Transitory ischemic attack associated with a rare fenestration of the cervical segment of the internal carotid artery: a case report

Background Fenestration of the cervical segment of the internal carotid artery is a very rare finding, and its origin is still not fully understood. Explanations of its genesis range from dissections leading to the fenestration to the more common interpretation as a developmental vascular variant. However, most reported cases were symptomatic and presented with dissections, where even endovascular treatment of the fenestration of the cervical segment of the internal carotid artery became necessary. Here we report a case of a fenestration of the cervical segment of the internal carotid artery suffering a transitory ischemic attack and local pain in absence of any sign of dissection. Case presentation A 62-year-old Caucasian male patient was admitted to our institution because of an episode of amaurosis fugax, initially accompanied with headache. Magnetic resonance imaging revealed an intact fenestration of the cervical segment of the internal carotid artery on the symptomatic side. With antiplatelet therapy, all symptoms vanished within 2 months of the initial event. Conclusions Our findings support the interpretation of a fenestration of the cervical segment of the internal carotid artery as a developmental vascular variant, but also suggest a substantial risk for dissection and ischemic stroke. Even in case of an accidental finding, clinicians should be aware of this. At least in this case, antiplatelet therapy seemed beneficial.

Transcriptome-based phylogeny of the semi-aquatic bugs (Hemiptera: Heteroptera: Gerromorpha) reveals patterns of lineage expansion in a series of new adaptive zones

Key innovations enable access to new adaptive zones and are often linked to increased species diversification. As such, they have attracted much attention, yet their concrete consequences on the subsequent evolutionary trajectory and diversification of the bearing lineages remain unclear. The monophyletic group of water striders and relatives (Hemiptera: Heteroptera: Gerromorpha) represent a group of insects that transited to live on the water-air interface and diversified to occupy ponds, puddles, streams, mangroves and even oceans. This lineage offers an excellent model to study the patterns and processes underlying species diversification following the conquest of new adaptive zones. However, such studies require a reliable and comprehensive phylogeny of the infraorder. Based on whole transcriptomic datasets of 97 species and fossil records, we reconstructed a new phylogeny of the Gerromorpha that resolved inconsistencies and uncovered strong support for previously unknown relationships between some important taxa. We then used this phylogeny to reconstruct the ancestral state of a set of adaptations associated with water surface invasion (fluid locomotion, dispersal and transition to saline waters) and sexual dimorphism. Our results uncovered important patterns and dynamics of phenotypic evolution revealing how the initial event of water surface invasion enabled multiple subsequent transitions to new adaptive zones, representing distinct niches of water surfaces, and further diversification of the group. This phylogeny and the associated transcriptomic datasets constitute highly valuable resources, making Gerromorpha an attractive model lineage to study phenotypic evolution.

Diagnostic Role of Collagen Type III Alpha in Fibroepithelial Lesions of the Breast: An Immunohistochemical Study

Background The fibroepithelial lesions (FELs) are heterogeneous biphasic tumors composed of epithelial and stromal components, they include fibroadenoma (FA) and phyllodes tumor (PT). The most FAs are benign, while the PTs have unpredictable biologic behavior, where they can recur if incompletely excised, and can even metastasize. According to the WHO Classification of Tumors of The Breast, PT is classified by the histological features into benign, borderline, and malignant. There is difference in management of the FELs, where a FA is treated conservatively or by simple enucleation. While PT must be excised with wide surgical margin to avoid the recurrence of this tumor, where it can recur as high grade. For this reason the preoperative distinction between FA and PT is critical for management. On another hand, still this differentiation is difficult and challenging in some cases especially on limited sample of core needle biopsy (CNB) and also on excision due to the heterogeneity of PT and overlapping features between the FELs. Recently, the use of immunohistochemical markers may have helpful role in differentiation between FA and PT, and grading of the last one. Collagen III α (Col A ) has been emerged as a potential new diagnostic maker useful in differentiation between fibroepithelial lesions. Methodology In this retrospective study we evaluated the histopathological features of Cases of FELs including FA and PT with its subgrades. We also evaluated an immunohistochemical diagnostic potential of collagen III α (Col A) in differentiating FA from PT, and categorizing the last one. Furthermore, correlations between Col A expression and clinicopathological parameters were performed. Results The staining expression of Col A was increased significantly in PTs when compared with FAs (P<) . Col A expression increased with increased grade of PT but without significant difference between benign PT and borderline PT, and between borderline PT and malignant PT. By pairwise comparison, there was a significant difference between CFA and benign PT according to Col A expression (P<) , and also between the typical FA and FA with PT like features (P<) . There was a trend of increased expression but did not reach the significance between FA with PT like features and benign PT (P=) . Distinct periductal cuffing pattern of Col A staining was present in all PTs and absent in most FAs (P<) , and only cases of FA with PT features exhibited this pattern. Conclusion Col A is a diagnostic marker can differentiate between FA and PT, especially between CFA and benign PT, and the Col A expression increased with increased grade of PT but without significant difference. FA with PT like features might be a distinct category that should be distinguished from typical FΑ as it may an initial event of tumor progression to PT.

