Tailored Vessel-Catheter Diameter Ratio in a Direct Aspiration First-Pass Technique: Is It a Matter of Caliber?

BACKGROUND AND PURPOSE: The aspiration technique has gained a prominent role in mechanical thrombectomy. The thrombectomy goal is successful revascularization (modified TICI ≥ 2b) and first-pass effect. The purpose of this study was to evaluate the impact of the vessel-catheter ratio on the modified TICI ≥ 2b and first-pass effect. MATERIALS AND METHODS: This was a retrospective, single-center, cohort study. From January 2018 to April 2020, 111/206 (53.9%) were eligible after applying the exclusion criteria. Culprit vessel diameters were measured by 2 neuroradiologists, and the intraclass correlation coefficient was calculated. The receiver operating characteristic curve was used for assessing the vessel-catheter ratio cutoff for modified TICI ≥ 2b and the first-pass effect. Time to groin puncture and fibrinolysis were weighted using logistic regression. All possible intervals (interval size, 0.1; sliding interval, 0.01) of the vessel-catheter ratio were plotted, and the best and worst intervals were compared using the χ2 test. RESULTS: Modified TICI ≥ 2b outcome was achieved in 75/111 (67.5%), and first-pass effect was achieved in 53/75 (70.6%). The MCA diameter was 2.1 mm with an intraclass correlation coefficient of 0.92. The optimal vessel-catheter ratio cutoffs for modified TICI ≥ 2b were ≤1.51 (accuracy = 0.67; 95% CI, 0.58-0.76; P = 0.001), and for first-pass effect, they were significant (≤1.33; P = .31). The modified TICI ≥ 2b odds ratio and relative risk were 9.2 (95% CI, 2.4-36.2; P = 0.002) and 3.2 (95% CI, 1.2-8.7; P = .024). The odds ratio remained significant after logistic regression (7.4; 95% CI, 1.7-32.5; P = .008). First-pass effect odds ratio and relative risk were not significant (2.1 and 1.5; P > .05, respectively). The modified TICI ≥ 2b best and worst vessel-catheter ratio intervals were not significantly different (55.6% versus 85.7%, P = .12). The first-pass effect best vessel-catheter ratio interval was significantly higher compared with the worst one (78.6% versus 40.0%, P = .03). CONCLUSIONS: The aspiration catheter should be selected according to culprit vessel diameter. The optimal vessel-catheter ratio cutoffs were ≤1.51 for modified TICI ≥ 2b with an odds ratio of 9.2 and a relative risk of 3.2.

Sex differences in clinical presentation, severity and outcome of stroke: results from a hospital-based registry.

BACKGROUND AND PURPOSE: Sex related differences in cardiovascular disease and stroke are issues of increasing interest. The aim of this study was to evaluate for sex differences in clinical presentation, severity of stroke and outcome in a population of patients admitted to 4 public and 1 private hospitals in three different regions of Italy. METHODS: All hospital admissions for ischemic and haemorrhagic stroke (ICD-IX code 434 and 431 respectively) between January 1st and December 31st, 2011 at five different hospitals located in three different regions of Italy: Milan (North), Rome and Perugia (Center), and Palermo (South) have been recorded and sex-differences have been evaluated. RESULTS: A total of 1272 stroke patients were included in the analysis: 1152 ischemic and 120 haemorrhagic strokes, 567 women and 705 men. Compared to men, women were significantly older (mean age 75.2 SD 13.7 vs 71.5 SD 12.5 years, P<0.001) and their stroke severities at onset, measured by NIHSS, were also compared to men (10 SD 8 vs 8 SD 7, P<0.001). Female sex was associated with a worse functional prognosis measured by modified Rankin Scale score (mRS≥3), as well as in-hospital mortality, without reaching statistical significance. There were no observed significant differences between sexes regarding the number of patients treated with thrombolytic therapy. Analysis of the distribution of risk factors between sexes showed a prevalence of atrial fibrillation in women (29% vs 21%, P=0.003). CONCLUSIONS: Both stroke severity and functional outcome were worse in women.

PKR is a novel functional direct player that coordinates skeletal muscle differentiation via p38MAPK/AKT pathways.

