimalliviruses implicates its role as a key player in the evolutionary arms race between competing phages and their hosts.
SIGNIFICANCE STATEMENT
The phage nucleus is an enclosed replication compartment built by Chimalliviridae phages that, similar to the eukaryotic nucleus, separates transcription from translation and selectively imports certain proteins. This allows the phage to concentrate proteins required for DNA replication and transcription while excluding DNA-targeting host defense proteins. However, the mechanism of selective trafficking into the phage nucleus is currently unknown. Here we determine the region of a phage nuclear protein that targets it for nuclear import and identify a conserved, essential nuclear shell-associated protein that plays a key role in this process. This work provides the first mechanistic model of selective import into the phage nucleus.
PubMed: 38562762
DOI: 10.1101/2024.03.21.585822 -
Radiology Case Reports Jun 2024A 56-year-old healthy woman presented with subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm and was treated with internal trapping of the...
A 56-year-old healthy woman presented with subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm and was treated with internal trapping of the affected site including the aneurysm. She suffered rebleeding due to recanalization of the aneurysm 5 days after the first treatment. Because of the close proximity of the coil mass to the posterior inferior cerebellar artery (PICA) origin at first treatment, additional coil embolization by tight packing of the coil mass was planned. However, navigation of the microcatheter into the coil mass was challenging due to the tightly packed coil mass. Thus, a Marathon microcatheter, which has narrower outer diameter and is designed for liquid embolization, was used and successfully placed into the coil mass in an anterograde fashion. Thereafter, the DAC was advanced just proximal to the coil mass to reduce the kickback of the microcatheter during deployment of the coils and avoid the coil mass expansion toward the PICA origin, resulting in complete obliteration of the aneurysm with PICA preservation. Follow-up angiography performed 6 months after the second treatment showed complete obliteration of the aneurysm. The patient's course was uneventful after 1 year following the second treatment, with a modified Rankin Scale score of 1. Therefore, coil embolization through the tightly packed coil mass using a Marathon microcatheter is feasible. A low-profile DAC is also useful for enabling physicians to push the coil deployed through the flexible Marathon microcatheter.
PubMed: 38559661
DOI: 10.1016/j.radcr.2024.02.075 -
Cureus Feb 2024The genus of bacteria is a group of Gram-negative rod-shaped bacteria in the Enterobacteriaceae family. It is an uncommon cause of infection in humans except in...
The genus of bacteria is a group of Gram-negative rod-shaped bacteria in the Enterobacteriaceae family. It is an uncommon cause of infection in humans except in specific settings, including hospital-acquired infections and in immunocompromised patients. In this report, we describe the case of a 12-year-old girl with sickle cell disease who presented with a picture of sepsis and was found to have species in her blood culture which was treated with antibiotics with a good response. From our literature review, risk factors were identified in the reported cases, for which further exploration is highly recommended.
PubMed: 38558673
DOI: 10.7759/cureus.55122 -
Open Veterinary Journal Feb 2024Camels are subjected to a wide variety of nutritional deficiencies as they are largely dependent upon grazing desert plants. As a consequence, the syndrome of pica or...
BACKGROUND
Camels are subjected to a wide variety of nutritional deficiencies as they are largely dependent upon grazing desert plants. As a consequence, the syndrome of pica or depraved appetite is occasionally seen in dromedary camels. The condition is manifested as chewing or eating abnormal things such as wood, dirt, bones, stones, clothes, plastics, mud, sand, or other inanimate objects.
AIM
This study was designed to investigate the clinical, ultrasonographic, and postmortem findings in dromedary camels with pica or depraved appetite.
METHODS
Twenty-five camels of 5 days to 15 years were examined. Owner complaints included depraved appetite, loss of body condition, regurgitation of stomach content, and partial or complete absence of feces. Symptoms described were present for a period varying between 3 days, up to 12 months. The stomach compartments and small and large intestines were scanned using ultrasonography from the right and left sides of the abdomen. Necropsy was carried out on six female and three male camels where the thoracic and abdominal organs were examined with special attention to the digestive system.
RESULTS
The affected animals had a history of gradual loss of body conditions, eating foreign objects, decreased or total absence of feces, and regurgitation of stomach content. Using ultrasound, the foreign body was imaged occluding completely or partially the intestines. Foreign bodies within the rumen could not be visualized with ultrasound. In cases where the rumen is impacted by sand, small pin-points revealing acoustic enhancement were imaged. Foreign bodies were removed from the rumen at exploratory rumenotomy ( = 11), laparotomy ( = 3), or at necropsy ( = 8) in the form of plastics, cloths, sand, mud, wool balls, robes, glasses, or even metallic objects which may be blunt or sharp. Sixteen (64%) of the camels were recovered while the remaining 9 (36%) did not survive.
