Search

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.

Исследовано влияние модифицированных микропризм Френеля на контрастную чувствительность и остроту зрения. Определены условия снижения контраста тестовых оптотипив вследствие дифракции и хроматизма белого света при использовании призм различного призматического действия. Получены данные о снижении контраста, которые необходимо учитывать при проведении исследований дефектов зрения методами визоконтрастометрии., Summary. The infl uence of modifi ed Fresnel microprism to contrast sensitivity and visual acuity were investigated.The conditions of the decrease of test optotype contrast due to the diffraction and chromaticity of white light while using prisms of different prismatic strength were obtained. It is necessary to consider above-outlined data when conducting eye diseases’ researches by vizocontrastometry methods.The aim: Microprism Fresnel elements are now widely used in the ophthalmology for the treatment of human eye disorders [1, 3, 9]. For the diagnostics of strabismus, in recent years, the device KK-42 is used [6, 8]. Above-mentioned set consists of 42 microprism elements with prismatic strength (PD) of 0.5 to 30.0 prism diopters (Δ) and is suitable for measuring strabismus angles in the range of up to 60 Δ. The aim is to study the infl uence of microprisms on the resolution ability and contrast sensitivity while using prisms for diagnostics of patients’ vision state.Method: For measuring vision acuity VС the electronic method was developed using special test object Mira.The images of Mira stroke elements in the white light are formed at the screen thus modeling the optotypes of test ophthalmic charts. Luminous fl ux is passing through the studied microprisms that are placed at a certain distance L from the screen. In the area of the screen the intensity of test Mira strokes without prisms and with prisms are registered electronically by photodetector. Obtained detector data can determine the microprisms infl uence on the resolution ability of test optotype images with the angular size γС and the chromaticity zone ΔγС.Results: All microprisms from the diagnostic set KK-42 were investigated for vision acuity and contrast decrease while using microprisms. The criterion of the identity for visual acuity data, which are received by the traditional way with test charts, and for the measurement results received by electronic method with Mira strokes, is the equality of the relative chromatic expansion kС = ΔγС / γС for the optotype at the screen and for the relative chromatic expansion kO = ΔγO / γO for the eye retina for the same prism, where ΔγO is the chromaticity area at the retina, γO is the average resolution ability of the human eye ≈ 1.0 arc min (‘).Patients did not notice the deterioration of optotype images while using prisms till. The angular expansion ΔγO of test image on the retina is less comparative to the angular distance γO between the individual elements of ophthalmic chart optotypes.With the growth of prismatic strength Δ the chromaticity value ΔγO increases due to chromatic aberration. When the chromaticity zone ΔγO becomes close to the vision acuity γO ≈ 1’ the value of patients’ visual acuity VС begins to decline.Conclusion: Obtained data have shown that microprisms did not change the vision acuity only for little prismatic strength with chromatic zone ΔγO < γO. For stronger prisms the resolution ability and contrast sensitivity are markedly decreased depending on the prismatic strength Δ due to diffraction and chromaticity of white light. These data have to be taken into account under any vizocontrastometry investigations., Досліджено вплив модифікованих мікропризм Френеля на контрастну чутливість та гостроту зору. Визначено умови зниження контрасту тестових оптотипів внаслідок дифракції та хроматизму білого світла при використанні призм різної призматичної дії. Отримано дані зі зменшення контрасту, які необхідно враховувати при проведенні досліджень дефектів зору методами візоконтрастометрії.

Human Transmissible Spongiform Encephalopaties (TSEs) or prion diseases occur in sporadic, acquired and genetic forms. All the genetic forms of human TSEs are linked to point or insertion mutations of the PRNP and several of these genetic forms are transmissible. Among the rarer point mutations, R208H was reported in 3 patient (JA. Mastrianni; et al. 1996; S. Capellari et al. 2005; C. Basset-Leobon et al. 2006). Here we described the clinical and pathological features of the CJD phenotype associated with the R208H-129VV haplotype in an Italian patient. Case report A 64-year-old woman was referred to the Italian National Register of the Creutzfeldt-Jakob disease and related disorders, with a clinical presentation characterized by mood disorder and ataxia. Two months after the onset, she showed cognitive decay, cerebellar symptoms, pyramidal symptoms involving the left leg, and a progressive action myoclonus of left hand. Four months later the patient was bed ridden in a state of akinetic mutism. The family history was negative for dementia or neurological disorders. The protein 14-3-3 test gave a positive result. The EEG became typical 4 months after the onset. The MRI of the brain showed mild hyperintense signals in the basal ganglia on T2-weighted images. The sequence of the PRNP gene ORF revealed a mutation at the codon 208 with the substitution of histidine for arginine (R208H) and the polymorphism Val/Val at the level of the codon 129. Death occurred 28 months after onset. Neuropathological examination showed severe spongiform changes in the cerebral cortex, striatum, thalamus and cerebellum. Conclusions: this report is the first on the R208H mutation found in association with val/val polymorphism in Italy and it strengthens the linkage of the R208H mutation to CJD.

The aim of this study was to establish a simple method for estimating the conduction velocity (CV) of post-ganglionic sympathetic sudomotor C fibres (SSFCV) in the upper and lower limbs by simultaneously measuring the sympathetic skin reflex (SSR) in two distant sites. Fifty healthy volunteers were studied. SSRs were recorded with standard surface electrodes applied to both proximal (axilla and crural line) and distal sites for each limb (hand and foot). The CV of the efferent branch of the SSR was calculated by dividing the difference in the latencies of the response from two recording sites by the distance between the sites (axilla-hand for upper limb; crural line-foot for lower limb). Day-to-day reproducibility and intra-individual variability of the SSFCV were calculated. For the upper limbs, the SSFCV in the axilla-hand tract was 2.0+/-0.3 m/sec (range 1.6-2.4 m/sec). For the lower limb, the SSFCV in the crural line-foot tract was 1.4+/-0.4 m/sec (range 1.2-1.6 m/sec). Mean intra-individual variability of the SSFCV for the upper and lower limbs was 0.11 and 0.09, respectively. The coefficient of variation of the SSFCV for the upper and lower limbs was 5.1% and 5.4%, respectively. Our data show that this simple and non-invasive method can reliably be used to measure the CV of the sympathetic sudomotor fibres, in suitable temperature conditions, and may be useful when investigating the physiological functions of peripheral nerves in patients with peripheral neuropathies.

Genetic transmissible spongiform encephalopathy (TSE) diseases are always associated with one of the more than 50 disease-associated point or insert mutations of the PrP gene (PRNP) [12] and represent approximately 10 to 20% of all forms of TSE diseases [9]. Each mutation is often associated with specific clinic-pathological phenotype [12] that are generally represented by Creutzfeldt-Jakob disease (CJD) [3, 8], Gerstmann–Sträussler–Scheinker disease or inherited prion protein cerebral amyloidoses [5], and fatal familial insomnia [4]. The methionine/valine polymorphism at codon 129 of PRNP plays also a role in determining the disease phenotype, especially when co-segregates with the pathogenic mutation [3]. Most PRNP mutations responsible for the CJD phenotype, including the R208H, are extremely rare and often there is no evidence of CJD in other family members. In particular, the R208H mutation co-segregates either with methionine or valine at codon 129 and it has been fully described in only 12 patients carrying M129 and 4 patients with V129 [8]. Here, we report clinical and neuropathological details of the fourth worldwide case of CJD carrying the rare R208H-129 Val PRNP genotype with a suggestive positive family history for dementia.