Predictors and Prognostic Implications of Hemorrhagic Transformation Following Cerebral Endovascular Thrombectomy in Acute Ischemic Stroke: A Multicenter Analysis.

PURPOSE: Hemorrhagic transformation (HT) following cerebral endovascular thrombectomy (EVT) for large vessel occlusion (LVO) in acute ischemic stroke is associated with poor outcome. Recent studies have shown that EVT can be efficacious in imaging-selected patients as late as 6-24 h from onset (late time window; LTW). We sought to determine predictors and prognostic implications of HT following EVT in LTW. METHODS: Consecutive patients undergoing EVT for LVO were recruited into a prospective multicenter database. HT was divided into petechial hemorrhagic-infarction and parenchymal hematoma (PH) type 1 or 2 defined as confluent hemorrhage covering < or > than 1/3 of the infarct volume, respectively. Multivariate analyses were performed to determine variables associated with HT subtypes. RESULTS: Among 611 patients included (mean age 70.5 ± 12.5 years; median NIHSS 16), 115 (18.8%) had HT and 33 of them (5.4%) had PH2. Independent PH2 predictors included failed recanalization (OR 7.0, 95% CI 2.3-21.6), longer time from symptom onset to admission (OR 1.002 per minute 95% CI 1.001-1.003) and hyperlipidemia (OR 3.12; 95%CI 1.12-8.7). HT was not associated with outcome. In contrast, PH2 patients had lower favorable outcome rates (14.3 vs 41.6%, p = 0.004) and higher mortality rates (39 vs 17%, p = 0.001). Patients who underwent EVT in the late versus early window had similar PH2 rates (4.5 vs 6.7%, p = 0.27). In multivariate models, PH2 tripled the odds of both 90-day poor outcome (OR 3.1, 95% CI 1.01-9.5) and 90-day mortality (OR 3.2, 95% CI 1.4-7.3). CONCLUSIONS: PH2 following EVT is associated with increased mortality and unfavorable outcome rates. Rates of PH2 are not different between LTW patients and those treated < 6 h from symptom onset.

In Vitro Antimicrobial and Antiproliferative Activity of Amphipterygium adstringens.

Amphipterygium adstringens is a plant widely used in Mexican traditional medicine for its known anti-inflammatory and antiulcer properties. In this work, we evaluated the in vitro antimicrobial and antiproliferative activities of the methanolic extract of A. adstringens against oral pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Candida albicans, and Candida dubliniensis, using microdilution (MIC) and agar diffusion methods (MBC), and the antiproliferative activity evaluating total growth inhibition (TGI) by staining the protein content with sulforhodamine B (SRB), using nine human cancer cell lines. Crude extract (CE) of A. adstringens showed some degree of activity against one or more of the strains with a MIC from 0.125 mg/mL to 63 mg/mL and MBC from 1.6 to 6.3 mg/mL and cytotoxic activity, particularly against NCI-ADR/RES, an ovarian cell line expressing multiple resistance drugs phenotype. The CE is a complex mixture of possible multitarget metabolites that could be responsible for both antimicrobial and antiproliferative activities, and further investigation is required to elucidate the identity of active compounds. Nevertheless the CE itself is useful in the development of new antimicrobial treatment based on natural products to prevent oral diseases and as alternative natural source for cancer treatment and prevention.

Long-chain alkanes and ent-labdane-type diterpenes from Gymnosperma glutinosum with cytotoxic activity against the murine lymphoma L5178Y-R.

