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Intra-arterial thrombolytics during endovascular thrombectomy for acute ischaemic stroke in the mr CLEAN Registry

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Stroke & Vascular Neurology 2023年第1期8卷 17-25页

作者： Sabine L Collette Reinoud P H Bokkers Aryan Mazuri Geert J LycklamaàNijeholt Robert J van Oostenbrugge Natalie E LeCouffe Faysal Benali Charles B L M Majoie Jan Cees de Groot Gert Jan R Luijckx Maarten Uyttenboogaart 无 Department of Radiology Medical Imaging CentreUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands Department of Radiology Haaglanden Medical CentreThe Haguethe Netherlands Department of Neurology Cardiovascular Research Institute Maastricht(CARIM)Maastricht University Medical CentreMaastrichtthe Netherlands Department of Neurology Amsterdam UMCUniversity of AmsterdamAmsterdam NeuroscienceAmsterdamthe Netherlands Department of Radiology Maastricht University Medical CentreMaastrichtthe Netherlands Department of Radiology and Nuclear Medicine Amsterdam UMCUniversity of AmsterdamAmsterdam NeuroscienceAmsterdamthe Netherlands Department of Neurology University Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands On behalf of the mr CLEAN Registry investigators

Introduction The efficacy and safety of local intra-arterial(IA)thrombolytics during endovascular thrombectomy(EVT)for large-vessel occlusions is uncertain.We analysed how often IA thrombolytics were administered in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands(mr CLEAN)Registry,whether it was associated with improved functional outcome and assessed technical and safety outcomes compared with EVT without IA thrombolytics.Methods In this observational study,we included patients undergoing EVT for an acute ischaemic stroke in the anterior circulation from the mr CLEAN Registry(March 2014-November 2017).The primary endpoint was favourable functional outcome,defined as an modified Rankin Scale score≤2 at 90 days.Secondary endpoints were reperfusion status,early neurological recovery and symptomatic intracranial haemorrhage(sICH).Subgroup analyses for IA thrombolytics as primary versus adjuvant revascularisation attempt were performed.Results Of the 2263 included patients,95(4.2%)received IA thrombolytics during EVT.The IA thrombolytics administered were urokinase(median dose,250000 IU(IQR,193750-250000))or alteplase(median dose,20 mg(IQR,12-20)).No association was found between IA thrombolytics and favourable functional outcome(adjusted OR(aOR),1.16;95%CI 0.71 to 1.90).Successful reperfusion was less often observed in those patients treated with IA thrombolytics(aOR,0.57;95%CI 0.36 to 0.90).The odds of sICH(aOR,0.82;95%CI 0.32 to 2.10)and early neurological recovery were comparable between patients treated with and without IA thrombolytics.For primary and adjuvant revascularisation attempts,IA thrombolytics were more often administered for proximal than for distal occlusions.Functional outcomes were comparable for patients receiving IA thrombolytics as a primary versus adjuvant revascularisation attempt.Conclusion Local IA thrombolytics were rarely used in the mr CLEAN Registry.In the relatively small study sample,no statistical difference was observe

关键词： arterial throm acute

The role of DJ-1 complexes and catecholamine metabolism： relevance for familial and idiopathic Parkinson＇s disease

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Neural Regeneration Research 2018年第5期13卷 815-816页

作者： Dominik Piston Matthew E.Gegg German centre for Neurodegenerative Diseases (DZNE) Bonn Germany Department of Clinical Neuroscience UCL Institute of Neurology London UK

Autosomal recessive mutations in the PARK7 gene,which encodes for the protein DJ-1,result in a loss of function and are a cause of familial Parkinson’s disease（PD）,while increased wild-type DJ-1protein levels are associated with some forms of cancer.Several functions of DJ-1 have been described,with the greatest evidence indicating that DJ-1 is a redox-sensitive protein involved in the regulation of oxidative stress and cell survival.

关键词： The role of DJ-1 complexes and catecholamine metabolism relevance for familial and idiopathic Parkinson’s disease GBA DA

Carotid artery endarterectomy in patients with symptomatic non-stenotic carotid artery disease

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Stroke & Vascular Neurology 2022年第3期7卷 251-257页

作者： Valentina Nardi John C Benson Anthony S Larson Waleed Brinjikji Luca Saba Fredric B Meyer Giuseppe Lanzino Amir Lerman Luis E Savastano Department of cardiovascular Diseases Mayo ClinicRochesterMinnesotaUSA Radiology Mayo ClinicRochesterMinnesotaUSA Radiology Azienda Ospedaliero UniversitariaCagliariItaly Neurosurgery Mayo ClinicRochesterMinnesotaUSA

