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Die zerebrale Amyloidangiopathie (CAA) assoziiert mit Inflammation (CAA-RI) ist eine seltene Form einer potenziell reversiblen Enzephalopathie bei einer Untergruppe von Patienten mit CAA. Die zerebralen Amyloidablagerungen können in einzelnen Fällen eine Entzündung vorwiegend in den Gefäßwänden und ein multifokales Marklagerödem hervorrufen. Dabei können monophasische, schubförmige oder primär progrediente Verlaufsformen auftreten. Wir stellen sieben Kasuistiken mit unterschiedlichen Verläufen der Erkrankung dar und geben einen Überblick über die Pathophysiologie, Klinik und Therapie der Erkrankung unter Berücksichtigung der aktuellen Literatur. Die dargestellten Fälle weisen ein sehr unterschiedliches und oft differenzialdiagnostisch schwieriges klinisches Bild auf und verbesserten sich alle unter einer Steroidmedikation ohne Anhalt für einen Rückfall der Erkrankung im Verlauf. Dabei zeigt sich, dass das Erkennen und die frühzeitige konsequente Behandlung der entzündlichen Verlaufsform der CAA mit und ohne direkte entzündliche Gefäßbeteiligung für die erfolgreiche Therapie entscheidend sind. [ABSTRACT FROM AUTHOR]

Background: Endovascular treatment (ET) is standard of care in patients with acute ischemic stroke due to large vessel occlusion, but data on ET in young patients remain limited. Aim: We aim to compare outcomes for young stroke patients undergoing ET in a matched cohort. Methods: We analyzed patients from an observational multicenter cohort with acute ischemic stroke and ET, the German Stroke Registry—Endovascular Treatment trial. Baseline characteristics, procedural parameters, and functional outcome at 90 days were compared between young (<50 years) and older (⩾50 years) patients with and without nearest-neighbor 1:1 propensity score matching. Results: Out of 6628 acute ischemic stroke patients treated with ET, 363 (5.5%) were young. Young patients differed with regard to prognostic outcome characteristics. Specifically, National Institutes of Health Stroke Scale (NIHSS) at admission was lower (median 13, interquartile range (IQR) 8–17 vs. 15, IQR 9–19, p < 0.001), and prestroke dependence was less frequent (2.9% vs. 12.2%, p < 0.001) than in older patients. Compared to a matched cohort of older patients, ET was faster (time from groin puncture to flow restoration, 35 vs. 45 min, p < 0.001) and intracranial hemorrhage was less frequent in young patients (10.0% vs. 25.9%, p < 0.001). Good functional outcome (modified Rankin Scale (mRS) 0–2) at 3 months was achieved more frequently in young patients (71.6% vs. 44.1%, p < 0.001), and overall mortality was lower (6.7% vs. 25.4%, p < 0.001). Among previously employed young patients (n = 177), 37.9% returned to work at 3-month follow-up, while 74.1% of the remaining patients were still undergoing rehabilitation. Conclusion: Young stroke patients undergoing ET have better outcomes compared to older patients, even when matched for prestroke condition, comorbidities, and stroke severity. Hence, more liberal guidelines to perform ET for younger patients may have to be established by future studies. [ABSTRACT FROM AUTHOR]

Endophytic diazotrophic bacteria could be isolated from the energy plants Pennisetum purpureum, Miscanthus sinensis, Miscanthus sacchariflorus and Spartina pectinata using semisolid nitrogen free media. Higher levels of diazotrophic bacteria were found if no nitrogen fertilizer was applied. The bacteria were characterized on the basis of typical morphology, physiological tests, and the use of phylogenetic oligonucleotide probes. They belong partially to the species Azospirillumlipoferum and Herbaspirillum seropedicae while others supposedly represent a new species of Herbaspirillum. Using PCR-fingerprinting techniques a limited genetic diversity of these isolates was found which may indicate an adaptation to the specific conditions of the interiorof these plants. [ABSTRACT FROM AUTHOR]

