Do Outcomes between Women and Men Differ after Endovascular Thrombectomy? A Meta-analysis.

BACKGROUND: Research on the presence of sex-based differences in the outcomes of patients undergoing endovascular thrombectomy for acute ischemic stroke has reached differing conclusions. PURPOSE: This review aimed to determine whether sex influences the outcome of patients with large-vessel occlusion stroke undergoing endovascular thrombectomy. STUDY SELECTION: We performed a systematic review and meta-analysis of endovascular thrombectomy studies with either stratified cohort outcomes according to sex (females versus males) or effect size reported for the consequence of sex versus outcomes. We included 33 articles with 7335 patients. DATA ANALYSIS: We pooled ORs for the 90-day mRS score, 90-day mortality, symptomatic intracranial hemorrhage, and recanalization. DATA SYNTHESIS: Pooled 90-day good outcomes (mRS ≤ 2) were better for men than women (OR = 1.29; 95% CI, 1.09-1.53; P = <.001, I2 = 56.95%). The odds of the other outcomes, recanalization (OR = 0.94; 95% CI, 0.77-1.15; P = .38, I2 = 0%), 90-day mortality (OR = 1.11; 95% CI, 0.89-1.38; P = .093, I2 = 0%), and symptomatic intracranial hemorrhage (OR = 1.40; 95% CI, 0.99-1.99; P = .069, I2 = 0%) were comparable between men and women. LIMITATIONS: Moderate heterogeneity was found. Most studies included were retrospective in nature. In addition, the randomized trials included were not specifically designed to compare outcomes between sexes. CONCLUSIONS: Women undergoing endovascular thrombectomy for large-vessel occlusion have inferior 90-day clinical outcomes. Sex-specific outcomes should be investigated further in future trials as well as pathophysiologic studies.

Effect of Ambient Lighting and Skin Tone on Estimation of Heart Rate and Pulse Transit Time from Video Plethysmography.

Video-based photoplethysmography (vPPG) enables remote and contactless detection of the peripheral pulse of blood flow. This provides a potential mean to extract heart rate (HR) and pulse transit time (PTT) for the purpose of remote health monitoring. The accuracy of average HR and PTT extracted from a two-minute vPPG recording has been investigated at six different lighting conditions among participants with a range of Fitzpatrick skin scores. 12 healthy volunteers (6 females, 27 ± 6 years) were recruited. The video, electrocardiogram and finger PPG were acquired from immobile resting subjects. The vPPG signals from red, green and blue channels, and a combination of those were investigated. The vPPG signals were extracted from two regions of interest (ROIs): one on the forehead and one on the palm of the left hand. The estimated HR error (HR-error) was significantly lower for vPPG from green channels in both ROIs (ROI1 [p<0.001], ROI2 [p<0.05]). The signal from ROI1 demonstrated lower HR-error than ROI2 (p<0.001). HR-error from the darkest lighting conditions (Lumen 1 and 2) were significantly higher than the others (p<0.05). Furthermore, HR-error showed a positive correlation with skin tone scores in every lighting condition. However, at brighter lighting intensity, HR-error was independent of the skin tone score. PTT calculated from vPPG (vPTT) were compared between the 6 levels of lightings and the result was significantly different (p<0.05). In darker lighting conditions, the vPTT increased. Pulse arrival time measured from PPG (PAT-PPG) was calculated, and a positive correlation was found between the ratio of vPTT/PAT-PPG and skin tone score at six different lightings. However, this dependency decreases in brighter lighting intensity. These results suggest that HR-error and the ratio of vPTT/PAT increase with darker skins and at darker backgrounds. However, at brighter lighting conditions, the skin tone score is not a confounder of vPPG accuracy.

A Prospective Study on the Prevalence, Extent of Disease and Outcome of Eosinophilic Gastroenteritis in Patients Presenting with Lower Abdominal Symptoms.

