em Genomics Methods for Xenopus Embryos and Tissues By cshprotocols.cshlp.org Published On :: 2020-05-01T06:29:31-07:00 High-throughput sequencing methods have created exciting opportunities to explore the regulatory landscape of the entire genome. Here we introduce methods to characterize the genomic locations of bound proteins, open chromatin, and sites of DNA–DNA contact in Xenopus embryos. These methods include chromatin immunoprecipitation followed by sequencing (ChIP-seq), a combination of DNase I digestion and sequencing (DNase-seq), the assay for transposase-accessible chromatin and sequencing (ATAC-seq), and the use of proximity-based DNA ligation followed by sequencing (Hi-C). Full Article
em The Impact of One-week Dietary Supplementation with Kava on Biomarkers of Tobacco Use and Nitrosamine-based Carcinogenesis Risk among Active Smokers By cancerpreventionresearch.aacrjournals.org Published On :: 2020-05-04T05:35:14-07:00 Tobacco smoking is the primary risk factor for lung cancer, driven by the addictive nature of nicotine and the indisputable carcinogenicity of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) as well as other compounds. The integration of lung cancer chemoprevention with smoking cessation is one potential approach to reduce this risk and mitigate lung cancer mortality. Experimental data from our group suggest that kava, commonly consumed in the South Pacific Islands as a beverage to promote relaxation, may reduce lung cancer risk by enhancing NNK detoxification and reducing NNK-derived DNA damage. Building upon these observations, we conducted a pilot clinical trial to evaluate the effects of a 7-day course of kava on NNK metabolism in active smokers. The primary objective was to compare urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL plus its glucuronides, major metabolites of NNK) before and after kava administration as an indicator of NNK detoxification. Secondary objectives included determining kava's safety, its effects on DNA damage, tobacco use, and cortisol (a biomarker of stress). Kava increased urinary excretion of total NNAL and reduced urinary 3-methyladenine in participants, suggestive of its ability to reduce the carcinogenicity of NNK. Kava also reduced urinary total nicotine equivalents, indicative of its potential to facilitate tobacco cessation. Plasma cortisol and urinary total cortisol equivalents were reduced upon kava use, which may contribute to reductions in tobacco use. These results demonstrate the potential of kava intake to reduce lung cancer risk among smokers. Full Article
em A Systematic Review on Cost-effectiveness Studies Evaluating Ovarian Cancer Early Detection and Prevention Strategies By cancerpreventionresearch.aacrjournals.org Published On :: 2020-05-04T05:35:14-07:00 Ovarian cancer imposes a substantial health and economic burden. We systematically reviewed current health-economic evidence for ovarian cancer early detection or prevention strategies. Accordingly, we searched relevant databases for cost-effectiveness studies evaluating ovarian cancer early detection or prevention strategies. Study characteristics and results including quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICER) were summarized in standardized evidence tables. Economic results were transformed into 2017 Euros. The included studies (N = 33) evaluated ovarian cancer screening, risk-reducing interventions in women with heterogeneous cancer risks and genetic testing followed by risk-reducing interventions for mutation carriers. Multimodal screening with a risk-adjusted algorithm in postmenopausal women achieved ICERs of 9,800–81,400 Euros/QALY, depending on assumptions on mortality data extrapolation, costs, test performance, and screening frequency. Cost-effectiveness of risk-reducing surgery in mutation carriers ranged from cost-saving to 59,000 Euros/QALY. Genetic testing plus risk-reducing interventions for mutation carriers ranged from cost-saving to 54,000 Euros/QALY in women at increased mutation risk. Our findings suggest that preventive surgery and genetic testing plus preventive surgery in women at high risk for ovarian cancer can be considered effective and cost-effective. In postmenopausal women from the general population, multimodal screening using a risk-adjusted algorithm may be cost-effective. Full Article
em Systemic Immune Response and Cancer Risk: Filling the Missing Piece of Immuno-Oncology By cancerres.aacrjournals.org Published On :: 2020-05-04T05:35:17-07:00 While immuno-oncology has made significant advances in activating local tumor immune responses, leading to improved outcomes, the role of systemic immunity in cancer incidence remains poorly understood. Le Cornet and colleagues prospectively studied circulating immune cells quantified by DNA methylation markers in relation to incidence of breast, colorectal, lung, and prostate cancer among initially healthy individuals. A positive association with cancer risk was observed for higher FOXP3+ T-cell–mediated immune tolerance and lower CD8+ T-cell–mediated cytotoxicity. Further studies of systemic immunity in cancer development are crucial to identify novel prediction markers and interventional targets for cancer immunoprevention.See related article by Le Cornet et al., p. 1885 Full Article
