Middle Branch Research Articles

Spontaneous Resolution in Dissecting Aneurysms of the Distal Middle Cerebral Artery

Spontaneous resolution of intracranial aneurysms is a rare phenomenon. We describe two cases of ruptured distal middle cerebral artery branch aneurysms associated with initial neurological deficit. Follow-up angiography showed complete resolution of the aneurysms.

Hybrid cavity polaritons in a ZnO-perovskite microcavity

We realize a Fabry-Perot hybrid microcavity containing an association of a ZnO thin layer and of a layer of the two-dimensional layered perovskite 5-methyl-2-furanmethanamonium lead bromide (MFMPB). From angle-resolved reflectivity experiments performed at low temperature of 5 K, we show that this hybrid cavity works in the strong-coupling regime and that the lower, middle, and upper polariton branches are observed. We show that the middle polariton branch (MPB) contains a significant component of the cavity photon and both of the two exciton species.

Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial.

Patients with symptomatic atherosclerotic internal carotid artery occlusion (AICAO) and hemodynamic cerebral ischemia are at high risk for subsequent stroke when treated medically. To test the hypothesis that extracranial-intracranial (EC-IC) bypass surgery, added to best medical therapy, reduces subsequent ipsilateral ischemic stroke in patients with recently symptomatic AICAO and hemodynamic cerebral ischemia. Parallel-group, randomized, open-label, blinded-adjudication clinical treatment trial conducted from 2002 to 2010. Forty-nine clinical centers and 18 positron emission tomography (PET) centers in the United States and Canada. The majority were academic medical centers. Patients with arteriographically confirmed AICAO causing hemispheric symptoms within 120 days and hemodynamic cerebral ischemia identified by ipsilateral increased oxygen extraction fraction measured by PET. Of 195 patients who were randomized, 97 were randomized to receive surgery and 98 to no surgery. Follow-up for the primary end point until occurrence, 2 years, or termination of trial was 99% complete. No participant withdrew because of adverse events. Anastomosis of superficial temporal artery branch to a middle cerebral artery cortical branch for the surgical group. Antithrombotic therapy and risk factor intervention were recommended for all participants. For all participants who were assigned to surgery and received surgery, the combination of (1) all stroke and death from surgery through 30 days after surgery and (2) ipsilateral ischemic stroke within 2 years of randomization. For the nonsurgical group and participants assigned to surgery who did not receive surgery, the combination of (1) all stroke and death from randomization to randomization plus 30 days and (2) ipsilateral ischemic stroke within 2 years of randomization. The trial was terminated early for futility. Two-year rates for the primary end point were 21.0% (95% CI, 12.8% to 29.2%; 20 events) for the surgical group and 22.7% (95% CI, 13.9% to 31.6%; 20 events) for the nonsurgical group (P = .78, Z test), a difference of 1.7% (95% CI, -10.4% to 13.8%). Thirty-day rates for ipsilateral ischemic stroke were 14.4% (14/97) in the surgical group and 2.0% (2/98) in the nonsurgical group, a difference of 12.4% (95% CI, 4.9% to 19.9%). Among participants with recently symptomatic AICAO and hemodynamic cerebral ischemia, EC-IC bypass surgery plus medical therapy compared with medical therapy alone did not reduce the risk of recurrent ipsilateral ischemic stroke at 2 years. clinicaltrials.gov Identifier: NCT00029146.

Revascularization for Complex Cerebral Aneurysms

Complex cerebral aneurysms may require indirect treatment with revascularization. This manuscript describes various surgical revascularization techniques together with clinical outcomes. Thirty-two consecutive patients with complex cerebral aneurysm were managed from November 2005 to October 2008. Techniques used for revascularization were high-flow bypass, low-flow bypass, branch artery reimplantion, and primary reanastomosis. Physiologic and anatomic monitoring technologies, including electroencephalography, somatosensory evoked potential monitoring, microvascular doppler ultrasonography, and/or indocyanine green videoangiography were used intraoperatively to assess both brain physiology and vascular anatomy. Patient outcome was determined using the Glasgow Outcome Scale at discharge and at a mean of 12 months post operation (range 6-25 months). Two cervical carotid aneurysms (6%) were resected followed by primary reanastomosis, 21 aneurysms (66%) were trapped following saphenous vein high-flow bypasses, five (16%) were clipped after superficial temporal or occipital artery low-flow bypasses, and four (12%) middle cerebral branch arteries were reimplanted. Of the 32 patients at discharge, 29 (91%) had a Glasgow Outcome Scale of four or five, two (6%) had severe disability, and one (3%) died. Cerebral revascularization remains an effective and reliable procedure for treatment of complex cerebral aneurysms. Low morbidity and mortality rates reflect the maturity of patient selection and surgical technique in the management of these lesions.