Abstract: The study of arcs on ICRF systems has mainly focused on the development of fast detectors to detect a breakdown, independently from its position, before they can damage the components [1]. However, the ability to localize an arc is also an important factor: arcs can be the sign of a defect and if they occur at the same location, they give a good indication of the position of this defect without having to use intrusive diagnostics like optical fibers. We present here a method to find the position of arcs based on the analysis of their high-frequency noise. Arcs are indeed fast transient which excite frequencies in the MHz range. The SHAD system reacts on the integral value of this noise signal to detect the development of arcs. But a further investigation of this signal shows detailed features like splittings and chirpings of the frequency peaks which give more information on the source of the breakdown: at its birth, the arc emits a short electromagnetic pulse of several nanoseconds that propagates inside the ICRF system; this pulse is reflected by components like the antenna, the stub tuners or the generators back to the arc thereby changing its boundary conditions. This resonance between the arc and the ICRF system can be measured and the time of propagation of the pulse gives useful data on the position of the breakdown. We have carried out tests on the Manipulator eXPeriment (a testbed to artificially create arcs in a representative ICRF system) and used a fast digitizer at 2Gigasamples/s to capture the signal of breakdowns at different locations. A RF model of the testbed was developed to simulate the theoretical propagation of this signal and to compare it with the measurements. This makes it possible to determine the accuracy of the position measurement and to evaluate the complexity of the model required to get a good estimation of the position. Indeed, to be useful and robust, the modeling should be kept as simple as possible. [Copyright &y& Elsevier]

Background: Because of the strong immunologic responses of surface protein TaSp in Theileria annulata infected host, we tried to characterize this protein in a T. annulata isolate from Iran. Methods: The RNA prepared from T. annulata infected cells was used to produce SMART-DScDNA. The Double strand cDNA was then amplified with primers derived from TaSp mRNA sequences. The PCR product was cloned in pTZ57R/T vector, sequenced and registered under accession no. JQ003240 in GenBank. Results: The sequence analysis showed 90%-94% nucleotide sequence identity and 68%-94% amino acid homology to the corresponding sequences of TaSp gene by T. annulata, T. sp. china I, T. sp. china and T. lestoquardi and three T. annulata reported from Iran respectively. Interestingly, the sequence analysis also showed small nucleotide sequence region near the 5` end in which the presented TaSp protein differed very strongly from the other known TaSp sequences. For the preparation of the recombinant protein, the cDNA was cloned in pQE-32 vector, the recombinant protein was prepared and assayed by Theileria infected bovine serum. Conclusion: The polymorphism in TaSp gene could be detected in intra- as well as inter species. The different characterized TaSp proteins had a common identic region, which may be helpful for development of broad band vaccine based on the recombinant proteins. The polymorphism in this gene, make this protein also interesting for the diagnostic purposes. [ABSTRACT FROM AUTHOR]

Abstract: Arc detection systems are developed for ICRH on ITER to prevent arcs from damaging the ICRF components. One of the detectors, the Sub-Harmonic Arc Detector (SHAD) is based on the detection of the frequencies emitted in the MHz range by arcs , and is consequently resilient to fast load changes. A prototype has been in operation on ASDEX-Upgrade for ten years and has demonstrated its capability to detect arcs. However, to reach the safety level required by ITER, the design has to be modified to eliminate the spurious detections triggered by plasma emission in the MHz range and to enhance the sensitivity to low-voltage arcs. These improvements, which must preserve the simplicity of the system to guarantee its reliability, are based on the experience of RF arcs in resonant structures acquired on ASDEX-Upgrade and on dedicated test-benches. We present the main features of arcs in time and frequency domains and their impact on the behaviour of the SHAD system. Several technological solutions are based on these data and have to support the harsh environment of a burning plasma experiment. The shielding, the location of the detector, the reliability can be affected by the nuclear radiations. These elements are integrated in the design to make of the SHAD a primary safety system for ICRF heating. [Copyright &y& Elsevier]

