Explore the vast range of titles available.

The origin of the pentaradial body plan of echinoderms from a bilateral ancestor is one of the most enduring zoological puzzles 1 , 2 . Because echinoderms are defined by morphological novelty, even the most basic axial comparisons with their bilaterian relatives are problematic. To revisit this classical question, we used conserved anteroposterior axial molecular markers to determine whether the highly derived adult body plan of echinoderms masks underlying patterning similarities with other deuterostomes. We investigated the expression of a suite of conserved transcription factors with well-established roles in the establishment of anteroposterior polarity in deuterostomes 3 – 5 and other bilaterians 6 – 8 using RNA tomography and in situ hybridization in the sea star Patiria miniata . The relative spatial expression of these markers in P. miniata ambulacral ectoderm shows similarity with other deuterostomes, with the midline of each ray representing the most anterior territory and the most lateral parts exhibiting a more posterior identity. Strikingly, there is no ectodermal territory in the sea star that expresses the characteristic bilaterian trunk genetic patterning programme. This finding suggests that from the perspective of ectoderm patterning, echinoderms are mostly head-like animals and provides a developmental rationale for the re-evaluation of the events that led to the evolution of the derived adult body plan of echinoderms. RNA tomography and in situ hybridization in echinoderms suggest a new ambulacral-anterior model to relate echinoderm pentaradial symmetry to the ancestral bilateral symmetry.

This study investigates three domains of public stigma (perceived negative reactions, perceived discrimination, and dangerousness) against older adults with depression. The sample comprised of older adults registered with primary care clinics (n = 1,291) and primary health care professionals (n = 469) from São Paulo and Manaus, Brazil. Participants read a vignette describing a 70-year-old individual (Mary or John) with a depressive disorder and answered questions measuring stigma. The prevalence of the three stigma domains was between 30.2 and 37.6% among older participants from São Paulo and between 27.6 and 35.4% among older participants from Manaus. Older adults from both cities reported similar prevalence of perceived stigma. Key factors associated with stigmatizing beliefs among older participants were reporting depressive symptoms, having physical limitations, and identifying the case of the vignette as a case of mental disorder. Among health professionals, the prevalence of the three stigma domains was between 19.8 and 34.8% in São Paulo and 30.2 and 44.6% in Manaus. The key factor associated with stigma among primary health care professionals was city, with consistently higher risk in Manaus than in São Paulo. Findings confirm that public stigma against older adults in Brazil is common. It is important to educate the public and primary health care providers in Brazil on stigma related to mental illness in order to reduce barriers to adequate mental health treatment.

Although the adult pentaradial body plan of echinoderms evolved from a bilateral ancestor, identifying axial homologies between the morphologically divergent echinoderms and their bilaterian relatives has been an enduring problem in zoology. The expression of conserved bilaterian patterning genes in echinoderms provides a molecular framework for resolving this puzzle. Recent studies in juvenile asteroids suggest that the bilaterian antero-posterior axis maps onto the medio-lateral axis of the arms, perpendicular to the proximo-distal axis of each of the five rays of the pentaradial body plan. Here, we test this hypothesis in another echinoderm class, the ophiuroids, using the cosmopolitan brittle star Amphipholis squamata . Our results show that the general principles of axial patterning are similar to those described in asteroids, and comparisons with existing molecular data from other echinoderm taxa support the idea that medio-lateral deployment of the bilaterian AP patterning program across the rays predates the evolution of the asterozoans, and likely the echinoderm crown-group. Our data also reveal expression differences between A. squamata and asteroids, which we attribute to secondary modifications specific to ophiuroids. Together, this work provides important comparative data to reconstruct the evolution of axial properties in echinoderm body plans.

In this trial involving 543 patients with stroke due to occlusion of medium or distal vessels, endovascular treatment within 24 hours after the onset of symptoms was not effective in improving functional outcome at 90 days.

The aim of this retrospective study was to determine the incidence, clinical presentation and midterm clinical and imaging outcome of endovascular treatment of 34 superior cerebellar artery (SCA) aneurysms in 33 patients. Between January 1995 and January 2007, 2,112 aneurysms were treated in our institution, and 36 aneurysms in 35 patients were located on the SCA (incidence 1.7%). Two of three distal SCA aneurysms were excluded. All the remaining 34 SCA aneurysms, of which 22 (65%) were ruptured and 12 (35%) were unruptured, in 33 patients were treated by endovascular techniques. There were 6 men and 27 women ranging from 29-72 years. In 14 patients (42%) multiple aneurysms were present. Initial angiographic occlusion was (near) complete in 32 aneurysms (94%) and incomplete in 2 aneurysms (6%). Complications leading to permanent morbidity or death occurred in two patients (6.1%, 95% CI 0.6 to 20.60%). Outcome at 6 months follow-up in 31 surviving patients was GOS5 in 26 (84%), GOS4 in 4 (13%) and GOS3 in 1 patient (3%). There were no episodes of (re)bleeding during 118 patient-years of follow-up. The 6-month angiographic follow up in 28 SCA aneurysms and extended angiographic follow-up in 19 showed stable occlusion in 27 aneurysms. No additional treatments were performed. SCA aneurysms are rare with an incidence of 1.7% of treated aneurysms at our institution. They are frequently associated with other aneurysms. Endovascular treatment is effective and safe in excluding the aneurysms from the circulation.