Object We sought to determine the safety and efficacy in secondary stroke prevention of carotid endarterectomy(CEA)in patients with symptomatic non-stenotic carotid artery disease(SyNC).Methods This was a single-centre retrospective case series.All patients who underwent CEA for unilateral anterior circulation cerebrovascular events with ipsilateralmr angiography,ulceration or low-density plaque on CT angiography)were assessed.The presence of vulnerable plaque characteristics was compared between arteries ipsilateral to the ischaemic event and contralateral arteries.The prevalence of perioperative/intraoperative complications,as well as recurrent ischaemic events at follow-up was determined.Results Thirty-two patients were included in the analysis,of which 25.0%were female.Carotid arteries ipsilateral to an ischaemic event had a significantly higher prevalence of IPH when compared with contralateral arteries(80.0%vs 0.0%;p<0.001).There were no intraoperative complications.One patient(3.1%)developed symptoms of transient ipsilateral ischaemia 1 day following CEA which resolved without treatment.In a median follow-up of 18.0 months(IQR 5.0-36.0),only one patient(3.1%)experienced a transient neurologic deficit with complete resolution(annualised rate of recurrent stroke after CEA of 1.5%for a total follow-up of 788 patient-months following CEA).All other patients(31/32,96.9%)were free of recurrent ischaemic events.Conclusion CEA appears to be safe and well-tolerated in patients with SyNC.Additional studies with larger cohorts and longer follow-up intervals are needed in order to determine the role of CEA in this patient population.

关键词： patients carotid prevention

Prevalence and associated factors of myocardial involvement in Duchenne muscular dystrophy patients in the first decade of life

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Chinese Medical Journal 2023年第9期136卷 1132-1134页

作者： Rong Xu Huayan Xu Kun Zhang Hong Xu Hui Liu Hang Fu Linjun Xie Ke Xu Chuan Fu Xuesheng Li Xiaoyue Zhou Rajiv Ananthakrishna Joseph BSelvanayagam Li Yu Xiaotang Cai Yingkun Guo Department of Radiology West China Second University HospitalSichuan UniversityKey Laboratory of Obstetric&Gynecologic and Pediatric Diseases and Birth Defects of Ministry of EducationChengduSichuan 610041China Department of Ultrasound West China Second University HospitalSichuan UniversityChengduSichuan 610041China Department of Radiology Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi 510040China mr Collabration Siemens Healthineers Ltd.Shanghai 210001China Department of cardiovascular Medicine Flinders Medical CentreSouth Australian Health and Medical Research InstituteCollege of Medicine and Public HealthFlinders UniversityAdelaideAustralia Department of Pediatric Cardiology West China Second University HospitalSichuan UniversityChengduSichuan 610041China Department of Pediatrics Neurology West China Second University HospitalSichuan UniversityChengduSichuan 610041China

To the Editor:Duchenne muscular dystrophy(DMD)is a rare X-linked inherited disorder caused by dystrophin deficiency,which results in sarcolemmal fragility and degeneration of skeletal and cardiac myocytes.[1]Cardiac involvement ismanifested asDMDcardiomyopathy,which is the leading cause of disease-related morbidity and mortality among DMD patients.

关键词： involvement patients dystrophy

Through-needle all-optical ultrasound imaging in vivo: a preclinical swine study

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Light(Science & Applications) 2017年第1期6卷 70-76页

作者： Malcolm C Finlay Charles A Mosse Richard J Colchester Sacha Noimark Edward Z Zhang Sebastien Ourselin Paul C Beard Richard J Schilling Ivan P Parkin Ioannis Papakonstantinou Adrien E Desjardins William Harvey cardiovascular Research Institute Queen Mary University of London and Barts Heart CentreLondon EC1A 7BEUK Wellcome/EPSRC centre for Interventional and Surgical Sciences University College LondonCharles Bell House67-73 Riding House StreetLondon W1W 7EJUK ucl centre for Materials Research Department of ChemistryUniversity College LondonLondon WC1H 0AJUK Department of Electronic and Electrical Engineering University College LondonLondon WC1E 7JEUK

