Upon the delivery of intracellular model antigens, NVP-AUY922 ic50 hepatocyte-targeted IDLVs induced transgene-specific regulatory T cells that contributed to the observed immune tolerance. Deep sequencing of IDLV-transduced livers showed only rare genomic

integrations that had no preference for gene coding regions and occurred mostly by a mechanism inconsistent with residual integrase activity. Conclusion: IDLVs provide an attractive platform for the tolerogenic expression of intracellular or secreted proteins in the liver with a substantially reduced risk of insertional mutagenesis. (HEPATOLOGY 2011;) “
“Obesity is associated with an aggressive course in chronic viral hepatitis; however, its impact in the development of clinical decompensation (CD) in patients with established cirrhosis is uncertain. We evaluated the role of obesity, in relationship to other recognized predictors, in the development of CD in patients with compensated cirrhosis. The study population, a subset of patients included in a randomized trial of beta-blockers in the prevention of varices in whom data on body mass index (BMI) was available, consisted of 161 patients with compensated cirrhosis. Laboratory tests and portal pressure (assessed by the hepatic venous pressure

gradient or HVPG) were assessed on inclusion. Patients were followed until CD (ascites, hepatic encephalopathy, Selleckchem LDE225 or variceal hemorrhage), or until September 2002. Altogether, 29% had a normal BMI, 40% were overweight, and 30% were obese. In a median follow-up of 59 months, CD occurred in 48/161 (30%) patients with an increasingly higher rate according to BMI group (15% in those with normal BMI; 31% in overweight; 43% in obese patients, P = 0.011). The actuarial probability of developing CD 上海皓元 was significantly higher in the abnormal BMI groups (P = 0.022). In a multivariate model that included parameters previously identified as being predictive of CD (HVPG, albumin,

Mayo endstage liver disease score), etiology, and treatment group, BMI (hazard ration 1.06; 95% confidence interval 1.01-1.12), P = 0.02] was an independent predictor of decompensation, together with HVPG and albumin. Conclusion: Obesity has a deleterious effect on the natural history of compensated cirrhosis of all etiologies, independent of portal pressure and liver function. Weight reduction may be a valuable therapeutic measure in this patient population. (HEPATOLOGY 2011;) The natural history of chronic liver diseases is characterized by the progression of fibrosis and nodule formation leading to the development of cirrhosis. Once cirrhosis is established, patients progress from a frequently asymptomatic compensated stage to a decompensated stage, marked by the development of clinical complications of portal hypertension and liver failure.

Upon the delivery of intracellular model antigens, GSK126 concentration hepatocyte-targeted IDLVs induced transgene-specific regulatory T cells that contributed to the observed immune tolerance. Deep sequencing of IDLV-transduced livers showed only rare genomic

integrations that had no preference for gene coding regions and occurred mostly by a mechanism inconsistent with residual integrase activity. Conclusion: IDLVs provide an attractive platform for the tolerogenic expression of intracellular or secreted proteins in the liver with a substantially reduced risk of insertional mutagenesis. (HEPATOLOGY 2011;) “
“Obesity is associated with an aggressive course in chronic viral hepatitis; however, its impact in the development of clinical decompensation (CD) in patients with established cirrhosis is uncertain. We evaluated the role of obesity, in relationship to other recognized predictors, in the development of CD in patients with compensated cirrhosis. The study population, a subset of patients included in a randomized trial of beta-blockers in the prevention of varices in whom data on body mass index (BMI) was available, consisted of 161 patients with compensated cirrhosis. Laboratory tests and portal pressure (assessed by the hepatic venous pressure

gradient or HVPG) were assessed on inclusion. Patients were followed until CD (ascites, hepatic encephalopathy, Selleckchem Erlotinib or variceal hemorrhage), or until September 2002. Altogether, 29% had a normal BMI, 40% were overweight, and 30% were obese. In a median follow-up of 59 months, CD occurred in 48/161 (30%) patients with an increasingly higher rate according to BMI group (15% in those with normal BMI; 31% in overweight; 43% in obese patients, P = 0.011). The actuarial probability of developing CD medchemexpress was significantly higher in the abnormal BMI groups (P = 0.022). In a multivariate model that included parameters previously identified as being predictive of CD (HVPG, albumin,

