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Background and purpose: Antiplatelet agents can diminish the chance of coronary heart diseases due to the prevention of unusual clotting in the arteries by inhibiting platelet aggregation and avoiding the formation of a blood clot. This mechanism can help to prevent ischemic stroke likewise. To improve the activity of these drugs and reduce their side effects, further studies are required. Experimental approach: Based on the previous studies representing the promising antiplatelet activity of indole hydrazones, a series of their homologs containing twenty-one compounds were prepared in two steps. First, alkylation reaction on the nitrogen of the indole ring, and second, chiff base formation by condensation of a primary amine and N-substituted indole-3 carbaldehyde. Consequently, their platelet anti-aggregation activity was evaluated based on the Born turbidimetric method. Findings/Results: Most of the compounds exhibited noticeable activity against platelet aggregation induced by arachidonic acid. Amongst them, two compounds 2e and 2f showed higher activity with IC50 values that made comparable to indomethacin and acetylsalicylic acid as standard drugs and had no toxicity on platelets. Conclusion and implications: The synthesized compounds exhibited promising activity against arachidonic acid-induced aggregation; however, none of them showed noticeable antiplatelet activity induced by adenosine di-phosphate. Chemical structure comparison of the prepared derivatives indicated the existence of a lipophilic medium-sized group on the phenyl ring increased their activity. In addition, the docking studies confirmed this hydrophobic interaction in the lipophilic pocket of cyclooxygenase-1 enzyme suggesting that hydrophobicity of this region plays a pivotal role in the anti-platelet activity of these compounds. To prove this finding, the enzymatic evaluation with the target enzyme is required.

Abstract Transforming growth factor‐β1 (TGF‐β1) is one of critical cytokines in radiation‐induced liver injury. Hepatic stellate cells (HSC) are activated in the early stage of radiation‐induced liver injury. However, it is currently unclear whether phosphatidylinositol 3‐kinase (PI3K/Akt) signal pathway is activated in radiation‐induced liver injury. Herein, male Sprague‐Dawley rats were irradiated with 6 MV X‐rays (30 Gy) on the right liver. Next, Hematoxylin and eosin staining, Masson staining, and electron microscopy were performed to examine pathological changes. Immunohistochemistry was performed to assess the expression of TGF‐β1, α‐SMA, and p‐Akt (S473) in liver tissues. In vitro, rat HSC cell line HSC‐T6 cells were given different doses of 6 MV X‐ray irradiation (10 and 20 Gy) and treated with LY294002. The expression of α‐SMA and p‐Akt in mRNA and protein levels were measured by reverse transcription‐polymerase chain reactioin (RT‐PCR) and Western blot. TGF‐β1 expression was detected by enzyme‐linked immuno sorbent assay (ELISA). After irradiation, the liver tissues showed obvious pathological changes, indicating the establishment of the radiation‐induced liver injury. Expression levels of TGF‐β1, α‐SMA, and p‐Akt (S473) protein in liver tissues were significantly increased after irradiation, and this increase was in a time‐dependent manner, suggesting the activation of HSC and PI3K/Akt signal pathway. in vitro experiments showed that the TGF‐β1 secreted by HSCs, and the expression of Akt and α‐SMA at mRNA and protein levels were significantly increased in irradiation groups. However, the expression of TGF‐β1, Akt, and α‐SMA were significantly decreased in PI3K/Akt signal pathway inhibitor LY294002‐treated group. Our results suggest that during radiation‐induced liver injury, HSCs are activated by TGF‐β1‐mediated PI3K/Akt signal pathway.

