Middle cerebral artery stroke in chronic heart failure patient: a case report

Middle cerebral artery (MCA) stroke describes the sudden onset of a focal neurologic deficit resulting from hemorrhagic or ischemic disruption of the MCA's blood supply. Ischemic stroke is frequently divided into several etiological categories, including atherosclerotic, cardio embolic, lacunar, and cryptogenic. Chronic heart failure (CHF) is also common cause of ischemic stroke. A 66-year-old male patient came to the emergency room at Kasih Ibu Gianyar Hospital with complaints of suddenly not being able to talk since 8 hours before entering the hospital. There is weakness on the right side of the upper extremities, and weakness on the right and left lower extremities. The patient has a history of chronic heart failure since 3 years. A thorax X-ray showed atherosclerosis. Computed tomography (CT) scan showed acute thromboembolic ischemic infarction in the left temporoparietal lobe in the left MCA territory. The causal relation between CHF and ischemic stroke represent manifestations of similar underlying risk factors, such as hypertension and diabetes mellitus. The pathophysiological mechanism of chronic heart failure can be at risk of causing a stroke infarction in large blood vessels in the brain such as the MCA, and patient MCA Stroke with CHF has high risk of recurrent stroke.

Correlation of cerebral blood flow velocity with haematocrit in neonates at risk of polycythaemia: a COHORT study

Background: The incidence of polycythemia is 1.5-4% of all live births. To diagnose polycythemia, a venous hematocrit is necessary, and polycythaemia is linked to changes in cerebral blood flow. The primary objective is to compare cerebral blood flow velocity (CBFV) and resistance index (RI) between polycythemia and normocythemia groups. The secondary objective is to correlate the peak systolic velocity (PSV) of anterior and middle cerebral arteries (ACA and MCA) with hematocrit in neonates at risk for polycythemia.Methods: In a prospective observational study, babies with a gestational age of >35 weeks and a risk factor for polycythaemia were enrolled in the study. Free-flowing venous blood was sent for haematocrit measurement between 2 and 6 hours of life. Repeat PCV is sent to babies with a prior value of PCV >65% at 36 hours of life or before discharge. PSV, end diastolic velocity (EDV), RI of ACA and MCA were measured using Mindray portable ultrasound machine with a mini- curved ultrasound transducer (8-13 mhz). Data is entered in excel and analysed.Results: Out of 75 enrolled babies, 19 had polycythaemia. The mean PSV盨D of MCA was 27.84�04 cm/s and 27.27�74 cm/s in the normocythemia and polycythemia groups, respectively, at 6 hours of life, which is statistically insignificant. The mean PSV盨D of MCA was 31.41�92 cm/s and 29.61�57 cm/s in normocythemia and polycythaemia groups, respectively, at 36 hours of life, which is statistically insignificant too.Conclusions: Cerebral Doppler values did not correlate with haematocrit between the normocythemia and polycythemia groups in the neonates at risk of polycythemia.

Study of Cerebral Hemispheric Lateralization in Stroke and the Arterial Territories Involved in High-risk Patients

Introduction: According to WHO, Stroke is the 2nd leading cause of death and disability after Ischemic heart disease. Prevalence rate of stroke in India varies from 44.45 to 150 per lakh population. Studies have reported a higher frequency of stroke of the left hemisphere. The artery reported to be the most affected is Left Middle Cerebral artery(MCA) followed by Right Middle Cerebral artery. The aim of this study is to determine the side of cerebral hemisphere most affected by stroke and the arterial territories involved in high?risk patients aged above 35 years presenting to the tertiary healthcare centre, as well as to study the sex predilection of stroke. Materials and Methods: A cross?sectional prospective study of 50 high risk stroke patients with Diabetes Mellitus(DM) and /or Hypertension(HTN) presenting to General medicine OPD of a tertiary healthcare centre were investigated with CT/MRI for the side of the cerebral hemisphere affected and the arterial territories involved. The data was tabulated over the course of three months and statistical analysis was carried out. Results: The left cerebral hemisphere was affected in 50%, right in 40% and bilateral involvement was found in 10% patients. Slight predilection of stroke towards the left was seen, however it was not found to be statistically significant (P?value= 0.249). MCA territory was involved in 66% of the patients, Posterior Cerebral Artery(PCA) territory in 8%, Vertebrobasilar Artery(VB) territory in 8%, Anterior Cerebral Artery(ACA) territory in 6% and MCA+ACA in 4%, MCA+VB in 2% and MCA?PCA watershed in 6% patients. Conclusions: We found a slight predilection of stroke towards the left, which was however, not found to be statistically significant.We also found that Middle Cerebral Artery(MCA) territory is the most commonly involved in stroke.