Mayo endstage liver disease score), etiology, and treatment group, BMI (hazard ration 1.06; 95% confidence interval 1.01-1.12), P = 0.02] was an independent predictor of decompensation, together with HVPG and albumin. Conclusion: Obesity has a deleterious effect on the natural history of compensated cirrhosis of all etiologies, independent of portal pressure and liver function. Weight reduction may be a valuable therapeutic measure in this patient population. (HEPATOLOGY 2011;) The natural history of chronic liver diseases is characterized by the progression of fibrosis and nodule formation leading to the development of cirrhosis. Once cirrhosis is established, patients progress from a frequently asymptomatic compensated stage to a decompensated stage, marked by the development of clinical complications of portal hypertension and liver failure.

A modified TGA DWI protocols for detecting TGA lesions are useful in large-scale clinical practice for confirming the diagnosis of TGA patients with clinical findings. “
“We describe a novel technique for cerebral embolic device placement with inadvertent entrapment and subsequent rescue in the endovascular treatment of innominate artery stenosis. A 62-year-old female presented with symptomatic right-sided subclavian steal syndrome. Single-site access for revascularization of critical innominate artery stenosis with simultaneous cerebral Selleck Y 27632 embolic protection performed for this diagnosis has not been previously reported. Initial nontarget self-expanding

stent deployment within the right subclavian artery resulted in entrapment of the embolic protection device. The device was retrieved through snare fixation and resheathing within a 6-French guide catheter navigated through common femoral artery access. Innominate artery balloon-mounted stent angioplasty was performed preceded by the embolic device retrieval, with complete resolution of symptoms. Endovascular STAT inhibitor distal protection device placement for prevention of cerebral atherothromboembolism during innominate artery stent angioplasty

is not without risk and utilization needs to be carefully considered. “
“Cardiac Echoscan is the simplified transthoracic echocardiogram focused on the main source of emboli detection in the acute stroke diagnosis (Stroke Echoscan). We describe the clinical impact related to the Stroke Echoscan protocol in our Center. Acute stroke patients who underwent the Stroke Echoscan by a trained stroke neurologist were included (Echoscan MCE公司 group). All examinations were reviewed by cardiologists. The main embolic stroke etiologies

were: ventricular akinesia (VA), severe aortic atheroma (AA) plaque and cardiac shunt (SHUNT). The rate of the embolic stroke etiologies and the median length of stay (LOS) were compared with a cohort of patients studied by cardiologist (Echo group). Eighty acute stroke patients were included. The sensitivity (S) and specificity (E) were: VA (S 98.6%, E 66.7%, k = .7), AA (S 93.3%, E 96.9%, k = .88) and SHUNT (S 100%, E 100%, k = 1), respectively. The rate of AA diagnosis was significantly higher in Echoscan group (18.8% vs. 8.9%; P = .05). Echoscan protocol significantly reduced the LOS: 6 days (IQR 3-10) versus Echo group 9 days (IQR 6-13; P < .001). The Echoscan protocol was an accurate quick test, which reduced the length of stay and increased the percentage of severe AA plaque diagnosis. "
“To report a novel endovascular coiling technique for ligation of aneurysms presenting with cranial neuropathy. We describe three patients (all female, median age: 57) presenting with unruptured, mass effect producing, aneurysms. All three were treated with coiling of the aneurysm inflow zone without deploying coils in the dome or fundus.

