Synthesis, in silico, and in vivo anti-inflammatory evaluation of 3ß-cinnamoyloxy substituted pregna-4,16-diene-6,20-diones derivatives.

Pregnane derivatives have been studied mainly for their 5α-reductase activity. However, the anti-inflammatory activities of such compounds are still poorly explored. In the search for new anti-inflammatory agents, seven new pregnane derivatives 6a-g, with cinnamic acid esters at C-3 were prepared and fully characterized. The anti-inflammatory activity of compounds was assessed in TPA induced mice ear model. From them, compound 6 b was the most active to reduce edema, with an ED50 of 0.017 mg/ear. Also, Molecular Docking and Molecular Dynamics studies were performed to identify a potential molecular target related to the inflammatory process. The in vivo results suggest that 6 b could be a potent anti-inflammatory compound, while in silico studies suggest its interaction with some critical enzymes in the inflammatory response.

Predictors of response to endovascular treatment of posterior circulation stroke.

BACKGROUND: Endovascular treatment is considered a reasonable approach for patients with acute posterior circulation stroke, but it remains uncertain which patients will benefit the most from it. OBJECTIVE: To find independent clinical and angiographic predictors of outcome after endovascular treatment for posterior circulation stroke. METHODS: We evaluated consecutive patients with acute posterior circulation stroke who underwent endovascular treatment in our comprehensive stroke center from January 2015 to December 2017. Good outcome was defined as a modified Rankin score of 0-3 at 90 days. Intracranial atheromatous disease was established on focal stenosis recorded during endovascular treatment. Associations were sought between a good outcome and clinical and angiographic factors. Adjusted logistic regression models were used to define independent outcome predictors. RESULTS: Forty-seven consecutive patients were included: mean age 70.9 ± 12.1 years, median admission NIHSS score, 16 (IQR: 8-30). On univariate analysis, age (p = 0.01), smoking (p = 0.04), hypertension (p = 0.03), successful reperfusion (p = 0.04), presence of extracranial atherosclerosis (p = 0.02), and absence of atherosclerosis (p = 0.03) were significantly associated with a good outcome. On multivariate analysis, age <70 years (odds ratio = 6.20, 95%CI 1.52-25.47, p = 0.01) and absence of intracranial atherosclerosis (odds ratio = 6.45, 95% CI 1.09-38.24, p = 0.04) were independently associated with a good outcome. CONCLUSIONS: Pretreatment determination of the presence or absence of intracranial atherosclerosis can aid management of posterior circulation stroke patients. The absence of intracranial atherosclerosis may have value as a positive selection criterion for endovascular treatment in future trials. The presence of intracranial atherosclerosis could be used as a selection tool in future studies investigating new treatment protocols for this population.

Procedural approaches and angiographic signs predicting first-pass recanalization in patients treated with mechanical thrombectomy for acute ischaemic stroke.

BACKGROUND: First-pass recanalization via mechanical thrombectomy (MT) has been associated with improved clinical outcome in patients with acute ischaemic stroke. The optimal approach to achieve first-pass effect (FPE) remains unclear. No study has evaluated angiographic features associated with the achievement of FPE. We aimed to determine the procedural approaches and angiographic signs that may predict FPE. METHODS: We performed a prospective, multi-centre, observational study of FPE in patients with anterior circulation stroke treated with MT between February and June 2017. MTs were performed using different devices, deployment manoeuvres (standard versus 'Push and Fluff' technique), proximal balloon guide catheter (PBGC), distal aspiration catheter (DAC) or both. The angiographic clot protrusion sign (ACPS) was recorded. Completed FPE (cFPE) was defined as a modified thrombolysis in cerebral infarction score of 2c-3. Associations were sought between cFPE and procedural approaches and angiographic signs. RESULTS: A total of 193 patients were included. cFPE was achieved in 74 (38.3%) patients. The use of the push and fluff technique (odds ratio (OR) 3.45, 95% confidence interval (CI): 1.28-9.29, p = 0.010), PBGC (OR 3.81, 95% CI: 1.41-10.22, p = 0.008) and ACPS (OR 4.71, 95% CI: 1.78-12.44, p = 0.002) were independently associated with cFPE. Concurrence of these three variables led to cFPE in 82 vs 35% of the remaining cases (p = 0.002). CONCLUSIONS: The concurrence of the PBGC, the push and fluff technique, and the ACPS was associated with the highest rates of cFPE. Appropriate selection of the thrombectomy device and deployment technique may lead to better procedural outcomes. ACPS could be used to assess clot integration strategies in future trials.