Background and Objective: Streptococcosis/lactococcosis is the cause of high morbidity and mortality in aquaculture sector and to date a number of species of Streptococcus and Lactococcus genera including S. iniae, S. agalactiae, S. dysagalactiae, S. parauberis, S. feacalis, L. garvieae and L. lactis have been discriminated as the cause of disease in aquatic animals. Despite the use of diagnostic molecular methods for each of these bacterial species, no data is available on a suitable, rapid and simple simultaneous detection tool for these pathogens. This paper describes a simultaneous detection method which is PCR based on a reverse line blot (RLB) for rapid detection and differentiation of four species of genera of Streptococcus and Lactococcus genera consisting of S. iniae, S. agalactiae, S. parauberis and L. garvieae the most important agents of the disease in fish. Materials and Methods: A reverse line blot (RLB) assay was developed for the simultaneously identification of four species of Streptococcus/lactococcusconsisting of S. iniae, S. parauberis, S. agalactiaeand Lactococcusgarvieae. The assay employs one set of primer pair for specific amplification of the 16S rRNA gene. These were designed based on the nucleotide sequences of 16S rRNA gene sharing a homology region with Streptococcus spp. and Lactococcus spp. DNA was extracted from the pure bacterial colonies and amplified. A membrane was prepared with specific oligonucleotide for each bacterial species. PCR products were then hybridized to a membrane. Results and Conclusion: The amplification resulted in PCR product of 241 bp in length. No cross-reactions were observed between any of the tested bacterial species, and mixed DNAs from these four bacterial species were correctly identified. This RLB method is a suitable technique for a simultaneous detection of these species of bacterial fish pathogens that are some of the main causes of streptococcal/lactococcal infections in both freshwater and marine aquatic animals, and so we recommend its use for integrated epidemiological monitoring of streptococcosis/lactococcis in aquaculture industry. [ABSTRACT FROM AUTHOR]

Abstract: The development of photovoltaic (PV) devices based on dye-sensitized TiO2-coated Ti fibers has opened up exciting possibilities for novel PV textile applications. The cohesion and adhesion of the TiO2 layer are identified as crucial factors in maintaining PV efficiency during textile manufacture and weaving operations. The present work describes a systematic investigation of the corresponding damage mechanisms and their influence on the overall PV fiber performance during mechanical deformation. The results confirm that with proper control of the tension of the weft and in the warp, high PV efficiency woven textures are feasible using this technology. [Copyright &y& Elsevier]

Abstract: The ICRF system at the ASDEX Upgrade tokamak is in operation since May 1992. Following some modifications of which the major one was the installation of 3dB couplers it has become a reliable additional heating system. The maximum power coupled into the plasma has been raised up to 7.2MW (90% of the installed RF power) for short pulses and up to 6.2MW for pulses several second long with energy of up to 29MJ. A power of 5MW is delivered on a regular basis to replace two NBI sources. [Copyright &y& Elsevier]

Introduction: Rescue intracranial stenting is necessary to provide sufficient recanalization after mechanical thrombectomy (MT) in patients with acute large vessel occlusions (LVO) due to an underlying intracranial atherosclerotic disease (ICAD). The CREDO heal is a novel stent that provides a potentially lower thrombogenicity due to surface modification. We present the first multicentric experience with the CREDO heal for acute rescue stenting., Methods: Data of 81 patients who underwent rescue stenting after MT at 12 centers in Germany and Spain were prospectively collected and retrospectively evaluated., Results: Final mTICI 2b‑3 was reached in 95.1% after median two MT maneuvers and stenting. Four periprocedural complications resulted in clinical deterioration (4.9%). Intraparenchymal hemorrhage occurred in one patient (1.2%) and functional independence at FU was reached by 42% of the patients. Most interventions were performed under Gp IIb/IIIa inhibitors., Conclusion: CREDO heal was effective and safe in our case series. However, more data is needed to define the optimal antithrombotic regime. The use under single antiplatelet medication is not supported by our study., Competing Interests: Conflict of interest: F. Dorn has (outside of this work) received outside of this work consulting honoraria from Cerenovus, Balt, Microvention, speakers honoraria from Q’Apel, Cerenovus, Acandis, Asahi Inc, Penumbra, Medtronic, Stryker, research grants from Cerenvous (outside of this work). P. Stracke has received consultancy honoraria from Acandis, Balt, speakers honoraria from Acandis, Q’Apel (outside of this work). M. Moehlenbruch has received grants outside this work from Balt, Covidien/Medtronic, MicroVention, and Stryker and consulting honoraria, speaker honoraria, and travel support outside this work from Codman and Siemens. M. Moreu is a Consultant for Stryker, Balt, Cardiva, Inspire, iVascular, Shareholder of Medtronic, Basecamp, Investigator for Angionautix, Stryker, Balt, Anaconda, Cerenovus, iVascular and has received speakers honoraria from Balt, Accandis, Stryker, Medtronic, iVascular, Inspire (outside of this work). H. Nordmeyer has recieved honoraria for lectures, presentations, educational events from Acandis, Cerenovus, Phenox, Rapid medical (outside of this work). J.H. Buhk Buhk is a consultant for Acandis, Cerenovus, Medtronic, MicroVention, Stryker, Vesalio (outside of this work). D. Vollherbst is a consultant for Medtronic (outside of this work). Y.L. Voss, M. Zidan, S. Neuhaus, N. Lehnen, W. Schwindt, M. Ergawy, C. Dyzmann, M. Moehlenbruch, J. Jesser, M. Moreu, C. Pérez-García, M. Bester, F. Flottmann, A. Simgen, S. Schob, A. Berlis, C. Maurer, H. Hentschel, C. Loehr, B. Eckert, J. Saura, F. Delgado and D. Paech declare that they have no competing interests., (© 2024. The Author(s).)