High-frequency ultrasound imaging can provide exquisite visualizations of tissue to guide minimally invasive procedures.Here,we demonstrate that an all-optical ultrasound transducer,through which light guided by optical fibers is used to generate and receive ultrasound,is suitable for real-time invasive medical imaging in vivo.Broad-bandwidth ultrasound generation was achieved through the photoacoustic excitation of a multiwalled carbon nanotube-polydimethylsiloxane composite coating on the distal end of a 300-μm multi-mode optical fiber by a pulsed laser.The interrogation of a high-finesse Fabry–Pérot cavity on a single-mode optical fiber by a wavelength-tunable continuous-wave laser was applied for ultrasound reception.This transducer was integrated within a custom inner transseptal needle(diameter 1.08 mm;length 78 cm)that included a metallic septum to acoustically isolate the two optical fibers.The use of this needle within the beating heart of a pig provided unprecedented realtime views(50 Hz scan rate)of cardiac tissue(depth:2.5 cm;axial resolution:64μm)and revealed the critical anatomical structures required to safely perform a transseptal crossing:the right and left atrial walls,the right atrial appendage,and the limbus fossae ovalis.This new paradigm will allow ultrasound imaging to be integrated into a broad range of minimally invasive devices in different clinical contexts.

关键词： cardiac medical devices optoacoustic photoacoustic ultrasound

Emerging artificial intelligence applications in liver magnetic resonance imaging

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World Journal of Gastroenterology 2021年第40期27卷 6825-6843页

作者： Charles E Hill Luca Biasiolli Matthew D Robson Vicente Grau Michael Pavlides Department of Engineering Science University of OxfordOxford OX37DQUnited Kingdom Radcliffe Department of Medicine University of OxfordOxford OX39DUUnited Kingdom mr Physics Perspectum LtdOxford OX42LLUnited Kingdom Department of Engineering University of OxfordOxford OX37DQUnited Kingdom Oxford centre for Clinical Magnetic Resonance Research Division of Cardiovascular MedicineRadcliffe Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Translational Gastroenterology Unit University of OxfordOxford OX39DUUnited Kingdom Oxford NIHR Biomedical Research centre University of OxfordOxford OX39DUUnited Kingdom

Chronic liver diseases(CLDs)are becoming increasingly more prevalent in modern society.The use of imaging techniques for early detection,such as magnetic resonance imaging(mrI),is crucial in reducing the impact of these diseases on healthcare systems.Artificial intelligence(AI)algorithms have been shown over the past decade to excel at image-based analysis tasks such as detection and segmentation.When applied to liver mrI,they have the potential to improve clinical decision making,and increase throughput by automating analyses.With Liver diseases becoming more prevalent in society,the need to implement these techniques to utilize liver mrI to its full potential,is paramount.In this review,we report on the current methods and applications of AI methods in liver mrI,with a focus on machine learning and deep learning methods.We assess four main themes of segmentation,classification,image synthesis and artefact detection,and their respective potential in liver mrI and the wider clinic.We provide a brief explanation of some of the algorithms used and explore the current challenges affecting the field.Though there are many hurdles to overcome in implementing AI methods in the clinic,we conclude that AI methods have the potential to positively aid healthcare professionals for years to come.

关键词： Liver diseases Magnetic resonance imaging Machine learning Deep learning Artificial intelligence Computer vision

Evolving role of magnetic resonance techniques in primary sclerosing cholangitis

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World Journal of Gastroenterology 2019年第6期25卷 644-658页

作者： Emmanuel A Selvaraj Emma L Culver Helen Bungay Adam Bailey Roger W Chapman Michael Pavlides Oxford centre for Clinical Magnetic Resonance Research Division of Cardiovascular Medicine Radcliffe Department of Medicine University of Oxford John Radcliffe Hospital Translational Gastroenterology Unit Nuffield Department of Medicine University of OxfordJohn Radcliffe Hospital Oxford NIHR Biomedical Research centre Oxford University Hospitals NHS Foundation Trust and the University of Oxford Department of Radiology John Radcliffe Hospital

Development of non-invasive methods to risk-stratify patients and predict clinical endpoints have been identified as one of the key research priorities in primary sclerosing cholangitis(PSC). In addition to serum and histological biomarkers, there has been much recent interest in developing imaging biomarkers that can predict disease course and clinical outcomes in PSC.Magnetic resonance imaging/magnetic resonance cholangiopancreatography(mrI/mrCP) continue to play a central role in the diagnosis and follow-up of PSC patients. Magnetic resonance(mr) techniques have undergone significant advancement over the last three decades both in mr data acquisition and interpretation. The progression from a qualitative to quantitative approach in mr acquisition techniques and data interpretation, offers the opportunity for the development of objective and reproducible imaging biomarkers that can potentially be incorporated as an additional endpoint in clinical trials. This review article will discuss how the role of mr techniques have evolved over the last three decades from emerging as an alternative diagnostic tool to endoscopic retrograde cholangiopancreatography, to being instrumental in the ongoing search for imaging biomarker of disease stage, progression and prognosis in PSC.