Economic mechanism of urban passenger transport’s sustainable development

The article is designed and formulated to define and ensure sustainable development of urban passenger transport, which is an essential component of the business strategies of enterprises automobile and highway transportation and promoting of the development of transport traffic. The article describes and investigates the current state of infrastructure and activities of urban passenger transport enterprises, namely the quality of services, existing conditions, internal and external factors of development of urban passenger transport enterprises. Covers the main problems of activity in the field of urban passenger transport, offers a methodology for developing measures to ensure sustainable development of urban passenger transport enterprises to maintain the quality and economic efficiency of such enterprises. Thereby providing existing social needs and defines a ways to meet them. The study based the mechanism on the renewal of rolling stock in accordance with the Euro-5 standard (in accordance with the procedure for conducting a tender for passenger transportation and the procedure for state technical inspection) to ensure the environmental component and improve the quality of transport services. The development of the mechanism for ensuring the sustainable development of enterprises is the initial event in the process of ensuring and calculating the effect of the organizational and economic mechanism for ensuring the sustainable development of urban passenger transport enterprises. This mechanism will provide a solid foundation for sustainable development of the transport industry and the creation of a free and competitive market for transport services. It is also necessary to understand the strong factor impact on an extensive system of this scale, so the implementation of this mechanism should prepare not only the calculation of resources for direct support of the process, but also the staff who will coordinate the implementation of the mechanism. The use of such a mechanism encompasses and encourages all participants in the interaction to make certain efforts with motivation for the joint positive effect of its implementation.

Root foraging alters global patterns of ecosystem legacy from climate perturbations

The response of terrestrial ecosystems to climate perturbations typically persist longer than the timescale of the forcing, a phenomenon that is broadly referred to as ecosystem legacy. Understanding the strength of legacy is critical for predicting ecosystem sensitivity to climate extremes and the extent to which persistent changes in land surface-atmosphere exchange might feedback onto the climate, for example, extending drought. The cause of ecosystem legacy has been tied to numerous factors such as changes in leaf area index, however, few studies have tested how changes in root profiles in response to stress might alter an ecosystem's recovery time. We utilize an Earth System Model that includes a dynamic root module where vegetation can forage for water and nutrients by altering their root profiles. As expected, the simulations show that in response to water stress events most ecosystems deepen their root profiles. In semi-arid ecosystems, this response expedites recovery (i.e. less legacy) relative to simulations without dynamics roots because access to deeper water pools after the initial event remains favorable. In wetter ecosystems, the development of deeper root profiles slows down the recovery timescale (i.e. more legacy) because the deeper root profile reduces access to nutrients. The recovery of hyperarid systems is also delayed presumably to the loss of shallow roots and ability to access water from smaller rain events. The results show that the response of root profiles to external forcing is a critical component of global patterns of legacy that is not typically represented in Earth System Models.

Rosmarinic Acid Increases Macrophage Cholesterol Efflux through Regulation of ABCA1 and ABCG1 in Different Mechanisms

Lipid dysregulation in diabetes mellitus escalates endothelial dysfunction, the initial event in the development and progression of diabetic atherosclerosis. In addition, lipid-laden macrophage accumulation in the arterial wall plays a significant role in the pathology of diabetes-associated atherosclerosis. Therefore, inhibition of endothelial dysfunction and enhancement of macrophage cholesterol efflux is the important antiatherogenic mechanism. Rosmarinic acid (RA) possesses beneficial properties, including its anti-inflammatory, antioxidant, antidiabetic and cardioprotective effects. We previously reported that RA effectively inhibits diabetic endothelial dysfunction by inhibiting inflammasome activation in endothelial cells. However, its effect on cholesterol efflux remains unknown. Therefore, in this study, we aimed to assess the effect of RA on cholesterol efflux and its underlying mechanisms in macrophages. RA effectively reduced oxLDL-induced cholesterol contents under high glucose (HG) conditions in macrophages. RA enhanced ATP-binding cassette transporter A1 (ABCA1) and G1 (ABCG1) expression, promoting macrophage cholesterol efflux. Mechanistically, RA differentially regulated ABCA1 expression through JAK2/STAT3, JNK and PKC-p38 and ABCG1 expression through JAK2/STAT3, JNK and PKC-ERK1/2/p38 in macrophages. Moreover, RA primarily stabilized ABCA1 rather than ABCG1 protein levels by impairing protein degradation. These findings suggest RA as a candidate therapeutic to prevent atherosclerotic cardiovascular disease complications related to diabetes by regulating cholesterol efflux in macrophages.