The value of clinical trial medication and yearly medicine cost avoidance from clinical trials conducted by the pharmaceutical industry in Finland

Background:Clinical trials have been reported to cause medication cost avoidance (MCA) for hospitals and societies, but there are no studies documenting MCA from the Nordic countries or from the pharmaceutical industry perspective. Methods:Three different methods were tested for determining the yearly MCA in clinical trials conducted by the pharmaceutical industry in Finland.MCA was evaluated with questionnaires to pharmaceutical companies operating in Finland in 2001, 2009 and 2013. Results:In method 1 (year 2001), the MCA in Finland was 70.3 million eurosin wholesale price and 50.9 million euros when excluding patients receiving placebo treatment. In method 2 (2009), the MCA was 52.0 million euros in wholesale price and 71.0 million euros in out-sale price i.e. including pharmacy fee and tax. The MCA in method 3 (2013) was 47.2 million euros in wholesale price. The collection of data and the MCA calculation was simple in method 1 (response rate 100%). The methods 2 and 3 were more precise but more time-consuming for the respondents, somewhat affecting the response rate (response rates 90% and 72%, respectively).Conclusions:All three methods covered the majority of industry-sponsored clinical medicine trials (64-100%) representing 59-63 % of all clinical trialsconducted in Finland in those years. Regardless of the methods, the study medications provided by the pharmaceutical industry promoted significant cost saving for the society. We recommend method 1 for a general and less time consuming MCA calculation andmethod 3 for a more precise calculation, to be conducted in survey formatand interview

Doppler sonographic evaluation of intrauterine growth restriction of fetus and its correlation with perinatal outcomes among the population of riverine (char) areas of Barpeta Assam

Background: Intrauterine growth restriction (IUGR) also known as fetal growth restriction (FGR), has been associated with a variety of detrimental perinatal outcomes. FGR is defined as estimated fetal weights (EFW) or abdominal circumference (AC) that fall within the third, or tenth percentiles with abnormal doppler parameters. FGR affects 10-15% of all pregnancies around the world.Methods: Prospective observational study of singleton pregnant women complicated by FGR were enrolled during the study period from September 2021 to August 2022. 100 patients were included in the study.Results: Abnormal umbilical artery flow was seen in 30% of cases, out of which 83% (25) had abnormal perinatal outcome. Out of 100 cases, live births were reported in 94%, stillbirths in 4%, and IUDs in 2%. There were 16 neonatal deaths and 15 neonatal complications among the adverse perinatal outcomes. Intraventricular hemorrhage and neonatal sepsis were the two leading causes of death. Neonatal sepsis, necrotizing enterocolitis and hypoxic ischemic injury was the leading cause of morbidity. Reverse end diastolic umbilical artery Doppler and bilateral uterine artery notch had 100% mortality. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of umbilical artery in predicting perinatal outcome in IUGR were 80.65%, 92.75%, 83.33% 91.43% and 89.47% respectively.Conclusions: Umbilical artery PI is the most sensitive parameter and had highest positive and negative predictive value and Accuracy in relation to adverse perinatal outcomes.

India China Trade Relations Impact on Economy: A Review Study

In this paper I have studies that both China and India have an extended history of international trade going back centuries ago, both their economies were until recently highly protected and controlled to a large extent albeit that their political systems are very different. China is still a very unique case in the sense that while it has allowed its economy to be opened to Capitalists MNCs, it is still governed by the Communist Party with a strong leadership not giving away state power. China and India are two neighboring countries in Asia who share the two largest population of the world and in fact added together they represent nearly one third of humanity. Globalization has imposed internal pressure and external pressure to bear on both India and China. For most Chinese and Indians alike, economic life is hard despite the fact that reforms and globalization have created various new opportunities

A relative study on cerebral hemodynamic changes after unilateral superficial temporal artery-middle cerebral artery(STA-MCA)bypass surgery / 中国脑血管病杂志