Background: MicroRNA (abbreviated miRNA)-based treatment holds great promise for application as clinical antitumor therapy, but good carriers for delivery of the miRNA drug are lacking. Exosomes secreted by mesenchymal stem cells (MSCs) have proved to be safe, and exogenously modified exosomes may potentially represent an excellent drug delivery vehicle.Methods: In this study, we designed a delivery nano system using single-stranded variable fragment (scFv)-modified exosomes derived from human cord blood MSCs. Genetic engineering technology was used to obtain anti-Glypican 3 (GPC3) scFv-modified exosomes, which were then loaded with miR-26a mimics through electroporation.Results: Results of electron microscopy and dynamic light scattering indicated that the diameter of the drug-carrying exosomes was about 160 nm. Furthermore, anti-GPC3 scFv-modified exosomes effectively delivered miR-26a to GPC3-positive hepatocellular carcinoma cells, thereby inhibiting cell proliferation and migration by regulating the expression of downstream target genes of miR-26a. The exosomes-based nano system displayed favorable anti-tumor effect in vivo with no obvious side effects.Conclusion: Our data provided a new perspective for the use of exosome delivery systems for miRNA-based antitumor therapy.

Background: The polycomb group protein enhancer of zeste homolog 2 (EZH2) has been found to be highly expressed in various tumors, and microRNA-26a (miR-26a) is often unmodulated in cancers. However, the functions of these two molecules in uveal melanoma (UM) and their relationships have not been reported.Methods: We explored the effects of the miR-26a–EZH2 axis in UM by examining the levels of miR-26a and EZH2. The EZH2 levels in various tumor types and the correlations between EZH2 levels and overall survival and disease-free survival were reanalyzed. The binding of miR-26a to the 3′-untranslated region of EZH2 mRNA was measured using the luciferase reporter assay. The regulation of EZH2 gene expression by miR-26a was also identified, and the effect of elevated EZH2 expression on UM cell function was further examined. Results: miR-26a was downregulated and EZH2 was upregulated in UM cells. Overexpression of miR-26a inhibited cell proliferation, and knockdown of EZH2 suppressed cell growth. EZH2 was a direct target of miR-26a in UM cells. The knockout of EZH2 mimicked the tumor inhibition of miR-26a in UM cells, whereas the reintroduction of EZH2 abolished this effect. In addition, a network of EZH2 and its interacting proteins (UBC, CDK1, HDAC1, SUZ12, EED) was found to participate in miR-26a-mediated tumor progression.Conclusion: The newly identified miR-26a–EZH2 axis may be a potential target for the development of treatment strategies for UM.

Splenic artery aneurysms are rare but can be fatal. The majority are asymptomatic and small (less-than 2cm). The diagnosis is often incidental on abdominal CT, but this case report presents of a 78-year-old woman who was diagnosed with a splenic artery aneurysm through a gastroscopy. The posterior gastric wall in the fundus-corpus junction showed a 7 cm area that was bulging into the lumen. The subsequent CT showed a gigantic splenic artery aneurysm measuring 9 cm in diameter. EUS is recommended because it has a high precision in diagnosing subepithelial lesions compared to abdominal CT scan.