The role of oroclinal bending in the structural evolution of the Central Anatolian Plateau: evidence of a regional changeover from shortening to extension

The role of oroclinal bending in the structural evolution of the Central Anatolian Plateau: evidence of a regional changeover from shortening to extensionThe NW-SE striking extensional Inönü-Eskişehir Fault System is one of the most important active shear zones in Central Anatolia. This shear zone is comprised of semi-independent fault segments that constitute an integral array of crustal-scale faults that transverse the interior of the Anatolian plateau region. The WNW striking Eskişehir Fault Zone constitutes the western to central part of the system. Toward the southeast, this system splays into three fault zones. The NW striking Ilıca Fault Zone defines the northern branch of this splay. The middle and southern branches are the Yeniceoba and Cihanbeyli Fault Zones, which also constitute the western boundary of the tectonically active extensional Tuzgölü Basin. The Sultanhanı Fault Zone is the southeastern part of the system and also controls the southewestern margin of the Tuzgölü Basin. Structural observations and kinematic analysis of mesoscale faults in the Yeniceoba and Cihanbeyli Fault Zones clearly indicate a two-stage deformation history and kinematic changeover from contraction to extension. N-S compression was responsible for the development of the dextral Yeniceoba Fault Zone. Activity along this structure was superseded by normal faulting driven by NNE-SSW oriented tension that was accompanied by the reactivation of the Yeniceoba Fault Zone and the formation of the Cihanbeyli Fault Zone. The branching of the Inönü-Eskişehir Fault System into three fault zones (aligned with the apex of the Isparta Angle) and the formation of graben and halfgraben in the southeastern part of this system suggest ongoing asymmetric extension in the Anatolian Plateau. This extension is compatible with a clockwise rotation of the area, which may be associated with the eastern sector of the Isparta Angle, an oroclinal structure in the western central part of the plateau. As the initiation of extension in the central to southeastern part of the Inönü-Eskişehir Fault System has similarities with structures associated with the Isparta Angle, there may be a possible relationship between the active deformation and bending of the orocline and adjacent areas.

Cavity polaritons of heavy-hole and light-hole excitons in a CuI microcavity

We have investigated the exciton-photon coupling phenomena in a CuI bulk microcavity consisting of a CuI active layer with an effective thickness of $\ensuremath{\lambda}/2$ and HfO${}_{2}/$SiO${}_{2}$ distributed Bragg reflectors. In the CuI active layer, a thermal strain removes the degeneracy of the heavy-hole (HH) and light-hole (LH) excitons at the $\ensuremath{\Gamma}$ point. Angle-resolved reflectance spectra measured at 10 K demonstrate strong coupling between the HH and LH excitons and cavity photon, resulting in the formation of three cavity-polariton modes: lower, middle, and upper polariton branches. The photoluminescence band from the lower polariton branch was clearly observed. The energies of the three cavity-polariton modes as a function of incidence angle are reasonably explained by analysis using a phenomenological Hamiltonian for the strong coupling. The vacuum Rabi splitting energies are evaluated as 50 and 29 meV for the HH and LH excitons, respectively. The magnitude of the Rabi splitting energy results from the large oscillator strength of the relevant exciton. Furthermore, it is confirmed that the strong coupling regime is fully maintained at room temperature because of the high stability of the excitonic system.

An asymptomatic case with multiple intrahepatic portosystemic venous shunts

A 35-year-old male patient was admitted for mild abdominal pain. He had no history of operation, medication, or any injury. Physical examination and laboratory results were normal. Portal vein (PV) Doppler ultrasound showed a shunt between middle hepatic vein (HV) and left branch of PV. Angiography of magnetic resonance imaging of the liver revealed aneurysms and shunts between left PV and middle HV (Fig. 1). Three shunts were seen between segment 2 and segment 3 branches of the left PV and the left HV (Fig.

