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BACKGROUND Cerebral angiosarcoma is an extremely rare malignant tumor that originates from vascular endothelial cells of the brain or meninges. Especially, primary brain stem angiosarcoma has not been reported. CASE DESCRIPTION A 64-year-old man presented with left subjective weakness, hypesthesia, and dizziness. Brain imaging showed a multistage hemorrhagic mass in the right dorsal pons, which was initially misdiagnosed as a cavernous malformation. The patient's neurological status suddenly deteriorated over a few months, and the mass grew rapidly. Surgical resection was performed, and the final pathology showed brain stem angiosarcoma. CONCLUSIONS To the best of our knowledge, this is the first case of brain stem angiosarcoma confirmed by pathology after surgical resection. The present report highlights that clinicians need to consider angiosarcoma as part of the differential diagnosis for rare hemorrhagic lesions in the brain stem when both imaging findings and neurological deterioration indicate rapid progression. BACKGROUND Vertex epidural hematoma (VEDH) is a rare intracranial mass constituting roughly 2,5% of all epidural hematomas. Bleeding usually derives from the superior sagittal sinus and presentation is often acute, seldom chronic. Fractures are common but diastasis of the sagittal suture in adults is unique. We hereby present a case combining these rare features along with diagnostic pitfalls and management. CASE DESCRIPTION A 43-year-old male with a history of hitting his head against the roll cage of the racing car three weeks prior to admission presented with unbearable headache of 9 NRS intensity and decreased muscular strength in the right upper limb down to 4/5 of Lovett scale. Initial Glasgow Outcome Scale (GOS) was 4. His axial CT scan mimicked convexity hyperostosis, meningioma, or lymphoma. Coronal reconstruction revealed a 102mL large biconcave mass of mixed hyper- and hypodensity at the vertex. Bone window showed sagittal suture diastasis. Contrast enhanced MRI gave evidence of superior sagittal sinus detachment. Parietofrontal craniotomy crossing the midline was performed in order to evacuate the hematoma. On two-week follow up his pain decreased, right arm strength recovered and he was GOS 5. CONCLUSION VEDH can present as an intensifying headache even weeks after purported trauma. Axial CT scans can be tricky because of the blind spot. Even large VEDH may be seen only in the very last few axial slices and may mimic other entities. Coronal reconstructions or additional MRI come in handy. One-piece parietofrontal craniotomy is an option to approach this hematoma. OBJECTIVE To introduce a membrane retraction technique that can provide good exposure of deep-seated recipient arteries in cortical sulci and simplify the anastomosis procedure. METHODS Only those adult patients with moyamoya disease underwent superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery during which the suitable recipient arteries were located deep in cortical sulci were included in this retrospective study. By placing 10-0 prolene sutures to the arachnoid membrane of the two banks of sulcus, arachnoid retraction was applied to pull the sulcus apart and then the deep-seated recipient arteries well exposed. Standard end-to-side anastomosis was completed. The mean occlusion time and successful rate were recorded and compared with those of the normal procedure. RESULT From Jun 2019 to Nov 2019, 124 STA-MCA bypass surgeries for the treatment of moyamoya disease were performed in Nan fang Hospital. The membrane retraction technique was used in 5 patients (5/110, 4.5%) and the successful rates were 100%. The mean temporary occlusion time was 27.2 minutes. No procedure-related complications were observed. All patients recovered uneventfully. The postoperative angiograms confirmed good patency of bypass grafts in all five cases. CONCLUSIONS The membrane retraction technique is an effective and safe method for the treatment of adult moyamoya patients with deep-seated recipient arteries within the sulci. BACKGROUND Neurological complications are common complications encountered by patients with Left Ventricular Assist Devices (LVAD). OBJECTIVE This single center retrospective study aims to identify the incidence and risk factors of neurological complications and interventions in patients supported with LVADs, and define the associated anticoagulation management. selleck products METHODS Between August 2009 and August 2017, 244 patients underwent LVAD implantation. 21 patients were excluded for having neurological complications prior to LVAD placement or for having previously undergone heart transplantation. RESULTS Fifty-six patients (25%) suffered 61 complications, and 11 (19.6%) died as a result. Gender, type of LVAD, or chronic medical comorbidities evaluated did not contribute to a difference in complication rate; in contrast, length of LVAD implantation was directly related to risk of neurological complication. Eleven patients (19.6%) underwent 13 surgical interventions, including five mechanical thrombectomies. Anticoagulation was reversed in 16 patients and held without complication. Anticoagulation was not held for ischemic complications and no clinically significant hemorrhagic transformation occurred. Intravenous Tissue plasminogen activator (TPA) was also successfully administered to 3 patients without complication. CONCLUSION Neurologic complications were observed in 25% of patients supported with LVADs, of which 20% required neurosurgical intervention. Anticoagulation can be safely withheld in patients with hemorrhagic complications. Patients with ischemic complications can continue to be anticoagulated with no significant risk of hemorrhagic transformation. Length of LVAD implantation was directly