The Diagnosis and Management of Acute Stroke with Emergent Large Vessel Occlusion Screen.

Objective: Endovascular therapy (EVT) is a well-documented treatment for acute occlusion of major cerebral arteries. We carried out in-hospital triage using the emergency large vessel occlusion (ELVO) screen, a pre-hospital scale for acute stroke, to diagnose EVT cases and considered its efficacy. Methods: We investigated stroke cases examined within 24 hours of onset in a 6-month period beginning on March 15, 2019. The results of ELVO screen were retrospectively considered with the presence of atrial fibrillation and treatment of EVT. Results: A total of 146 cases were included. Of the 65 positive ELVO screen cases, 33 (51%) had large vessel occlusion (LVO). Of the 81 negative ELVO screen cases, 11 (14%) had LVO (sensitivity, 75%; specificity, 69%; positive predictive value, 51%; negative predictive value, 86%; accuracy, 71%; P <0.001). Among LVO cases, 16 of the 33 (48%) positive ELVO screen cases and 2 of the 11 (18%) negative ELVO screen cases were treated by EVT. Complications of atrial fibrillation were significantly more common in positive ELVO screen cases (P = 0.001). EVT was carried out in nearly half of the positive ELVO screen cases of atrial fibrillation, being a significantly higher rate (10 of 24 cases, 42%; P = 0.02). Conclusion: The accuracy of EVT use increased in positive ELVO screen cases, particularly in those with atrial fibrillation. In-hospital triage using ELVO screen, a pre-hospital scale, significantly aided in selecting patients requiring EVT.

Successful Cesarean Section Deliveries in a Patient with a History of Developmental Venous Anomaly-Induced Hemorrhage.

While hemorrhage can occur because of developmental venous anomalies (DVAs), there is no established opinion concerning their association with pregnancy and childbirth. In the present report, we discuss the case of a now 39-year-old woman with DVA in whom pregnancy and childbirth were successful. When she was 28, she experienced disturbance of consciousness and paralysis on the left side of the body, and brain computed tomography revealed cerebral hemorrhage coupled with subarachnoid hemorrhage. Cerebral angiography revealed a DVA with an arteriovenous shunt, with superficial drainage surrounding the hematoma. No associated cavernous hemangiomas were observed, and the patient was diagnosed with DVA-induced hemorrhage and treated via conservative therapy. Later, at the ages of 32 and 35, she gave birth via Caesarean section under general anesthesia. At the age of 37, she experienced sudden headache and nausea, following which she was again diagnosed with DVA-induced hemorrhage. Fortunately, she experienced no exacerbation of symptoms such as paralysis. However, she currently has mild, residual paralysis on the left side of the body, and she regularly walks to the hospital using a cane for follow-up examinations.

Community-acquired necrotizing fasciitis caused by Acinetobacter calcoaceticus: a case report and literature review.

A 61-year-old man presented with pain in the abdomen and right lower limb. He had a history of hepatitis B virus-induced liver cirrhosis, but had not been visiting the outpatient clinic and did not receive any medication. Cutaneous necrosis and bulla were observed on his abdomen and right lower limb. The necrotic skin was incised, and he was diagnosed with necrotizing fasciitis. A nonfermentative Gram-negative bacillus infection was confirmed from aspirated fluid and blood cultures. Therefore, meropenem and immunoglobulins were administered. Because necrosis was widespread, surgical debridement was performed. Thereafter, Acinetobacter calcoaceticus infection was confirmed by semi-quantitative PCR using the bullous fluid and blood cultures. Meropenem was administered for 3 weeks, followed by levofloxacin alone for 1 week. The patient's condition improved; therefore, skin grafting was performed as planned and yielded a favorable response. After rehabilitation, the patient could walk without support and infection did not recur. However, he had severe liver cirrhosis and large esophageal varices, and he eventually died from sudden varix rupture. Necrotizing fasciitis is an uncommon soft tissue infection, associated with high morbidity and mortality, and early recognition and treatment are crucial for survival. Acinetobacter is rarely associated with necrotizing fasciitis. Although this is a very rare case of the occurrence of necrotizing fasciitis due to A. calcoaceticus infection, we believe that this organism can be pathogenic in immunocompromised patients such as those with liver cirrhosis by reporting this case.

Peripartum cardiomyopathy with biventricular thrombus which led to massive cerebral embolism.