화염제어 연속계산법을 이용한 CH4-고온공기 확산화염의 점화특성 연구

CH₄ -고온공기 대향류 확산화염의 점화특성을 화염제어 연속계산법을 이용하여 수치해석적으로 검토하였다. 화학반응의 계산에는 GRI-v1.2 반응기구를 이용하였으며, 화염 최고온도를 총괄 스트레인율의 역수에 대해 나타내어 점화 및 소화특성에 관한 화염 최고온도의 S-곡선을 얻을 수 있었다. 총괄 스트레인율 변화에 따른 화염구조를 고찰하기 위해 S-곡선에서 Upper Branch와 Middle Branch의 화염 온도분포와 속도구배를 비교하였다. 총괄 스트레인율값은 화염면과 혼합층의 연료과 공기측 경계에서 정의되는 국소 스트레인율값과도 비교하였다. 연료측과 공기측의 국소 스트레인율은 총괄 스트레인율과의 좋은 상관관계에 있음을 알 수 있었다. 화염제어 연속계산법이 확산화염의 점화, 소화특성을 검토하는데 매우 유용한 방법임을 확인하였다.

Control of exciton-photon interactions in CuCl microcavities

We have investigated the active-layer-thickness dependence of exciton-photon interactions in planar CuCl microcavities with HfO${}_{2}/$SiO${}_{2}$ distributed Bragg reflectors. The active layer thickness was changed from $\ensuremath{\lambda}/$32 to $\ensuremath{\lambda}/$4, while the cavity length was fixed at $\ensuremath{\lambda}/$2. We performed angle-resolved reflectance measurements and clearly detected three cavity-polariton modes, originating from the lower, middle, and upper polariton branches, in a strong-coupling regime of the ${Z}_{3}$ and ${Z}_{1,2}$ excitons and cavity photon. The incidence-angle dependence of the cavity-polariton modes was analyzed using a phenomenological Hamiltonian for the strong coupling. It was found that the interaction energies of the cavity-polariton modes, the so-called vacuum Rabi splitting energies, are systematically controlled from 22(37) to 71(124) meV for the ${Z}_{3}$(${Z}_{1,2}$) exciton by changing the active layer thickness from $\ensuremath{\lambda}/$32 to $\ensuremath{\lambda}/$4. The active-layer-thickness dependence of the Rabi splitting energy is quantitatively explained by a simple theory for quantum-well microcavities.

Composition of mixed‐species flocks and shifts in foraging location of flocking species on Hainan Island, China

A total of 134 bird species were recorded at Jianfengling, Hainan Island, in China from May 2000 to September 2004, of which 44 participated in one or more of 134 mixed‐species flocks. These flocks averaged 3.8 ± 0.2 species and 20.3 ± 1.2 individuals. Flocking propensity in a given species ranged from 1.5 to 100%. For flocking species, frequency of flocking and number of individuals in flocks was positively correlated with frequency and number in point counts. Among all species pairs with flocking frequency above 5%, cluster and correlation analysis indicated there were two principal groups of flocking birds – canopy species and understorey species: associations were positive within a group, but negative between groups. Canopy birds had a higher flocking propensity than understorey birds. They also made significantly less use of inner branches and trunks and greater use of middle branches, and foraged at a significantly greater height when in mixed‐species flocks than when solitary. For understorey bird species, there were no significant differences in foraging locations between solitary and mixed‐species flocks. Higher flocking frequency occurred in the wet season for canopy birds, but in the dry season for understorey birds. Overall patterns were consistent with the explanation that flocking enables an expansion of foraging niche by reducing the risk of predation.