BACKGROUND/AIMS: The epidemiology of eosinophilic gastroenteritis remains unclear. We aim to determine the prevalence of eosinophilic gastroenteritis in patients with lower abdominal symptoms. METHODS: In a prospective study, colonoscopy was performed on 2,469 consecutive patients. Biopsies were taken from the terminal ileum and ascending, transverse, descending and sigmoid colon in all patients. RESULTS: Sixty-four of the 2,469 patients (2.6%) had eosinophilic gastroenteritis. Only five of the 64 patients (7.8%) with eosinophilic gastroenteritis had endoscopic mucosal abnormalities during colonoscopy. Six of these 64 patients (9.4%) had severe disease at presentation, and seven of these 64 patients (10.9%) required systemic steroid treatment. An elevated absolute peripheral eosinophil count was independently associated with severe disease at presentation (4/6 [66.7%] vs 3/58 [5.2%], p=0.005; odds ratio [OR], 25.320; 95% confidence interval [CI], 2.628 to 243.910), and severe disease at the time of presentation was independently associated with the use of systemic steroid treatment (6/7 [85.7%] vs 0/57 [0%], p=0.008; OR, 18.021; 95% CI, 2.163 to 150.152). CONCLUSIONS: The prevalence of eosinophilic gastroenteritis is common, and patients usually present normal-appearing mucosa on colonoscopy. Those with severe disease at presentation usually have a raised absolute peripheral eosinophil count and should be commenced on systemic steroids as an initial therapy.

Urban parks provide ecosystem services by retaining metals and nutrients in soils.

Urban greenspaces provide ecosystem services like more natural ecosystems do. For instance, vegetation modifies soil properties, including pH and soil organic matter content, yet little is known about its effect on metals. We investigated whether the accumulation and mobility of heavy metals, nutrients and carbon is affected by plant functional types (evergreen or deciduous trees, lawns) in urban parks of varying ages in southern Finland. Plant types modified soil physico-chemical parameters differently, resulting in diverging accumulation and mobility of metals and other elements in park soils. However, the effects of plant functional type depended on park age: lawns in parks of ca. 50 y old had the highest contents of Cr, Cu, Fe, Mn, Ni, and Zn, and in these, and older parks (>100 y old), contents of most metals were lowest under evergreen trees. The mobility of metals and other elements was influenced by the amount of water leached through the soils, highlighting the importance of vegetation on hydrology. Soils under evergreen trees in young parks and lawns in intermediately-aged parks were most permeable to water, and thus had high loads of Ca, Cr, Cu, Fe, Ni, tot-P and tot-N. The loads/concentrations of elements in the leachates was not clearly reflected by their content/concentration in the soil, alluding to the storage capacity of these elements in urban park soils. Our results suggest that in urban systems with a high proportion of impermeable surfaces, park soil has the potential to store nutrients and metals and provide an important ecosystem service particularly in polluted cities.

Systematic analysis of the p53-related microRNAs in breast cancer revealing their essential roles in the cell cycle.

Numerous miRNAs have been found to be involved in the regulation of the p53 signaling pathway. Conversely, p53 regulates the transcription or processing of microRNAs (miRNAs). Given that complexities in the association between p53 and miRNAs exist, and due to the rapidly increasing amount of literature regarding the interactions between p53 and miRNAs, the present study systematically analyzed the associations between miRNAs and p53 in breast cancer using a literature-based discovery approach, natural language processing. A total of 22 miRNAs were found to be associated with p53. Next, three popular online tools (PicTar, miRanda and TargetScan) were used to predict the targets of each miRNA, and certain targets were validated by experiments. Gene Ontology annotation and network analysis demonstrated that the majority of the targets of the p53-related miRNAs were enriched in the cell cycle process. These results suggest that, in addition to regulating the transcription of cell cycle-related genes, p53 also indirectly modulates the cell cycle via miRNAs.

Community based intervention to optimize osteoporosis management: randomized controlled trial.

BACKGROUND: Osteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis are underutilized. This pragmatic randomised study was done to evaluate the impact of a multifaceted community-based care program aimed at optimizing evidence-based management in patients at risk for osteoporosis and fractures. METHODS: This was a 12-month randomized trial performed in Ontario, Canada. Eligible patients were community-dwelling, aged ≥55 years, and identified to be at risk for osteoporosis-related fractures. Two hundred and one patients were allocated to the intervention group or to usual care. Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing, patient education and patient-specific recommendations for osteoporosis treatment. The primary outcome was the implementation of appropriate osteoporosis management. RESULTS: 101 patients were allocated to intervention and 100 to control. Mean age of participants was 71.9 ± 7.2 years and 94% were women. Pharmacological treatment (alendronate, risedronate, or raloxifene) for osteoporosis was increased by 29% compared to usual care (56% [29/52] vs. 27% [16/60]; relative risk [RR] 2.09, 95% confidence interval [CI] 1.29 to 3.40). More individuals in the intervention group were taking calcium (54% [54/101] vs. 20% [20/100]; RR 2.67, 95% CI 1.74 to 4.12) and vitamin D (33% [33/101] vs. 20% [20/100]; RR 1.63, 95% CI 1.01 to 2.65). CONCLUSIONS: A multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care. TRIAL REGISTRATION: This trial has been registered with clinicaltrials.gov (ID: NCT00465387).