Objective To investigate the hemodynamic,cerebral perfusion and neurological function changes between unilateral symptomatic internal carotid artery occlusion(SICAO)and symptomatic middle cerebral artery occlusion(SMCAO)after superfical temporal artery-middle cerebral artery(STA-MCA)bypass surgery as well as the correlation between relative peak volume of blood flow(rPVOL)in STA measured by carotid Doppler ultrasonography(CDU)and relative cerebral blood flow(rCBF)by CT perfusion(CTP).Methods Retrospective analysis of 112 patients who diagnosed with unilateral SICAO or SMCAO through DSA and/or CT angiography(CTA)and underwent superficial temporal artery-middle cerebral artery(STA-MCA)bypass in the Department of Neurosurgery at First Affiliated Hospital of Soochow University from March 2019 to June 2022.The patients were divided into SICAO group(50 cases)and SMCAO group(62 cases)and followed up for 360 days.General clinical and imaging data of patients in two groups were collected.General clinical information included age,gender,clinical manifestations(stroke,transient ischemic attack[TIA]),hypertension,diabetes,smoking history,blood biochemical indicators(total cholesterol,triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,high-sensitivity C-reactive protein),National Institute of Health stroke scale(NIHSS)scores at admission and 7 days after surgery,and modified Rankin Scale(mRS)scores at admission and 7,180 and 360 days after surgery(mRS scores 2 as good prognosis,＞2 as poor prognosis).Imaging data included hemodynamic parameters(STA diameter[D],resistance index[RI],time-averaged-mean velocity[TAMV],and time-average-peak flow velocity[TAPV])evaluated by CDU within 7 days before and 7,30,180 and 360 days after STA-MCA bypass,as well as CTP parameters(rCBF,relative cerebral blood volume[rCBV],relative mean transit time[rMTT]and relative time to peak[rTTP])of the head region of interest(ROI)before and 7,180 and 360 days after surgery.Patients were observed 1 year after surgery through outpatient or telephone follow-up to determine if they have experienced recurrent stroke(TIA,cerebral infarction,etc.)and other postoperative complications(subdural hematoma,cerebral hemorrhage,etc.).DSA imaging was also performed to determine the patency of vascular anastomosis of patients in SICAO and SMCAO groups.STA hemodynamic parameters,head CTP parameters,NIHSS scores,and mRS scores at different time points before and after STA-MCA bypass surgery were compared between SICAO and SMCAO groups correspondingly;STA hemodynamic parameters,head CTP parameters,and mRS scores were pairwise compared between different time points within each group.A correlation analysis was conducted between rCBF and rPVOL in STA which was measured by CTP and CDU accordingly in the SICAO and SMCAO groups to further determine the consistency of the blood flow through STA and intracranial cerebral blood flow.Results(1)There was no statistically significant difference in general clinical data between the two groups(all P＞0.05).(2)Comparison of STA hemodynamic parameters:D,TAMV,and TAPV of both groups significantly increased at 7,30,180,and 360 days after surgery(all P＜0.05)compared with preoperative,and reaching their peak at 7 days after surgery,and there was no statistically significant difference in D,TAMV,and TAPV among 30,180,and 360days after surgery(all P＞0.05).There was no statistically significant difference in D,TAMV,or TAPV between the two groups at each time point(D:F=2.286,TAMV:F=0.180,TAPV:Wald x=1.709;all P＞0.05).RI of the two groups was significantly reduced at 7,30,180,and 360 days after surgery(all P＜0.05)compared with preoperative,and there was no statistically difference in RI among 7,30,180,and 360 days after surgery(all P＞0.05).There was also no statistically difference in RI between the two groups at each time point(Wald x2=0.788,P＞0.05).(3)Comparison of CTP parameters between two groups:compared to preoperative,rCBF and rCBV in the SICAO group and SMCAO group increased at 7,180,and 360 days after surgery(all P＜0.05),there was no statistically difference in CTP parameters within the two groups at different time points(Wald x2 was 0.177,2.954,respectively,all P＞0.05),and the rMTT and rTTP of both groups decreased at 7,180,and 360 days after surgery(all P＜0.05),there was no significant difference in rMTT and rTTP between the two groups at different time points(Waldx2 was 2.157,1.706,respectively,all P＞0.05),and there was no statistically difference in the parameters of each postoperative time point within each group(all P＞0.05).(4)Comparison of vascular patency between two groups:1 year DSA showed that 91.1％(102/112)of patients were patent,with 92.0％(46/50)in the SICAO group and 90.3％(56/62)in the SMCAO group.There was no statistically difference between the two groups(x2=0.001,P＞0.05).The STA hemodynamics and intracranial CTP parameters of the two groups of patients with patent anastomosis were significantly improved compared to preoperative.A total of 10 patients were non-patent by 1 year DSA,including 4 cases in the SICAO group and 6 cases in the SMCAO group.In 1 non-patent SICAO patient and 3 non-patent SMCAO patients,the STA hemodynamic parameters evaluated by CDU 180 days and 360 days after surgery also showed corresponding improvement compared to preoperative,with an increase in TAMV and TAPV,and a decrease in RI.(5)Comparison of neurological improvement between the two groups:compared with preoperative,the mRS scores of the SICAO group and the SMCAO group significantly decreased at 7,180,and 360days postoperatively(all P＜0.05);there was no statistically difference in the mRS scores within each group at 7,180,and 360 days after surgery(P＞0.05).There was no statistically difference in mRS scores between the two groups at different time points including admission and 7,180 and 360 days after surgery(Wald x2=0.006,P＞0.05).The NIHSS scores of the SICAO group and the SMCAO group decreased at 7 days after surgery compared to admission(Z was 21.040,-5.183,respectively,all P＜0.01),and there was no statistically difference in NIHSS scores between the two groups at admission and 7 days after surgery(both P＞0.05).(6)Spearman rank correlation analysis showed that rPVOL and rCBF were highly positively correlated in the SICAO group(r=0.865,P＜0.01)and in the SMCAO group(r=0.864,P＜0.01).Conclusions Unilateral STA-MCA bypass can improve cerebral perfusion and neurological function in patients with SICAO and SMCAO,and there is no statistical difference between the two groups of patients.The rPVOL measured by CDU was highly correlated with the rCBF in patients after STA-MCA bypass surgery.