Background: Waterpipe smoking is increasing worldwide with no proven interventions for cessation. We compared abstinence rates with 12-week varenicline therapy versus placebo among habitual waterpipe smokers willing to quit., Methods: This double-blind placebo-controlled single-center trial, randomized waterpipe smokers from Lebanon who did not smoke other tobacco products to receive varenicline or placebo for 12 weeks. All participants also received three structured 30-minute individual behavioral intervention sessions. The primary outcome was repeated point prevalence abstinence assessed by self-report and verified by exhaled carbon monoxide three times during 12 weeks and analyzed with the intention to treat. End of treatment urine cotinine, weight, blood pressure, anxiety, depression, withdrawal, and adverse symptoms were also assessed., Results: In total, 152 waterpipe smokers (mean age 38 years [SD = 13], 39% females) willing to quit, who smoked waterpipe exclusively (average 2.3 per day [SD = 1.6] for 16.8 years [SD = 10.8]) were randomized. Seventy-nine participants (52%) with any missing abstinence assessment were considered to have relapsed. Repeat point prevalence abstinence rate was numerically higher among the varenicline group compared to placebo, but the difference did not reach statistical significance when assessed by self-report (16.9 vs. 13.6%, respectively, p = .6) and when further verified by exhaled carbon monoxide (14.1% vs. 9.9%, respectively, p = .4). Abstinence rates were similar in both groups when further verified by urine cotinine at end of treatment. No serious adverse events were reported, adverse symptoms and other outcomes were similar in the varenicline and placebo arms., Conclusions: Varenicline for 12 weeks was not more effective than placebo to achieve abstinence among daily waterpipe smokers., Implications: Varenicline in combination with a behavioral intervention did not significantly enhance the quit rate among exclusive waterpipe smokers compared to behavioral intervention plus placebo. We experienced difficulty enrolling exclusive waterpipe smokers willing to quit and observed high dropout rates among participants demonstrating the difficulties of waterpipe smoking cessation., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Glioblastoma (GBM) is an aggressive and malignant brain tumor with extremely poor prognosis. Despite advances in treatment, the pathogenesis of GBM remains elusive. Mounting studies have revealed the critical role of circular RNAs (circRNAs) in the development and progression of human cancers including GBM, but the comprehension of their functions is still insufficient. In this study, we investigated the expression profile of a circRNA derived from GLIS family zinc finger 3 (GLIS3) in GBM and normal astrocytes. CircGLIS3 expression was detected through quantitative real-time polymerase chain reaction (qRT-PCR) analysis. Functional experiments were performed to analyze the influence of circGLIS3 on GBM cell proliferation and apoptosis. In addition, mechanism assays were to uncover the potential regulatory mechanism of circGLIS3., Results: CircGLIS3 was up-regulated in GBM cells and knockdown of circGLIS3 significantly hampered proliferation and promoted apoptosis of GBM cells. Furthermore, circGLIS3 positively regulated CAPG and GLIS3 by sponging miR-449c-5p to affect GBM cell proliferation and apoptosis., Conclusions: In summary, our study identified that circGLIS3 could promote proliferation and inhibit apoptosis of GBM cells via targeting miR-449c-5p/GLIS3/CAPG axis in vitro. This study could offer a novel molecular perspective for further investigation into mechanisms essential to GBM progression., (© 2022. The Author(s).)

Introduction: Glioma is the most frequent primary cerebral tumor in adults. Recent evidence has suggested that circular RNAs (circRNAs) are associated with the pathological processes in glioma. In our study, we aimed to investigate the function and mechanism of circ_CAPG (circ_0055412) in glioma., Methods: Firstly, circ_0055412 expression was examined through RT-qPCR analysis. Loss-of-function assays and animal experiments were implemented to evaluate the role of circ_0055412 on cisplatin resistance of glioma cells. Moreover, mechanism assays were done to probe into the regulatory mechanism of circ_0055412 in glioma cells., Results: Circ_0055412 was found to be notably upregulated in glioma cells. Moreover, depletion of circ_0055412 enhanced cisplatin sensitivity of glioma cells in vitro and in vivo. Moreover, circ_0055412 recruited eukaryotic translation initiation factor 4A3 (EIF4A3) protein to stabilize capping actin protein, gelsolin like (CAPG) mRNA. Furthermore, circ_0055412 served as a sponge for microRNA-330-3p (miR-330-3p) and regulated nuclear factor of activated T cells 3 (NFATC3) expression to activate the transcription of catenin beta 1 (CTNNB1), thus participating in the activation of Wnt/β-catenin signaling pathway., Conclusion: Circ_0055412 contributed to cisplatin resistance of glioma cells via stabilizing CAPG mRNA and modulating Wnt/β-catenin signaling pathway. This finding might provide novel information for the treatment of glioma., (© 2022 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.)