Differentiation potential of human embryonic mesenchymal stem cells for skin-related tissue.

BACKGROUND: Mesenchymal stem cells (MSC) have the capacity to differentiate into cells of connective tissue lineages, including bone, fat, cartilage and muscle, but the differentiation of embryonic MSC into epidermal cells by mesenchymal-epithelial transition has not been confirmed. OBJECTIVES: To determine the biological characteristics of human embryonic MSC (hMSC) and their potential for differentiation into epithelial cells. METHODS: hMSC were derived from 4-7-week-old embryos; they were localized and isolated, then primary culture was done. The biological characteristics of hMSC were detected by immunohistochemical methods and flow cytometry. Their differentiation potential was determined by coculture with conditioning medium and in vivo injection. RESULTS: hMSC express the relative specific antigens of MSC, such as SH2, alpha-smooth actin, CD29, CD44, CD90 and S100. After stimulation and in vivo transplantation, hMSC possess the potential to differentiate into epidermal cells with the production of keratin 19 and E-cadherin. CONCLUSIONS: hMSC derived from the early human embryo have the ability to transform into epidermal cells in vivo and in vitro.

The perception of continuity of care from the perspective of patients with diabetes.

BACKGROUND AND OBJECTIVES: Traditional indices of continuity of care typically capture frequency of physician visits but lack information regarding how patients themselves perceive continuity of care. The present study's objectives were (1) to examine the meaning of continuity of care from the perspective of patients with diabetes and (2) to understand the factors that enhance or detract from continuity of care. METHODS: Seven focus groups with 46 adult patients were held at a health service organization in Northern Ontario. All focus group interviews were tape recorded, transcribed verbatim, and analyzed using a phenomenological approach. Triangulation occurred through participant feedback of transcript summaries and consensus of themes by the multidisciplinary research team. RESULTS: Patients conceptualized continuity of care in a broad and multifaceted manner that was comprised of five components: (1) access to services, (2) interactions with physician, (3) interactions with other health care providers, (4) personal self responsibility, and (5) communication. CONCLUSIONS: Continuity of care was perceived by patients to include a wider range of components than what is traditionally associated with continuity of care. The emphasis on personal self responsibility by some patients provides a deeper understanding of what patients feel encompass continuity of care.

The Diabetes Continuity of Care Scale: the development and initial evaluation of a questionnaire that measures continuity of care from the patient perspective.

The purpose of the present study was to develop and pilot test a questionnaire to assess continuity of care from the perspective of patients with diabetes. Seven patient and two healthcare-provider focus groups were conducted. These focus groups generated 777 potential items. This number was reduced to 56 items after item reduction, face validity testing and readability analysis, and to 47 items after a preliminary factor analysis. Readability was assessed as requiring 7-8 years of schooling. Sixty adult patients with diabetes completed the draft Diabetes Continuity of Care Scale (DCCS) at a single point in time to assess the validity of the instrument. Patients completed the draft DCCS again 2 weeks later to assess test-retest reliability. A provisional factor analysis and grouping according to clinical sense yielded five domains: access and getting care, care by doctor, care by other healthcare professionals, communication between healthcare professionals, and self-care. The internal consistency (Cronbach's alpha) for the whole scale was 0.89. The test-retest reliability was r = 0.73. The DCCS total score was moderately correlated with some of the measures used to establish construct validity. The DCCS could differentiate between patients who did and did not achieve specific process and clinical indicators of good diabetes care (e.g. Hba1c tested within 6 months). The development of the DCCS was centred on the patient's perspective and revealed that the patient perspective regarding continuity of care extends beyond the concept of seeing one doctor. Initial testing of this instrument demonstrates that it has promise as a reliable and valid measure in this area.

Alpha-2,6-sialylation regulation in CD34+ progenitor cells in the human bone marrow and granulocyte colony-stimulating factor mobilization.