Objective: The study objective was to investigate the factors associated with the physical and psychological wellness of United States (US) adults with asthma. Methods: This cross-sectional analysis used a sample of 2329 US adults with asthma in the 2021 Medical Expenditure Panel Survey data. A logistic regression model investigated the association of the following factors and the dependent variables (physical wellness and psychological wellness): age, sex, race, ethnicity, education, employment, healthcare provision, marriage, income, regular physical activity, current smoker, pain, and limitations. Nationally representative estimates were produced through a weighted analysis. The data structure was maintained using cluster and strata variables. The alpha limit was 0.05. Results: Factors associated with higher odds of reporting good physical wellness included: private (versus no) healthcare provision (odds ratio [OR] = 2.63, 95% confidence interval [CI] = 1.10-6.26), good (versus poor) psychological wellness (OR = 6.83, 95% CI = 4.35-10.72), regular (versus no regular) physical activity (OR = 2.18, 95% CI = 1.42-3.34), little/moderate (versus quite a bit/extreme) pain (OR = 3.51, 95% CI = 2.38-5.15) and no (versus any) limitation (OR = 3.73, 95% CI = 2.30-6.06). In the psychological wellness model, those aged ≥70 (OR = 6.18, 95% CI = 2.72-14.07), 60-69 (OR = 4.64, 95% CI = 2.13-10.10), and 50-59 (OR = 4.96, 95% CI = 2.24-11.02) versus those aged 18-29, and good (versus poor) physical wellness (OR = 6.89, 95% CI = 4.34-10.94) were associated with higher odds of reporting good versus poor psychological wellness. Conclusion: These results may be helpful at targeting resources to optimize the wellness of US adults with asthma. Additional studies are needed to determine any temporal associations between these findings.