Macrophage capping protein (CAPG) genes were investigated based on The Cancer Genome Atlas (TCGA) database and clinical experiments. Glioblastoma (GBM) genes expression profiling chip of 529 disease samples and 10 normal samples selected from TCGA database were used for analysis, 25 brain glioma tissue samples and 15 normal brain tissues were collected in the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University in China from 2016 to 2017 to analyze CAPG genes. TCGA results showed that the expression level of CAPG genes in GBM was higher than that in normal tissues, and the expression level of men, aged over 46 years and high grade gliomas in pathological stages was higher than that of women, aged ≤46 and low grade gliomas in pathological stages, and the survival time of high expression was shorter than that of low expression. The expression level of CAPG in glioma tissues was higher than that in normal tissues, and the expression level of CAPG in males was higher than that in females, as males had lymphatic transfer and low differentiation compared with females, but the expression level was not related to age. Survival analysis showed that higher expression level indicated shorter survival time, they were positively correlated. The expression of CAPG in glioma is high, and it is highly expressed with the severity of the disease, and it is also obviously related to the prognosis. Therefore, CAPG could be used as a biomarker for pathological grade and prognosis in glioma. However, the related studies are not consistent on the expression of different sex and ages, so further study is needed.

Background: Adherent and invasive placenta, termed Placenta Creta Spectrum (PCS), is associated with increased maternal morbidity and mortality. Incidence and risk factors for Placenta Creta are on the rise and call to optimize the obstetric care for this condition., Objectives: We sought to compare maternal and neonatal outcomes between a ProActive Peripartum Multidisciplinary Approach (PAMA) as compared to the urgent management of the Placenta Creta Spectrum patients., Study Design: We conducted a single-center prospective observational study between 2005-2016. PCS patients registered with the implementation of a PAMA protocol 2014-2016 epoch(E2) were compared with the pre-PAMA 2005-2013 epoch(E1), managed by urgent team recruitment. The PAMA protocol is grounded on a continuum of care; A. Antenatal: PCS risk assessment based on clinical history and imaging, surgical, anesthesia, urological consults and designation of a dedicated team to be present at planned surgery; B. Delivery: planned at 34-35 weeks, massive transfusion protocol activation, insertion of ureteral catheters, vertical uterine incision, placement of vessel loops on the iliac vessels, avoidance of active placenta delivery, followed by the decision of hysterectomy or uterine repair; C. Post-operative care: intensive care admission. We evaluated maternal and neonatal outcomes., Results: During the study period 158,438 deliveries were registered in our institution; we identified a total of 72 PCS cases (0.05%): 50(69.4%) in E1 and 22 (30.6%) in E2. Patient characteristics were comparable among epochs. Significantly, patients in E2 vs. E1 had fewer events of massive blood transfusion 36.0% vs. 13.6%, p = 0.05; were transfused less RBC units: median 4 vs. 1.5, p = 0.012, had no transfusion-related respiratory complications and hemorrhage control re-laparotomies. Hysterectomy and hollow visceral injury rates were comparable (72% vs. 63.7%, 26% vs. 22%; respectively). The hysterectomy pathology assessment was available for the majority of the cases in both epochs; percreta diagnosis rate significantly increased in E2. The neonatal outcome was similar among the epochs., Conclusions: Institution of a PAMA protocol for PCS resulted in eliminating the urgent deliveries and in reducing the associated significant hemorrhagic related maternal morbidity, with no increase in the rate of hysterectomy or adverse neonatal outcome., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Plants produce various secondary metabolites that offer a potential source of novel insecticides and repellents for the control of mosquito vectors. Plants of the genus Cinnamosma are endemic to, and widely-distributed throughout, the island of Madagascar. The barks of these species are commonly used in traditional medicines for treating a wide range of maladies. The therapeutic nature of the bark is thought to be associated with its enrichment of pungent drimane sesquiterpenes, which elicit antifeedant and toxic effects in some insects. Here we test the hypothesis that a bark extract of Cinnamosma fragrans (CINEX) and its major drimane sesquiterpenes are insecticidal, antifeedant, and repellent to Aedes aegypti, the principal mosquito vector of chikungunya, dengue, yellow fever, and Zika viruses. We demonstrate that CINEX is 1) toxic to larval and adult female mosquitoes, and 2) antifeedant and repellent to adult female mosquitoes. Moreover, we show that cinnamodial (CDIAL), a sesquiterpene dialdehyde isolated from CINEX, duplicates these bioactivities and exhibits similar toxic potency against pyrethroid-susceptible and -resistant strains of Ae. aegypti. Importantly, we show that CDIAL is an agonist of heterologously-expressed mosquito Transient Receptor Potential A1 (TRPA1) channels, and the antifeedant activity of CDIAL is dampened in a TRPA1-deficient strain of Ae. aegypti (TRPA1-/-). Intriguingly, TRPA1-/- mosquitoes do not exhibit toxic resistance to CDIAL. The data indicate that modulation of TRPA1 is required for the sensory detection and avoidance of CDIAL by mosquitoes, but not for inducing the molecule's toxicity. Our study suggests that CDIAL may serve as a novel chemical platform for the development of natural product-based insecticides and repellents for controlling mosquito vectors.