The use of peripheral blood (PB) progenitor cells to reconstitute hematopoiesis after high-dose chemotherapy is now common practice in the treatment of malignancies. Growth factors such as granulocyte colony-stimulating factor (G-CSF) induce high proliferation and self-renewal within the stem cell compartment of the bone marrow. This is followed by the release of a very high number of progenitor cells into the peripheral blood, the mechanism of which remains unclear. Previously, we have showed that high cell-surface sialylation reduces matured myeloid attachment to the bone marrow stroma, which is likely to help their release into the peripheral blood. Consequently, we decided to investigate the possibility that sialylation may also contribute to the CD34(+) cell release into the peripheral blood during G-CSF treatment. We found that G-CSF-mobilized PB CD34(+) cells exhibit an increase in the sialyltransferase ST6Gal-I mRNA level. The analysis of the heterogeneity of ST6Gal-I transcripts showed a predominance of the Y form in both bone marrow (BM) and G-CSF PB CD34(+) cells. Higher levels in ST6Gal-I mRNA resulted in a higher expression of alpha-2,6-sialylation on the surface of G-CSF PB CD34(+) cells when compared to noninduced PB CD34(+) cells but not higher to BM CD34(+) cells. Our present results, together with recent observations, suggest that ST6Gal-I and alpha-2,6-sialylation expression in myeloid cells is tightly dependent on the presence of G-CSF in their environment. Up-regulation of ST6Gal-I together with alpha-2,6-sialylation of cell surface glycoproteins is likely to modulate cellular adherence and survival of progenitor cells.

Syntaxin 5 is a common component of the NSF- and p97-mediated reassembly pathways of Golgi cisternae from mitotic Golgi fragments in vitro.

A cell-free system that mimics the reassembly of Golgi stacks at the end of mitosis requires two ATPases, NSF and p97, to rebuild Golgi cisternae. Morphological studies now show that alpha-SNAP, a component of the NSF pathway, can inhibit the p97 pathway, whereas p47, a component of the p97 pathway, can inhibit the NSF pathway. Anti-syntaxin 5 antibodies and a soluble, recombinant syntaxin 5 inhibited both pathways, suggesting that this t-SNARE is a common component. Biochemical studies confirmed this, showing that p47 binds directly to syntaxin 5 and competes for binding with alpha-SNAP. p47 also mediates the binding of p97 to syntaxin 5 and so plays an analogous role to alpha-SNAP, which mediates the binding of NSF.

An isoform of the Golgi t-SNARE, syntaxin 5, with an endoplasmic reticulum retrieval signal.

The early Golgi t-SNARE (target-membrane-associated soluble-N-ethylmaleimide-sensitive factor attachment protein receptor) syntaxin 5 is thought to specify the docking site for both COPI and COPII coated vesicles originating from the endoplasmic reticulum (ER) and COPI vesicles on the retrograde pathway. We now show that there are two forms of syntaxin 5 that appear to be generated from the same mRNA by alternative initiation of translation. The short form (35 kDa) corresponds to the published sequence. The long form (42 kDa) has an N-terminal cytoplasmic extension containing a predicted type II ER retrieval signal. When grafted onto a reporter molecule, this signal localized the construct to the ER. Biochemical fractionation and immunofluorescence microscopy showed that there was less of the long form in the Golgi apparatus and more in peripheral punctate structures, some of which colocalized with markers of the intermediate compartment. The predicted absence of the long form in budding yeast points to a function unique to higher organisms.

The role of the membrane-spanning domain and stalk region of N-acetylglucosaminyltransferase I in retention, kin recognition and structural maintenance of the Golgi apparatus in HeLa cells.

Using a series of chimeric and truncated N-acetylglucosaminyltransferase I (NAGT I) molecules we have shown that part of the lumenal stalk region is both necessary and sufficient for kin recognition of mannosidase II and retention in the Golgi stack. The membrane-spanning domain was not required for retention, but replacing part or all of this domain with leucine residues did have a dramatic effect on Golgi morphology. In stable cell lines, stacked cisternae were replaced by tubulo-vesicular clusters containing the mutated NAGT I. The loss of stacked cisternae was proportional to the number of leucines used to replace the membrane-spanning domain.

[Analysis of complications following laparoscopic surgery].

OBJECTIVE: To analysis the causes, management and prevention of complications following gynecological laparoscopic surgery. METHOD: We analysed retrospectively the clinical data of 22 cases with complications following laparoscopic surgery performed from Sep 1992 to May 1994. RESULTS: The overall incidence of operative complications was 6.29% (22/350). Among them, 9 cases (including pneumoderma 6 and pneumo-omentum 3) were related to inappropriate CO2 insufflation. The other 10 cases were associated with bleeding, i.e. vessel injury 4 cases, hypodermal ecohymosis 5, and bleeding from the sutured site 1. The remaining 3 were omental or intestinal hernia of the incisional sites. One out of the 22 cases were turned to laparotomy. The outcomes of this group were all good. CONCLUSIONS: The occurrence of these complications was related to the doctors experiences and skills. Therefore, well-training and practice should be emphasized in order to avoid these complications.