em You Must Remember Meeting Clara: Remembering Clara Derber Bloomfield (1942-2020) By cancerres.aacrjournals.org Published On :: 2020-05-04T05:35:17-07:00 Full Article
em [PERSPECTIVES] Toward Systems Pathology for PTEN Diagnostics By perspectivesinmedicine.cshlp.org Published On :: 2020-05-01T06:30:15-07:00 Germline alterations of the tumor suppressor PTEN have been extensively characterized in patients with PTEN hamartoma tumor syndromes, encompassing subsets of Cowden syndrome, Bannayan–Riley–Ruvalcaba syndrome, Proteus and Proteus-like syndromes, as well as autism spectrum disorder. Studies have shown an increase in the risk of developing specific cancer types in the presence of a germline PTEN mutation. Furthermore, outside of the familial setting, somatic variants of PTEN occur in numerous malignancies. Here we introduce and discuss the prospect of moving toward a systems pathology approach for PTEN diagnostics, incorporating clinical and molecular pathology data with the goal of improving the clinical management of patients with a PTEN mutation. Detection of a germline PTEN mutation can inform cancer surveillance and in the case of somatic mutation, have value in predicting disease course. Given that PTEN functions in the PI3K/AKT/mTOR pathway, identification of a PTEN mutation may highlight new therapeutic opportunities and/or inform therapeutic choices. Full Article
em [PERSPECTIVES] RNA Regulators in Leukemia and Lymphoma By perspectivesinmedicine.cshlp.org Published On :: 2020-05-01T06:30:15-07:00 Posttranscriptional regulation of mRNA is a powerful and tightly controlled process in which cells command the integrity, diversity, and abundance of their protein products. RNA-binding proteins (RBPs) are the principal players that control many intermediary steps of posttranscriptional regulation. Recent advances in this field have discovered the importance of RBPs in hematological diseases. Herein we will review a number of RBPs that have been determined to play critical functions in leukemia and lymphoma. Furthermore, we will discuss the potential therapeutic strategies that are currently being studied to specifically target RBPs in these diseases. Full Article
em Involvement of the Olfactory Apparatus by Gliomas [HEAD & NECK] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 SUMMARY: The olfactory bulbs and tracts are central nervous system white matter tracts maintained by central neuroglia. Although rare, gliomas can originate from and progress to involve the olfactory apparatus. Through a Health Insurance Portability and Accountability Act–compliant retrospective review of the institutional teaching files and brain MR imaging reports spanning 10 years, we identified 12 cases of gliomas involving the olfactory bulbs and tracts, including 6 cases of glioblastoma, 2 cases of anaplastic oligodendroglioma, and 1 case each of pilocytic astrocytoma, diffuse (grade II) astrocytoma, anaplastic astrocytoma (grade III), and diffuse midline glioma. All except the pilocytic astrocytoma occurred in patients with known primary glial tumors elsewhere. Imaging findings of olfactory tumor involvement ranged from well-demarcated enhancing masses to ill-defined enhancing infiltrative lesions to nonenhancing masslike FLAIR signal abnormality within the olfactory tracts. Familiarity with the imaging findings of glioma involvement of the olfactory nerves is important for timely diagnosis and treatment of recurrent gliomas and to distinguish them from other disease processes. Full Article
em Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle-Delayed 3D-FLAIR Sequences in Meniere Disease [HEAD & NECK] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: Endolymphatic hydrops in patients with Menière disease relies on delayed postcontrast 3D-FLAIR sequences. The purpose of this study was to compare the degree of perilymphatic enhancement and the detection rate of endolymphatic hydrops using constant and variable flip angles sequences. MATERIALS AND METHODS: This was a retrospective study performed in 16 patients with Menière disease who underwent 3T MR imaging 4 hours after gadolinium injection using two 3D-FLAIR sequences with a constant flip angle at 140° for the first and a heavily-T2 variable flip angle for the second. The signal intensity ratio was measured using the ROI method. We graded endolymphatic hydrops and evaluated the cochlear blood-labyrinth barrier impairment. RESULTS: Both for symptomatic and asymptomatic ears, the median signal intensity ratio was significantly higher with the constant flip angle than with the heavily-T2 variable flip angle (7.16 versus 1.54 and 7.00 versus 1.45, P < .001). Cochlear blood-labyrinth barrier impairment was observed in 4/18 symptomatic ears with the heavily-T2 variable flip angle versus 8/19 with constant flip angle sequences. With heavily-T2 variable flip angle sequences, endolymphatic hydrops was observed in 7–10/19 symptomatic ears versus 12/19 ears with constant flip angle sequences. We found a significant association between the clinical symptomatology and the presence of endolymphatic hydrops with constant flip angle but not with heavily-T2 variable flip angle sequences. Interreader agreement was always perfect with constant flip angle sequences while it was fair-to-moderate with heavily-T2 variable flip angle sequences. CONCLUSIONS: 3D-FLAIR constant flip angle sequences provide a higher signal intensity ratio and are superior to heavily-T2 variable flip angle sequences in reliably evaluating the cochlear blood-labyrinth barrier impairment and the endolymphatic space. Full Article