Many cultural and religious beliefs place virginity at a high level of social significance, in that women who lose their virginity before marriage may face humiliation, ostracism, divorce, and extreme violence. This led to an increase in the demand for virginity restoration through surgical hymen reconstruction among these cultures. However, data regarding the acceptance of hymenoplasty in societies that consider sexuality a taboo are scarce. In this cross-sectional study, we investigated the effects of gender and religion on sexual attitudes towards hymenoplasty, premarital sex, and virginity in a sample of 600 Lebanese university students. Our findings showed that approval of hymenoplasty was low among participants regardless of gender (25.7 % men vs. 19.1 % women) and religious affiliations (22.5 % Muslims vs. 22.3 % Christians). Arguments for rejection were rooted in moral ethics and personal convictions: "form of deceiving and cheating" (80.7 %) and "betrayal of honesty in the relationship" (80.4 %). Reasons for acceptance included: personal belief in "women's rights, autonomy, and freedom" (72.2 %) and "physical harm and death" (63.5 %).Male participants were more likely to approve premarital coital sex than females (61.0 vs. 27.3 %). Muslims were also more likely to reject marrying a non-virgin than Christians (39.9 vs. 18.0 %). Female participants expressed more tolerance towards marrying a non-virgin male partner (78.3 vs. 57.3 %). Low acceptance of hymenoplasty among Lebanese university students was found to be related to moral ethics and personal convictions independently from gender and religious affiliation. Differences in sexual attitudes towards premarital coital sex and virginity, however, were more significantly influenced by culture and religion.

Background: The complication of the posterior fossa surgery is seldom described in the literature. The purposes of this retrospective study are to draw attention to the potential complications associated with posterior fossa surgery and to critically review the predisposing factors that might influence the complication rate., Methods: We undertook a 10-year (1992-2002) retrospective study of all posterior fossa surgery performed at LSUHSC. A total of 500 patients were obtained from the operation database, and they were categorized into 5 groups based on the surgical approaches: (1) cerebellopontine angle lesion, (2) microvascular decompression for facial pain and spasm, (3) cerebellar lesions, (4) Chiari I decompression, and (5) petroclival lesions. Data collected for analysis included patient demographics, pathological characteristics of the lesions, and the postoperative complications that occurred as unexpected and undesirable events that prolonged hospital stay and may require surgical/medical intervention., Results: Of the 500 patients reviewed, 220 (44%) patients had tumor resections at the cerebellopontine angle; 110 (22%) patients had microvascular decompression for trigeminal neuralgia and hemifacial spasm; 86 (17.2%) patients had cerebellar lesions; 60 (12%) patients had Chiari I decompression; and 24 (4.8%) patients required transpetrosal approaches for petroclival lesions. The overall complication rate in our study was 31.8%, affecting 159 patients. Cerebrospinal fluid leaks were the most frequently encountered, presenting in 65 (13%) patients followed by meningitis in 46 (9.2%) patients, wound infection in 35 (7%) patients, and CN palsies in 24 (4.8%) patients. Other complications that were observed to develop almost exclusively in patients undergoing cerebellar parenchymal tumor resection included cerebellar edema in 25 (5%) patients, hydrocephalus in 23 (4.6%) patients, cerebellar hematoma in 15 (3%) patients, and cerebellar mutism in 6 (1.2%) patients. The overall mortality rate related to surgery was 2.6% occurring in 13 patients., Conclusion: Posterior fossa surgery involves greater morbidity and mortality and has a wider variety of complications than surgery in the supratentorial compartment. These complications may be avoided by careful perioperative planning, strict adherence to aseptic technique, meticulous microsurgical dissection, proper wound closure, and the judicious use of prophylactic agent. A thorough understanding of the patient's history, neurological findings, imaging studies, operative anatomy, as well as all potential adverse events associated with the procedure is also essential to minimize complications.

