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Background Large-bore aspiration catheters enabling greater flow rates and suction force for mechanical thrombectomy might improve outcomes in patients with stroke secondary to large-vessel occlusion. Complete or near-complete reperfusion after a single thrombectomy pass (first-pass effect) is associated with improved clinical outcomes. We assessed the efficacy and safety of novel MIVI Q™ aspiration catheters in combination with stent-retriever devices. Methods We retrospectively analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute anterior large-vessel occlusion treated with a combined approach using MIVI Q™ aspiration catheters and stent retrievers. Reperfusion was defined according to the modified thrombolysis in cerebral infarction (mTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores. Results We included 52 patients (median age, 75 y IQR: 64–83); 31 (59.6%) women; 14 (26.9%) with terminal internal carotid artery occlusions, 26 (50%) middle cerebral artery (MCA) segment M1 occlusions, and 12 (23.1%) MCA segment M2 occlusions; median NIHSS score at admission was 19 (IQR: 13–22). After the first pass, 25 (48%) patients had mTICI ≥ 2c. At the end of the procedure, 47 (90.4%) had mTICI ≥ 2b and 35 (67.3%) had mTICI ≥ 2c. No serious device-related adverse events were observed. Symptomatic intracranial hemorrhage developed in 1 patient. Mean NIHSS score was 13 at 24 h and 5 at discharge. At 90 days, 24 (46.2%) patients were functionally independent (mRS 0–2). Conclusion This preliminary study found good efficacy and safety for MIVI Q™ aspiration catheters used in combination with stent-retriever devices

Parkinson’s disease (PD) is an incurable neurological disease characterised by impairment of motor function, death of substantia nigra pars compacta (SNc) dopamine (DA) neurons and accumulation of the protein α-synuclein. Macroautophagy, a major process by which deleterious cellular contents are degraded, is implicated in both sporadic and genetic PD, and macroautophagy inducers are currently in PD clinical trials. However, little is known about the interaction between α-synuclein and macroautophagy in vivo. In this thesis, the interaction between impaired macroautophagy in DA neurons and α-synuclein was studied by generating novel transgenic mice. Mice were bred featuring conditional knockout of ATG7, a gene essential for macroautophagy, in DA neurons (ATG7cKODAT-IRES-cre), and expressing the full-length human α-synuclein gene (hSNCA). Mice carrying the ATG7cKODAT-IRES-cre genotype developed key features of PD, including loss of SNc DA neurons, reductions in caudate-putamen DA and the development of protein aggregates in DA neurons. Presence of the hSNCA gene had minimal effect on histological phenotypes. Paradoxically, ATG7cKODAT-IRES-cre mice displayed improvements in some elements of motor function, including increased locomotion, increased gait swing speed and improved motor coordination in old age. There was no effect of the hSNCA gene on behavioural phenotypes. In order to determine a physiological basis for the discrepancy between the neuropathological and motor phenotypes associated with the ATG7cKODAT-IRES-cre genotype, DA neurotransmission was examined using fast-scan cyclic voltammetry (FCV). FCV demonstrated that the ATG7cKODAT-IRES-cre genotype increased evoked DA levels, reduced the rate of DA reuptake, and increased evoked DA in response to repeated stimuli. The finding that impaired macroautophagy in DA neurons enhances DA neurotransmission was confirmed in a second transgenic mouse model. These data demonstrating that impaired macroautophagy enhances dopamine neurotransmission, thus improving behavioural phenotypes while worsening some pathological phenotypes, has direct implications for PD pathogenesis, drug discovery and clinical trials.

Peripheral nerve injury (PNI) is increasingly common with over 200,000 peripheral nerve repairs performed every year in the United States. Common causes of PNI include trauma, tumor excision, and iatrogenic injury. The current gold standard for nerve repair is the autologous nerve graft (autograft) wherein a healthy sensory nerve is taken from another part of the body to repair injured nerve. However, only about 40-50% of patients receiving autograft treatment exhibit adequate functional recovery. This is likely due to the differences in sensory versus motor axon guidance. A major developmental mechanism of axon guidance is axon facilitated axon guidance, where a pioneer axon reaches the end target first, followed by the bolus of growing axons that use the pioneer axon as a guide; this is also seen in vitro when motor neurons and sensory neurons are co-cultured. Current nerve repair strategies do not take into consideration modality dependent axon regeneration. To address this, we have utilized the technique of axon stretch-growth to develop tissue engineered nerve grafts (TENGs) consisting of long, aligned axon tracts. We have previously reported the efficacy of TENGs in bridging critical nerve gap lengths. These first generation TENGs were comprised of pure sensory stretch grown axons. Here we expand this technology to include motor and mixed motor-sensory stretch grown axons to better suit different nerve types. Motor and mixed motor-sensory TENGs were fabricated by implementing the technique of forced neuronal aggregation and culturing these motor aggregates in custom-built mechanobioreactors. These stretch grown constructs were then used as a testbed to determine key molecular mediators of axon guidance by analyzing expression levels of specific cell adhesion molecules (CAMs) in sensory and motor TENGs over time and the effect of stretch growth on CAM expression. Lastly, sensory, motor, and mixed motor-sensory TENGs were transplanted into a rat sciatic nerve injury model to determine the regenerative efficacy of these modality specific constructs. Electrophysiological and nerve and muscle morphometry assessments confirmed that inclusion of motor axons into the constructs improved functional regeneration outcomes.