EC-IC Bypass: "Learning Curve" Experiences of Initial 100 Bypasses in Bangladesh / Bypass EC-CI: Experiências de "curva de aprendizado" de desvios iniciais em Bangladesh

Objectives Extracranial to intracranial (EC-IC) bypass is an important part of the armamentarium of a neurosurgeon in managing different vascular and neoplastic pathologies. Here, we report our initial experiences of EC-IC bypasses as experiences in the 'learning curve', including preparation and training of the surgeon, getting cases, patient selection, imaging, operative skills and microtechniques, complications, follow-up, and outcome. Lessons learned from the 'learning curve experiences' can be very useful for young vascular neurosurgeons who are going to start EC-IC bypass or have already started to perform and find themselves in the learning curve. Methods From July 2009 to September 2018, 100 EC-IC bypasses were performed. We looked back to these cases of EC-IC bypass as our initial or 'learning curve' experiences. The recorded data of patient management (EC-IC bypass patient) were reviewed retrogradely. Our preparation for EC-IC bypass was described briefly. Case selection, indications, preparation of the patient for operation, techniques and technical experiences, preoperative difficulties and challenges, postoperative follow-up, complications, patency status of the bypass, and ultimate results were reviewed and studied. Result A total of 100 bypasses were performed in 83 patients, of which 43 were male and 40 were female. The age range was from 04 to 72 years old (average 32 years old). Eleven patients were lost to follow-up postoperatively after 3 months and they were not even available for telephone follow-up. The follow-up period ranged from 3 to 120 months (average of18.4 months). Eight bypasses were high flow bypasses, whereas the number of low flow STA-MCA bypasses was 92. Indication of bypass were (in 83 cases):1. Arterial stenosis/occlusion/dissection causing cerebral ischemia (middle cerebral artery [MCA] stenosis/occlusion-05, MCA dissection-04, internal carotid artery [ICA] occlusion-19); 2. Intracranial aneurysm-30; 3. Moya-Moya disease-21; and 4. Direct carotid cavernous fistula [CCF]-04. Common clinical presentation was hemiparesis & dysphasia in ischemic group with history of transient ischemic attack (H/O TIA) (including Moya Moya disease). Features of subarachnoid hemorrhage (SAH) were the presenting symptoms in intracranial aneurysm group. The average ischemic time, due to clamping of recipient artery, was 28 minutes (range: 20­60 minutes). There was no clamp-related infarction. Two anastomoses were found thrombosed intraoperatively. One preoperatively ambulant patient deteriorated neurologically in the postoperative period. She developed hemiplegia but improved later. Here, the cause seemed to be hyperperfusion. Headache resolved in all cases. TIA and seizures were also gone postoperatively. Ophthalmoplegia recovered in all cases in which it was present, except in one CCF, in which abducent nerve palsy persisted. Complete unilateral total blindness developed in one patient postoperatively (due to ophthalmic artery occlusion), where high flow bypass with ICA occlusion were performed. Red eye and proptosis were cured in CCF cases. Motor and sensory dysphasia improved in all cases in which it was present, except for one case in which preoperative global aphasia converted to sensory aphasia in the postoperative period. Three patients died in the postoperative period. The rest of the patients improved postoperatively. All patients were ambulant with static neurostatus and without new stroke/TIA until the last follow-up. All bypasses were patent until the last follow-up. Conclusion The initial experiences of 100 cases of EC-IC bypass revealed even in inexperienced hand mortality and morbidity in properly indicated cases were low and result were impressive according to the pathological group and aim of bypass. Lessons learned from these experiences can be very helpful for new and beginner bypass neurosurgeons.

Revascularizacion cerebral en el moyamoya del adulto / Cerebral revascularization in adult moyamoya

Introducción: el Moyamoya (MM) es una enfermedad crónica esteno-oclusiva de los vasos arteriales intracraneanos asociado al desarrollo secundario de arteriolas dilatadas en la base del cerebro. La historia natural de la enfermedad predispone a infartos y/o hemorragias cerebrales. El objetivo del presente trabajo es mostrar nuestra experiencia en el manejo quirúrgico del MM del adulto. Material y método: se realizó una revisión retrospectiva de 11 pacientes adultos con diagnóstico de MM tratados entre mayo 2014 y mayo 2020. Se analizaron las historias clínicas, estudios diagnósticos, protocolos y videos operatorios. En el preoperatorio se utilizó la escala angiográfica de Suzuki y para la valoración clínica pre y postoperatoria la escala de Rankin modificada. Resultados: se operaron 11 pacientes (8 femeninos), 9 son portadores de EMM y 2 con SMM secundario a NF1 y enfermedad de Hashimoto. Se realizaron 16 procedimientos de revascularización en 11 pacientes (en 5 pacientes la revascularización cerebral fue bilateral), 12 fueron combinados (bpTS más EDMS) y en 4 sólo sinangiosis tipo EDAMS.El aumento del flujo sanguíneo cerebral se constató en todos los casos mediante ADC luego de los 6 meses de la cirugía. La permeabilidad del bpTS se comprobó en 10 de 12 bpTS (83.3 %) y la revascularización de la sinangiosis fue muy buena en todos los pacientes. El 82 % de los pacientes mejoraron un punto o más en la escala de Rankin y un paciente presentó un infarto frontal en TAC postoperatoria sin repercusión clínica. Conclusiones: la evolución natural de la enfermedad conduce al deterioro neurológico por ACV isquémico y/o hemorrágico. En nuestra experiencia, la mejor opción terapéutica en el adulto es la revascularización cerebral combinada porque disminuye la incidencia de ACV con resultados favorables y escasa morbilidad