Objectives: Adnexal torsion is usually diagnosed in pre-menopausal women and is less common in post-menopausal patients. The risk of malignancy in cases of torsion in menopausal patients is not known. We set out to describe our experience with adnexal torsion in post-menopausal women and to discuss issues related to management in this situation., Methods: A retrospective chart review was conducted of all post-menopausal patients diagnosed with torsion of the adnexa from January 1990 through December 2005. Patient charts were reviewed for information regarding pre-operative signs and symptoms, pathology, demographics, surgical findings, procedure and outcome. As a control group, we chose a consecutive cohort of 29 pre-menopausal patients diagnosed with adnexal torsion during 2002., Results: Twenty-seven patients were found to be menopausal at the time of diagnosis of adnexal torsion. Median age at presentation was 63 years (range 43-93). A median delay of 40 h was found between the time of hospital admittance to surgery for post-menopausal patients in comparison to the pre-menopausal ones. The cause of torsion was benign in pre-menopausal patients whereas 22% of post-menopausal patients were diagnosed with malignant disease. More adnexas were found to be necrotic in menopausal patients and this resulted in under-diagnosis of malignancy on frozen section analysis., Conclusion: The diagnosis of adnexal torsion is less evident in post-menopausal patients leading to delayed treatment. The high risk of malignancy is of major importance and should be taken into account when counseling patients and when using frozen section during surgery.

Background: In spite of traditional and current epidemiological research, there have been few environmental risk factors identified for malignant brain tumors. It has been an equally difficult challenge to identify genetic causes for brain tumors because of the rarity of families with multiple affected individuals, which prevents the use of traditional methods of genetic analysis such as genetic linkage, sib-pair, or even population-based association studies. Thus, it is important to take advantage of rare occasions of familial brain tumors., Methods: Identification and careful study of such families may provide important clues about the etiology of brain malignancies. We studied one family of which two nonnuclear family members were affected with pathologically diagnosed glioblastoma multiforme. Fluorescence in situ hybridization (FISH) assays were used on archival sections from each patient's tumor to investigate the loss and/or gain of important allelic endpoints. Tissue sections were prepared and processed for FISH. DNA probes for targeted gene loci were used to assess allelic gain/loss. FISH probes targeted regions including 19q13, 1p36, 10q/phosphate and tensin homolog (PTEN), chromosome 3, chromosome 7, chromosome 17/17q and p53/17p., Results: FISH analyses identified distinct abnormalities in the two patients, suggesting that despite the familial connections and histologically similar tumors, genetic abnormalities are abundant and heterogeneous among these malignancies., Conclusion: These abnormalities, however, serve to contribute to valuable information regarding patient outcomes, albeit their precise roles in the etiology of this malignancy are yet to be determined.

Objective: The objective of this study was to assess the role of stereotactic radiosurgery in the management of newly diagnosed multiple intracranial metastases from known primary cancer locations., Methods: Fifty (29 women and 21 men) patients received radiosurgery for newly diagnosed 3 or more metastatic brain tumors. Their mean age was 53 years. Lung cancer was the most common primary cancer (66%)., Results: Arrest in the growth of irradiated tumors was achieved in 41 (82%) patients. Eight patients (16%) required further intervention for tumors in other brain locations. Mean survival after diagnosis of brain disease was 12 months and the brain disease-controlled period was 19 months. The period of brain disease control prolonged (P=.03) with decreasing tumor volumes (<10 mL). Control of treated tumors positively affected survival after diagnosis of brain disease (P=.0001)., Conclusion: Radiosurgery as an adjuvant improves survival in patients with cancer who have newly diagnosed multiple intracranial metastases by arresting the growth of tumors.