Stability and Self-Sustained Oscillations in a Ventricular Cardiomyocyte Model

The Luo-Rudy I model, describing the electrophysiology of a ventricular cardiomyocyte, is associated with an 8-dimensional discontinuous dynamical system with logarithmic and exponential non-linearities depending on 15 parameters. By numerical approaches appropriate to bifurcation problems, sections in the static bifurcation diagram were determined. For different values of a steady depolarizing/hyperpolarizing current (Ist), the corresponding projection of the static bifurcation diagram in the (Ist, V) plane is complex, featuring three branches of stationary solutions delimited by two saddle-node bifurcation points. In addition, on the upper branch oscillations can occur within an Ist range [−4.45, −0.51 μA/cm2] where the Jacobian of the linearized system features two complex conjugated eigenvalues. Oscillations are either damped at a stable focus or amplified until the system trajectory is diverted to the lower branch of stable stationary solutions when reaching the unstable manifold of a homoclinic saddle. The middle branch of solutions is a series of unstable saddle points, while the lower one a series of stable nodes. For variable slow inward and K+ current maximal conductances (gsi and gK), in a range between 0 and 4-fold normal values, the dynamics is even more complex, and in certain instances self-sustained oscillations tending to a stable limit cycle appear. All these types of behavior were correctly predicted by linear stability analysis and bifurcation theory methods based on numerical continuation algorithms. Both unsustained oscillations, resulting in early after-depolarizations, and sustained oscillations may trigger dangerous ventricular arrhythmias by multiple mechanisms. In particular settings, e.g. for a normal gK and one-fifth-of-normal gsi, these two arrhythmia-threatening conditions may occur simultaneously.

Trapping with high-flow bypass for a traumatic giant pseudoaneurysm of the supraclinoid carotid artery in an adolescent: case report

Traumatic aneurysms account for 14–39% of all pediatric aneurysms [1]. Most are located on distal anterior or middle cerebral arteries (MCA) or branches. They are rare on the internal carotid artery (ICA) and even more rare on the supraclinoid portion of the ICA [2–5, 22]. Because of the high mortality and morbidity of traumatic aneurysms, early diagnosis and treatment are recommended [3, 6, 7]. We describe the first reported pediatric case of traumatic pseudoaneurysm of the supraclinoid ICA to be successfully treated with high-flow bypass followed by aneurysm trapping.

Lymphatic drainage of the external ear

Lymphoscintigraphy reveals inconsistencies in our knowledge of the lymphatic anatomy of the external ear. Fifteen external ears from 9 unembalmed human cadavers were studied. Six percent hydrogen peroxide was used to find the lymphatic vessels using a surgical microscope. They were injected with a radio-opaque mixture, dissected, photographed, and radiographed to demonstrate lymphatic vessels in the tissue. Final results were transferred to the computer for analysis. Four groups of lymph collecting vessels were found. The anterior branch, in all specimens, drained directly or indirectly (having merged with a vessel descending from the scalp) into the preauricular lymph nodes. The superior, middle, and inferior (lobule) branches drained to their multiple first tier lymph nodes. An accurate lymphatic map of the external ear is described to upgrade our anatomic knowledge. It will be of benefit for the clinical management of malignancies in this region.

Mannose Trimming Is Required for Delivery of a Glycoprotein from EDEM1 to XTP3-B and to Late Endoplasmic Reticulum-associated Degradation Steps

Although the trimming of α1,2-mannose residues from precursor N-linked oligosaccharides is an essential step in the delivery of misfolded glycoproteins to endoplasmic reticulum (ER)-associated degradation (ERAD), the exact role of this trimming is unclear. EDEM1 was initially suggested to bind N-glycans after mannose trimming, a role presently ascribed to the lectins OS9 and XTP3-B, because of their in vitro affinities for trimmed oligosaccharides. We have shown before that ER mannosidase I (ERManI) is required for the trimming and concentrates together with the ERAD substrate and ERAD machinery in the pericentriolar ER-derived quality control compartment (ERQC). Inhibition of mannose trimming prevents substrate accumulation in the ERQC. Here, we show that the mannosidase inhibitor kifunensine or ERManI knockdown do not affect binding of an ERAD substrate glycoprotein to EDEM1. In contrast, substrate association with XTP3-B and with the E3 ubiquitin ligases HRD1 and SCF(Fbs2) was inhibited. Consistently, whereas the ERAD substrate partially colocalized upon proteasomal inhibition with EDEM1, HRD1, and Fbs2 at the ERQC, colocalization was repressed by mannosidase inhibition in the case of the E3 ligases but not for EDEM1. Interestingly, association and colocalization of the substrate with Derlin-1 was independent of mannose trimming. The HRD1 adaptor protein SEL1L had been suggested to play a role in N-glycan-dependent substrate delivery to OS9 and XTP3-B. However, substrate association with XTP3-B was still dependent on mannose trimming upon SEL1L knockdown. Our results suggest that mannose trimming enables delivery of a substrate glycoprotein from EDEM1 to late ERAD steps through association with XTP3-B.