Introduction: Moyamoya is a chronic steno-occlusive disease of the intracranial vessels associated to the secondary development of dilated arterioles at the base of the brain. The natural history of the disease predisposes to cerebral infarcts and/or hemorrhages. The objective of this paper is to show our experience and surgical management of adult moyamoya. Materials and Methods: retrospective review of 11 adult patients with moyamoya treated from May 2014 to May 2020 was performed. Clinical charts, neuroimaging studies, operative records and surgical videos were analyzed. The Suzuki scale was used as a preoperative score, and the modified Rankin scale was used for pre and postoperative clinical assessment. Results: Eleven patients (8 females) were operated at our Institution: 9 are MMD and 2 MMS secondary to NF1 and Hashimoto disease. We performed 16 cerebral revascularizations in 11 patients (in 5 patients thecerebral revascularization was bilateral), 12 were combined (STA-MCA bypass plus EDMS) and in only 4 EDAMS synangiosis was done.The increase in cerebral blood flow was verified in all cases by follow-up DSA at 6 months. The STA-MCA bypass permeability was verified in 10 of 12 cases (83.3%) and the revascularization by synangiosis was demonstrated in all patients. Clinical follow-up showed that 82 % of the patients improved one point or more on the modified Rankin scale and one patient presented a frontal infarction on postoperative CT without clinical worsening. Conclusions: The natural course of the disease leads to neurological deterioration due to ischemic and hemorrhagic stroke. According to our experience, the best therapeutic option in adults is combined cerebral revascularization because it decreases the incidence of stroke with good results and low morbidity

Rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis technique / 器官移植

Objective To explore the feasibility of rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis (MCA) technique. Methods Twelve healthy adult crossbred dogs were evenly divided into the MCA and hand suturing (HS) groups according to the anastomosis method between abdominal aorta and artificial blood vessels. The intraoperative duration of abdominal aorta occlusion, intraoperative condition of anastomotic stoma and postoperative imaging examination of anastomotic stoma were compared between two groups. Results The intraoperative duration of abdominal aorta occlusion in the MCA group was significantly shorter than that in the HS group [(5.2±2.3) min vs. (24.4±4.3) min, P < 0.001]. No anastomotic leakage of blood or anastomotic stenosis occurred in the MCA group during the operation. Intraoperative anastomotic leakage of blood occurred in all of the 6 dogs in the HS group. Among them, 1 dog died of excessive blood loss, and 2 dogs experienced mild anastomotic stenosis due to repeated repair. Postoperative color Doppler ultrasound and angiography showed smooth blood flow at the anastomotic stoma without stenosis or thrombosis in the MCA group. In the HS group, 4 dogs presented with anastomotic stenosis on angiography at postoperative 4 weeks. Conclusions MCA technique may achieve rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models, which reduces the incidence of anastomotic complications and accelerates postoperative recovery.

Decompressive craniectomy for malignant middle cerebral artery territory infarct: an institutional experience

Background: Decompressive craniectomy is the surgical procedure to reduce intracranial pressure, refractory to medical measures. We have described our experience associated with the clinical profile, radiological profile, postoperative status and long term outcome in patients with malignant middle cerebral artery (MCA) territory infarct.Methods: Data were collected from patients who underwent hemispheric decompressive craniectomy for malignant MCA territory infarct in our hospital from May 2014 to June 2019. Clinical, radiological, surgical profile and long term outcome were studied.Results: There were a total of 51 patients aged between 28 years to 76 years. Hypertension (70%) was the most common comorbidity associated. All the patients had at least one focal neurological deficit at the time of presentation. Mean time from the first symptoms to surgery was 2.4 days (about 58 hours). 7 patients died within one month of the surgery. Two third improved objectively within 1 month of surgery. Out of 44 patients, who survived beyond one month, none of the patients were functionally independent after one year of surgery (modified Rankin scale (mRS) of 0 or 1). The patients had a mean mRS of 3.8 at one year.Conclusions: Over several decades decompressive craniectomy has been found to be the most effective measure to reduce mortality and morbidity associated with malignant MCA territory infarct. Early surgery (<48 hours) in patients with good Glasgow Coma scale score reduces the mortality. Larger multicentric trials are required to look at the long term effect on morbidity and mortality.

Análise do efeito do tratamento com nanopartículas de prata (AGNO3 ) revestidas com pectina sobre a angiogênese induzida pelas células do Tumor de Ehrlich em modelo da membrana corioalantoidea / Analysis of the effect of treatment of silver nanoparticles (AgNO3 ) with pectin-coated on ehrlich tumor cell-induced angiogenes in the chorioalantoid membrane model