Complicaciones vasculares durante la trombectomía mecánica en el ictus agudo, una experiencia multicéntrica en España / Vascular Complications during Mechanical Thrombectomy in Acute Stroke, a Multicentric Experience in Spain

Objetivo Determinar la frecuencia de las complicaciones observadas durante la trombectomía en el ictus isquémico agudo. Materiales y Métodos Se revisó de forma retrospectiva las trombectomías realizadas en nuestra institución cuando los ictus isquémicos tuvieron una indicación de tratamiento endovascular. Se registraron los diferentes dispositivos utilizados en ese periodo de tiempo y si presentaron relación con el desarrollo de las complicaciones inmediatas mediante arteriografía. Resultados De un total de 228 casos, se registraron complicaciones en el 16,6% de los casos. Se identificaron embolias (n » 31), hemorragias subaracnoideas (n » 2), hemorragia gangliobasal (n » 1), vasoespasmo (n » 1), disección (n » 1) y peusoaneurismas (n » 2). La embolia a nuevos territorios se presentó solo en 5 casos. Discusión El tratamiento endovascular ha demostrado ser efectivo para la recanalización en oclusión de gran vaso. El uso de dispositivos presume un riesgo por la manipulación de los vasos. Conclusión La embolia fue la complicación más frecuente. El tratamiento endovascular en el ictus genera un desenlace clínico favorable de los pacientes, al mismo tiempo, el bajo porcentaje de complicaciones que encontramos no suponen una afectación negativa en el desenlace final.

Purpose To determine the complications we observed during thrombectomy in acute ischemic stroke. Materials and Methods We reviewed retrospectively thrombectomies performed in our institution when endovascular treatment for stroke was done. The different devices used in this period of time were recorded and we determined if these were related to the development of immediate complications duringthe procedure visualized in arteriography. Results We had 228 cases, complications were found in 16.6% of the cases. Embolisms (n » 31), subarachnoid hemorrhages (n » 2), gangliobasal hemorrhage (n » 1), vasospasm (n » 1), dissection (n » 1) and peusoaneurysms (n » 2) were identified. 5 embolisms happened to new territories during thrombectomy. Discussion Endovascular treatment has been shown to be effective for recanalization in large vessel occlusion. The use of devices presumes a risk for the manipulation of the vessels. Conclusion Embolism was the most frequent complication. The endovascular treatment in the acute stroke produces a favorable clinical outcome of the patients and we found a low percentage of complications that would not suppose a negative affectation in the final outcome.

Trombectomía retrógrada en ictus isquémico basilar sin acceso vascular posterior / Retrograde thrombectomy in basilar ischemic ictus without posterior vascular access

RESUMEN INTRODUCCIÓN: El 10 % de los ictus afecta la circulación posterior, tiene una importante repercusión neurológica y llegan a comprometer la vida. El manejo inicial de estos pacientes incluye la trombolisis farmacológica y mecánica para reestablecer el flujo de la irrigación de estructuras vitales como el mesencéfalo y las estructuras del puente. METODOLOGÍA: Se presenta el caso de un paciente de 81 años que presentó inestabilidad de la marcha con hemianopsia izquierda. Se documentó en angiotomografía la oclusión de la arterial basilar, arterial vertebral izquierda y la estenosis crítica de arteria vertebral derecha. Debido a que la cateterización de las arterias vertebrales no era posible, se decidió acceder a la arteria basilar a través de la arteria comunicante posterior. RESULTADOS: Se realizó una adecuada revascularización de la arteria basilar, comprobada por arteriografía. Sin embargo, 12 horas después, el paciente presentó reoclusión de territorio basilar que provocó muerte cerebral. CONCLUSIÓN: Los pacientes con difícil cateterización de circulación posterior por oclusión o estenosis crítica proximal del territorio posterior, con patencia y permeabilidad del polígono de Willis, serían candidatos a este tipo de procedimiento, se deben realizar más estudios con pacientes que presenten condiciones similares para optimizar su desenlace neurológico posterior a ictus en territorio de estructuras vitales.