Myogenic differentiation is a highly orchestrated multistep process controlled by extracellular growth factors that modulate largely unknown signals into the cell affecting the muscle-transcription program. P38MAPK-dependent signalling, as well as PI3K/Akt pathway, has a key role in the control of muscle gene expression at different stages during the myogenic process. P38MAPK affects the activities of transcription factors, such as MyoD and myogenin, and contributes, together with PI3K/Akt pathway, to control the early and late steps of myogenic differentiation. The aim of our work was to better define the role of PKR, a dsRNA-activated protein kinase, as potential component in the differentiation program of C2C12 murine myogenic cells and to correlate its activity with p38MAPK and PI3K/Akt myogenic regulatory pathways. Here, we demonstrate that PKR is an essential component of the muscle development machinery and forms a functional complex with p38MAPK and/or Akt, contributing to muscle differentiation of committed myogenic cells in vitro. Inhibition of endogenous PKR activity by a specific (si)RNA and a PKR dominant-negative interferes with the myogenic program of C2C12 cells, causing a delay in activation of myogenic specific genes and inducing the formation of thinner myofibers. In addition, the construction of three PKR mutants allowed us to demonstrate that both N and C-terminal regions of PKR are critical for the interaction with p38MAPK and Akt. The novel discovered complex permits PKR to timely regulate the inhibition/activation of p38MAPK and Akt, controlling in this way the different steps characterizing skeletal muscle differentiation.

Hepatitis C virus core protein enhances B lymphocyte proliferation.

HCV chronic infection leads to liver diseases and also to a wide range of extrahepatic disorders including benign, but pre-lymphomatous forms (mixed cryoglobulinemia) to frank hematological neoplasia (non-Hodgkin's lymphoma). Recent data showed the involvement of p53 superfamily members in the pathogenesis of different lymphatic malignancies. In fact, tymomas and a subset of non-Hodgkin's lymphomas (NHLs) express high levels of p63. Thus, we analyzed whether alterations in p53 superfamily gene expression are observable in B lymphocytes isolated from HCV-infected patients with and without lymphoproliferative disorders. We showed, by real-time PCR, a significant induction of DNp63 mRNAs in B lymphocytes obtained from HCV-positive low grade non-Hodgkin's lymphoma patients. Since our current understanding of HCV proteins emphasizes the ability of the HCV core protein to deregulate the expression and activity of p53-related proteins, we established different B lymphocyte cell lines (Wil2-ns, Daudi and Ramos) stably expressing HCV core protein, in order to investigate the possible involvement of the viral protein in the upregulation of DNp63 in B lymphocytes. The analysis of p63 family transcripts showed no transcriptional changes for the p63 TA isoforms, whereas an increase (>5 times) of DNp63 mRNA occurred. In all cell lines, this abnormal expression was associated with a significant increase of cell proliferation that was specifically inhibited by silencing DNp63 mRNA. These findings suggest a pathogenetic role of the HCV core in HCV-related lymphomagenesis, through the induction of DNp63's pro-proliferative effects.

Respiratory allergy to Cupressus sempervirens in Rome.

Mediterranean Cypress pollen is the major aerospore component in winter and early spring. Several recent studies have assessed the incidence of respiratory allergy to this pollen. A personal series of patients encountered in 1994-96 revealed a 9.33% incidence of positive prick-test responses to Cypress pollen among a population with atopical status. That series included 16 (19.05%) single and 68 (80.95%) multiple allergy sufferers. Among the former the symptoms encountered were rhinitis (62.5%) and asthma (37.5%). Given the ever-increasing incidence of Cypress pollen allergy, there is a need to restrict the planting of the tree for ornamental purposes, especially in areas with a high pollen count.

[Study of spontaneous resolution of bronchial spasm after methacholine challenge. Comparison of patients with different degree of hyperreactivity]. / Studio della risoluzione spontanea del broncospasmo dopo PD con metacolina. Confronto tra pazienti con iperreattività di diverso grado.