Characterization of a cis-Golgi matrix protein, GM130.

Antisera raised to a detergent- and salt-resistant matrix fraction from rat liver Golgi stacks were used to screen an expression library from rat liver cDNA. A full-length clone was obtained encoding a protein of 130 kD (termed GM130), the COOH-terminal domain of which was highly homologous to a Golgi human auto-antigen, golgin-95 (Fritzler et al., 1993). Biochemical data showed that GM130 is a peripheral cytoplasmic protein that is tightly bound to Golgi membranes and part of a larger oligomeric complex. Predictions from the protein sequence suggest that GM130 is an extended rod-like protein with coiled-coil domains. Immunofluorescence microscopy showed partial overlap with medial- and trans-Golgi markers but almost complete overlap with the cis-Golgi network (CGN) marker, syntaxin5. Immunoelectron microscopy confirmed this location showing that most of the GM130 was located in the CGN and in one or two cisternae on the cis-side of the Golgi stack. GM130 was not re-distributed to the ER in the presence of brefeldin A but maintained its overlap with syntaxin5 and a partial overlap with the ER-Golgi intermediate compartment marker, p53. Together these results suggest that GM130 is part of a cis-Golgi matrix and has a role in maintaining cis-Golgi structure.

[Synergistic effects of tumor necrosis factor interferon-gamma and chemotherapeutic drugs on human ovarian cancer cell lines in vitro].

Three ovarian cancer cell lines, NIH: OVCAR-3, 3AO, and AO were used in this study to assess the synergistic effect of TNF-alpha, IFN-gamma and chemotherapeutic drugs (epirubicin, carboplatin, fluorouracil). It was found that NIH: OVCAR-3 and 3AO cells were resistant to the individual treatment with TNF-alpha and IFN-gamma, while AO cells were sensitive to TNF-alpha but not to INF-gamma. Epirubicin and TNF-alpha were the two major cytotoxic agents to NIH: OVCAR-3. 3AO cells were susceptible to epirubicin, 5-Fu, TNF-alpha and IFN-gamma, while AO cells were sensitive to TNF and epirubicin. Carboplatin did not show any synergistic effect on all these three cell lines when combined with cytokines.

Mapping the distribution of Golgi enzymes involved in the construction of complex oligosaccharides.

The distribution of beta 1,2 N-acetylglucosaminyltransferase I (NAGT I), alpha 1,3-1,6 mannosidase II (Mann II), beta 1,4 galactosyltransferase (GalT), alpha 2,6 sialyltransferase (SialylT) was determined by immuno-labelling of cryo-sections from HeLa cell lines. Antibody labelling in the HeLa cell line was made possible by stable expression of epitope-tagged forms of these proteins or forms from species to which specific antibodies were available. NAGT I and Mann II had the same distribution occupying the medial and trans cisternae of the stack. GalT and SialylT also had the same distribution but they occupied the trans cisterna and the trans-Golgi network (TGN). These results generalise our earlier observations on the overlapping distribution of Golgi enzymes and show that each of the trans compartments of the Golgi apparatus in HeLa cells contains unique mixtures of those Golgi enzymes involved in the construction of complex, N-linked oligosaccharides.

[150 cases of vedio-laparoscopic gynecologic surgery].

From September 1992 to September 1993, 150 patients aged 15-68 years underwent laparoscopic gynecologic surgery. These patients included 63 patients with acute abdominal diseases (46 had ectopic pregnancy, 9 rupture of ovary, and 8 torsion of ovarian cyst), which consisted of 90% of total patients with acute abdomen in corresponding period, 63 patients with mass of adnexa, which made up 72% of total patients with ovarian tumors, and 24 patients with uterine diseases. We successfully performed laparoscopic salpingostomy, fallotomy, removal of ovarian cyst, oophorosalpingectomy, myomectomy and laparoscopy assisted vaginal hysterectomy (LAVH) with 2-4 puncture technic after general anesthesia. The largest ovarian tumor and the enlarged uterus were 14 and 16 cm in diameter respectively. Four patients had laparotomy because of severe pelvic adhesions and the laparotomy rate was about 2.6%. The procedure lasted 20-240 minutes and bleeding was less than 200ml. No major surgical complication was encountered.