em Assessment of Apparent Internal Carotid Tandem Occlusion on High-Resolution Vessel Wall Imaging: Comparison with Digital Subtraction Angiography [EXTRACRANIAL VASCULAR] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: Not all tandem occlusions diagnosed on traditional vascular imaging modalities, such as MRA, represent actual complete ICA occlusion. This study aimed to explore the utility of high-resolution vessel wall imaging in identifying true ICA tandem occlusions and screening patients for their suitability for endovascular recanalization. MATERIALS AND METHODS: Patients with no signal in the ICA on MRA were retrospectively reviewed. Two neuroradiologists independently reviewed their high-resolution vessel wall images to assess whether there were true tandem occlusions and categorized all cases into intracranial ICA occlusion, extracranial ICA occlusion, tandem occlusion, or near-occlusion. DSA classified patient images into the same 4 categories, which were used as the comparison with high-resolution vessel wall imaging. The suitability for recanalization of occluded vessels was evaluated on high-resolution vessel wall imaging compared with DSA. RESULTS: Forty-five patients with no ICA signal on MRA who had available high-resolution vessel wall imaging and DSA images were included. Among the 34 patients (34/45, 75.6%) with tandem occlusions on DSA, 18 cases also showed tandem occlusions on high-resolution vessel wall imaging. The remaining 16 patients, intracranial ICA, extracranial ICA occlusions and near-occlusions were found in 2, 6, and 8 patients, respectively, on the basis of high-resolution vessel wall imaging. A total of 20 cases (20/45, 44.4%) were considered suitable for recanalization on the basis of both DSA and high-resolution vessel wall imaging. Among the 25 patients deemed unsuitable for recanalization by DSA, 11 were deemed suitable for recanalization by high-resolution vessel wall imaging. CONCLUSIONS: High-resolution vessel wall imaging could allow identification of true ICA tandem occlusion in patients with an absence of signal on MRA. Findings on high-resolution vessel wall imaging can be used to screen more suitable candidates for recanalization therapy. Full Article
em Intermixed Dimethyl-Sulfoxide-Based Nonadhesive Liquid Embolic Agents Delivered Serially via the Same Microcatheter for Cerebral AVM Treatment [INTERVENTIONAL] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: Conventional nonadhesive liquid embolic agents currently are the criterion standard for endovascular embolization of cerebral AVMs. However, inadequate distal penetration into the nidus and unstable proximal plug formation are the major limitations of this approach and of the currently available embolic materials. The aim of this study was to evaluate the hypothetic efficacy of combining liquid embolic agents with different properties and viscosities for use in endovascular embolization of cerebral AVMs. MATERIALS AND METHODS: From March 2018 to March 2019, sixteen patients with cerebral AVMs (12 women, 4 men; age range, 33–61 years) underwent endovascular embolization with combined liquid embolic agents delivered serially via a single microcatheter. The procedure consists of initial embolization with PHIL 30%, followed by Menox 18 through the same microcatheter. According to the Spetzler-Martin scale, 11 (68.75%) AVMs were grades I–II, 4 (25%) were grade III, and 1 (6.25%) was grade IV. Angiographic, technical, and clinical outcomes were analyzed independently. RESULTS: Combined PHIL and Menox embolization through the same microcatheter via 21 pedicles was performed in these 16 patients. Once the length of the reflux reached approximately 2 cm, PHIL 30% was switched to Menox 18. Antegrade flow and distal penetration of the serially applied liquid embolic agents were observed in all 16 cases. The ability to completely control the flow of the materials and avoid any dangerous proximal reflux was noted in all performed embolizations. The estimated average size reduction of the treated AVMs was 85%, ranging from 50% to 100%. Complete embolization was achieved in 10/16 or 62.5% of the cases. There was no procedure-related complication during or after the embolization. No mortality or postprocedural clinical worsening was seen. Clinical success and complete obliteration were confirmed with at least 1 follow-up angiography in 10/16 patients. CONCLUSIONS: Serial delivery of nonadhesive liquid embolic agents via the same microcatheter was safe and effective in our study and may be a potential technique for routine AVM treatment. However, further investigations are required to validate the safety and the efficacy of the method. Full Article