The study was designed to assess the spontaneous recovery of bronchial spasm induced by methacholine in bronchial challenge tests and to examine the mechanisms and the modalities involved as well as the influence of dosage. The phenomenon was analysed in 32 hyperreactive patients diagnosed as asthmatics by measuring FEV1 as soon as maximum bronchial constriction (PD20) had been achieved and after 5, 10, 15, 30 and 60 minutes. The data obtained were subjected to variance analysis. Results show: 1) as regards duration of spontaneous recovery, that FEV1 returned to pre-challenge levels after 60 minutes in both the severely and moderately hyperreactive patients; 2) as regards onset of regression, that onset depended on the level of sensitivity, occurring after 30 minutes in the severely affected, after 15 minutes in the mild cases; 3) as regards recovery intensity, that in the moderated cases the recovery was more pronounced in the first 15 minutes than subsequently. Data show that the onset and intensity of the spontaneous recovery change according to the degree of sensitivity. That might reflect a greater affinity and/or bonding of methacholine in the muscarinic receptors of the severely affected, but the possibility of a difference in mediator metabolization speed cannot be excluded. In conclusion, research into the recovery of bronchial spasm may contribute to a better understanding of bronchial hypersensitivity and provide new information of value on the diagnosis, pathogenesis and treatment of the condition.

Sensitivity of FEV1 and indices of flow volume curve in the methacholine test.

Our aim was to asses the association between the decrease of FEV1 and the modifications of the indices (PEF, MEF25, MEF50 and MEF75% of FVC) during methacholine challenge. 105 patients of both sexes with mild bronchial asthma were included in this study and were subjected to methacholine test according to ATS standards. The results were analysed using analysis of variance (MANOVA), discriminant stepwise and multiple regression. The reduction of FEV1 induced by increasing dosage of methacholine was associated with a significant decrease of the other flow-volume curve indices but we can observe a different flow behaviour. The MEF50 was more significant during the first level of variations and the MEF75 and MEF25 being more significant during the subsequent phases. We conclude that the evaluation of the flow volume indices can be important for better study the site of action of methacholine.

Time course of methacholine induced bronchoconstriction during drugs and spontaneous resolution.

We examined the resolution of the bronchial spasm induced by methacholine after administration of a dose sufficient to provoke PD20 to study, in patients with bronchial asthma, how spontaneous resolution (as opposed to bronchodilator-induced resolution) takes place. According to a randomization criterion, the patients were divided into four groups: 1) resolution induced by salbutamol (S), 2) by ipratropium bromide (I), 3) after placebo (P) and 4) spontaneous resolution (R). In brief, we observed that variations in FEV1 after methacholine PD20, reach statistically significant levels after 15 minutes in patients from groups (S) and (I), after 30 minutes in patients from groups (P) and (R) (p < 0.05). Comparing the phenomenon at various intervals in the four experimental situation, we found a pairing trend: groups (S) and (I) on the one hand, and groups (P) and (R) on the other. On the whole, this phenomenon shows that pharmacological treatment accelerates the process of spontaneous resolution of the bronchial spasm induced by methacholine which, in our experience, beings to show after 15 minutes, and that after 60 minutes, there are no statistically significant differences in the four groups. It is our opinion that closer examination of this phenomenon may provide greater knowledge of the mechanisms that come into play during the phase after stimulation of the muscarinic receptors and that reasonably involve the system to eliminate the muscarinic drug.

Respiratory allergy to parietaria pollen in 348 subjects.

We have revisited 348 records of allergic outpatients to Parietaria, ratio M/F 1:1 and mean age 29.46 +/- 12.49 yrs. 97 of them were skin positive to Parietaria only (A-group: M/F 37/60); 251 patients were skin positive also to other allergens (B-group: M/F 137/114). Mean age of A-group patients (35.41 +/- 12.91) was higher than B-group (27.16 +/- 11.54; p < 001). Dividing mono and polysensitized subjects by age decade, a different distribution was found between the two groups (p < 001): monosensitized patients showed an increasing number of subjects from the 3rd to the 4th decade and a decreasing trend in the following decades; polysensitized patients showed a prevalence in age < 20 yrs and a decreasing trend in the other decades. In B-group Gramineae were the most frequent allergens associated to Parietaria (84.8%) followed by Olea Europaea (41.1%), Dermatophagoides farinae (37.4%) and Dermatophagoides pteronyssinus (36.2%). Main symptoms were rhinoconjunctivitis (187 cases), rhinitis + asthma (141 cases) and bronchial asthma (20 cases). Comparing the clinical features of the two groups, we have found that monosensitized patients showed a female prevalence, a prevalence of rhinitis with late onset of symptoms while in patients suffering from isolated asthma the onset was early.