A 37-year-old female who delivered her second child via a cesarean section 4 months previously presented to our hospital with gradual worsening of dyspnea on effort. Chest radiographic appearance showed cardiomegaly (cardiothoracic ratio 61%) and slight bilateral pulmonary congestion. Echocardiogram revealed diffuse hypokinesis of both left and right ventricles (left ventricular ejection fraction 29%) and large biventricular thrombus [left ventricular apex (28 mm × 21 mm, 22 mm × 14 mm) and right ventricular apex (16 mm × 11 mm)]. She was diagnosed as having peripartum cardiomyopathy (PPCM) and anticoagulation therapy was started. Surgical thrombectomy was not selected because of risk of complications. Massive cerebral infarction occurred 10 days after diagnosis. She was discharged with aphasia and right incomplete hemiplegia 65 days after admission. Biventricular thrombus is a rare complication of PPCM. If high risk of massive embolism is considered, surgical thrombectomy may be warranted even in cases with low cardiac function. .

Effect of aflatoxin B1 on UDP-glucuronosyltransferase mRNA expression in HepG2 cells.

Aflatoxin B1 (AFB1) is a potent mycotoxin that induces hepatocellular carcinoma in many animal species, including humans. In this study, we examined the effects of AFB1 on UDP-glucuronosyltransferase (UGT) mRNA expression in HepG2 cells (human hepatocellular carcinoma cell line). The cells were treated with AFB1 for 48 h at a concentration of 10 µM, and their viability (87%) was not significantly different from that of control cells. Reverse transcription polymerase chain reaction (RT-PCR) analysis demonstrated that the mRNAs of four UGT1As (UGT1A1, UGT1A3, UGT1A4 and UGT1A9) and seven UGT2Bs (UGT2B4, UGT2B7, UGT2B10, UGT2B11, UGT2B15, UGT2B17 and UGT2B28) are expressed in HepG2 cells. The mRNAs of aryl hydrocarbon receptor (AhR), pregnane X receptor (PXR), retinoid X receptor (RXR) and glucocorticoid receptor (GR) as transcriptional regulators were also detected. AFB1 significantly increased mRNA levels of UGT1A3, UGT2B10, UGT2B15 and UGT2B17 in HepG2 cells to 2.5-, 2.0-, 1.9- and 1.5-fold, respectively, whereas the mRNA levels of transcriptional regulators were hardly affected by AFB1. These findings suggest that AFB1 induces UGT2B isoforms rather than UGT1A isoforms in HepG2 cells, and that the change may closely contribute to the toxicity of AFB1.

Developments and applications of capillary microextraction techniques: a review.

Sample preparation is important for isolating desired components from complex matrices and greatly influences their reliable and accurate analysis. Recent trends in sample preparation include miniaturization, automation, high-throughput performance, and reduction in solvent consumption and operation time. This review focuses on novel microextraction techniques using capillaries for off-line and on-line sample preparation. Open-tubular trapping (OTT), in-tube solid-phase microextraction (SPME), wire-in-tube SPME, fiber-in-tube solid-phase extraction (SPE), sorbent-packed capillary in-tube SPME and monolithic capillary in-tube SPME are critically evaluated and applications of these techniques in biological, pharmaceutical, environmental and food analyses are summarized.

Combination treatment with normobaric hyperoxia and cilostazol protects mice against focal cerebral ischemia-induced neuronal damage better than each treatment alone.

Normobaric hyperoxia (NBO) and cilostazol (6-[4-(1-cyclohexy-1H-tetrazol-5-yl)butoxyl]-3,4-dihydro-2-(1H)-quinolinone) (a selective inhibitor of phosphodiesterase 3) have each been reported to exert neuroprotective effects against acute brain injury after cerebral ischemia in rodents. Here, we evaluated the potential neuroprotective effects of combination treatment with NBO and cilostazol against acute and subacute brain injuries after simulated stroke. Mice subjected to 2-h filamental middle cerebral artery (MCA) occlusion were treated with NBO (95% O(2), during the ischemia) alone, with cilostazol (3 mg/kg i.p. after the ischemia) alone, with both of these treatments (combination), or with vehicle. The histological and neurobehavioral outcomes were assessed at acute (1 day) or subacute (7 days) stages after reperfusion. We measured regional cerebral blood flow (rCBF) during and after ischemia by laser-Doppler flowmetry and recovery (versus vehicle) in the combination therapy group just after reperfusion. Mean acute and subacute lesion volumes were significantly reduced in the combination group but not in the two monotherapy groups. The combination therapy increased endothelial nitric-oxide synthase (eNOS) activity in the lesion area after ischemia versus vehicle. Combination therapy with NBO plus cilostazol protected mice subjected to focal cerebral ischemia by improvement of rCBF after reperfusion, in part in association with eNOS activity.