Avaliou-se a interferência das nanopartículas de prata sobre a angiogênese relacionada ao crescimento tumoral. A pesquisa científica foi realizada através da incubação de 42 ovos embrionados de galinhas. Após 24 horas de incubação, esses mesmos ovos foram separados em seis grupos contendo sete ovos cada, para os tratamentos com: Grupo 1: Soro fisiológico; Grupo 2: Tumor de Ehrlich (TE); Grupo 3: Nanopartículas de prata; Grupo 4: Prednisolona; Grupo 5: Nanopartículas de prata e Tumor de Ehrlich; Grupo 6: Prednisolona e Tumor de Ehrlich. Após o tempo total de incubação, as membranas corioalantoideas (MCAs) foram removidas, e analisadas através do microscópio de luz e fotografadas. O grupo 1 apresentou um padrão normal de crescimento e foi utilizado como controle negativo; O grupo 2 apresentou um aumento na quantidade de vasos sanguíneos; o grupo 3 apresentou baixa interferência na angiogenese embrionária e não contribuiu para o desenvolvimento do tumor; O grupo 4 demonstrou diminuição no desenvolvimento de vasos sanguíneos; O grupo 5 indicou que as nanopartículas de prata, quando associadas ao TE, não favorece o desenvolvimento tumoral e o grupo 6 demonstrou que o fármaco prednisolona associado ao TE, se comporta como um excelente inibidor de neoangiogese tumoral. Considera-se através da técnica realizada a possibilidade de utilizar nanopartículas de prata para o tratamento de células tumorais de Ehrlich, porém devem ser realizados testes confirmatórios para estudar a relação da substância descrita às células tumorais empregadas.

The interference of silver nanoparticles on angiogenesis related to tumor growth was evaluated. Scientific research was carried out by incubating 42 embryonated chicken eggs. After 24 hours of incubation, these same eggs were separated into six groups containing seven eggs each, for treatments with: Group 1: Saline; Group 2: Ehrlich's tumor (ET); Group 3: Silver nanoparticles; Group 4: Prednisolone; Group 5: Silver nanoparticles and Ehrlich's Tumor; Group 6: Prednisolone and Ehrlich's Tumor. After the total incubation time, the chorioallantoid membranes (MCAs) were removed, and analyzed using a light microscope and photographed. Group 1 showed a normal growth pattern and was used as a negative control; Group 2 showed an increase in the amount of blood vessels; group 3 showed low interference in embryonic angiogenesis and did not contribute to the development of the tumor; Group 4 demonstrated a decrease in the development of blood vessels; Group 5 indicated that silver nanoparticles, when associated with TE, do not favor tumor development and group 6 demonstrated that the drug prednisolone associated with TE, behaves as an excellent inhibitor of tumor neoangiogenesis. Through the technique performed, the possibility of using silver nanoparticles for the treatment of Ehrlich tumor cells is considered, however, confirmatory tests should be performed to study the relationship of the substance described to the tumor cells employed.

Establishment and evaluation of a monkey acute cerebral ischemia model

OBJECTIVES: Cerebral ischemia seriously threatens human health and is characterized by high rates of incidence, disability and death. Developing an ideal animal model of cerebral ischemia that reflects the human clinical features is critical for pathological studies and clinical research. The goal of this study is to establish a local cerebral ischemia model in rhesus macaque, thereby providing an optimal animal model to study cerebral ischemia. METHODS: Eight healthy rhesus monkeys were selected for this study. CT scans were performed before the operation to exclude cerebral vascular and intracranial lesions. Under guidance and monitoring with digital subtraction angiography (DSA), a microcatheter was inserted into the M1 segment of the middle cerebral artery (MCA) via the femoral artery. Then, autologous white thrombi were introduced to block blood flow. Immediately following embolization, multisequence MRI was used to monitor cerebrovascular and brain parenchymal conditions. Twenty-four hours after embolization, 2 monkeys were sacrificed and subjected to perfusion, fixation and pathological examination. RESULTS: The cerebral ischemia model was established in 7 rhesus monkeys; one animal died during intubation. DSA and magnetic resonance angiography (MRA) indicated the presence of an arterial occlusion. MRI showed acute local cerebral ischemia. HE staining revealed infarct lesions formed in the brain tissues, and thrombi were present in the cerebral artery. CONCLUSION: We established a rhesus macaque model of local cerebral ischemia by autologous thrombus placement. This model has important implications for basic and clinical research on cerebral ischemia. MRI and DSA can evaluate the models to ensure accuracy and effectiveness.

Assessing cytotoxicity and antiproliferation effects of Sida rhombifolia against MCA-B1 and A549 cancer cells

This research aims to determine the cytotoxicity and antiproliferation activities of Sida rhombifolia leavesextract against cancer cells MCA-B1, A549, and normal Vero cells. Sida rhombifolia leaves were extractedwith ethanol using ultrasonication method and fractionated using n-hexane, ethyl acetate, and water. The testedsamples were ethanol extract and n-hexane fraction based on the results of cytotoxicity using the Brine ShrimpLethality Test. The antiproliferation activity test by using Trypan Blue Dye method and the cells harvested afterconfluence on the third or fourth day and the total cells were calculated by using the Neubauer Hemocytometer.The result showed that the inhibitory activity of ethanol extract at a concentration of 500 ppm is 69.44% withIC50 202.556 ppm on MCA-B1 cancer cells and 69.44% with IC50 276.836 ppm on A549 cancer cells, whilethe n-hexane fraction at a concentration of 1,000 ppm was 64.13% with IC50 425.969 ppm in MCA-B1 cancercells and 57.18% with IC50 786.617 ppm on A549 cancer cells. After being tested on normal Vero cells, theinhibition of normal Vero cells proliferation is not more than 1%. This indicates that ethanol extracts andn-hexane fraction are safe for normal cells and analysis by using LC-MS/MS showed a benzazepine compoundin the ethanol extract of S. rhombifolia is known for its role as antiproliferation. These results indicate thatS. rhombifolia leaves extract has the potential to be developed as anticancer compounds..