Intracranial cavernous malformations are vascular anomalies consisting of endothelium-lined caverns filled with blood at various stages of thrombosis and organized and separated by a collagenous stroma devoid of mature vessel wall elements. They represent a clinical challenge both in diagnosis and management due to the variety of presenting symptoms and neuroradiological features. This study analyzes the clinical manifestations and surgical outcomes in 16 patients with cavernous malformations who were treated surgically at the Louisiana State University Health Sciences Center in Shreveport. The most common presenting features were headache, seizure, and focal neurologic deficits. Three patients had deep lesions (two in the brainstem and one in the basal ganglion), and 13 patients had superficial lesions. All patients underwent surgery and had complete excision of the lesion. The overall outcome was satisfactory for all patients with significant symptom relief over a mean follow-up period of 60 months. The optimal management of cavernous malformations should be determined on a case-by-case basis and, when indicated, surgery provides good outcome.

Background: Intracerebral hemorrhage (ICH) is a major public health problem. This subset of stroke often coexists with other serious medical problems such as hypertension, diabetes, and obesity. Management of hemorrhagic stroke is controversial and there is no standardized system for assessing presentation and predicting outcome of this disease. We propose a new grading system based on clinical and radiologic factors important in influencing outcome in ICH that can be used by the entire health care team., Methods: We conducted a retrospective study of the last 50 patients who presented with hypertensive ICHs to Louisiana State University Health Sciences Center in Shreveport during 2001 to 2003. Significant predictors of outcome at 6 months as measured by the Glasgow outcome score (GOS) were determined and a grading system based on clot volume, hydrocephalus on initial computed tomographic scan, and focal neurologic deficit was formulated., Results: Three factors observed to have significant association with GOS were presence of a focal neurologic deficit on initial presentation (P = .003), presence of hydrocephalus on initial computed tomographic scan (P < .0001), and clot volume (P = .003). Patients were scored on these variables as follows: neurologically intact (0 point), any focal neurological deficit (1 point); absence of hydrocephalus (0 point), presence of hydrocephalus (1 point); and clot volume less than 20 mL (1 point), 20 to 50 mL (2 points), and greater than 50 mL (3 points) [corrected] The scores were summed to assign an ICH grade to each patient for predicting his GOS at 6 months. Given the nonsignificant difference between a patient's grade and his actual observed GOS (mean difference 0.04, P = .79), as well as their significant correlation (correlation coefficient = 0.76, P < .0001), we believe our grading system is useful for predicting a patient's GOS., Conclusion: An accurate and reliable grading scale for ICH is helpful in standardizing the management of ICH, improving communication of patient presentation among health care workers, and predicting outcomes.

Purpose: To report the use of a transradial approach to coil embolization of an intracranial aneurysm in a morbidly obese patient., Technical Note: When the transfemoral approach was inaccessible in a morbidly obese patient with a ruptured intracranial aneurysm, coil embolization was performed via a 6-F sheath placed in the radial artery. Multiple platinum coils were delivered to exclude the 14-mm basilar tip aneurysm. Because heparin was not reversed, the sheath was left in the artery for 24 hours then removed. The radial artery was pulsatile, and blood supply to the hand was good., Conclusions: The radial artery appears to be a suitable route for access to the intracranial vessels when the femoral artery is not available.