Cilostazol protects against hemorrhagic transformation in mice transient focal cerebral ischemia-induced brain damage.

Cilostazol, an antiplatelet drug used to treat intermittent claudication, has been reported to offer neuroprotection and endothelial protection in animals with ischemic brain injury. Here, we evaluated the protection afforded by cilostazol against ischemic brain injury and hemorrhagic transformation. Mice subjected to a 2-h filamental middle cerebral artery (MCA) occlusion were treated with cilostazol (10mg/kg, intraperitoneally just after the occlusion) or with vehicle. Histological outcomes (infarct volume and hemorrhagic transformation) and Evans blue extravasation were assessed after reperfusion. Mean infarct volume, hemorrhagic transformation, and Evans blue extravasation were all significantly reduced in the cilostazol-treated group. Thus, cilostazol protected against ischemic brain injury and hemorrhagic transformation in mice subjected to transient focal cerebral ischemia.

Combination effects of normobaric hyperoxia and edaravone on focal cerebral ischemia-induced neuronal damage in mice.

We evaluated the potential neuroprotective effects of combination treatment with normobaric hyperoxia (NBO) and edaravone, a potent scavenger of hydroxyl radicals, on acute brain injuries after stroke. Mice subjected to 2-h filamental middle cerebral artery occlusion were treated with NBO (95% O2, during the ischemia) alone, with edaravone (1.5 mg/kg, intravenously after the ischemia) alone, with both of these treatments (combination), or with vehicle. The histological and neurological score were assessed at 22-h after reperfusion. Infarct volume was significantly reduced in the combination group [36.3+/-6.7 mm3 (n=10) vs. vehicle: 65.5+/-5.9 mm3 (n=14) P<0.05], but not in the two monotherapy-groups [NBO: 50.5+/-5.8 mm3 (n=14) and edaravone: 56.7+/-5.8 mm3 (n=10)]. The combination therapy reduced TUNEL-positive cells in the ischemic boundary zone both in cortex [6.0+/-1.4 x 10(2)/mm2 (n=5) vs. vehicle: 18.9+/-2.4 x 10(2)/mm2 (n=5), P<0.01] and subcortex [11.6+/-1.5 x 10(2)/mm2 (n=5) vs. vehicle: 22.5+/-2.1 x 10(2)/mm2 (n=5), P<0.01]. NBO and combination groups exhibited significantly reduced neurological deficit scores at 22-h after reperfusion (vs. vehicle, P<0.05). Combination therapy with NBO plus edaravone prevented the neuronal damage after focal cerebral ischemia and reperfusion in mice, compared with monotherapy of NBO or edaravone.

Successful "blind-alley" formation with bypass surgery for a partially thrombosed giant basilar artery tip aneurysm refractory to upper basilar artery obliteration. Case report.

Partially thrombosed giant aneurysms that are located at the basilar artery (BA) bifurcation and are not amenable to clip application are among the most challenging lesions for neurosurgeons. They compress vital structures such as the brainstem and the thalamus, and the prognosis is extremely poor when they are left untreated. Although obliteration of the upper BA is a promising approach for these aneurysms, some lesions are refractory to this treatment, and effective additional strategies have not been clearly established. The authors report a case treated by placement of clips in the unilateral posterior cerebral artery (PCA) and posterior communicating artery as well as by superficial temporal artery-PCA bypass after unsuccessful upper BA obliteration. Complete thrombosis and dramatic shrinkage of the aneurysm were obtained.

A Fullerene/Lipid Electrode Device: Reversible Electron Transfer Reaction of C60 Embedded in a Cast Film of an Artificial Ammonium Lipid on an Electrode in Aqueous Solution.

Two reversible one-electron transfers are observed for an electrode device made from C60 and an artificial lipid (see schematic drawing). Cyclic voltammetric studies reveal that the redox couples are unchanged even after 50 cycles, thus indicating that the C60 radical monoanion and the C60 dianion generated in aqueous solution are very stable.