SUMMARY INTRODUCTION: 10% of the strokes affect the posterior circulation, with important neurological deficit and they may compromise the life. Initial management of these patients includes pharmacological thrombolysis and mechanical thrombectomy to re-establish the flow of irrigation from vital structures such as the midbrain and brainstem. METHOD: We present the case of an 81-year-old patient, with unsteady gait with left hemianopsia. Basilar and left vertebral artery occlusion were demonstrated by angiotomography, and critical right vertebral artery stenosis. Due a catheterization of the vertebral arteries was not possible, Basilar artery access through a posterior communicating artery was performed. RESULTS: Adequate revascularization of the basilar artery was performed, by angiography. However, 12 hours later, the patient presented the re-occlusion of the basilar artery that caused brain death. CONCLUSION: Patients with occlusion or severe stenosis in posterior circulation with patency and permeability of the Willis polygon would be candidates for this type of procedure. Further studies are needed to confirm the neurological outcome after stroke in the territory of vital structures with limited vascular access.

Utilidad de la resonancia magnética fetal como método de diagnóstico corporal prenatal y revisión de nuestra experiencia: Serie de casos / Utility of Magnetic Resonance as a Prenatal Diagnosis Method and Review of Our Experience: Case Series

La resonancia magnética (RM) fetal es una valiosa técnica complementaria de la ecografía prenatal, útil en la detección y caracterización de anomalías del desarrollo fetal. El objetivo es mostrar la utilidad de esta técnica diagnóstica, así como dar a conocer nuestra experiencia mediante seis casos diagnosticados en el periodo comprendido entre 2013 y 2015. Esta experiencia incluye gestantes en el segundo y tercer trimestres de gestación, remitidas por sospecha diagnóstica de diversas patologías fetales con ecografía obstétrica.

Magnetic resonance imaging (MRI) and fetal ultrasound are complementary techniques. Fetal MRI is useful in the detection and characterization of congenital anomalies. Our objective is to show the usefulness of this diagnostic technique and to show our experience with six cases evaluated in our institution from 2013 to 2015. It includes pregnant women during the second and third trimester, remitted due to suspicion of various pathologies as detected by fetal ultrasound.

Obesity and the risk of spontaneous abortion after oocyte donation.

OBJECTIVE: To determine whether obesity increases the risk of spontaneous abortion. DESIGN: Retrospective study. SETTING: Oocyte donation program at the Instituto Valenciano de Infertilidad in Spain. PATIENT(S): Seven hundred twelve cycles of recipients of ovum donation with known body mass index (BMI), good-quality embryo transfer, and absence of uterine pathology or clinical history of antiphospholipid antibodies or recurrent abortion. INTERVENTION(S): Recipients were divided in four BMI (kg/m(2)) groups: lean, with BMI <20 (n = 92; 12.9%); normal, with BMI = 20-24.9 (n = 398; 55.9%); overweight, with BMI = 25-29.9 (n = 172; 24.2%); and obese, with BMI >/=30 (n = 50; 7%). Clinical parameters were compared among the groups. MAIN OUTCOME MEASURE(S): Spontaneous abortion rates according to BMI. RESULT(S): No difference was found among the four BMI groups in any of the parameters of the cycle analyzed. The overall abortion rate was 15.8% (57 of 360). There were significant differences in abortion rates between the obese (38.1%), and the normal (13.3%) and overweight (15.5%) groups. When several cutoff BMI values were established (20, 25, and 30), only the obese women demonstrated a greater risk of abortion. Compared with the normal population, the obese group showed a significant fourfold increase in the risk of spontaneous abortion. CONCLUSION(S): Our findings confirm that obesity (BMI >/=30) is an independent risk factor for spontaneous abortion. Therefore, it would be advisable for obese patients to reduce weight before becoming pregnant.