The antitumor potential of Gymnosperma glutinosum was previously reported using the in vitro and in vivo L5178Y-R lymphoma murine model. The present study was carried out to isolate and identify the cytotoxic compounds present in the Gymnosperma glutinosum leaf hexane extract. Gymnosperma glutinosum was collected in the semi-arid region of Escobedo, State of Nuevo León, México, but it is commonly found in northeastern Mexico; it is traditionally used as a treatment for diarrhea, ulcers and rheumatism. G. glutinosum leaves were extracted with hexane and further fractioned and subfractioned over silica gel by gradient elution with hexane, chloroform, ethyl acetate and methanol. The cytotoxicity of fractions and subfractions was assessed in vitro against L5178Y-R lymphoma cells. Structure elucidation of the active compounds was determined by spectroscopic methods. Fractions and subfractions showed significant (p < 0.05) and concentration-dependent 20% to 56% cytotoxicity against L5178Y-R cells at concentrations ranging from 7.8 µg/mL to 500 µg/mL. The bioassay-guided fractionation of the hexane extract resulted in the isolation and identification of the alkane hentriacontane and the diterpene ent-labd-7-en-13S,14R,15-triol as the metabolites responsible for the activity.

Antimicrobial activity of Hedeoma drummondii against opportunistic pathogens.

Hedeoma drummondii is a medicinal plant with diverse properties; however, validations of its medicinal uses are scarce. To evaluate its antimicrobial properties H. drummondii, was tested against opportunistic pathogens of medical importance. Antimicrobial tests were performed by the microdilution method in order to determine the Minimal Inhibitory Concentration (MIC) for each extract. Extracts of this plant showed relevant antimicrobial activity, results revealed that the hexanic extract has stronger activity and broader spectrum compared to acetone and methanol extracts. The activity of hexanic extract may be attributed mainly to the presence of the monoterpenes pulegone and menthol. In conclusion, the hexanic extract possess relevant antibacterial properties which suggests that H. drummondii have bioactive principles; these new data provide scientific support for the use of this plant in traditional medicine, particularly for gastrointestinal diseases.

The effects of patellar thickness on patellofemoral forces after resurfacing.

The purpose of this study was to determine the effect of patellar bone and patellar implant thickness on patellofemoral forces after resurfacing in total knee arthroplasty. Seven cadaver knees were tested using an Oxford Knee Testing Rig. This model gave the specimens 6 degrees freedom while dynamic data were collected. Each knee was tested from full extension to 95 degrees knee flexion. Knees were implanted with Press Fit Condylar femoral, tibial, and patellar implants. The effect of varying patellar thickness on patellofemoral forces was determined by using custom modular oval-domed polyethylene patellar components with progressive thickness increments of 2 mm. Patellofemoral forces were measured by a custom-designed uniaxial patellar load cell. Statistically significant increases in patellofemoral compression forces were found from 70 degrees to 95 degrees flexion with increased patellar bone and patellar implant thickness.

Suboptimal (thin) distal cement mantle thickness as a contributory factor in total hip arthroplasty femoral component failure. A retrospective radiographic analysis favoring distal stem centralization.

One hundred cemented total hip arthroplasties (THAs) were evaluated regarding the potential benefit of THA femoral component distal stem centralization, specifically regarding cement mantle thickness. Factors potentially predictive of femoral component mechanical loosening, both relating (22 factors) and not relating (41 factors) to cement, were analyzed on initial postoperative radiographs. Nine THAs with femoral component mechanical failure (group 1) were compared to (1) 88 non-failed THAs (group 2) and (2) 9 matched-paired, nonfailed THAs (group 3). Significant differences were evident regarding minimum and maximum cement mantle thickness in Gruen zone 5 and combined zones 5/6 (groups 1 vs 2 and groups 1 vs 3), with failed femoral components having thinner cement mantles. Discriminate analysis determined minimum cement mantle thickness in zone 5 to be the factor most predictive of femoral component failure. These data indicate that a suboptimal (thin) cement mantle at the medial diaphysis (Gruen zones 5 and 6) contributed to femoral component mechanical loosening in this THA series. This relationship may not pertain to femoral stems of different materials or cross-sectional characteristics. Many THA systems currently provide for a method of centralization of the femoral component distal stem as a mechanism to ensure an adequate circumferential distal cement mantle. Continued investigation into techniques directed toward centralization of the distal femoral stem is warranted by the findings of this study.