Optimization of Maintenance Strategy for Sea Water Pumps in Nuclear Plants

Probabilistic Safety Analysis (PSA) methodology is a significant supplement to the deterministic safety analysis in the nuclear power plant. PSA can be used to evaluate the NPP device change, equipment maintenance, in service inspection. The practicability of modifying sea water pump maintenance programme is evaluated in this paper by determining the initial event probability in fault-tree and modifying the PSA calculation model. Based on the evaluation results, the preventive maintenance of sea water pump and 6kv switch can be changed from executed in the plant overhaul to executed in the routine maintenance. This could make a great contribution in optimizing the NPP sea water pump maintenance program.

High-Fat Diet Impairs Mouse Median Eminence: A Study by Transmission and Scanning Electron Microscopy Coupled with Raman Spectroscopy

Hypothalamic dysfunction is an initial event following diet-induced obesity, primarily involving areas regulating energy balance such as arcuate nucleus (Arc) and median eminence (ME). To gain insights into the early hypothalamic diet-induced alterations, adult CD1 mice fed a high-fat diet (HFD) for 6 weeks were studied and compared with normo-fed controls. Transmission and scanning electron microscopy and histological staining were employed for morphological studies of the ME, while Raman spectroscopy was applied for the biochemical analysis of the Arc-ME complex. In HFD mice, ME β2-tanycytes, glial cells dedicated to blood-liquor crosstalk, exhibited remarkable ultrastructural anomalies, including altered alignment, reduced junctions, degenerating organelles, and higher content of lipid droplets, lysosomes, and autophagosomes. Degenerating tanycytes also displayed an electron transparent cytoplasm filled with numerous vesicles, and they were surrounded by dilated extracellular spaces extending up to the subependymal layer. Consistently, Raman spectroscopy analysis of the Arc-ME complex revealed higher glycogen, collagen, and lipid bands in HFD mice compared with controls, and there was also a higher band corresponding to the cyanide group in the former compared to the last. Collectively, these data show that ME β2-tanycytes exhibit early structural and chemical alterations due to HFD and reveal for the first-time hypothalamic cyanide presence following high dietary lipids consumption, which is a novel aspect with potential implications in the field of obesity.

Victims of the Terrorist Attacks in Belgium and Professional Mental Health Aid Barriers: A Qualitative Study

Introduction: Terrorist attacks can cause short and long-term stress-reactions, anxiety, and depression among those exposed. Sometimes, professional mental health aid, meaning all types of professional psychotherapy, would be appropriate, but victims often delay or never access mental health aid, even up to a decade after the initial event. Little is known about the barriers terrorist-victims encounter when they try to access professional mental health aid.Method: Using a qualitative design, 27 people exposed to the 22/03/2016 terrorist attack in Belgium were interviewed using half-structured, in-depth interviews, on their experiences with professional mental health aid. A reflexive thematic analysis was employed.Results: Five main barriers for professional mental health aid seeking by victims were found. First, their perception of a lack of expertise of mental health aid professionals. Second, the lack of incentives to overcome their uncertainty to contact a professional. Third, social barriers: people did not feel supported by their social network, feared stigma, or trusted that the support of their social network would be enough to get them through any difficulties. Fourth, a lack of mental health literacy, which seems to be needed to recognize the mental health issues they are facing. Finally, there are financial barriers. The cost of therapy is often too high to begin or continue therapy.Conclusions: This study showed that the barriers for seeking professional mental health aid are diverse and not easily overcome. More mental health promotion is needed, so that there is a societal awareness of possible consequences of being exposed to terrorist attacks, which might result in less stigma, and a quicker realization of possible harmful stress reactions due to a disaster.

Hospital healthcare flows: A longitudinal clustering approach of acute coronary syndrome in women over 45 years

Acute coronary syndrome (ACS) in women is a growing public health issue and a death leading cause. We explored whether the hospital healthcare trajectory was characterizable using a longitudinal clustering approach in women with ACS. From the 2009–2014 French nationwide hospital database, we extracted spatio-temporal patterns in ACS patient trajectories, by replacing the spatiality by their hospitalization cause. We used these patterns to characterize hospital healthcare flows in a visualization tool. We clustered these trajectories with kmlShape to identify time gap and tariff profiles. ACS hospital healthcare flows have three key categories: Angina pectoris, Myocardial Infarction or Ischemia. Elderly flows were more complex. Time gap profiles showed that readmissions were closer together as time goes by. Tariff profiles were different according to age and initial event. Our approach might be applied to monitoring other chronic diseases. Further work is needed to integrate these results into a medical decision-making tool.