关键词： Primary sclerosing cholangitis Magnetic resonance imaging Magnetic resonance cholangiopancreatography Magnetic resonance elastography Diffusion magnetic resonance imaging Endoscopic retrograde cholangiopancreatography

运用高时空分辨率mr k空间及时间敏感编码技术实时评估先天性心脏病病人左、右心室容积及功能

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国际医学放射学杂志 2008年第A6期31卷 483-484页

作者： V.Muthurangu P.Lurz J.D.Critchely J.E.Deanfield A.M.Taylor M.S.Hansen 李翠玲 centre for cardiovascular mr Cardiothoracic UnitUCL Institute of Child Health30Guildford StLondon WC1N 1EHEngland.

目的比较心电门控mr电影成像、标准实时mr成像及实时k空间-时间敏感编码成像3种技术评估先天性心脏病病人心室容积的大小。

关键词：先天性心脏病 mr k空间右心室心电门控高时空分辨率编码技术影像质量技术评估射血分数

Symptomatic Val122del mutated hereditary transthyretin amyloidosis: Need for early diagnosis and prioritization for heart and liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2021年第4期20卷 323-329页

作者： Adriano-Valerio Schettini Laura Llado JulieK Heimbach JoseGonzalez Costello Marie Tranäng Olivier Van Caenegem Richard C Daly Peter Van den Bergh Carlos Casasnovas Joan Fabregat John J Poterucha Maxime Foguenne Bo Göran Ericzon Jan Lerut Institute for Experimental and Clinical Research(IREC) Catholic University of Louvain(UCL)Avenue Hippocrate 55Brussels 1200Belgium Liver Transplant Unit Department of SurgeryHospital Universitari de BellvitgeCalle de la Feixa LlargaBarcelona 08907Spain Division of Transplantation Surgery William J.von Liebig Transplant CenterMayo Clinic2001st St SWRochesterMN 55905USA Advanced Heart Failure and Transplant Unit Cardiology DepartmentHospital Universitari de BellvitgeCalle de la Feixa LlargaBarcelona 08907Spain Familial Amyloidotic Polyneuropathy World Transplant Registry(FAPWTR) Division of Transplantation SurgeryKarolinska Universitetssjukhuset HuddingeF82Karolinska InstitutetStockholm 14186Sweden Cardiothoracic Intensive Care Unit Department of Cardiovascular DiseasesUniversity Hospitals Saint-Luc-UCLAvenue Hippocrate 10Brussels 1200Belgium cardiovascular Surgery Department Mayo Clinic2001st St SWRochesterMN 55905USA Neuromuscular Reference centre University Hospital Saint-Luc-UCLAvenue Hippocrate 10Brussels 1200Belgium Neuromuscular Unit Neurology DepartmentHospital Universitari de BellvitgeCalle de la Feixa LlargaBarcelona 08907Spain Division of Gastroenterology and Hepatology Mayo Clinic2001st St SWRochester MN 08907USA Division of Transplantation Surgery CLINTECKarolinska Universitetssjukhuset HuddingeF82Karolinska InstitutetStockholm 14186Sweden

Background: Hereditary transthyretin(ATTRv) amyloidosis is an autosomal dominant disease linked to transthyretin gene mutations which cause instability of the transthyretin tetramer. After dissociation and misfolding they reassemble as insoluble fibrils(i.e. amyloid). Apart from the common Val30 Met mutation there is a very heterogeneous group of non-Val30 Met mutations. In some cases, the clinical picture is dominated by a rapidly evolving restrictive and hypertrophic cardiomyopathy. Methods: A case series of four liver recipients with the highly clinically relevant, rare and particularly aggressive Val122 del mutation is presented. Medical and surgical therapeutic options, waiting list policy for ATTRv-amyloidosis, including the need for heart transplantation, and status of heart-liver transplantation are discussed. Results: Three patients needed a staged(1 patient) or simultaneous(2 patients) heart-liver transplant due to rapidly progressing cardiac failure and/or neurologic disability. Domino liver transplantation was impossible in two due to fibrotic hepatic transformation caused by cardiomyopathy. After a follow-up ranging from 3.5 to 9.5 years, cardiac(allograft) function was maintained in all patients, but neuropathy progressed in three patients, one of whom died after 80 months. Conclusions: This is the first report in(liver) transplant literature about the rare Val122 del ATTRv mutation. Due to its aggressiveness, symptomatic patients should be prioritized on the liver and, in cases with cardiomyopathy, heart waiting lists in order to avoid the irreversible neurological and cardiac damage that leads to a rapid lethal outcome.

关键词： Hereditary transthyretin amyloidosis Heart transplantation Liver transplantation Non-Val30Met mutation Val122del mutation Domino liver transplantation