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The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT.We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months' mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage.Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months' mortality (OR 0.407, 95% CI 0.171-0.969, p = 0.042). After adjustment for pre-defined variables, CAS was associated with a lower rate of 3 months' mortality (aOR 0.430, 95% CI 0.187-0.989, p = 0.047) and a higher rate of complete recanalization (aOR 1.986, 95% CI 1.121-3.518, p = 0.019), successful recanalization (aOR 2.433, 95% CI 1.263-4.686, p = 0.008) and parenchymal hematoma (aOR 2.876, 95% CI 1.173-7.050, p = 0.021). CAS was associated with lower 3 months mortality (OR 0.373, 95% CI 0.141-0.982, p = 0.046) and higher rates of successful recanalization (OR 2.082, 95% CI 1.099-3.942, p = 0.024) after adjustment for variables associated with 3 months' mortality and successful recanalization, respectively.Among AIS patients with TO, CAS during EVT was associated with a higher rate of successful reperfusion and a lower rate of 3 months' mortality.

Accumulating evidence suggests a potential role of dietary protein among nutritional factors interfering with the regulation of blood pressure. Dietary protein source (plant versus animal protein), and especially, protein composition in terms of amino acids has been postulated to interfere with mechanisms underlying the development of hypertension. Recently, mounting interest has been directed at amino acids in hypertension focusing on habitual dietary intake and their circulating levels regardless of single amino acid dietary supplementation. The aim of the present review was to summarize epidemiological evidence concerning the connection between amino acids and hypertension. Due to the large variability in methodologies used for assessing amino acid levels and heterogeneity in the results obtained, it was not possible to draw robust conclusions. Indeed, some classes of amino acids or individual amino acids showed non-causative association with blood pressure as well as the incidence of hypertension, but the evidence was far from being conclusive. Further research should be prompted for a thorough understanding of amino acid effects and synergistic actions of different amino acid classes on blood pressure regulation.

To assess vitreous and plasma changes of vascular endothelial growth factor A (VEGF-A), adrenomedullin (ADM) and endothelin-1 (ET-1) in proliferative diabetic retinopathy (PDR).9 patients with PDR in type 2 diabetes (T2DM) and 11 age-matched non-diabetic patients were enrolled. The levels of VEGF-A, ADM and ET-1 were measured using an enzyme (ELISA) and a radioimmunoassay (RIA) both in vitreous and plasma samples.Vitreous ADM and VEGF-A levels were significantly higher in PDR patients (p=0.04 and p=0.02), whereas no differences were found in ET-1 levels (p=0.29). Plasma ADM levels were significantly higher in the PDR group (p0.01), whereas no significant differences were found in the plasma ET-1 and VEGF-A levels (p=0.30 and p=0.37). The ADM vitreous/plasma ratio was significantly reduced in PDR group.The role of ET-1 in advanced PDR is still controversial; it has been supposed a role limited to induce hypoxic state and promote angiogenesis in the early phases. Once the neo-angiogenic process starts, other mediators are mainly involved as VEGF and ADM. Our findings suggest that ADM is an important marker of advanced PDR as well as VEGF. Conversely, ET-1 is not significantly involved in the advanced stage of PDR.

Histiocytoid cardiomyopathy (Histiocytoid CM) is a rare form of cardiomyopathy observed predominantly in newborn females that is fatal unless treated early in life. We have performed whole exome sequencing on five parent-proband trios and identified nuclear-encoded mitochondrial protein mutations in three cases. The molecular genetic basis of Histiocytoid CM remains unknown despite several hypotheses in medical literature. The findings presented in this manuscript may represent components of genetic etiologies for this heterogeneous disease. Two probands had de novo non-sense mutations in the second exon of the X-linked nuclear gene NDUFB11. A third proband was doubly heterozygous for inherited rare variants in additional components of complex I, NDUFAF2 and NDUFB9, confirming that Histiocytoid CM is genetically heterogeneous. In a fourth case, the proband with Histiocytoid CM inherited a mitochondrial mutation from her heteroplasmic mother, as did her brother who presented with cardiac arrhythmia. Strong candidate recessive or compound heterozygous variants were not found for this individual or for the fifth case. Although NDUFB11 has not been implicated before in cardiac pathology, morpholino-mediated knockdown of ndufb11 in zebrafish embryos generated defective cardiac tissue with cardiomegaly, looping defects, and arrhythmia which suggests the role of NDUFB11 in the pathogenesis of this abnormal cardiac pathology. Taken together, the unbiased whole exome sequencing approach confirms the suspected genetic heterogeneity of Histiocytoid CM. Therefore, the novel NDUFB11 mutation may cause a complex 1 deficiency in synergy with additional unknown mtDNA variants.