Background: A direct aspiration first pass technique (ADAPT) is an effective alternative to stent retriever thrombectomy for patients with large vessel occlusion (LVO). The PERFECT study evaluated direct aspiration with the EMBOVAC large bore aspiration catheter in patients with LVO strokes., Methods: PERFECT was a prospective, post-market, single-arm, multicenter, observational study of patients enrolled across 11 European centers between October 2020 and July 2022. Three direct aspiration passes with EMBOVAC were mandated before switching strategy. The primary endpoint was core-lab assessed successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) post-procedure. Other outcomes included first pass mTICI ≥2c, independent 90-day modified Rankin Scale (mRS) evaluation, and symptomatic intracerebral hemorrhage (sICH) at 24 hours by a clinical events committee., Results: EMBOVAC was used in 100 patients (mean age 70.4±14.0 years, 59.0% (59/100) female). Final mTICI ≥2b was achieved in 98.0% (97/99), final mTICI ≥2b with no change in frontline therapy or thrombolytics use during the procedure was achieved in 87.9% (87/99), final mTICI ≥2c in 86.9% (86/99), and first pass mTICI ≥2c in 53.5% (53/99). sICH at 24 hours was 0%. The 90-day mRS ≤2 rate was 56.6% (56/99) and all-cause mortality was 12.9%. One device-related serious adverse event occurred within 90 days (1.0%)., Conclusions: PERFECT demonstrates that EMBOVAC achieves successful reperfusion rates and favorable clinical outcomes when used in the endovascular treatment of acute ischemic stroke (AIS) using a direct aspiration technique as first line therapy in a real-world setting in patients with AIS secondary to large vessel occlusion., Trial Registration: www., Clinicaltrials: gov Unique identifier: NCT04531904., Competing Interests: Competing interests: OJ: personal fees: Fa. Arcandis/Germany. GM: payment/honoraria for lectures, presentations, Speakers Bureaus, manuscript writing, educational events: Medtronic, Microvention; consulting fees: Stryker Neurovascular, Microvention Europe, Balt SAS, Sim and Size; paid lectures: Medtronic 675, Cerenovus, Bracco, Phenox. BG: consulting fees: Surge2surgery. HN: payment/honoraria for lectures, presentations, educational events: Acandis, Cerenovus, Phenox, Rapid medical. CC: payment/honoraria for lectures, presentations, Speakers bureaus, manuscript writing, educational events: Medtronic, Microvention, MIVI, Stryker. CL: proctoring/consultant services: Phenox; consultant services: Penumbra; travel and meeting expenses: Acandis, Penumbra; payment of honoraria for lectures and support for attending meetings: Phenox, Penumbra, Acandis. AS: employed by/holds shares: GSK. JF: research support: German Ministry of Science and Education, German Ministry of Economy and Innovation, German Research Foundation, European Union, Hamburgische Investitions-/ Förderbank, Medtronic, Microvention, Philips, Stryker; consultancy appointments: Acandis, Bayer, Boehringer Ingelheim, Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche, Route92, Stryker, Tonbridge, TG Medical; stock holdings: Tegus Medical, Vastrax, Eppdata. KD: academic grants: Science Foundation Ireland. MP, BE, AP, MZ, AM, KL: nothing to disclose., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Pharmacist-provided medication therapy management (MTM) services have demonstrated improved clinical outcomes for patients. MTM services could incorporate additional lifestyle and wellness counseling to potentially enhance health care for underserved patients., Objective: To report the outcomes of a new pharmacist-provided MTM lifestyle and wellness counseling program for underserved rural Arizonans with diabetes and/or hypertension., Methods: A community health center referred rural Arizonans with type 2 diabetes and/or hypertension to the MTM pharmacist for telephonic MTM lifestyle and wellness counseling between July 2020 and June 2023. Data were collected on clinical characteristics, adherence issues, and pharmacist recommendations. A nurse reviewed the patients' electronic health record to determine which recommendations had been accepted by the primary care provider after 90 days. Summary statistics were computed., Results: For 93 patients in the program, pharmacists identified many drug-drug interactions, adverse drug reactions, utilization/cost concerns, and recommended preventative vaccines. Pharmacists provided counseling for exercise, nutrition, laboratory values, and disease state education. Twenty-nine patients reported missing any doses of their medications in the past 2 weeks. Patients used a variety of methods to remind them to take their medications. A total of 309 recommendations were made by the pharmacist averaging 3.3 ± 1.4 per patient. Of these, 113 (36.6%) were accepted within 90 days. The most common recommendations made were screening needed (n = 77) and vaccination due (n = 70). The most frequently accepted recommendations by the patients' provider were reinforcing lifestyle/disease self-management strategies (61.7%) and decreasing medication dose (60.0%)., Conclusion: This novel MTM lifestyle and wellness counseling program demonstrated some success for underserved Arizonans with diabetes and/or hypertension. Over one-third of recommendations made by the pharmacist to the patients' primary care provider were accepted, which is encouraging in showing the value of this program but suggests further work is needed to act upon them or understand why they are not implemented., Competing Interests: Disclosure Dr Axon reports grant funding from the American Association of Colleges of Pharmacy, Merck & Co, National Council for Prescription Drug Programs, Pharmacy Quality Alliance, and Tabula Rasa HealthCare Group, outside of this study. The remaining authors report no disclosures., (Copyright © 2025 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Increasing naloxone distribution is a high priority means to mitigating opioid overdose rates in the United States. Since a variety of naloxone distribution models exist, with differences in infrastructure and funding between states and health-systems, it is important to review their differences and understand the strengths and barriers to widespread implementation of each model., Methods: The following 4 databases were searched for articles reporting on naloxone distribution models: (1) PubMed/Medline (National Library of Medicine), (2) Embase (Elsevier), (3) Scopus (Elsevier), and (4) the Cochrane library. Reports from all years written in English that discussed naloxone distribution models in the United States were included, as were all study designs., Results: Of 5825 articles initially identified, 173 were selected for full text review. Of these, 49 met full criteria and were included for data extraction and analysis. Most distribution models occurred in community-based opioid education and naloxone distribution programs and in community pharmacies via a standing order/statewide protocol. Most programs reported strengths related to feasibility, but frequently reported cost as a limitation. Fewer studies described distribution models in ambulatory care or hospital settings, though these studies also highlighted strengths related to feasibility, particularly with support from working partners, and when utilizing an interprofessional care approach. Few studies reported health/economic outcomes data associated with naloxone distribution, such as changes in the number of patient/layperson access, the number of opioid overdose reversals, or cost-savings., Conclusions: This review outlines the many ways in which naloxone is distributed in the United States and emphasizes a need for improved outcomes data collecting/reporting in the various settings where naloxone is distributed. This would allow for future studies to evaluate which distribution model factors are associated with improvements in health outcomes, such as increased layperson access, and lower opioid overdose/mortality rates., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Studies have explored the association of particular conditions, or combinations of conditions, and pain among specific populations. However, there is limited information regarding the association of the number of comorbid conditions, as well as other demographic, economic, health, and limitation variables, with pain among adults in the United States. This cross-sectional database study aimed to examine the relationships between number of comorbid conditions (including cancer, arthritis, joint pain, stroke, heart attack, angina, coronary heart disease, high cholesterol, high blood pressure, other heart diseases, diabetes, asthma, chronic bronchitis, and emphysema), demographic, economic, health, and limitation variables with pain among United States adults using 2021 Medical Expenditure Panel Survey data. A multivariable logistic model assessed the association between the number of comorbid conditions (≥6, 5, 4, 3, 2, 1, versus 0 conditions) and quite a bit/extreme (versus little/moderate) pain, adjusting for demographic, economic, health, and limitation variables. The study found that greater numbers of comorbid conditions were associated with higher odds of quite a bit or extreme pain. In addition, age, education, employment, income, overall health, regular physical activity, and three limitation variables were each associated with pain in the multivariable model. These findings offer insight into the association between number of comorbid conditions and other variables with pain and suggest areas where interventions may be helpful to help improve pain outcomes for United States adults.