Targeted Extracranial-Intracranial Bypass With Intra-Aneurysmal Administration of Indocyanine Green: Case Report

Early origin of the middle cerebral artery M2 segment is a normal variant. When such a vessel is occluded proximally, the parenchyma distal to the vessel may become ischemic. Targeted extracranial to intracranial bypass to such a specific branch may preserve perfusion to the end organ. We describe the use of intra-aneurysmal injection of indocyanine green to identify a target middle cerebral artery branch (MCA) for bypass, immediately followed by proximal parent vessel sacrifice via endovascular embolization. A 45-year-old woman presented to an outside hospital with headaches. Magnetic resonance imaging revealed a giant aneurysm of the right MCA. The aneurysm gave rise to an M2 branch that supplied the right anterior frontal operculum, as well as the anterolateral portion of the superior temporal gyri. Balloon test occlusion was nondiagnostic because of the territory involved, and the risk of sizable infarction after vessel sacrifice was thought to be high. Craniotomy and targeted extracranial to intracranial bypass to an M4 opercular branch was performed with intra-aneurysmal injection of indocyanine green. In our combined endovascular/open cerebrovascular suite, an opercular MCA branch that fluoresced during the first-pass arterial circulation of indocyanine green was identified, and a superficial temporal artery to MCA bypass was performed. Angiographic verification of bypass patency was confirmed, followed by embolic occlusion of the giant aneurysm with preservation of flow to the parenchyma at risk through the bypass. Targeted bypass to distal branches is feasible with intra-arterial and intra-aneurysmal injection of indocyanine green, allowing confident preservation of blood supply to areas distal to the sacrificed vessel.

Extracranial Posterior Communicating Artery Bypass for Revascularization of Patients With Common Carotid Artery Occlusion

Extracranial-intracranial bypass surgery provides blood flow augmentation in patients suffering from intracranial or long-distance conductance artery stenosis or occlusion that otherwise cannot be treated. The standard procedure for these cases is an anastomosis between the superficial temporal and middle cerebral arteries. However, in patients presenting with common carotid artery occlusion, the superficial temporal artery is no longer sufficiently perfused. For these patients, alternative revascularization strategies have to be applied. To describe a novel strategy for revascularization of patients with common carotid artery occlusion, ie, the extracranial posterior communicating artery bypass. Two patients with chronic cerebrovascular compromise resulting in transitory ischemic attacks and/or border-zone infarctions caused by common carotid artery occlusion were referred to our institution. A radial artery bypass was established between the third segment of the vertebral artery and an M3 branch of the middle cerebral artery. The vertebral artery was exposed between the vertebral lamina of C1 and occipital bone via a paramedian incision. The bypass was tunneled subcutaneously, conducted intracranially via a tailored extended burr-hole craniotomy, and anastomosed to a recipient M3 vessel. The postoperative course of both patients was uneventful in terms of cerebral ischemia or bleeding complications. In both patients, postoperative angiographic controls revealed an excellent bypass function with markedly improved hemispheric filling of multiple middle cerebral artery branches. The patients were discharged without new neurological symptoms. Our extracranial posterior communicating artery bypass using a radial artery transplant from the vertebral artery to the middle cerebral artery is a useful tool to treat patients suffering from hemodynamic cerebrovascular compromise caused by common carotid artery occlusion.