To investigate the influence of aging on conventional magnetic resonance (MR) imaging-, magnetization transfer MR imaging-, and diffusion-tensor MR imaging-derived measurements.Dual-echo T1-weighted magnetization transfer and diffusion-tensor MR images of the brain were obtained in 89 healthy subjects. Normalized brain parenchymal volume (NBV) was measured by using a fully automated technique. Magnetization transfer ratio (MTR), apparent diffusion coefficient (ADC), and fractional anisotropy (FA) histograms were created for the whole brain (MTR values) or for a large representative portion of it (ADC and FA values). Bivariate correlations were assessed by using the Spearman rank correlation coefficient. A stepwise selection procedure was used to identify the combination of variables that were most influenced by subject age in a multivariate regression model.Significant correlations were found between subject age and the following variables: number of hyperintense areas in the brain at T2-weighted MR imaging (r = 0.63, P.001), NBV (r = -0.79, P.001), mean ADC (r = 0.34, P =.001), ADC peak height (r = -0.34, P =.001), and FA peak height (r = -0.57, P.001). NBV correlated significantly with number of hyperintense areas (P.001), MTR peak height (P.001), mean ADC (P =.001), ADC peak height (P =.001), and FA peak height (P.001). The final multivariable regression model included NBV and number of hyperintense areas at T2-weighted MR imaging as independent predictors of subject age.In addition to the extent of T2-weighted MR imaging hyperintense areas and the measurement of NBV, diffusion-tensor MR imaging provides additional in vivo information about microstructural age-related brain tissue changes.

BACKGROUND AND PURPOSE: In multiple sclerosis (MS), the severity of tissue damage can vary from edema and inflammation to irreversible demyelination and axonal loss. Compared with conventional T2-weighted MR imaging, magnetization transfer (MT) and diffusion tensor (DT) MR imaging provide quantitative indices with increased specificity to the most destructive aspects of MS. To increase our understanding of the pathophysiologic processes of MS, we assessed the correlations between MT and DT MR imaging–derived metrics and the correlations between these quantities and measures derived from conventional MR in patients with MS. METHODS: T2-weighted, T1-weighted, MT, and DT MR images of the brain were obtained from 34 patients with relapsing-remitting MS (RRMS) and 15 age-matched control subjects. T2 and T1 lesion volumes (LV) and brain volume were measured. MT ratio (MTR), mean diffusivity (D̄), and fractional anisotropy (FA) histograms from the overall brain tissue (BT) and the normal-appearing brain tissue (NABT) were obtained. Average lesion MTR, D̄, and FA were also calculated. The correlations between T2 and T1 LV, brain volume, MT-, and DT-derived metrics were assessed with the Spearman rank correlation coefficient. RESULTS: No significant correlations were found between MT and FA histogram–derived metrics and quantities derived from conventional MR scans (T2 and T1 LV and brain volume). On the contrary, T2 and T1 LV (but not brain volume) were significantly correlated with the average D̄ values of BT and NABT (r values ranging from 0.52 to 0.78). No significant correlation was found between MT- and DT-derived metrics. CONCLUSION: These results suggest that MT and DT MR imaging provide, at least partially, independent measures of lesion burden in patients with RRMS. This suggests that a multiparametric MR approach has the potential for increasing our ability to monitor MS evolution.

BACKGROUND AND PURPOSE: We assessed whether the extent of macro- and microscopic disease in the cortical and subcortical brain tissue, as revealed by MR and magnetization transfer (MT) imaging, correlates with cognitive dysfunction in patients with multiple sclerosis (MS). METHODS: Dual-echo rapid acquisition with relaxation enhancement (RARE), fast fluid-attenuated inversion recovery (fast-FLAIR), T1-weighted, and MT MR images of the brain were obtained from 16 MS patients with cognitive impairment and from six without. Impaired and unimpaired patients were similar across demographic and other disease-related variables. Total and cortical/subcortical lesion loads were assessed using RARE, fast-FLAIR, and T1-weighted sequences. In each patient, cortical/subcortical disease was also assessed by means of MT ratio (MTR) histographic analysis. RESULTS: All the impaired patients had multiple hyperintense lesions in the cortical/subcortical regions on both RARE and fast-FLAIR images; two unimpaired patients had such lesions on the RARE images and four had them on the fast-FLAIR images. Total and cortical/subcortical RARE/fast-FLAIR hyperintense and T1 hypointense lesion loads were significantly greater in the group of cognitively impaired patients. Patients with cognitive deficits also had significantly lower MTR histographic values for all the variables. A multivariate regression model showed that average cortical/subcortical brain MTR was the only factor that was significantly associated with cognitive impairment. CONCLUSION: The extent and severity of MS disease in the cortical and subcortical regions significantly influence the cognitive functions of MS patients. MTR histographic findings suggest that subtle changes undetectable by conventional imaging are also important in determining MS cognitive decline.