New non-invasive ultrasonic technology and Vittamed 105 monitor for monitoring of intracranial volumetric trends and pulse wave has been created and clinically tested. The clinical investigations of new technology show the similarity between the invasively recorded intracranial pressure (ICP) and non-invasively recorded intracranial blood volume (IBV) pulse waves, slow waves and slow trends under intensive care unit (ICU) conditions. Sukurta nauja neinvazinė ultragarsinė technologija ir Vittamed 105 monitorius, skirtas intrakranijinių tūrinių trendų ir pulsinių bangų stebėsenai. Naujos technologijos klinikiniai tyrimai neurochirurginės reanimacijos sąlygomis parodė, kad invaziškai ir neinvaziškai registruoti galvospūdžio trendai bei invaziškai ir neinvaziškai registruotos intrakranijinės pulsinės bangos. Создана новая ультразвуковая технология для мониторинга интракраниальных пульсаций и трендов, а также новый Vittamed 105 монитор. Клинические исследования в условиях отдела реанимации показали хорошее совпадение между инвазионным и неинвазионным методами зарегистрированными пульсовыми волнами и трендами внутричерепного давления.

Objective. To evaluate the most effective surgical procedures in the early and late reconstruction of brachial plexus after its traumatic injury. Material and methods. A total of 14 consecutive patients with brachial plexus injuries were examined and operated on at the Department of Plastic and Reconstructive Surgery and Burns at Kaunas University of Medicine Hospital. Less than half of them (43%) came for surgery in the early stage of disease – within 12 months after injury – and 57% in the late stage – 1–15 years after trauma. Altogether, 23 operations – neurolysis, nerve transfer, tendon transfer, and arthrodesis – were performed. Patients were followed up for an average of 12.5 months (range 4 to 19 months) after surgery. Postoperative motor assessment of hand function was based on the motor classification M0–M6 of Mallet and British Medical Research Council Muscle grading system. Results were considered positive if the range of active movements increased no less than 5–10odependently from the level of injury and motor strength – no less than 1–2 grades (M0-->M2 or M2-->M3). Results. Of the eight investigated, six patients from early group showed positive results. The most effective surgical procedures were neurolysis and nerve transfer. A significant improvement in the patients of late group was observed after tendon transfer procedure. Nevertheless, the recovery process of motor function was too slow or even minimal in 31% of patients to satisfy the patient and the... [to full text] Tikslas. Įvertinti efektyviausias chirurgines procedūras skubiai rekonstruojant traumos pažeistą peties rezginį ir vėliau. Tyrimo medžiaga ir metodai. Vienas paskui kitą atvykę 14 ligonių, patyrusių peties rezginio traumą, ištirti ir operuoti Kauno medicinos universiteto klinikų Plastinės ir rekonstrukcinės chirurgijos bei nudegimų skyriuje. 43 proc. jų kreipėsi dėl chirurginės pagalbos 12 mėnesių laikotarpiu po pažeidimo, t. y. ankstyvosios stadijos metu. 57 proc. ligonių atvyko 1–15 metų po traumos, t. y. vėlyvosios stadijos metu. Ligoniams atliktos 23 operacijos (neurolizė, nervų perkėlimas, sausgyslių perkėlimas, artrodezė). Kontroliniai tyrimai šių ligonių atlikti praėjus vidutiniškai 12,5 mėn. (svyravo nuo 4 iki 19) po operacijos. Pooperacinė motorinė rankos funkcija vertinta remiantis Mallet ir British Medical Research Council Muscle Grading (M0–M5) klasifikacijos sistemomis. Rankos funkcija vertinta teigiamai, jei raumens jėga padidėjo ne mažiau kaip 1–2 laipsniais (M0-->M2 ar M2-->M3), o aktyvių judesių amplitudė, priklausomai nuo pažeidimo lygio, padidėjo ne mažiau kaip 5–10 laipsnių. Rezultatai. Šeši iš aštuonių atvykusių išsitirti ligonių, kuriems konstatuota ankstyvoji peties rezginio pažeidimo stadija, rezultatai buvo teigiami. Efektyviausios chirurginės procedūros – neurolizė ir nervų perkėlimas. Sausgyslės perkėlimas buvo efektyviausias ligoniams, operuotiems vėlyvosios pažeidimo stadijos metu. Nepaisant to, motorinės funkcijos atsikūrimas, kad tenkintų... [toliau žr. visą tekstą]