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Background: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale. Methods: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA. Results: We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70–11.74). MTA was Conclusions: Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country’s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability.

Pial arteriovenous fistulas (AVFs) are rare neurovascular malformations. They differ from arteriovenous malformations (AVMs) in that they involve single or multiple feeding arteries, draining directly into a dilated cortical vein with no intervening nidus. Pial and dural AVFs differ in blood supply, as the first originate from pial or cortical arteries and the latter from outside the dural leaflets. Unlike dural AVFs, most of the pial AVFs are supratentorial. The vast majority are congenital, manifesting during infancy. Acquired pial AVFs are significantly rarer and occur after vasculopathy, head trauma, brain surgery, or cerebral vein thrombosis. We describe a unique case of an acquired pial AVF in a 50-year-old man secondary to a cortical vein thrombosis manifesting as a focal-onset seizure with secondary generalization. A cerebral digital subtraction angiography revealed a low-flow pial AVF fed by a postcentral branch of the left middle cerebral artery draining to the superior sagittal sinus via a cortical vein. It also showed a collateral venous circulation adjacent to the previously thrombosed left parietal vein. There was no evidence of an associated dural AVF or venous varix. Endovascular treatment was scheduled three months later, but the angiogram preceding the embolization showed spontaneous and complete closure of the malformation. To our knowledge, this is the first case illustrating acquired pure pial AVF unaccompanied by a dural component following cortical vein thrombosis, eventually resulting in an unprompted closure.

The present study investigates the protective effects of sulfated polysaccharide isolated from Hypnea spinella alga (HSSP) on alloxan-induced stress oxidant, hepatic dysfunction and histological changes in male rats liver, pancreas and kidney. The chemical characterization of HSSP using various assays such as FIR, XRD and GC-MS spectroscopy. Our results showed that HSSP reduced the activity of α-amylase in serum, pancreas and intestine, as well as a reduction of blood glucose level. In addition, HSSP enhanced superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx), reduced lipid peroxidation in the hepatic, pancreatic and renal antioxidant enzymes and improved the liver-kidney dysfunction parameters by decreasing of aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), creatinine, albumin and urea rates in plasma. Moreover, HSSP treatment in diabetic rats protects against alloxan induced pancreatic β-cells and hepatic cells damages.

The Salicornia species have been used for treatment and prevention of a various diseases. To the best of my knowledge, little information is regarding the antioxidant and protective activities of lipid extract from Salicornia Arabica (SALE). The objectives of this present work were designed to determine the in vitro antioxidant activities of SALE against cadmium-induced toxicity in erythrocytes isolated from rats. The distribution of fatty acid reflected the richness in saturated fatty acids that were predominated by palmitic acid. Our analysis showed that the major fatty acid components were palmitic acid (47.78%), linoleic acid (17.75%), followed by nanadecenoic acid (10.96%). Minor fatty acids including lignoseric acid and palmatoleic acid (C16:0). The in vitro antioxidant activity of SALE was evaluated using both test DPPH and ABTS assays. An important antioxidant potential was observed. The protective potential of SALE was evaluated by estimating the levels of stress markers like MDA concentration and SOD, CAT and GPx activities. Our results showed that cadmium significantly decreased the SOD, CAT and GPx activities in erythrocytes homogenates and enhanced lipid peroxidation. The pre-treatment with SALE ameliorated antioxidant status and inhibited MDA level in erythrocytes. In conclusion, the lipid isolated from S. arabica showed protective potential against Cd-induced erythrocytes damage, which could be related to active compounds present in this fraction.

BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, pInterpretationThere was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

Although rare, spondylodiscitis is the main manifestation of hematogeneous osteomyelitis in patients aged more than 50 years. In this chapter, we discuss the pathophysiology of spinal infections. We review the vascular supply of the spine and its development with age, which is important in understanding the typical patterns of infection in adults and children. Routes of pathogen spread are detailed, with a review of the literature. We identify specificities of pathophysiology in the most common causes of spinal infection, namely, pyogenic and tuberculous spondylodiscitis.

Salmonella osteomyelitis is uncommon and generally associated with sickle cell disease. Vertebral location is extremely rare and has mainly been reported in case reports. Magnetic resonance imaging (MRI) is the modality of choice for assessing discovertebral and soft tissue abnormalities. Imaging features are similar to other spondylodiscitis. Bacteria isolation is necessary for definitive diagnosis and antibiotic susceptibility testing, allowing adequate medical treatment.