Summary: We describe the dynamics and the nature of the presymptomatic phase of multiple sclerosis (MS) in a patient for whom MR abnormalities suggestive of MS were found before the development of clinical symptoms. The patient was monitored with serial monthly MR imaging of the brain and spinal cord for 5 months. Disease activity during the presymptomatic phase showed imaging characteristics comparable to that of early relapsing-remitting MS in terms of enhancing lesions, duration of enhancement, and new lesions depicted by T2-weighted imaging. Measurements derived from magnetization transfer imaging suggested that the amount and degree of tissue destruction within and outside the lesions revealed by T2-weighted imaging were mild. This, together with the fact that only one of the 43 new lesions that developed during the presymptomatic phase was located in a neurologically eloquent area, may be the reason why, for a relatively long period, the patient had no clinical manifestations of MS despite the marked MR findings of disease activity.

BACKGROUND AND PURPOSE: Improving the sensitivity of MR imaging for the detection of multiple sclerosis (MS) lesions in the cord might be useful in the diagnostic workup and could lead to a better understanding of the evolution of the disease. The purpose of this study was to compare fast spin-echo (FSE) with magnetization transfer–prepared gradient-echo (MT-GE) and fast short-inversion-time inversion recovery (fast-STIR) MR sequences to determine which is best for imaging cervical cord lesions in MS patients. METHODS: FSE, MT-GE, and fast-STIR MR images were obtained in 56 MS patients and 10 healthy control subjects with a 1.5-T MR system and a phased-array coil. Cord lesions seen on images obtained with each sequence were counted by two observers in two stages (stage 1: random review of the complete sets of images from each technique; stage 2: side-by-side review with a retrospective count of lesions). RESULTS: At the end of stage 1, a mean of 1.16 cord lesions per patient were seen on FSE images, 1.57 on MT-GE images (35% more than on FSE), and 1.92 on fast-STIR images (66% more than on FSE). Two or more cervical cord lesions were found on 16 FSE images (29%), 23 on MT-GE images (46%), and 30 on fast-STIR images (54%). Differences were reduced after stage 2: MT-GE detected 22% more lesions and fast-STIR 36% more lesions than FSE. Considering the three sequences together, 113 cervical cord lesions were seen in 50 patients (89%). CONCLUSION: Both MT-GE and fast-STIR sequences depict more cervical cord MS lesions than the FSE sequence, with fast-STIR having the best sensitivity. Fast-STIR MR images may be useful for the diagnostic workup of patients with suspected MS and for improving our understanding of the evolution of MS.

CARTOSAT-1 satellite was launched in May 2005; the optical sensor is configured with two pushbroom cameras, namely Aft and Fore, tilted in along track direction by -5° and +26°, providing stereoscopic imagery in the same pass with a ground resolution of 2.5 m. Within the ISRO-ISPRS Cartosat Scientific Assessment Program (C-SAP), investigations were carried out on a stereopair belonging to the test field called TS-6, acquired on 8th June 2005 over the city of Rome, Italy (30 x 7.5 km2), in order to test the sensor potentialities for DSM generation. The stereo images were processed with PCI-OrthoEngine software, using a generic rigorous sensor model; the image orientation and the DSM geocoding were based on GCPs collected by GPS surveys with a mean 3D accuracy of 5-10 cm. For the evaluation of the DSM accuracy, it was compared with the DSM generated from a block of 6 aerial photos (scale 1:9’000) over an area of about 3.5 x 4 km2. An orientation with horizontal and vertical accuracy at sub-pixel level may be obtained with a “generic rigorous model”; as regards DSM extraction, an accuracy ranging from 1 to 2 pixel, depending on the feature of the land cover (urban zone, bare soil) is achievable with commercial image matchers., International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences, XXXVI (1/W51), ISSN:1682-1750, ISSN:2194-9034, ISSN:1682-1777