em Treatment Outcomes of Endovascular Embolization Only in Patients with Unruptured Brain Arteriovenous Malformations: A Subgroup Analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) [INTERVENTIONAL] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: Endovascular embolization only has been advocated for treatment of brain arteriovenous malformations in recent trials. Our aim was to evaluate the results of embolization only in a cohort of patients who were enrolled in the A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) study at 39 clinical sites in 9 countries. MATERIALS AND METHODS: We analyzed the rates and severity of stroke and death in patients who underwent embolization only. Events were identified through in-person neurologic follow-up visits performed at 6-month intervals during the first 2 years and annually, with telephone contact every 6 months thereafter. All event-related data were reviewed by independent adjudicators. RESULTS: Among 30 patients who had embolization planned, 26 underwent embolization only. A total of 13 stroke events were reported in the follow-up period among 26 subjects (ischemic, hemorrhagic, or both in 4, 7, and 2 subjects, respectively). The adverse event occurred after the first embolization in 11 of 13 patients. One patient had a major motor deficit, and 2 patients developed major visual field deficits. One event was fatal. The modified Rankin Scale score was 0–2 at last follow-up in 11 of the 12 stroke survivors. Estimated stroke-free survival was 46% at 12 months. CONCLUSIONS: Although the rates of stroke and/or death were high in patients treated with embolization only in ARUBA, the rates of favorable outcomes following stroke were high during follow-up. Full Article
em White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke [INTERVENTIONAL] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: The increased severity of white matter disease is associated with worse outcomes and an increased rate of intracerebral hemorrhage in patients with ischemic stroke undergoing thrombolytic treatment. However, whether white matter disease is associated with outcomes in patients undergoing endovascular treatment remains unclear. MATERIALS AND METHODS: In this prespecified exploratory analysis of our prospective multi-institutional study that enrolled consecutive adult patients with anterior circulation ischemic stroke undergoing endovascular treatment from November 2017 to September 2018, we compared the following outcomes between patients with none-to-minimal (van Swieten score, 0–2) and moderate-to-severe (van Swieten score, 3–4) white matter disease using logistic regression: 90-day mRS 3–6, death, intracerebral hemorrhage, successful recanalization, and early neurologic recovery. RESULTS: Of the 485 patients enrolled in the Blood Pressure after Endovascular Stroke Therapy (BEST) study, 389 had white matter disease graded (50% women; median age, 68 years; range, 58–79 years). A van Swieten score of 3–4 (n = 74/389, 19%) was associated with a higher rate of 90-day mRS of 3–6 (45% versus 18%; adjusted OR, 2.73; 95% CI, 1.34–5.93; P = .008). Although the death rate was higher in patients with van Swieten scores of 3–4 (26% versus 15%), the adjusted likelihood was not significantly different (adjusted OR, 1.14; 95% CI, 0.56–2.26; P = .710). Ordered regression revealed a shift toward worse mRS scores with increasing van Swieten scores (adjusted common OR, 3.04; 95% CI, 1.93–4.84; P < .001). No associations between white matter disease severity and intracerebral hemorrhage, successful recanalization, and early neurologic recovery were observed. CONCLUSIONS: Moderate-to-severe white matter disease is associated with worse outcomes in patients undergoing endovascular treatment without a significant increase in hemorrhagic complications. Studies comparing patients with and without endovascular treatment are necessary to determine whether the benefit of endovascular treatment is attenuated with greater white matter disease. Full Article
em Contrast-Induced Acute Kidney Injury in Radiologic Management of Acute Ischemic Stroke in the Emergency Setting [INTERVENTIONAL] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: The use of invasive cerebral angiography with CTA for active treatment of patients with suspected ischemic strokes has been increasing recently. This study aimed to identify the incidence of postcontrast acute kidney injury using baseline renal function when CTA and cerebral angiography were performed sequentially. MATERIALS AND METHODS: This retrospective observational study evaluated adults (18 years of age or older) with ischemic stroke who underwent CTA and cerebral angiography sequentially between 2010 and 2018. The incidence of postcontrast acute kidney injury was determined using the baseline estimated glomerular filtration rate. The value of the baseline estimated glomerular filtration rate at which the occurrence of postcontrast acute kidney injury increased was also determined. RESULTS: Postcontrast acute kidney injury occurred in 57/601 (9.5%) patients. Those with a baseline estimated glomerular filtration rate of <30 mL/min/1.73 m2 showed a higher incidence of acute kidney injury. Age, chronic kidney disease, medication (nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β blockers, statins, and insulin) use following contrast media exposure, and serum albumin affected the incidence of postcontrast acute kidney injury. The incidence of postcontrast acute kidney injury increased when the baseline estimated glomerular filtration rate was <43 mL/min/1.73 m2. CONCLUSIONS: Patients with low baseline renal function had the highest incidence of postcontrast acute kidney injury after CTA and cerebral angiography, but no fatal adverse effects were documented. Thus, patients suspected of having a stroke should be actively managed with respect to neurovascular function. Full Article
em MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke [INTERVENTIONAL] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: Vessel wall imaging is increasingly performed in the diagnostic work-up of patients with ischemic stroke. The aim of this study was to compare vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated with thrombosuction. MATERIALS AND METHODS: From 2009 to 2017, forty-nine patients with an ischemic stroke underwent 7T MR imaging within 3 months after symptom onset as part of a prospective intracranial vessel wall imaging study. Fourteen of these patients underwent intra-arterial treatment using thrombosuction (intra-arterial treatment group). In the intra-arterial treatment group, vessel walls were evaluated for major vessel wall changes. All patients underwent pre- and postcontrast vessel wall imaging to assess enhancing foci of the vessel wall using coregistered subtraction images. A Wilcoxon signed rank test was performed to test for differences. RESULTS: In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side (n = 18.5) compared with the contralateral side (n = 3, P = .005). Enhancement was more often concentric on the ipsilateral side (n = 8) compared with contralateral side (n = 0, P = .01). No differences were found in the group without intra-arterial treatment between the number and configuration of ipsilateral and contralateral enhancing foci. CONCLUSIONS: Patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall. This finding should be taken into account when assessing vessel wall MR images in patients with stroke. Full Article
em Suspected Metallic Embolization Distal to Coiled Intracranial Aneurysms Detectable by Susceptibility-Weighted MR Imaging [INTERVENTIONAL] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: After endovascular coiling of intracranial aneurysms, round dark parenchymal lesions believed to be particulate metal are sometimes encountered in MR imaging studies of the brain. We used SWI to assess the frequency of such occurrences, in addition to exploring likely causes and clinical implications. MATERIALS AND METHODS: We reviewed 700 MR imaging studies performed between September 2018 and March 2019 at our institution as follow-up monitoring of coiled intracranial aneurysms. Any sizeable (>5 mm) rounded dark-signal lesions encountered were presumed to be metallic. The magnitudes and locations of such lesions were recorded. In patients with these lesions, pertinent procedural documentation was screened for devices used, including coils, microcatheters, microguidewires, and stents. Medical records were also examined to determine whether any related symptoms ensued. RESULTS: Twenty patients (2.8%) exhibited a total of 25 lesions on SWI. Diameters ranged from 5 to 11 mm (median, 8 mm). All except 2 lesions were located in brain regions downstream from aneurysms, but all lesions occupied vascular territories of vessels used to place guiding catheters. Other than the Synchro 14, which was routinely deployed, no device was regularly used in patients with SWI-detectable lesions; and none of the affected patients developed focal neurologic symptoms as a consequence. CONCLUSIONS: Although the origins remain unclear, distal embolization of particulate metal distal to coiled cerebral aneurysms is occasionally observed on follow-up MR imaging studies. Such lesions, however, seem to have no apparent clinical impact. Full Article
em Reliability of CT Angiography in Cerebral Vasospasm: A Systematic Review of the Literature and an Inter- and Intraobserver Study [INTERVENTIONAL] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: Computed tomography angiography offers a non-invasive alternative to DSA for the assessment of cerebral vasospasm following subarachnoid hemorrhage but there is limited evidence regarding its reliability. Our aim was to perform a systematic review (Part I) and to assess (Part II) the inter- and intraobserver reliability of CTA in the diagnosis of cerebral vasospasm. MATERIALS AND METHODS: In Part I, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm (≥ 50% narrowing) and whether findings would justify augmentation of medical treatment or conventional angiography ± balloon angioplasty. Four raters took part in the intraobserver reliability study. RESULTS: In Part I, the systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, we found interrater reliability to be moderate at best ( ≤ 0.6), even when results were stratified according to specialty and experience. Intrarater reliability was substantial ( > 0.6) in 3/4 readers. In the per arterial segment analysis, substantial agreement was reached only for the middle cerebral arteries, and only when senior raters’ judgments were dichotomized (presence or absence of ≥50% narrowing). Agreement on the medical or angiographic management of vasospasm based on CTA alone was less than substantial ( ≤ 0.6). CONCLUSIONS: The diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH. Full Article