In order to prepare thermally stable isosorbide-derived thermoplastic polyurethane, the synthesis of two new chiral exo–exo configured diols, prepared from isosorbide, and two types of diphenols (bisphenol A and thiodiphenol) was described. The synthesis conditions were optimized under conventional heating and microwave irradiations. To prove their suitability in polymerization, these monomers were successfully polymerized using 4,4′-diphenylmethane diisocyanate (MDI) and hexamethylene diisocyanate (HDI). Both monomers and polymers have been studied by NMR, FT-IR, TGA, DSC; intrinsic viscosity of polymers has also been determined. The results showed the effectiveness of the synthetic strategy proposed; moreover, a dramatic reduction of the reaction time and an important improvement of the monomers yield using microwave irradiation have been demonstrated. The monomers, as well as the polymers, showed excellent thermal stability both in air and nitrogen. It was also shown that the introduction of sulphur in the polyurethane backbone was effective in delaying the onset of degradation as well as the degradation rate.

A linear biobased polyacetal was prepared from the reaction between isosorbide and methylene chloride according a one step procedure. Cyclic polyacetal was obtained using the previous linear polymer as precursor. The respective architectures of both polymers and their chemical compositions were carefully established using 1 H NMR and MALDI-TOF spectroscopies. Their molecular weight characteristics were defined using a triple detection size exclusion chromatography while their thermal characteristics were investigated by the conduction of calorimetric and thermogravimetric experiments. The registering of the thermomechanical properties of each kind of isosorbide-based polyacetal showed that the cyclic polymer was the only one able to show a rubbery plateau. This peculiarity was justified by calculation of the threshold value above which entanglements were possible.

We report our assessment of the experience of female interventional radiologists in different Arab countries based on an online questionnaire that was sent to 57 female interventional radiologists in 5 Arab countries. These interventional radiologists were identified from the Pan Arab Interventional Radiology Society database and through personal communications. The survey included items related to demographics, social status, and the professional challenges of interventional radiologists, with a response rate of 93%. Forty-five percent of respondents were between 31 and 45 years of age. Interventional radiology practice represented 25%-50% of work time for 51% of respondents, and the main challenges reported were related to radiation exposure, balancing family/work life, and the male-dominated interventional radiology community.

Clopidogrel (clopi) is a prodrug widely prescribed in the management of coronary artery disease and requires the intervention of hepatic cytochrome P450 2C19 (CYP2C19) for its activation. However, there is interindividual variability in response to clopi despite the use of recommended doses. Thus, the studies have highlighted the effect of the CYP2C19 gene polymorphism or Cyp2C19 gene on the response to clopi and particularly Cyp2C19 * 2 which may be associated with an increased risk of major cardiovascular events or MACE.To evaluate the effect of Cyp2C19 * 2 polymorphism on MACE occurrence and hemorrhagic complications in patients treated with clopi.We carried out a descriptive longitudinal study including 71 patients placed under clopi for a minimum duration of one month. Genotyping of the Cyp2C19 allele was performed by conventional polymerase chain reaction (PCR). After a follow-up period of 495 ± 183 days, we performed a statistical analysis to evaluate the association between the Cyp2C19 * 2 polymorphism and the occurrence of MACE or hemorrhagic complications.Among our patients, 51% had an angioplasty, 42% medical treatment and 7% a coronary artery bypass surgery. In our study population, 52% were heterozygous (HTZ), 28% homozygous (HMZ) healthy * 1 / * 1 and 20% HMZ had the loss of function allele * 2 / * 2. The allelic frequency of Cyp2C19 * 2 was 46%. Follow-up mean duration was of 495 ± 183 days. During this period, the prevalence of MACE was 11% and that of hemorrhagic complications was 13%. In our study, we did not observe a significant association between the occurrence of MACE or hemorrhagic complications with the genotype carrying the Cyp2C19 * 2 allele.Among patients treated with clopi, wearing a Cyp2C19 * 2 function loss allele didn't seem to be associated with a significantly higher risk of MACE, nor a significantly lower risk of hemorragic complications. This suggests the necessity of larger studies.

A newly profiling of Salicornia arabica (SAPS) polysaccharides was investigated. The water-soluble polysaccharide extract extracted from the Tunisian halophyte (SA) contained sulfate (9.64 ± 0.003%), carbohydrate (86.33 ± 0.003%), protein (1.24%), and uronic acids (3.33 ± 0.37%). The analysis of the monosaccharide composition revealed the presence of arabinose, Glucopyranose galactose, Glucuronic acid and glucose. The identified polysaccharide was considered as heterogeneous and highly branched via gaz chromatography, Fourier Transform Infrared Spectrometer (FT-IR), Thin layer chromatography (TLC) analysis. It also displayed an important radical scavenging and reducer power as well it exhibited effective antimicrobial properties.