Surgical treatment for the far lateral herniated lumbar disc.

Twenty-nine patients underwent surgery for far lateral herniated nucleus pulposus. Average patient age was 65 years in the 14 male and 15 female patients involved. The L4-5 disc was the most commonly herniated level (59%) followed by L3-4 (31%), L5-S1 (7%), and L2-3 (3%). All patients were initially seen with radiculopathy and 23 patients (79%) had motor weakness. A pars interarticularis sparing technique is described for approaching this type of disc herniation. This approach allows direct visualization of the disc and involved root. The results are encouraging with 72% of patients having good or excellent relief of pain. Seventy-one percent of those with preoperative weakness had no weakness or improvement in strength postoperatively. In general, far lateral herniated nucleus pulposus occurs in older patients and at high lumbar disc levels. Postoperative results are similar to the more common posterolateral herniated nucleus pulposus in patients of the same age group. A surgical approach is described to better address the less familiar anatomy.

Slipped capital femoral epiphysis in black children: incidence of chondrolysis.

The risk of chondrolysis and avascular necrosis (AVN) in black children treated for slipped capital femoral epiphysis (SCFE) is controversial. A retrospective study was conducted of 29 black patients (44 hips) treated for SCFE at Kings County Hospital, Brooklyn, New York, to evaluate our own experience. All patients were treated with in situ pinning. The overall rates of chondrolysis and AVN were 6.8 and 4.5%, respectively. Fifty-two percent of patients had bilateral SCFE. Obesity was extremely common and correlated significantly with bilateral disease. Obesity did not correlate directly with a higher incidence of chondrolysis or AVN. Adherence to technical details described should reduce complications further.

Atlantoaxial lateral mass osteoarthritis. A frequently overlooked cause of severe occipitocervical pain.

Localized C1-C2 lateral mass osteoarthritis is a degenerative disorder of the upper cervical spine that has a natural history markedly different from that of degenerative afflictions of the lower cervical spine. Atlantoaxial lateral mass arthritis is a distinct cause of occasionally severe occipitocervical pain in elderly persons. In this series, the diagnosis was suggested by the medical history of nine elderly patients who presented with severe occipitocervical pain (frequently diagnosed as occipital neuralgia). Physical examination demonstrated marked restriction of rotation of the cervical spine to the affected side, and localized tenderness unilaterally at the occipitocervical junction. The diagnosis was confirmed by plain radiographs of the C1-C2 articulation (open-mouth view), demonstrating marked, usually unilateral joint-space narrowing, osteophyte formation, and subchondral sclerosis. Bone scanning demonstrated focal uptake unilaterally at the occipitocervical junction. Additional imaging studies, including computed tomography, magnetic resonance imaging, or cervical myelogram, were performed to rule out coexisting intraspinal pathology. Conservative treatment was usually successful; however, C1-C2 arthrodesis was successful for severe occipitocervical pain due to atlantoaxial lateral mass arthritis not responsive to conservative treatment.

Dissociation of modular hip arthroplasty components after dislocation. A report of three cases at differing dissociation levels.

Modular hip arthroplasty systems, currently widely employed, offer the advantage of increased intraoperative flexibility in component selection with reduced inventory, as well as the disadvantage of modular component dissociation. Dissociation during closed reduction for dislocation is reported in three patients at three different interface levels: (1) fixed acetabular shell-polyethylene linear interface, (2) bipolar acetabular component-femoral head interface, and (3) femoral head-neck interface. Subsequent open reduction was required in each case. Although this potential disadvantage of modular hip systems does not outweigh the benefits, it does warrant that certain precautions be taken when implanting modular components. The acetabular linear should lie flush within the metallic shell after impaction. The femoral head should be firmly impacted onto the neck. Both should resist reasonable manual force of disassembly. Should a modular hip arthroplasty component dislocate, gentle reduction under general anesthesia and fluoroscopic control is warranted. Careful inspection of pre- and postreduction roentgenograms for signs of modular component dissociation is mandatory.