em CT Angiography in Evaluating Large-Vessel Occlusion in Acute Anterior Circulation Ischemic Stroke: Factors Associated with Diagnostic Error in Clinical Practice [INTERVENTIONAL] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 BACKGROUND AND PURPOSE: It is currently not completely clear how well radiologists perform in evaluating large-vessel occlusion on CTA in acute ischemic stroke. The purpose of this study was to investigate potential factors associated with diagnostic error. MATERIALS AND METHODS: Five hundred twenty consecutive patients with a clinical diagnosis of acute ischemic stroke (49.4% men; mean age, 72 years) who underwent CTA to evaluate large-vessel occlusion of the proximal anterior circulation were included. CTA scans were retrospectively reviewed by a consensus panel of 2 neuroradiologists. Logistic regression analysis was performed to investigate the association between several variables and missed large-vessel occlusion at the initial CTA interpretation. RESULTS: The prevalence of large-vessel occlusion was 16% (84/520 patients); 20% (17/84) of large-vessel occlusions were missed at the initial CTA evaluation. In multivariate analysis, non-neuroradiologists were more likely to miss large-vessel occlusion compared with neuroradiologists (OR = 5.62; 95% CI, 1.06–29.85; P = .04), and occlusions of the M2 segment were more likely to be missed compared with occlusions of the distal internal carotid artery and/or M1 segment (OR = 5.69; 95% CI, 1.44–22.57; P = .01). There were no calcified emboli in initially correctly identified large-vessel occlusions. However, calcified emboli were present in 4 of 17 (24%) initially missed or misinterpreted large-vessel occlusions. CONCLUSIONS: Several factors may have an association with missing a large-vessel occlusion on CTA, including the CTA interpreter (non-neuroradiologists versus neuroradiologists), large-vessel occlusion location (M2 segment versus the distal internal carotid artery and/or M1 segment), and large-vessel occlusion caused by calcified emboli. Awareness of these factors may improve the accuracy in interpreting CTA and eventually improve stroke outcome. Full Article
em MR Thermometry in Cerebrovascular Disease: Physiologic Basis, Hemodynamic Dependence, and a New Frontier in Stroke Imaging [ADULT BRAIN] By www.ajnr.org Published On :: 2020-04-09T06:30:48-07:00 SUMMARY: The remarkable temperature sensitivity of the brain is widely recognized and has been studied for its role in the potentiation of ischemic and other neurologic injuries. Pyrexia frequently complicates large-vessel acute ischemic stroke and develops commonly in critically ill neurologic patients; the profound sensitivity of the brain even to minor intraischemic temperature changes, together with the discovery of brain-to-systemic as well as intracerebral temperature gradients, has thus compelled the exploration of cerebral thermoregulation and uncovered its immutable dependence on cerebral blood flow. A lack of pragmatic and noninvasive tools for spatially and temporally resolved brain thermometry has historically restricted empiric study of cerebral temperature homeostasis; however, MR thermometry (MRT) leveraging temperature-sensitive nuclear magnetic resonance phenomena is well-suited to bridging this long-standing gap. This review aims to introduce the reader to the following: 1) fundamental aspects of cerebral thermoregulation, 2) the physical basis of noninvasive MRT, and 3) the physiologic interdependence of cerebral temperature, perfusion, metabolism, and viability. Full Article
em Cần bán quầy tầng hai chợ Đồng Xuân, Hoàn Kiếm, Hà Nội By batdongsan.com.vn Published On :: Thu, 07 May 2020 10:04:13 GMT Chính chủ cần bán kiot 304 A2 tầng 2 chợ Đồng Xuân, khu vực kinh doanh quần áo, ngay cầu thang máy, thuận tiện đi lại và chuyển hàng. Diện tích: 3m2. Giá bán: 1 tỷ có thương lượng. Liên hệ: Minh - 0936693133 hoặc 0937898883.... Full Article
em Shophouse Phạm Thế Hiển ở liền - giữ tiền cho anh chị mùa Covid. LH ngay em: 0901 636 577 By batdongsan.com.vn Published On :: Sun, 03 May 2020 10:47:31 GMT Bán shophouse mặt tiền quận 8 thanh toán 3,4 tỷ. Còn lại trả góp. - Hình thức: 1 trệt 1 lầu (được xây thêm 1 lửng). - Sổ hồng vĩnh viễn.Diện tích 151m2 đối diện công viên, gần trường học và dân cư và lưu lượng khách vài ngàn người mỗi ngày.Liên hệ: Mỹ Linh: Trưởng phòng kinh doan... Full Article
em Còn 6 ngày! Thanh toán 18%/9 tháng+ CK 18%+ hoàn 5%+bảo hiểm 400tr khi mua căn hộ trung tâm TP biển By batdongsan.com.vn Published On :: Fri, 08 May 2020 12:17:45 GMT Thân chào quý anh/ chị. Hiện em đang có 1 căn hàng chủ đầu tư 2 phòng ngủ, 2 WC (68,9m2) cực thoáng mát view biển, tầng trung, hướng Đông Bắc giá chỉ 36,9 triệu/m2 (2.580 tỷ) hiện đang được chiết khấu chỉ còn 1.609 tỷ ( tương đương 24,6 tr/m2). Cụ thể: + Chiết khấu nội bộ 6%/ giá trị căn: Giảm ngay 154,8 triệu. + Hoàn lại 5%/ giá trị thanh toán: Tương ứng 100,6 triệu. + ... Full Article