Objectifs Confirmer le diagnostic d’une fistule carotido-caverneuse (FCC) en se basant sur la clinique et les donnees de l’imagerie (angio-TDM et angio-IRM) : – rappeler la classification de Barrow des FCC ; – illustrer les differents aspects en imagerie et en angiographie des FCC ; – preciser l’apport de la radiologie interventionnelle dans le traitement des FCC. Materiels et Methodes Etude retrospective des patients ayant beneficie d’un traitement endovasculaire d’une FCC entre 2012 et 2018. Tous nos patients ont eu une angio-TDM et une angio-IRM. Une angiographie cerebrale diagnostique a ete realisee chez tous nos patients. La technique d’embolisation de la FCC a ete choisie en fonction des donnees angiographiques. Une angiographie de controle a ete realisee entre 3et 6 mois post-embolisation. Resultats Nous avons collige 16 patients âges entre 11et 59 ans. Un contexte traumatique a ete retrouve chez 14 patients. La symptomatologie revelatrice a ete une exophtalmie pulsatile avec chemosis chez tous les patients. En imagerie, une exophtalmie unilaterale, une dilatation de la veine ophtalmique et une opacification precoce du sinus caverneux des le temps arteriel ont ete les elements cles du diagnostic ( Fig. 1 ). La FCC a ete secondaire a une rupture d’un anevrisme arteriel de la carotide intra-caverneuse dans 2 cas. La voie arterielle avec embolisation par des Coils selon la technique de remodelage au ballon a ete utilisee dans l’ensemble des cas, la voie veineuse a ete utilisee chez une patiente. Une exclusion complete et immediate a ete obtenue chez 12 patients ( Fig. 2 ). L’exclusion etait partielle dans 4 cas. Le controle angiographique realise 3 mois apres l’embolisation a revele l’exclusion spontanee chez 3 de ces patients. Un seul patient a necessite une reprise. Un patient a eu une recanalisation de sa FCC apres exclusion complete necessitant une 2eme embolisation apres 3 mois. Conclusion Les FCC sont rares avec predilection du contexte post traumatique. L’angiographie constitue une pierre angulaire dans le diagnostic, l’etablissement de la strategie therapeutique endovasculaire et le suivi post embolisation.

The objective of this current study was to investigate the possible hyperlipidemic and antioxidative effects of Cystoseira crinita sulfated polysaccharide (CCSP) in rats fed with a high-fat diet, exhibited an inhibitory activity on pancreatic lipase in vitro. In vivo administration of this extract to HFD-rats lowered body weight and potentially inhibited key enzymes of lipid metabolism and absorption as lipase activity in both plasma and small intestine, which led to a notable decrease of blood LDL- cholesterol (LDL-Ch) and triglycerides (TG) levels, and an increase in HDL-cholesterol (HDL-Ch) levels in HFD-rats. CCSP was also observed to protect the liver-kidney functions efficiently, by decreasing of aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH) and Creatine phosphokinase (CPK) activities and creatinine, albumin, T-bilirubin, uric acid, and urea rates in plasma. The histological analysis of liver and kidney tissues further established the positive effect of CCSP.

This paper describes both the synthesis and characterization of a biobased and non-aromatic polyacetal produced from the reaction between isosorbide and methylene chloride. The reaction was conducted in an aprotic dipolar and harmless solvent using a one-step, fast and economical procedure. The chemical composition of this polymer was investigated using Nuclear Magnetic Resonance and Fourier Transform Infra-Red spectroscopies. The molecular weights were examined by size exclusion chromatography and MALDI-TOF spectrometry. The synthesis conditions (concentration, mixing speed, solvent nature, stoichiometry, addition mode of one reactan) were found to strongly influence both polymer architecture and reaction yield. Under moderated stirring conditions, the polyacetal was characterized by a larger amount of macro-cycles. Inversely, under higher intensity mixing and with an excess of methylene chloride, it was mainly composed of linear chains. In this latter case, the polymeric material presented an amorphous morphology with a glass transition temperature (Tg) close to 55 °C. Its degradation temperature was evaluated to be close to 215 °C using thermogravimetry according to multi-ramp methodology. The chemical approach and the physicochemical properties are valuable in comparison with that characteristic of other isosorbide-based polyacetals.