CONCLUSION
The syndrome of pica or depraved appetite is an important condition in dromedary resulting in the ingestion of objects other than normal feed. Substantial economic losses are expected as a result of this syndrome. Ultrasonography of the digestive system may help the clinician in some cases to localize of occluding foreign bodies in the intestines, while in the transabdominal scanning of the stomach is valuable only in cases of sand impaction.
Topics: Animals; Camelus; Appetite; Pica; Sand; Foreign Bodies
PubMed: 38549572
DOI: 10.5455/OVJ.2024.v14.i2.5 -
Journal of Cerebrovascular and... Mar 2024Percutaneous techniques for femoral arterial access are increasingly being performed due to advances in endovascular cerebral procedures, as they provide a less morbid...
Percutaneous techniques for femoral arterial access are increasingly being performed due to advances in endovascular cerebral procedures, as they provide a less morbid and minimally invasive approach than open procedures. Common complications associated with this peripheral puncture include hematoma, bleeding, pseudoaneurysm, arteriovenous fistula, retroperitoneal bleeding, inadvertent venous puncture, dissection, etc. The retrograde femoral access is currently the most frequently used arterial access as it is technically straightforward, allows for the use of larger size sheaths and catheters, allows repeated attempts, etc. Although being technically less challenging, grave complications can occur due to hardware failure. Here, we present a case of unruptured posterior inferior cerebellar artery (PICA) aneurysm, who underwent uneventful diagnostic cerebral digital substraction angiography (DSA) via right femoral artery route on first attempt, but on second attempt for therapeutic intervention, landed up with stuck guide wire and faced decannulation difficulty due to unravelling of guide wire and multiple knot formation, which was finally removed after multiple attempts at pulling and improvised manoeuvres. Such cannulation and decannulation difficulties have been reported multiple times for central venous access, but extremely rarely for femoral routes, making this case a rarity and worth reporting.
PubMed: 38528441
DOI: 10.7461/jcen.2024.E2023.06.002 -
Reumatismo Mar 2024To report cross-sectionally serum levels of 25-hydroxyvitamin D [25(OH)D] in women living in Italy within 12 months from breast cancer (BC) diagnosis. (Clinical Trial)
Clinical Trial
OBJECTIVE
To report cross-sectionally serum levels of 25-hydroxyvitamin D [25(OH)D] in women living in Italy within 12 months from breast cancer (BC) diagnosis.
METHODS
Baseline data were obtained from 394 women diagnosed with primary BC, enrolled from 2016 to 2019 in a lifestyle trial conducted in Italy. Subjects' characteristics were compared between two 25(OH)D concentrations (hypovitaminosis D<20 and ≥20 ng/mL) with the Chi-squared test or Fisher's exact test for small-expected counts. Using multiple logistic regression-adjusted models, we estimated odds ratios (ORs) of hypovitaminosis D with 95% confidence intervals (CIs) in the total sample and in the unsupplemented subgroup.
RESULTS
Hypovitaminosis D was found in 39% of all subjects, 60% in unsupplemented subjects, and 10% in supplemented subjects. Increasing ORs of hypovitaminosis D were found with increasing body mass index, 25-30, >30, and ≥35 versus <25 kg/m2 (ORs: 2.50, 4.64, and 5.81, respectively, in the total cohort and ORs: 2.68, 5.38, and 7.08 in the unsupplemented); living in the most southern Italian region (OR 2.50, 95%CI 1.22-5.13); and with hypertriglyceridemia (OR 2.46; 95%CI 1.16-5.22), chemotherapy history (OR 1.86, 95%CI 1.03-3.38), and inversely with anti-estrogenic therapy (OR 0.43, 95%CI 0.24-0.75) in the total sample.
CONCLUSIONS
Hypovitaminosis D in women recently diagnosed with BC and participating in a lifestyle trial in Italy was widespread and highest with obesity, hypertriglyceridemia, and chemotherapy use. Considering that hypovitaminosis D is a risk factor for lower efficacy of bone density treatments and possibly BC mortality, our results suggest the need to promptly address and treat vitamin D deficiency.
Topics: Female; Humans; Breast Neoplasms; Hypertriglyceridemia; Italy; Life Style; Risk Factors; Vitamin D; Vitamin D Deficiency
PubMed: 38523582
DOI: 10.4081/reumatismo.2024.1632