Purpose: Flow arrest using a balloon guide catheter (BGC) in mechanical thrombectomy (MT) due to large vessel occlusion has been associated with better outcomes. Known limitations of currently commercially available BGCs are incompatibility with large bore aspiration catheters (AC) and lack of distal flexibility. Walrus presents variable stiffness and compatibility with large bore AC. The goal of this study is to describe the first experience with Walrus in a realistic stroke simulation model., Methods: A full-length modular vascular model under physiological conditions was used. 8F + -Walrus inner-diameter (ID) 0.087in 95 cm combined with 6F-Sofia AC ID 0.070in 131 cm and an 8F-Flowgate2 BGC ID 0.084in 95 cm with a 5F-Sofia AC ID 0.055in 125 cm were used to perform aspiration MT. User surveys, access to target and occlusion site, technique, time of delivery, anatomical change, and catheter kick-back were assessed., Results: Seven neuroradiologists with average of 10 years-experience in MT performed primary aspiration using the above-mentioned combinations in three different anatomies (N = 41). All operators would likely (29%) or very likely (71%) use again Walrus in combination with large bore AC and the majority (86%) found its navigability easier than with other BGCs. Time to reach final BGC position and catheter kick-back did not differ significantly among anatomies or catheter combinations (p > 0.05). However, Walrus was more likely to reach ICA petrous segment (p < 0.05) and intracranial occlusion with AC (p < 0.01)., Conclusion: The Walrus combined with large bore AC presented significantly better distal access and navigability for primary aspiration in an in vitro stroke model., (© 2023. The Author(s).)