em CHUYÊN chuyển nhượng Masteri giá thật đang có 2PN view hồ bơi giá chỉ 3,3 tỷ. LH em Ni 0901381558 By batdongsan.com.vn Published On :: Fri, 08 May 2020 14:49:48 GMT Em chuyên giỏ hàng Masteri Thảo Điền và Masteri An Phú. Giá và vị trí căn hộ nào cũng có hàng. * Có mặt ở Masteri 24/7 để dẫn khách hàng đi xem thực tế căn hộ đã bàn giao, những căn hộ đã có nội thất đầy đủ. * Sổ hồng pháp lý rõ ràng, hỗ trợ vay ngân hàng lên tới 80% giá trị căn hộ. * Cam kết tư vấn đúng nhu cầu, đúng sự thật. Trước khi mua Masteri, muốn tìm hiểu tốt n... Full Article
em Mở bán đất nền dự án tại Làng Chuyên Gia Phú Uy Khang, DA trọng điểm tỉnh Bình Dương 0978636388 By batdongsan.com.vn Published On :: Wed, 06 May 2020 09:11:21 GMT Vị trí đắc địa mặt tiền đường 22/12, An Phú, Thuận An, Bình Dương. + Mua đất giá gốc tối đa hóa lợi nhuận. + Có sổ hồng riêng từng nền có thể sang tên ngay. + Ngân hàng MBBank hỗ trợ 70%. + Đất nền thổ cư 100%. + Đã có giấy phép xây dựng đầy đủ và miễn phí.Tiện ích: + Vòng xoay A... Full Article
em Chuyển quyền sử dụng đất do bố để lại có cần sự đồng ý của anh chị em? By batdongsan.com.vn Published On :: Sat, 30 Jun 2018 09:20:58 GMT Năm 2012 bố tôi mất. Sau đó, tôi có làm giấy tờ sang tên 3 thửa đất lại cho tôi (giấy tờ đất đứng tên bố). Hiện nay, tôi muốn chuyển nhượng 400m2 đất cho người khác nhưng anh chị em trong nhà không đồng ý. Hỏi: Tôi có quyền chuyển nhượng quyền sử dụng đất cho người khác được không? Full Article
em Bán nhà đường Gò Dầu TP nhà đẹp 2 lầu hẻm 7m ( 4m x 18m) giá 7,65 tỷ TL By batdongsan.com.vn Published On :: Mon, 13 Jan 2020 09:30:54 GMT -vị trí : mặt tiền rộng, khu vực kinh doanh đa sầm uất mọi nghành nghề, tuyến đường huyết mạch của Tân phú, gần trường học,ủy ban phường,tieefkm năng sinh lời rất cao trong thời gian sắp tới, -Tiện ích : gần trường học , ngân hàng , công viên cây xanh trước nhà , thích , mở văn... Full Article
em 5 kinh nghiệm nhất định phải biết khi tìm thuê văn phòng By batdongsan.com.vn Published On :: 09:34 24/02/2020 Bất cứ doanh nghiệp nào cũng muốn thuê được một văn phòng làm việc ưng ý, giá cả phải chăng. Để đạt được điều đó, hãy ghi nhớ 5 kinh nghiệm tìm thuê văn phòng dưới đây: Full Article
em Cho thuê lại nhà để kiếm tiền thụ động: Tính dễ mà làm không dễ By batdongsan.com.vn Published On :: 16:05 28/02/2020 Học theo nhiều bạn trẻ khác, tôi thử tìm nhà nguyên căn rồi cho thuê lại, ước tính mỗi tháng có thể đều đặn thu về 8 triệu đồng nhưng mọi chuyện không dễ như tôi nghĩ. Full Article
em Nên mua nhà nhỏ trong hẻm to hay nhà to trong hẻm nhỏ? By batdongsan.com.vn Published On :: 18:03 26/03/2020 Với cùng một khoản tiền, việc nên mua nhà nhỏ trong hẻm to hay nhà to trong hẻm nhỏ là điều khiến nhiều người phân vân hiện nay. Để tháo gỡ khúc mắc này, người mua cần phải xem xét cẩn thận các ưu, nhược điểm của từng loại hình nhà ở. Full Article
em 10 điểm khác biệt giữa đầu tư và đầu cơ bất động sản By batdongsan.com.vn Published On :: 15:55 30/03/2020 Tuy đều hướng đến mục đích chung là thu lợi nhuận nhưng đầu tư và đầu cơ bất động sản lại là 2 phương thức khác nhau. Bài viết dưới đây sẽ chỉ ra 10 điểm khác biệt rõ nét nhất giữa đầu tư và đầu cơ bất động sản như sau: Full Article
em Mua nhà thời Covid: Có nên mạo hiểm để tính đường dài? By batdongsan.com.vn Published On :: 10:29 29/04/2020 [CÓ HẸN VỚI CHUYÊN GIA BẤT ĐỘNG SẢN #23] Lựa chọn mua nhà vào thời điểm dịch Covid-19 có phải là sáng suốt? Những nhà đầu tư vốn mỏng muốn tham gia thị trường lúc này cần lưu ý những gì? Full Article
em Tiết kiệm chi phí, bảo vệ môi trường nhờ biết tận dụng đồ bỏ đi để làm vườn By batdongsan.com.vn Published On :: 19:35 28/04/2020 Đừng vội vứt những chai nhựa, chai thủy tinh, giấy gói quà hay bóng đèn đã cháy đi bởi bạn có thể tái sinh chúng để trồng cây, cắm hoa, bảo quản hạt giống... Full Article
em Trương Tuấn Em By batdongsan.com.vn Published On :: Thu, 27 Jun 2019 11:13:14 GMT Kinh nghiệm: 4 năm trong lĩnh vực bất động sản Danh sách dự án bất động sản đã thực hiện: KDC Gò Cát Quận 9, Dream Villages, Kdc Đại Phúc, New Time City... Với triết lý đáp ứng cao hơn sự mong đợi của khách hàng, tôi luôn học hỏi bổ sung kiến thức nhằm mang lại cho quý khách hàng 1 tài sản bất động sản an toàn về pháp lý và lợi nhuận cao thanh khoản nhanh. Với khách hàng là ân nhân vì vậy tất cả mọi suy nghĩ hành động đều hướng về sự an toàn và lợi nhuận cho khách hàng. Rất hy vọng được phục vụ quý khách hàng Full Article
em 1BR Linden Residences for sales at EMPIRE CITY THU THIEM By batdongsan.com.vn Published On :: Wed, 11 Mar 2020 15:40:00 GMT 1BR Linden T2A-xx-06, river view, high floor with Superior class & lifestyle. Selling price: 8,65 billion VND (included fee and tax) Investors: Tien Phuoc - Keppel Land - Tran Thai - Gaw Capital Partner Address: Functional Area 2 (Area 2B) Thu Thiem New Urban Area, District 2, ... Full Article
em Bà mẹ trẻ chia sẻ kinh nghiệm "lên đời" nhà cũ với 200 triệu đồng By batdongsan.com.vn Published On :: 16:55 15/04/2020 Bà mẹ một con Vũ Ngọc Hương Trang (sinh năm 1992) khiến cư dân mạng không khỏi xuýt xoa khi chia sẻ những hình ảnh khác nhau một trời một vực trước và sau khi cải tạo căn nhà cũ đã xuống cấp cùng những kinh nghiệm vô cùng quý giá mà cô nghiệm ra sau quá trình tự tay sửa sang nhà. Full Article