Multidisciplinary treatment discussion of a personalized approach of laparoscopic right hemicolectomy for variant middle colic artery and ileocolic vein / 中国肿瘤临床

Objective: To investigate the variants of middle colic artery (MCA) and ileocolic vein (ICV) and their influence on the deci-sion regarding approach of laparoscopic right hemicolectomy. Methods: We analyzed the diagnosis and treatment of one right colon cancer patient with variant MCA and ICV who was admitted to the Tianjin Medical University Cancer Hospital in March 2018. The pa-tient underwent laparoscopic right hemicolectomy via a limited medial approach after a multidisciplinary treatment (MDT) discussion. Following were the observation indicators: 1) surgical and postoperative recovery situations; 2) postoperative pathological examina-tion; and 3) follow-up situation. Results: 1) Surgical and postoperative recovery situations: the patient successfully underwent laparo-scopic right hemicolectomy via a limited medial approach. No intraoperative or postoperative complications occurred. Duration of postoperative hospital stay was 11 days. 2) Postoperative pathological examination: the number of dissected lymph nodes was 39. Postoperative pathological tumor stage was pT3N0. Postoperative pathological tumor type was moderately differentiated adenocarci-noma. 3) Follow-up situation: the patient was followed-up for 10 months with disease-free survival. Conclusions: Individual and stan-dard surgery will be the best choice for treating colon cancer patients. MDT can facilitate clinical decision-making and benefit patients.

A Clinical Study On Topographical Analysis Of Vascular Territories In Stroke With Clinical And Etiopathogenesis

Stroke incidence is currently increasing in India, compared to Western countries. Mostly it’s attributed to risk factors like hypertension, diabetes, smoking, and dyslipidemia and alcohol consumption. Risk factors are poorly controlled with insufficient infrastructure and inadequate public awareness, poor rehabilitation services contributes for increasing prevalence of the stroke with disability. This clinical study focussed on topographical analysis of vascular territories involved in stroke with clinical and etipathogeneis contributing stroke.

#meuprimeiroassédio: interações de mulheres violadas / #myfirstharassment: interactions of raped women

O rompimento da integridade física, psíquica, moral e sexual do indivíduo configura-se em um ato de violência. Mulheres de todas as idades frequentemente são vítimas de violência exercida pela "força-potência-dominação" empregada por homens e respaldada pela cultura patriarcal, que estabelece relações hierárquicas assimétricas entre os gêneros. Gênero é uma construção social que naturaliza condutas de ambos os sexos. Comumente utiliza-se a terminologia "violência de gênero" como sinônimo de violência contra a mulher. Além desse uso não evidenciar para qual dos lados, feminino ou masculino, o vetor da dominação aponta, ele também não denuncia como a dominação masculina ocorre e não analisa as relações homem-mulher resultantes deste controle. De forma a preencher essa lacuna, este trabalho utiliza o embasamento teórico-conceitual de violência patriarcal contra a mulher para problematizar as análises deste estudo, evitando dúvidas em relação a como se configura o vetor de força-potência-dominação. O assédio sexual pode ser definido como qualquer forma de violência de natureza sexual, seja por meio de agressão física ou verbal, seja por meio de outros tipos de agressão; o assédio é uma via de manifestação do poder masculino sobre o feminino. No entanto, pesquisas mostram que mulheres não reconhecem o assédio como uma violência sexual, tampouco identificam situações que configuram assédio. A partir de um episódio de assédio sexual realizado na internet contra uma criança, o projeto feminista Think Olga criou a mobilização #MeuPrimeiroAssédio buscando promover o debate para a desnaturalização de violência sexual contra a mulheres. Esta pesquisa busca identificar as identidades reveladas a partir dos papéis sociais esperados de homens e mulheres pela cultura patriarcal nas interações ocorridas via publicações de participantes da mobilização #MeuPrimeiroAssédio. É um estudo de análise de dados naturalísticos amparado na Comunicação Mediada por Computador e pelo recorte metodológico êmico da Análise de Categorizações de Pertença e de Análise da Conversa. A análise das interações revelou três categorizações de pertença: (a) Meninas: infância, socialização, percepções e culpa, evidenciando a "socialização de gênero das meninas", "como as meninas vêem o abusador" e "a culpa relatada pelas meninas", (b) Mulher Ideal, revelando as identidades de "mulher bela", "mãe ideal" e "mulher obrigada a perdoar" e (c) Mulheres corajosas, imunes e educadoras, apresentando as identidades "mulheres corajosas", "mulheres imunes" e "mulheres educadoras". Outras possíveis categorizações podem ser buscadas nas interações que fizeram parte deste estudo e, espera-se que estes achados possam contribuir para melhorar o entendimento acerca do assédio sexual que acontece em nossa sociedade.