Correlation and path analysis on artemisinin content and yield with different agronomic traits of Artemisia annua

To provide the basis for improving utilization of Artemisia annua germplasm resources and breeding variety, the interrelations between artemisinin content, artemisinin yield and agronomic traits of A. annua were studied. The artemisinin content and each agronomic trait of 63 A. annua germplasm resources were measured by the visual observation and measurement methods. And the correlation analysis, regression analysis and path analysis were adopted. The result showed that there were significant differences in the artemisinin content and yield of 63 germplasm resources from the main production region of A. annua. Correlation analysis showed that there were significantly positive correlation between leaf weight and artemisinin yield with stem and branch characters, but there were negative correlation between artemisinin content with leaf characters of A. annua plant. The artemisinin content of A. annua increased with the increasing of primary branch number, bottom secondary branch number, and bottom stem diameter, etc. On the other hand, it decreased with the increasing of top secondary branch number, secondary leaf axis length, and bottom branch diameter, etc. The artemisinin yield of A. annua increased with the increasing of artemisinin content, leaf weight, and bottom secondary branch number, etc., and decreased with the increasing of bottom branch diameter, middle secondary branch number, and stem weight, etc. Path analysis showed that the primary branch number and bottom secondary branch number had a direct positive effect on the artemisinin content of A. annua. But the top secondary branch number had a direct negative effect on the artemisinin content of A. annua. The leaf weight and artemisinin content had a direct positive effect on the artemisinin yield and the ratio of leaf/stem, branch weight and stem weight had a direct negative effect. On the breeding A. annua variety, it can take into account both high leaf yield and high artemisinin content. And it was strongly recommend that the plant with moderate plant height and crown, shortness pinnae and secondary leaf axis, less middle and top secondary branch, strong stem, higher primary branch number and bottom secondary branch number, and higher ratio leaf/stem could be selected for breeding new varieties with high leaf yield and high artemisinin content.

E0497 Clinical evaluation on the safety and therapeutic efficacy of Excel drug-eluting stent

ObjectiveTo investigate the clinical safety and mid-and short-term efficacy of rapamycin eluting stent (Excel) in patients with coronary artery disease.MethodsBetween Jul. 2006 and Jun. 2009, 240 patients of coronary heart...

Optimization research for a high pressure common rail diesel engine based on simulation

A TP (Temperature Phase) model is presented to carry out optimization calculation for a high-pressure common rail diesel engine. Temperature is the most important parameter in the TP model. For the lower branch (when temperature T < 850 K) of the S-shaped curve (auto-ignition phase), a 6-step ad-hoc model with adjusted rate constants of nheptane is used, referred to steady state assumption. Steady state assumption is based on the observation that, due to very fast chemical processes in combustion problems, many chemical species and reactions are in a quasi-steady state or partial equilibrium. When a species is assumed to be in the steady state, the corresponding differential equation can be replaced by an algebraic relation, which reduces the computational costs. For the middle branch (850 K ≤ T < 1100 K) of the S-shaped curve, a 4-step model is used to calculate the unstable phase. For the upper branch (T ≥ 1100 K) of the S-shaped curve, onestep model is used because the one-step model has widely been used in descriptions of flame stability where it essentially serves as a model that produces a thin flame with strong temperature sensitivity. When zone temperature T < 1500 K, only the soot precursors -PAHs (Polycyclic aromatic hydrocarbons) is created and there is no soot emission. When zone temperature T ≥ 1500 K, PAHs and soot source terms (particle inception, surface growth, oxidation, coagulation) are calculated. The TP model is then applied in multidimensional simulations to carry out optimizing, which reduces experiment cost. The results of cylinder pressures, the corresponding heat release rates, NOx and soot with variation of injection time at constant rail pressure, variation of EGR-rate at constant rail pressure and variation of rail pressure at constant EGR-rate between simulation and experimental data are analyzed. The results indicate that the TP model can carry out optimization and CFD (computational fluid dynamics) and can be a tool to calculate for a high-pressure common rail diesel engine.

A High CSF Signal on FLAIR: It is Not Always Blood

We describe a patient with progressive neurologic deficit due to middle cerebral branch occlusion. Temporary partial balloon occlusion of the abdominal aorta led to an increased signal in the subarachnoid space on fluid-attenuated inversion recovery images with no evidence of subarachnoid hemorrhage. After spontaneous recanalization, the increased signal of the subarachnoid space returned to normal. We assume that signal changes in the subarachnoid space were due to a temporary increase in blood volume in the superficial brain vessels.