em Điểm mặt những xu hướng thiết kế nhà nổi bật năm 2019 By batdongsan.com.vn Published On :: 14:26 23/05/2019 Nếu bạn vẫn đang phân vân đi tìm một phong cách phù hợp hay gặp khó khăn khi muốn theo đuổi một phong cách nhất định cho căn nhà của mình, dưới đây là gợi ý những xu hướng thiết kế được ưa thích nhất năm 2019 dành cho bạn. Full Article
em Ưu, nhược điểm của 9 vật liệu bàn bếp phổ biến nhất hiện nay By batdongsan.com.vn Published On :: 09:40 09/09/2019 Mặt bàn bếp – nơi chúng ta sơ chế thực phẩm và đặt các thiết bị, dụng cụ hỗ trợ nấu nướng nên vật liệu bàn bếp cần đảm bảo yêu cầu chịu lực và vệ sinh. Ngoài ra, cũng cần chú ý đến tính thẩm mỹ và giá thành, đồng thời mang lại không gian năng động cho mỗi gia đình. Full Article
em Mua bán nhà Bình Chánh 3.7x17m, 2 tấm hẻm xe hơi ngay chợ Hưng Long giá 850tr, LH 0839331665 By batdongsan.com.vn Published On :: Tue, 05 May 2020 23:21:08 GMT Mua bán nhà Bình Chánh, DT 3.7x17m, 2 tấm hẻm xe hơi ngay chợ Hưng Long, giá 850tr.- DTXD: 3.7mx 17m. - DTSD: 120m2. - Trệt, 1 lầu - 1PK + 2PN + 2WC - Thiết kế đẹp, hiện đại.- Hẻm rộng thông thoáng xe hơi vào tận nhà. - Vị trí cực kì đẹp, gần chợ Hưng Long, trường học, BV... - Dễ... Full Article
em Cho thuê mua kiot chợ đầu mối hải sản Minh Lộc, điểm nhấn kinh tế ven biển Hậu Lộc LH: 0977999113 By batdongsan.com.vn Published On :: Tue, 05 May 2020 10:30:01 GMT Shophouse và kiot chợ hiện đại bậc nhất tại Minh Lộc. Nơi kinh doanh buôn bán sầm uất bậc nhất khu vực Hậu Lộc. Liên hệ: 0977999113. Quy mô chợ: 1927 m2 trong đó có 272 gian hàng từ 3m 6m, 68 căn kiot thương mại xây 2.5 tầng. Hình thức sở hữu: Cho thuê 50 năm trả tiền 1 lần. Thôn... Full Article
em Lựa chọn thiết bị gia dụng: Tiết kiệm điện thôi chưa đủ! By batdongsan.com.vn Published On :: 10:10 03/12/2018 Tiết kiệm là một trong những từ khoá được nhắc đến nhiều nhất khi lựa chọn mua bất cứ một thiết bị nào trong gia đình. Nhưng tiết kiệm điện chỉ là một phần rất nhỏ khi sử dụng các thiết bị trong gia đình. Nếu bạn không muốn luôn tình trạng “rỗng ví” hằng tháng vì những chi phí sinh hoạt ngày càng trở nên đắt đỏ thì khi chọn bất cứ thiết bị gia dụng nào cũng nên cân nhắc các yếu tố sau đây. Full Article
em Chọn bàn nước vừa đẹp vừa tiết kiệm diện tích cho nhà nhỏ By batdongsan.com.vn Published On :: 08:20 10/12/2018 Những mẫu bàn nước dưới đây có thiết kế vô cùng sáng tạo khi có thể lồng ghép với nhau để không chiếm quá nhiều diện tích trong phòng khách. Full Article
em Tô điểm nhà mùa hè với tranh đồng hồ đẹp By batdongsan.com.vn Published On :: 08:20 23/03/2019 Xuân qua hè đến, bạn đã lên kế hoạch làm đẹp cho ngôi nhà của mình chưa? Hãy cùng chúng tôi tô điểm không gian sống cho gia đình bạn với những bức tranh họa tiết hoa rực rỡ hoặc khung cảnh lãng mạn của cuộc sống dưới đây nhé. Full Article
em 5 kinh nghiệm vàng khi chọn mua sofa mới By batdongsan.com.vn Published On :: 09:07 30/03/2020 Hàng ngày chúng ta vẫn thường thư giãn, đọc sách, ăn uống, xem tivi, tán gẫu cùng gia đình và bạn bè hay thậm chí ngủ trên sofa trong phòng khách. Vì thế, không quá lời khi nói rằng, chọn mua sofa mới là một trong những công việc cực kỳ quan trọng mà chúng ta cần thực hiện khi trang hoàng tổ ấm thân yêu của mình. Full Article
em Đồng Nai: Không mở thêm khu công nghiệp tại 3 khu vực trọng điểm By batdongsan.com.vn Published On :: 14:17 27/02/2020 Ba khu vực trọng điểm là TP. Biên Hòa, huyện Nhơn Trạch và huyện Long Thành của tỉnh Đồng Nai đã dày đặc các khu công nghiệp nên sẽ không mở thêm khu công nghiệp tại đây. Full Article
em Phê duyệt nhiệm vụ quy hoạch khu dân cư Cát Lái hơn 70ha By batdongsan.com.vn Published On :: 09:41 04/03/2020 Theo quy hoạch, Khu dân cư Cát Lái sẽ bố trí các công trình cao tầng dọc các trục giao thông chính, các cụm công trình có chức năng dịch vụ - thương mại ở khu trung tâm. Full Article
em Duyệt nhiệm vụ lập Quy hoạch chung đô thị Văn Giang, tỉnh Hưng Yên By batdongsan.com.vn Published On :: 10:39 05/03/2020 Đô thị Văn Giang (tỉnh Hưng Yên) có tổng diện tích quy hoạch gần 7.184ha, quy mô dân số khoảng 350.000 người tính đến năm 2040. Full Article
em Phê duyệt nhiệm vụ lập quy hoạch tỉnh Hà Nam By batdongsan.com.vn Published On :: 15:38 20/03/2020 Phó Thủ tướng Trịnh Đình Dũng vừa phê duyệt nhiệm vụ lập Quy hoạch tỉnh Hà Nam thời kỳ 2021-2030, tầm nhìn đến năm 2050. Full Article
em Cho thuê căn hộ Masteri Thảo Điền 1 - 3PN, cam kết giá tốt, hỗ trợ xem nhà 24/7 By batdongsan.com.vn Published On :: Wed, 06 May 2020 17:40:21 GMT Bảng giá tham khảo cho thuê căn hộ Masteri Thảo Điền.1. Căn hộ 1 phòng ngủ: Diện tích: 45 - 52m2, giá thuê từ 12 - 16 triệu/tháng.2. Căn hộ 2 phòng ngủ: Diện tích: 59 - 72m2, giá thuê từ 15 - 22 triệu/tháng.3. Căn hộ 3 phòng ngủ: Diện tích: 86 - 90m2, giá thuê từ 23 - 33 triệu/th... Full Article
em Xem nhà 24/7: Cho thuê CC Royal City giá rẻ nhất thị trường từ 10tr/th. LH 0944266333 - 0946053050 By batdongsan.com.vn Published On :: Thu, 07 May 2020 16:28:00 GMT Xem nhà 24/7: Chuyên cho thuê các căn hộ chung cư cao cấp Royal City giá tốt nhất thị trường, chỉ từ 10 triệu/tháng, diện tích từ 55m2 - 221m2. Liên hệ em Bình: 0944.266.333 - 0946.053.050. http://vinhomeshanoi.net/ - Giá cam kết rẻ nhất thị trường. - Tư vấn nhiệt tình chính xác nhất. - Xem nhà bất kể khi nào 24/7. - Ký hợp đồng trực tiếp với chủ nhà. - Có ưu đãi cho khách hàng... Full Article