related to risk of neurological complication. Finally, our study adds to existing literature that mechanical thrombectomy and even IV TPA are options for LVAD patients with ischemic complications. In order to determine the level of cell damage in cancerous cells, current cytogenetic tests have limitations such as time consumption and high cost. The aim of this study was to demonstrate the ability of nonlinear refractive (NLR) index as a predictor of breast cell damage caused by magneto-plasmonic nanoparticle based thermo-radiotherapy treatments. MCF-7 breast cancer cells were subjected individually to the treatment of radiation, radio-frequency (RF) hyperthermia, and radiation + RF hyperthermia. These treatments were repeated in the presence of magneto-plasmonic nanoparticle (Au@IONP). The MTT and nonlinear optical assays were used to evaluate the damage induced by different treatment modalities. The results of MTT were correlated with Z-scan, as the magnitude of nonlinear refraction increased with higher intensity of induced cell damages. In this regard, the lowest cell viability (38%,) and highest magnitude of NLR index (+28.12) were obtained from combination of radiation (at 4 Gy dose) and hyperthermia treatment in the presence of nanoparticles. The proposed optical index (NLR) indicated high capability and can be used as an auxiliary tool to monitor induced cell damage during different treatment strategies. This technique is fast, noninvasive, does not impose cost, and finally does not waste materials. V.Photodynamic therapy (PDT) became an important tool for the treatment of various cutaneous malignant and non-malignant diseases. This therapy involves the application of a photosensitizer to the affected area which is followed by illumination with the light of a particular wavelength resulting in the death of cancerous cells. This review encompasses a brief description of the mechanism of photodynamic therapy and different photosensitizers used clinically. However, the major obstacle with a majority of photosensitizers is its limited bioavailability and long-term photosensitivity which limits its use. To overcome these limitations different nanocarriers systems has been developed and studied for their efficacy in PDT, which forms the focal point of the review. V.Bowen's disease, also named squamous cell carcinoma in situ, is usually treated by surgical excision. However, surgery could cause scars and influence joint function. It is also not suitable to patients with large area of lesions or multiple lesions. Photodynamic therapy (PDT) has advantages of efficacy, safety, without scars or damage to joint function. It could be used repeatedly. Therefore, PDT might be recommended to treat multiple Bowen's disease. This report shared a case of a patient having suffered from multiple Bowen's disease for several times and successfully treated by PDT. PDT not only avoided scars and joint dysfunction, but also raised quality of the patient's daily life. V.Photodynamic therapy (PDT) is currently one of the cancer treatment options. PDT requires the application of a photosensitizer (such as porphyrins, chlorines, and phthalocyanines) that selectively targets malignant cells. It is a big dilemma to find a proper photosensitizer. In our study, we have tested a new in-vitro group of cyanine dyes. These dyes are widely applied in biotechnology as fluorescent markers. Two malignant adenocarcinoma cell lines (MCF-7/WT and MCF-7/DOX) were investigated using photodynamic reaction (PDR) with four cyanine dyes (KF-570, HM-118, FBF-749, and ER-139). KF-570 and HM-118 were irradiated with red light (630 nm), whereas FBF-749 and ER-139 with green light (435 nm). To evaluate PDR efficiency, a clonogenic test was conducted. Apoptosis was investigated by TUNEL and NCA (neutral comet) assays. Proteins selected as indicators of the apoptotic pathway (AIF, sPLA2, Smac/Diablo) and intracellular response markers (SOD-1 and GST-pi) were detected using western blot. The highest number of apoptotic cells (ca. 100%) was observed after PDR with HM-118 and KF-570 in both conducted tests, in both cell lines. The results showed that HM-118 and KF-570 cyanine dyes demonstrated a major phototoxic effect causing apoptosis in doxorubicin-resistant and sensitive cell lines. V.Stabilization of dental implants by means of biomaterials such as bioceramic granules and cements is currently compromised by the poor mechanical properties of these bioceramics. Recently, our group developed a calcium phosphate cement reinforced with poly(vinyl alcohol) fibers with improved flexural strength and toughness. Herein we evaluated the capacity of these fiber-reinforced calcium phosphate cements to stabilize dental implants in vitro and in vivo using a range of mechanical and biological test methods. In vitro, filling of circumferential crestal peri-implant bone defects with synthetic bone analogues with fiber-reinforced calcium phosphate cement demonstrated superior implant stability as compared to fiber-free calcium phosphate cement over a 12-week period. Similarly, filling of circumferential crestal peri-implant bone defects with fiber-reinforced calcium phosphate cement effectively stabilized dental implants installed in a rabbit femoral condyle defect as assessed via both implant stability quotient (ISQ) and torque-out measurements. Moreover, histological and histomorphometric evaluation demonstrated the osteocompatibility of fiber-reinforced calcium phosphate cement, as evidenced by absence of soft tissue ingrowth, direct contact between the bone and cement, and gradual degradation of the biomaterial and replacement by newly-formed bone. These data demonstrate that fiber-reinforced calcium phosphate cement stabilize dental implants during osseointegration.
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