Endovascular treatment of symptomatic intracranial arterial stenosis: six-year experience in a single-center series of 42 consecutive patients with acute and mid-term results.

BACKGROUND: The limitations of the medical management of symptomatic intracranial arterial stenosis encourage the development of new therapeutic strategies such as intracranial stenting. OBJECTIVE: To report and analyze the results of a series of 42 patients treated with 3 different endovascular techniques: isolated angioplasty, balloon-expandable coronary stents, and the Wingspan self-expandable intracranial stent system. METHODS: Forty-two patients presenting with symptomatic intracranial arterial stenosis were treated with one of these techniques. Computed tomography angiography was performed 6 months after the procedure, and the clinical neurological statuses were categorized using the modified Rankin Scale and the National Institutes of Health Stroke Scale. RESULTS: A total of 42 lesions were treated: 9 with isolated angioplasty, 14 with balloon-expandable coronary stents, and 19 with Wingspan self-expandable intracranial stents. The mean patient age was 62.9 years, and the mean arterial diameter stenosis was 73.9%. Technical success was achieved in 97.6% of the patients. The overall incidence of procedural complications was 21.4%, and the postoperative permanent morbidity/mortality rate was 7.1%. There were 3 cases of in-stent thrombosis (1 fatal) and 5 cases of asymptomatic restenosis (11.9%), 3 in the isolated angioplasty group and 2 in the Wingspan self-expandable intracranial stent group (mean follow-up 20.4 months). The rate of restenosis was higher in the angioplasty group (33%) than in the coronary (0%) and Wingspan stent (10.5%) groups. CONCLUSION: Endovascular treatment of symptomatic intracranial stenosis has significant overall morbidity and mortality rates. Nevertheless, the very critical natural history of severe refractory lesions and the relatively favorable postoperative evolution suggest that it should be considered the first alternative strategy in cases in which medical therapy has failed.

Settlement evolution, field systems and sedimentary processes in a Mediterranean mid-mountain (Montseny Massif, Catalunya)

This paper presents the first results of a current research project about human – environmental interactions in the Montseny Massif. Our work sets out to integrate two research lines in the studied area: - Archaeological and archaeo-morphological surveys in a lower part of the mountains in order to characterize the evolution of the settlements and field systems. - The geological and geomorphological characterization of the slope and terrace deposits in relation with field systems and archaeological data. First results point out the intensive occupation of these inland areas during the Iberian and the Roman periods. Post-Roman sediments show different processes of erosion.

Miz-zikronot yeme yalduti ¿o mar¿e ha-¿ir Dwinsq

Warsha 1903

Svensksund mid Fort Slava

Helsingfors : A.W. Gröndahl & A.C. Öhman 1845 : Dresden, Adler u. Dietze

Centrality and investment strategies at the beginning of industrialisation in mid-nineteenth-century Catalonia

We apply social networks analysis to the study of an important database on investment and companies" share in the Catalonia (Spain) of the nineteenth century. In contrast with most of the existing related literature, usually addressing power relationships across administration boards, we focus on the structure of interactions among individual investors and firms. Centrality analysis uncovers interesting roles played by certain economic sectors (e.g. textile and financial). Furthermore, the diverse composition (in terms of economic activity) of communities in the network (subgroups more densely connected internally than with the rest of the network) reveals a high investment diversification, which nicely agrees with a known characteristic of traditional Catalan business strategies.

Mid-gut ACTH-secreting neuroendocrine tumor unmasked with (18)F-dihydroxyphenylalanine-positron emission tomography.

Ectopic ACTH Cushing's syndrome (EAS) is often caused by neuroendocrine tumors (NETs) of lungs, pancreas, thymus, and other less frequent locations. Localizing the source of ACTH can be challenging. A 64-year-old man presented with rapidly progressing fatigue, muscular weakness, and dyspnea. He was in poor condition and showed facial redness, proximal amyotrophy, and bruises. Laboratory disclosed hypokalemia, metabolic alkalosis, and markedly elevated ACTH and cortisol levels. Pituitary was normal on magnetic resonance imaging (MRI), and bilateral inferior petrosal sinus blood sampling with corticotropin-releasing hormone stimulation showed no significant central-to-periphery gradient of ACTH. Head and neck, thoracic and abdominal computerized tomography (CT), MRI, somatostatin receptor scintigraphy (SSRS), and (18)F-deoxyglucose-positron emission tomography (FDG-PET) failed to identify the primary tumor. (18)F-dihydroxyphenylalanine (F-DOPA)-PET/CT unveiled a 20-mm nodule in the jejunum and a metastatic lymph node. Segmental jejunum resection showed two adjacent NETs, measuring 2.0 and 0.5 cm with a peritoneal metastasis. The largest tumor expressed ACTH in 30% of cells. Following surgery, after a transient adrenal insufficiency, ACTH and cortisol levels returned to normal values and remain normal over a follow-up of 26 months. Small mid-gut NETs are difficult to localize on CT or MRI, and require metabolic imaging. Owing to low mitotic activity, NETs are generally poor candidates for FDG-PET, whereas SSRS shows poor sensitivity in EAS due to intrinsically low tumor concentration of type-2 somatostatin receptors (SST2) or to receptor down regulation by excess cortisol. However, F-DOPA-PET, which is related to amine precursor uptake by NETs, has been reported to have high positive predictive value for occult EAS despite low sensitivity, and constitutes a useful alternative to more conventional methods of tumor localization. LEARNING POINTS: Uncontrolled high cortisol levels in EAS can be lethal if untreated.Surgical excision is the keystone of NETs treatment, thus tumor localization is crucial.Most cases of EAS are caused by NETs, which are located mainly in the lungs. However, small gut NETs are elusive to conventional imaging and require metabolic imaging for detection.FDG-PET, based on tumor high metabolic rate, may not detect NETs that have low mitotic activity. SSRS may also fail, due to absent or low concentration of SST2, which may be down regulated by excess cortisol.F-DOPA-PET, based on amine-precursor uptake, can be a useful method to localize the occult source of ACTH in EAS when other methods have failed.