Background: Dissections of the cervical brain-supplying arteries are a leading cause of ischemic stroke in young adults, with an annual incidence of 2.5-3 / 100 000 for carotid artery dissection and 1-1.5 / 100 000 for vertebral artery dissection. It can be assumed that many cases go unreported. We present the clinical features here to help physicians diagnose this disease entity as rapidly as possible., Methods: This review is based on pertinent publications retrieved by a selective search in PubMed., Results: Spontaneous dissection of the internal carotid or vertebral artery is characterized by a hematoma in the vessel wall. It often arises in connection with minor injuries; underlying weakness of the arterial wall (possibly only temporary) may be a predisposing factor. Acute unilateral pain is the main presenting symptom. In internal carotid dissection, the site of the pain is temporal in 46% of cases, and frontal in 19%; in vertebral artery dissection, it is nuchal and occipital in 80%. Pain and local findings, such as Horner syndrome, are generally present from the beginning, while stroke may arise only after a latency of hours to days. If the diagnosis is made early with MRI, CT, or ultrasound, and anticoagulation or antiplatelet drugs can help prevent a stroke, yet none of these methods can detect all cases. Recurrent dissection is rare, except in patients with connective tissue diseases such as Ehlers-Danlos syndrome or fibromuscular dysplasia. Spontaneous dissection of the great vessels of the neck must be differentiated from aortic dissection spreading to the supra-aortic vessels and from traumatic dissection due to blunt or penetrating vascular trauma., Conclusion: Dissection of the cervical brain-supplying vessels is not always revealed by the imaging methods that are used to detect it. Stroke prevention thus depends on the physician's being aware of the symptoms and signs of this disease entity, so that early diagnosis can be followed by appropriate treatment.

Purpose: Identification of independent treatment factors associated with high radiation exposure during endovascular mechanical thrombectomy (EMT) in acute ischemic stroke., Methods: This retrospective analysis included all patients treated by means of EMT during the 2‑year period 2017-2018 in a comprehensive stroke center. The EMT were performed by four internal and three external certified neuroradiologists in a clinic overlapping on call system. Radiation exposure as the dependent variable (dose area product DAP, Gy ⋅ cm 2 ) was dichotomized in < 100 Gy ⋅ cm 2 and ≥ 100 Gy ⋅ cm 2 . Independent variables were age (< 75 years vs. ≥ 75 years), time of intervention (during vs. beyond workday), treating neuroradiologist (internal vs. external), occlusion type ("mono" vs. "tandem"), reperfusion success (TICI 0-2A vs. TICI 2B/3), recanalization attempts (≤ 2 vs. > 2) and dose protocol (normal dose in 2017 vs. low dose in 2018)., Results: The EMT treatment of 208 patients (111 female, 97 male, mean age 71.6 years) was analyzed. Median DAP was 86.6 Gy ⋅ cm 2 and could be reduced from 104.8 Gy ⋅ cm 2 (N = 105 in 2017) to 73.3 Gy ⋅ cm 2 (N = 103 in 2018) with LD program. Univariable and multivariable binary logistic regression analysis revealed a significantly increased radiation exposure (≥ 100 Gy ⋅ cm 2 ) in tandem occlusion type (P < 0.001), > 2 recanalization attempts (P < 0.001) and normal dose protocol (P = 0.002)., Conclusion: Low dose programs can significantly reduce the radiation exposure in EMT. High radiation exposure is significantly associated with more than two recanalization attempts and in cases of tandem occlusions., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

This study evaluated a pharmacist-led telephonic Medication Therapy Management (MTM) program for rural patients in Arizona with poor access to healthcare services. A pharmacist provided telephonic MTM services to eligible adult patients living in rural Arizona communities with a diagnosis of diabetes and/or hypertension. Data were collected and summarized descriptively for demographic and health conditions, clinical values, and medication-related problems (MRPs) at the initial consultation, and follow-up data collected at 1 and 3 months. A total of 33 patients had baseline and one-month follow-up data, while 15 patients also had three-month follow-up data. At the initial consultation, the following MRPs were identified: medication adherence issues, dose-related concerns, adverse drug events (ADE), high-risk medications, and therapeutic duplications. Recommendations were made for patients to have the influenza, herpes zoster, and pneumonia vaccines; and to initiate a statin, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker, and/or rescue inhaler. In conclusion, this study demonstrated that while pharmacists can identify and make clinical recommendations to patients, the value of these interventions is not fully realized due to recommendations not being implemented and difficulties with patient follow-up, which may have been due to the COVID-19 pandemic. Additional efforts to address these shortcomings are therefore required.