This anatomic study evaluated the extent that a fronto-orbital osteotomy (FOO) added to a bilateral frontal craniotomy widened the exposure to the midline compartment of the anterior, middle, and posterior cranial fossae. The goal was to determine if osteotomy would significantly increase angles for two targets: the foramen magnum (FM) and anterior clinoid process (ACP). Stepwise dissections were performed on five cadaveric heads. A bilateral frontal craniotomy was made, followed by FOO. After the ethmoids were removed, the planum sphenoidale was drilled to enter the sphenoid sinus. Further drilling exposed the anterior clivus, which was drilled down to FM. Excellent exposure of the basilar artery, vertebral artery, and brain stem was achieved. With and without FOO, angles of exposure were measured for two targets: the ACP and FM. The angle of exposure after FOO increased markedly with an average gain of 76% for the ACP and of 80% for FM. Compared with a conventional bifrontal craniotomy, the addition of FOO increased the surgical exposure and minimized frontal lobe retraction for accessing lesions of the anterior, middle, and posterior cranial fossae.

Background: Trigeminal neuralgia (TN) is a painful condition of controversial origin; however, vascular compression of the root entry zone of the trigeminal nerve is thought to be responsible in some cases. Recently, stereotactic radiosurgery has been established as an alternative treatment for medically intractable TN., Methods: Forty patients with medically refractory TN underwent gamma knife surgery for pain control at our institution. Dose planning was based on high-resolution, contrast-enhanced, axial, volume acquisition magnetic resonance images. Images were reviewed to detect vascular compression of the trigeminal nerve at the root entry zone by an observer blinded to the affected side and the outcome. Another observer, blinded to radiologic findings, conducted the patient follow-up. Results were classified as excellent and good (favorable outcomes) and failure (unfavorable) based upon the intensity of pain, frequency of episodes, pain medications, and need for additional interventions after radiosurgery., Results: Pain was left-sided in 22 patients and right-sided in 18 patients. Vascular compression of the affected nerve at the root entry zone was demonstrable in 14 patients. Prescription dose ranged from 70 to 90 Gy. At a median follow-up of 14 months (range, 3-31 months), 16 patients (40%) had excellent pain control, 12 (30%) had good control, while 12 (30%) had failed treatment. The Kaplan-Meier actuarial pain control rate at 15 months was 82.25 +/- 0.8% (95%CI). Magnetic resonance detectable vascular compression did not affect the outcome (p = 0.6). Increasing marginal dose (> or =40Gy) was a significant predictor of favorable outcome (p = 0.015)., Conclusions: gamma knife surgery is an effective and safe treatment for TN. In our study, we found that vascular compression of the nerve at the root entry zone was not a predictor of the outcome of gamma surgery for TN. The outcome improves with marginal prescription dose of 80 Gy or higher.

Primary central nervous system lymphomas (PCNSLs) represent malignant non-Hodgkin's B-cell lymphomas confined to the central nervous system. Recent years have brought a dramatic increase in the frequency of PCNSL in the immunocompromised and immunocompetent populations. Cryoglobulins are cold-precipitable immunoglobulins associated with a number of infectious, autoimmune, and neoplastic disorders. Although it is known that patients with hematologic malignancies (eg, B-cell lymphomas, chronic lymphocytic leukemia, plasma cell dyscrasias) may have cryoglobulinemias and cryoglobulin deposition in several organs (eg, kidney, liver skin, blood vessels, peripheral nervous system), PCNSL associated with cryoglobulin deposition has not been previously described. This report demonstrates localized cryoglobulin deposition within the tumor bed in an immunocompetent patient with PCNSL.

A prospective trial to investigate feasibility of vaginal delivery after more than one cesarean section, and the safety of vaginal delivery for mother and neonate. Twenty-six pregnant women with a history of two or more cesarean sections were admitted to the delivery room and accepted trial of labor under internal fetal and uterine monitoring. Epidural anesthesia and oxytocin were applied when needed. A similar group of patients (controls) preferred repeated cesarean section. Nineteen women (73%) were successfully delivered by the vaginal route. There were no cases of uterine rupture or perinatal loss. The maternal complication rate was lower than that of the control group. Trial of labor in selected cases of two or more low-segment cesarean sections may be considered safe for mother and fetus.