Background: The optimal acute management of patients with acute ischemic stroke and a tandem lesion, defined as intracranial large vessel occlusion (LVO) with concomitant carotid artery stenosis or occlusion, remains unclear. Our aim is to assess the efficacy and safety of immediate carotid artery stenting (CAS) compared to delayed management in patients undergoing endovascular treatment (EVT) for acute ischemic stroke due to tandem lesions. Study design: CASES is a phase 3 multicenter prospective randomized open-label blinded endpoint (PROBE) non-inferiority clinical trial. Patients with a computed tomography angiography proven intracranial LVO in the anterior circulation and ipsilateral proximal carotid artery stenosis (⩾50%) or occlusion of presumed atherosclerotic origin will be randomized to either immediate CAS during EVT or to EVT followed by a deferred strategy, which may include carotid endarterectomy (CEA), CAS, or medical management. CASES will be conducted in 27 EVT centers in Belgium and the Netherlands. A total of 600 patients will be included. Study outcomes: The primary outcome is the score on the modified Rankin Scale (mRS) at 90 days. Secondary outcomes include excellent (mRS 0–1) and good (mRS 0–2) functional outcome at 90 days, stroke severity measured with the National Institutes of Health Stroke Scale (NIHSS) at 24 h and 5–7 days, recanalization, infarct volume at 24 h, ischemic stroke recurrence, carotid artery re-occlusion, symptomatic intracranial hemorrhage, and mortality. Summary: This study will provide high-quality randomized data on the efficacy and safety of immediate CAS in patients undergoing EVT for acute ischemic stroke due to a tandem lesion. Trial registration: ClinicalTrials.gov NCT06511089; ISRCTN 14956654 Graphical Abstract This is a visual representation of the abstract.

Introduction CT angiography (CTA) is increasingly used as primary diagnostic tool to replace digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH). However, 3D rotational angiography (3DRA) has substituted DSA as a reference standard. In this prospective observational study, we compare CTA with 3DRA of all cerebral vessels in a large cohort of patients with SAH. Methods Of 179 consecutive patients with SAH admitted between March 2013 and July 2014, 139 underwent 64- to 256-detector row CTA followed by complete cerebral 3DRA within 24 h. In 86 patients (62 %), 3DRA was performed under general anesthesia. Two observers from outside hospitals reviewed CTA data. Results In 118 of 139 patients (85 %), 3DRA diagnosed the cause of hemorrhage: 113 ruptured aneurysms, three arterial dissections, one micro-arteriovenous malformation (AVM), and one reversible vasoconstriction syndrome. On CTA, both observers missed all five non-aneurysmal causes of SAH. Sensitivity of CTA in depicting ruptured aneurysms was 0.88–0.91, and accuracy was 0.88–0.92. Of 113 ruptured aneurysms, 28 were ≤3 mm (25 %) and of 95 additional aneurysms, 71 were ≤3 mm (75 %). Sensitivity of depicting aneurysms ≤3 mm was 0.28–0.43. Of 95 additional aneurysms, the two raters missed 65 (68 %) and 58 (61 %). Sensitivity in detection was lower in aneurysms of the internal carotid artery than in other locations. Conclusion CTA had some limitations as primary diagnostic tool in patients with SAH. All non-aneurysmal causes for SAH and one in ten ruptured aneurysms were missed. Performance of CTA was poor in aneurysms ≤3 mm. The majority of additional aneurysms were not depicted on CTA.

The authors assert that the essential elements of attachment theory and Individual Psychology are similar to each other. In particular, both theories include a coherent and stable view of the self and the world and both acknowledge the importance of social interaction for the expression of these patterns. Additional suggestions for areas in which clinicians and researchers of either theory may collaborate are presented.

Purpose:The purpose of this study is to report mid- and long-term clinical and angiographic results of coiling of basilar tip aneurysms.Materials and Methods:Between January 1995 and August 2006, 154 basilar tip aneurysms were coiled. A total of 114 (74%) had ruptured and 40 (26%) were unruptured. There were 42 men and 112 women taking part in this study, with a mean age of 50.5 years (median, 50; range, 25–73 years). The mean aneurysm size was 11.1 mm (median, 10; range, 2–30 mm) and 71 (46%) were large or giant. Of 154 aneurysms, 40 (26%) were primarily coiled with a supporting device.Results:Initial occlusion was (near) complete in 144 (94%) and incomplete in 10 (6%) aneurysms. The combined procedural mortality and morbidity was 3.8% (6 of 154, 95% CI 1.4–8.3%). The mean clinical follow-up of 144 surviving patients was 53 months (range, 3–144 months; 637 patient-years). The annual incidence rate for recurrent haemorrhage was 0.3% (2 in 637 patient years, 95% CI 0.04–1.1%). During angiographic follow-up of mean 34 months (range, 6–122 months) in 138 patients (96%), 27 basilar tip aneurysms (17.5%) re-opened over time and were additionally coiled. Of these, 11 repeatedly re-opened and were repeatedly coiled. An aneurysm size of median >10 mm was the only significant predictor for re-treatment at follow-up (OR 7.0, 95% CI 2.5–19.7).Conclusion:Coiling of basilar tip aneurysms is safe and effective in preventing recurrent haemorrhage. Follow-up angiography is mandatory to timely detection of re-opening, especially in large and giant aneurysms.