¿Por qué las mujeres con cáncer de mama deben estar guapas y los hombres con cáncer de próstata pueden ir sin afeitar? Oncología, disidencia y cultura hegemónica

El universo oncológico, aparentemente, constituye un ámbito de profundos consensos; aliviar el sufrimiento de pacientes y familias, la búsqueda de una cura efectiva o erradicar el estigma asociado al diagnóstico son objetivos que generan un amplio acuerdo social. Desde una perspectiva cultural, sin embargo, se constata la presencia de ciertas áreas de tensión y disidencia en torno al cáncer. En este artículo, aplicando conceptos analíticos de Gramsci y Foucault, se define en forma de decálogo lugares comunes que como el pensamiento positivo, la feminidad, la prevención o el espíritu de lucha conforman una cultura hegemónica en cáncer de mama enfrentada a los discursos de culturas subalternas como la feminista o ambientalista. Frente a la idea de unidad y consenso, el análisis de la literatura antropológica proporciona una imagen compleja donde la vivencia del cáncer, resignificando la enfermedad como un espacio de conflicto ideológico, es construida en términos de lucha de intereses y proyectos de control social.

Gramática aplicada a ELE: la perífrasis “ir a + infinitivo” y el futuro sintético

La presencia en español de dos construcciones —la perífrasis «IR A+Infinitivo» y lasformas verbales sintéticas terminadas en –rá— que pueden alternarse en determinadoscontextos como mecanismos para expresar la futuridad en español ha llevado a unageneralización en el uso de tales construcciones descuidando la vertiente pragmática delas mismas, y, en consecuencia, se ha tendido a ofrecer al estudiante de ELE unaconsideración básicamente gramatical de los usos de la perífrasis y del futuro sintético. Eneste sentido, el objetivo de nuestra propuesta busca establecer las principales divergencias de carácter pragmático que —creemos— deberían incorporarse a la explicación de estos contenidos gramaticales.

Explaining vineyard specialization in the province of Barcelona (Spain) in the mid-19th century

[cat] Presentem un model estadístic de l’especialització vitícola a la província de Barcelona cap el 1860 que combina la pressió boserupiana de l’augment de població, l’atracció de la demanda induïda per un creixement de tipus smithià (mesurada per les distancies horàries al port més proper), i l’adequació dels sòls disponibles per sembrar gra o plantar ceps (mesurada per l’estès hídric, el pendent i el risc de glaçades). L’assoliment global d’uns nivells de R2 ajustats que oscil·len entre 0,608 i 0,826 poden considerar-se força bons. Creiem que la desigualtat en la propietat de la terra també va jugar un paper molt important, però l’hem hagut d’ometre de moment per manca de dades estadístiques. També cal aprofundir en el tractament del problema de possible endogeneïtat derivat de l’ús de variables socio-demogràfiques.

Explaining vineyard specialization in the province of Barcelona (Spain) in the mid-19th century

[cat] Presentem un model estadístic de l’especialització vitícola a la província de Barcelona cap el 1860 que combina la pressió boserupiana de l’augment de població, l’atracció de la demanda induïda per un creixement de tipus smithià (mesurada per les distancies horàries al port més proper), i l’adequació dels sòls disponibles per sembrar gra o plantar ceps (mesurada per l’estès hídric, el pendent i el risc de glaçades). L’assoliment global d’uns nivells de R2 ajustats que oscil·len entre 0,608 i 0,826 poden considerar-se força bons. Creiem que la desigualtat en la propietat de la terra també va jugar un paper molt important, però l’hem hagut d’ometre de moment per manca de dades estadístiques. També cal aprofundir en el tractament del problema de possible endogeneïtat derivat de l’ús de variables socio-demogràfiques.

3D kinematics of the near-IR HH 223 outflow in L723

In this work, we derive the full 3D kinematics of the near-infrared outflow HH 223, located in the dark cloud Lynds 723 (L723), where a well-defined quadrupolar CO outflow is found. HH 223 appears projected on to the two lobes of the eastwest CO outflow. The radio continuum source VLA 2, towards the centre of the CO outflow, harbours a multiple system of low-mass young stellar objects. One of the components has been proposed to be the exciting source of the eastwest CO outflow. From the analysis of the kinematics, we get further evidence on the relationship between the near-infrared and CO outflows and on the location of their exciting source. The proper motions were derived using multi-epoch, narrow-band H2 (2.122 μm line) images. Radial velocities were derived from the 2.122 μm line of the spectra. Because of the extended (∼5 arcmin), S-shaped morphology of the target, the spectra were obtained with the multi-object-spectroscopy (MOS) observing mode using the instrument Long-Slit Intermediate Resolution Infrared Spectrograph (LIRIS) at the 4.2 m William Herschel Telescope. To our knowledge, this work is the first time that MOS observing mode has been successfully used in the near-infrared range for an extended target.

Determination of the HMX and RDX content in synthesized energetic material by HPLC, FT-MIR, and FT-NIR spectroscopies

A new method has been developed for determining the content of mixtures of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) and hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX), the HMX/RDX ratio, in explosive compositions by Fourier transform infrared spectroscopy (FT-IR), in the regions MIR (mid infrared) and NIR (near infrared) with reference values obtained by chromatographic analysis (HPLC). Plots of relative MIR (A917 / A783) or NIR absorbance values (A4412 / A4317) versus HMX/RDX ratio determined by HPLC analysis revealed good linear relationships.