The breaking of physical, psychological, moral and sexual integrity of the individual is an act of violence. Women of all ages are often victims of violence exercised by the "force-power-domination" employed by men and backed up by patriarchal culture, which establishes asymmetrical hierarchical relations between genders. Gender is a social construction that naturalizes conduct of both sexes. The term "gender violence" is commonly used as synonym for violence against women. Besides not evincing which side, either male or female, the vector of domination points to, this terminology also does not denounce how male domination occurs and does not analyze man-woman relations resulting from this control. In order to fill this gap, this work uses the theoretical-conceptual basis of patriarchal violence against women to discuss the analysis of this study, avoiding doubts regarding how the force-power-domination vector is configured. Sexual harassment can be defined as any form of sexual violence, whether through physical or verbal aggression or through other types of aggression; harassment is a way of manifestation of male power over the feminine. However, researches show that women do not recognize harassment as sexual violence, nor do they identify situations that constitute harassment. From an online sexual harassment episode against a child, the feminist project Think Olga created the #MeuPrimeiroAssédio (#MyFirstHarassment) mobilization to promote the debate on the denaturalization of sexual violence against women. This research aims to identify the identities revealed from the expected social roles of men and women by the patriarchal culture in the interactions that took place via the publications of participants of the mobilization #MeuPrimeiroAssédio. It is a study of naturalistic data analysis based on the Computer-Mediated Communication (CMC) and the methodological cutoff of the Membership Categorization Analysis (MCA) and Conversation Analysis (CA). The analysis of the interactions revealed three Membership Categorizations: (a) Girls: childhood, socialization, perceptions and guilt, evidencing the "gender socialization of girls", "how girls see the abuse perpetrator" and "guilt reported by girls" (b) Ideal Woman, revealing the identities of "beautiful woman," "ideal mother" and "woman obligated to forgive," and (c) courageous, immune and educating women, presenting the identities "brave women", "immune women" and "Educating women". Other possible categorizations can be sought in the interactions that were part of this study, and it is hoped that these findings may contribute to improve the understanding about sexual harassment that happens in our society.

Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

PURPOSE: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. MATERIALS AND METHODS: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. RESULTS: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. CONCLUSION: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.

Emergent Double-barrel Bypass Shortly after Intravenous Administration of Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke

Although intravenous recombinant tissue plasminogen activator (IV rt-PA) is effective in many cases of acute ischemic stroke, the neurologic symptoms can worsen after IV rt-PA because of sustained vessel occlusion. For such cases, several reperfusion modalities are available, including intra-arterial thrombolysis (IAT), carotid endarterectomy, and superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Invasive procedures, such as major surgery, should be generally avoided within 24 hours after the administration of IV rt-PA. A 66-year-old man with no previous medical history developed left hemiparesis. A computed tomography scan revealed no acute lesion and he received IV rt-PA within 1.5 hours after symptom onset. Emergent magnetic resonance imaging showed significant diffusion-perfusion mismatch. He received IAT 2 hours after IV rt-PA administration, but IAT failed because of total occlusion of the cervical internal carotid artery. We initially planned to perform STA-MCA bypass the next morning because he had received IV rt-PA, but, 8 hours after IV rt-PA administration, his hemiparesis worsened from motor grade 3/4 to motor grade 1/2. Because of the large perfusion defect in both MCA divisions, double-barrel STA-MCA bypass was performed 10 hours after IV rt-PA administration. His symptoms rapidly improved after surgery and his modified Rankin Scale score 3 months later was grade 0. We suggest that emergent double-barrel bypass can be a viable option in patients who have perfusion defects of both MCA divisions in acute ischemic stroke after IV rt-PA administration.

Sequência anemia-policitemia em gêmeos: definição, classificação e tratamento / Twin anemia-polycythemia sequence: definition, classification and treatment

A presença de anastomoses vasculares placentárias nas gestações gemelares monocoriônicas favorece o surgimento de complicações graves como a Síndrome de Transfusão Feto-Fetal (STFF) e a Sequência Anemia-Policitemia em Gêmeos (TAPS). STFF e TAPS são ambas formas crônicas de transfusão feto-fetal. TAPS, descrita em 2007, é caracterizada por anemia crônica no gêmeo doador e policitemia no gêmeo receptor, na ausência de discordância no volume de líquido amniótico, característica da STFF clássica. O diagnóstico pode ser feito pré- e pós-natal. O critério diagnóstico pré-natal é baseado na discordância intergemelar da medida do Doppler do pico de velocidade sistólica da artéria cerebral média (PSV-ACM). O diagnóstico pós-natal é baseado na grande diferença da hemoglobina intergemelar, ao nascimento, e reticulocitose no gêmeo doador.(AU)

The presence of placental vascular anastomoses in monochorionic twins favors the development of several complications like Twin-Twin Transfusion Syndrome (TTTS) and Twin Anemia-Polycythemia Sequence (TAPS). TTTS and TAPS are both chronic forms of fetofetal transfusion. TAPS, described on 2007, is characterized by chronic anemia in the donor twin and polycythemia in the recipient twin, in the absence of amniotic fluid volume discordances, characteristic of classical TTTS. The diagnostic can be made pree posnatally. The prenatal diagnostic criteria is based on the inter-twin discordance in Doppler measurement of peak systolic velocity in the middle cerebral artery (MCA-PSV). The postnatal diagnosis is based on large intertwin hemoglobin difference at birth and retoculocytosis in the donor twin.(AU)