Introduction Les accidents vasculaires cerebraux (AVC) constituent un mode de revelation des vascularites du systeme nerveux central (VSNC). Leurs aspects clinico-radiologiques sont meconnus dans la population pediatrique tunisienne. Objectifs Rapporter les caracteristiques clinico-radiologiques et evolutives des AVC secondaires aux VSNC dans une serie hospitaliere d’enfants tunisiens. Patients et methodes Il s’agit d’une etude retrospective (2004–2016) ayant inclus tous les enfants presentant un AVC secondaire a une VSNC et suivis au service de Neurologie de l’Enfant et de l’Adolescent de l’Institut National Mongi Ben Hmida de Neurologie de Tunis. Une IRM encephalique a ete realisee chez tous les patients. Les donnees clinico-radiologiques, biologiques et evolutives ont ete analysees. Resultats Six enfants (3 garcons/3 filles) ont ete inclus. L’âge moyen etait de 8 ans. Le tableau clinique etait domine par un AVC ischemique dans le territoire sylvien (5/6 cas). L’IRM encephalique a montre des lesions d’âges differents avec un aspect grele de l’artere sylvienne (5/6 cas) et en chapelet de l’artere carotide interne (1/6 cas). Les etiologies etaient dominees par les vascularites systemiques (3/6 cas). L’evolution etait marquee par une epilepsie sequellaire dans 2/6 cas. Discussion Notre etude reflete la frequence de l’AVCI comme signe majeur des VSNC. L’imagerie encephalique (IRM, angiographie conventionnelle) constitue l’examen cle du diagnostic positif. Les etiologies sont reparties en vascularites monophasiques souvent dues aux infections et chroniques (primitives du SNC ou systemiques). Le traitement et l’evolution dependent de l’etiologie et de la precocite du traitement etiologique. Conclusion L’AVC ischemique constitue le signe le plus frequent aux cours des VSNC de l’enfant. Un bilan etiologique exhaustif permet d’instituer un traitement adapte et precoce afin d’ameliorer le pronostic.

Introduction La sclerose en plaques (SEP) pseudotumorale est une forme caracterisee par la presence d’une lesion demyelinisante extensive, superieure a 2 cm de diametre. Elle peut mimer toutes sortes de lesions extensives. Observation Un patient âge de 35 ans a consulte pour lourdeur du membre inferieur gauche evoluant depuis 10 jours. Une TDM cerebrale faite en urgence a montre une plage hypodense du centre semi-ovale droit. L’IRM morphologique a montre une lesion frontale droite de 30 mm de grand axe, en hyperignal T2 et FLAIR, hyposignal T1, prenant le contraste de facon annulaire et exercant un leger effet de masse sur le ventricule lateral. L’IRM multimodale a montre en spectroscopie une augmentation du rapport choline/NAA avec presence de lipides et de lactate au sein de la lesion orientant vers une masse neoplasique. Une augmentation du coefficient de diffusion a ete objectivee en sequence de diffusion et la perfusion a montre une rupture de la barriere hemato-encephalique sans hyperperfusion ce qui est en faveur d’une origine inflammatoire. Le patient a recu un traitement corticoide avec amelioration. Une IRM de controle a montre la regression de la lesion avec presence des plusieurs lesions disseminees repondants aux criteres de SEP. Discussion Les formes pseudotumorales (de Balo, de Marburg ou de Schilder) sont des variantes rares de SEP. Leurs aspects morphologiques peuvent mimer des lymphomes ou des gliomes. La spectroscopie, comme le souligne notre observation, peut etre trompeuse. La recherche d’autres lesions et les resultats des explorations electrophysiologiques et biologiques permettent d’eviter des gestes chirurgicaux inutiles aux patients. Conclusion L’IRM multimodale et en particulier la spectroscopie peut induire en erreur a la phase aigue d’une SEP pseudo-tumorale en montrant des anomalies metaboliques similaires a celles d’une lesion tumorale de bas grade.

Introduction Le syndrome de regression caudale est un syndrome malformatif rare, associant a des degres variables une agenesie des vertebres sacrees et coccygiennes avec un raccourcissement du femur et des anomalies genito-urinaires et cardiovasculaires. Son etiopathogenie demeure inconnue. Le diabete maternel et la predisposition genetique seraient des facteurs etiologiques probables. L’imagerie est la cle du diagnostic positif. Elle est representee par l’echographie en antenatal et par l’imagerie par resonance magnetique (IRM) apres la naissance. Materiel et methodes Etude retrospective incluant deux patientes ayant ete explorees par IRM cerebro-medullaire (3-Tesla). Resultats L’âge de nos patientes etait de 3 et 7 ans. Une patiente avait une derivation ventriculo-peritoneale pour une hydrocephalie. La symptomatologie clinique etait variable associant une encopresie et une enuresie primaire dans un cas et un retard psychomoteur dans un autre cas. L’imagerie par resonance magnetique a permis de poser le diagnostic d’une agenesie caudale chez les deux enfants. Elle a montre egalement une stenose associee de l’aqueduc de Sylvius chez l’une de nos patientes. Conclusion L’IRM est l’examen de choix a realiser en cas de suspicion d’un syndrome d’agenesie caudale. Elle permet d’effectuer un bilan lesionnel complet et precis des differentes malformations vertebrales, medullaires et cerebrales associees.