Current Advances in Endovascular Treatment of Intracranial Atherosclerotic Disease and Future Prospective

Objectives/BackgroundMedical therapy is the first line of treatment for intracranial atherosclerotic disease (ICAD). Percutaneous transluminal angioplasty and stenting (PTAS) are mainly considered for those patients with severe stenosis and recurrent events despite aggressive medical therapy. In this review, we discuss the application of PTAS as a treatment option for ICAD and its future prospect.Materials and MethodsWe did the literature review of the key articles and guidelines to elaborate on the role of PTAS in the management of ICAD based on the current data and expert opinion. We searched PubMed, Google Scholar, and Scopus up to August 2020, and included articles published only in the English language.ResultsSince the publication of the results from SAMMPRIS and VISSIT trials, stenting is no longer recommended for secondary stroke prevention in patients with symptomatic ICAD. However, recent clinical studies on intracranial stenting for a subgroup of ICAD patients have shown promising results, likely due to better patient selection and continued advancement of endovascular techniques.ConclusionThere exists a lack of consensus regarding the best endovascular treatment approach (e.g., angioplasty alone or balloon mounted stent vs. self-expanding stent with or without prior angioplasty) or management of in-stent restenosis. Another area of clinical controversy relates to the ideal use and duration of antiplatelet therapy.     

COVID-19 Associated Reversible Cerebral Vasoconstriction Syndrome Successfully Treated with Nimodipine and Aspirin

There have been limited cases linking SARS-CoV-2 infection with the development of reversible cerebral vasoconstriction syndrome (RCVS). We hereby report a rare case of RCVS in the setting of mild SARS-CoV-2 respiratory infection successfully treated with nimodipine and aspirin. SARS-CoV-2 attacks the ACE2-receptors, which are expressed in various body organs including the lungs, kidneys, and blood vessels. Vasoconstriction can result from down-regulation of the ACE2-receptors that can lead to sympathetic hypertonia of the cerebral blood vessel walls and/or over-activation of the renin-angiotensin axis.     

Impact and cost effectiveness of pneumococcal conjugate vaccine in India

Background

World Health Organization has recommended the introduction of pneumococcal conjugate vaccine (PCV) in the childhood immunisation programme of all the countries in the world. In lieu of its introduction in India, there is a need to generate evidence on cost-effectiveness of this vaccine. The current study looks into the impact and cost-effectiveness of PCV vaccine in India.

Glycerokinase in mammalian adipose tissue: stimulation by lipogenic substances.

A connecting link between carbohydrate and fat metabolism in adipose tissue is theconcentration of alpha-glycerophosphate derived predominantly from the glycolysis ofglucose entering the fat cell. However, several investigators have reported the presence of a glycerol specific kinase in the epidiymal fat-pad of the rat and obob mouse.This enzyme's presence in other mammalian adipose tissue could contribute to the alpha-glycerophosphate pool and thus affect both carbohydrate and fat metabolism within the fat cell. Glycerokinase was demonstrated in isolated fat cells obtained from the subcutaneous, perirenal, epididymal, and dorsal intrascapular brown fat depots of the adultmale rat. It was found to be particularly sensitive to in vivo lipogenic stimuli in both the subcutaneous and the brown adipose tissue and concluded that insulin is involved in adipose glycerokinase stimulation. Therefore, the main function of glycerokinase in normal adipose tissue may be to augment the anabolic action of insulin. It isfurther suggested that deviation from the normal control of this lipogenic enzyme couldlead to a gradual accumulation of fat and eventual obesity.     

Inhibition of insulin release during hypovolemic shock

Hyperglycemia, a frequent occurrence during circulatory failure, is not associated with increased circulating insulin concentrations. In this study, large primates (baboons) were subjected to hemorrhagic hypotension for 2 hr to determine whether hypoinsulinemia was due to decreased pancreatic output of insulin or acceleration of insulin degradation. Within 5 min of the onset of hemorrhage, portal vein insulin, as well as peripheral venous concentrations declined substantially and remained below preshock levels throughout the experiment. Tolbutamide, injected after 60 min of shock, elicited only a minimal rise in portal and peripheral venous insulin levels, when compared to that observed in a group of nonshock animals. The disappearance of immunoreactive insulin from serum in another group of shocked animals was not accelerated beyond that of controls. Phentolamine, when injected after 1 hr of shock in another group of animals, was able to elicit a rise in serum insulin with a subsequent decrease in glucose levels. These studies demonstrate that the hypoinsulinemia of the shock state is due to reduced pancreatic output of insulin, which may be under complex adrenergic control and may play an important role in the glucose intolerance of circulatory failure.     

A new model for the study of transport of [C]-diphenylhydantoin through the gingival crevicular tissues in the rabbit

Radioactive molecules can be monitored as they pass from the confines of the gingival crevice into the crevicular tissues and subsequently into the blood of rabbit. Initial studies employed this technique to trace [¹⁴C]-diphenylhydantoin (DPH). Evidence suggests that DPH has an affinity for the crevicular tissues and that this tissue may be rate limiting in drug intake into serum. Administration of systemic non-radioactive DPH appeared to eliminate this effect. In all cases substantial amounts of [¹⁴C]-DPH were observed in crevicular tissue two hours after termination of the incubation. Levels of systemically administered DPH were not different in the crevicular tissue portion of rabbit gingiva and the entire gingiva.