A modified TGA DWI protocols for detecting TGA lesions are useful in large-scale clinical practice for confirming the diagnosis of TGA patients with clinical findings. “
“We describe a novel technique for cerebral embolic device placement with inadvertent entrapment and subsequent rescue in the endovascular treatment of innominate artery stenosis. A 62-year-old female presented with symptomatic right-sided subclavian steal syndrome. Single-site access for revascularization of critical innominate artery stenosis with simultaneous cerebral this website embolic protection performed for this diagnosis has not been previously reported. Initial nontarget self-expanding

stent deployment within the right subclavian artery resulted in entrapment of the embolic protection device. The device was retrieved through snare fixation and resheathing within a 6-French guide catheter navigated through common femoral artery access. Innominate artery balloon-mounted stent angioplasty was performed preceded by the embolic device retrieval, with complete resolution of symptoms. Endovascular Ulixertinib research buy distal protection device placement for prevention of cerebral atherothromboembolism during innominate artery stent angioplasty

is not without risk and utilization needs to be carefully considered. “
“Cardiac Echoscan is the simplified transthoracic echocardiogram focused on the main source of emboli detection in the acute stroke diagnosis (Stroke Echoscan). We describe the clinical impact related to the Stroke Echoscan protocol in our Center. Acute stroke patients who underwent the Stroke Echoscan by a trained stroke neurologist were included (Echoscan 上海皓元医药股份有限公司 group). All examinations were reviewed by cardiologists. The main embolic stroke etiologies

were: ventricular akinesia (VA), severe aortic atheroma (AA) plaque and cardiac shunt (SHUNT). The rate of the embolic stroke etiologies and the median length of stay (LOS) were compared with a cohort of patients studied by cardiologist (Echo group). Eighty acute stroke patients were included. The sensitivity (S) and specificity (E) were: VA (S 98.6%, E 66.7%, k = .7), AA (S 93.3%, E 96.9%, k = .88) and SHUNT (S 100%, E 100%, k = 1), respectively. The rate of AA diagnosis was significantly higher in Echoscan group (18.8% vs. 8.9%; P = .05). Echoscan protocol significantly reduced the LOS: 6 days (IQR 3-10) versus Echo group 9 days (IQR 6-13; P < .001). The Echoscan protocol was an accurate quick test, which reduced the length of stay and increased the percentage of severe AA plaque diagnosis. "
“To report a novel endovascular coiling technique for ligation of aneurysms presenting with cranial neuropathy. We describe three patients (all female, median age: 57) presenting with unruptured, mass effect producing, aneurysms. All three were treated with coiling of the aneurysm inflow zone without deploying coils in the dome or fundus.

The design and primary outcomes of the VIRAHEP-C trial have been reported elsewhere.8 Adults who were treatment-naïve, infected with genotype 1, had detectable HCV RNA, and had histological evidence of chronic HCV were eligible to participate. Patients were classified by race as either African American or Caucasian, and by ethnicity as either Hispanic or non-Hispanic, based on self-report. All participants were required to have

been born in the United States. From eight clinical centers across the United States, 401 patients were enrolled and began therapy between July 2002 and December 2003. For the present study, serum samples were acquired from a subset of 272 patients from the total VIRAHEP-C cohort, comprising 157 responders Selleckchem Idasanutlin (104 CA, 53 AA) and 115 nonresponders (34 CA, 81 AA). All specimens analyzed were obtained under Institutional Review Board–approved protocols for which participants

provided written informed consent, including consent for genetic testing. Patients received peginterferon alfa-2a (Pegasys; Roche Pharmaceuticals, Nutley, NJ) 180 μg/week and ribavirin (Copegus; Roche Pharmaceuticals) 1,000-1,200 mg/day for at least 24 weeks. Patients who became HCV RNA–negative by week 24 continued treatment for a total of 48 weeks, whereas patients who remained HCV RNA–positive stopped treatment and were considered nonresponders. The primary endpoint of the trial was SVR, defined as the absence of detectable HCV RNA for at least 24 weeks after stopping therapy. HCV RNA testing was performed at a central laboratory (SeraCare BioServices, Gaithersburg, MD) FK228 using the Cobas Amplicor Assay (sensitivity, 50 IU/mL; Roche Molecular Diagnostics, Alameda, CA). Selected samples were tested for HCV RNA levels using the Cobas Amplicor Monitor Assay and for HCV RNA genotype using 上海皓元医药股份有限公司 the Versant HCV Genotype Assay (Bayer, Tarrytown, NY). All patients had undergone liver biopsy within 18 months of screening, and

the biopsy specimens were assessed by a blinded central pathologist. All biopsies were assessed for severity of hepatitis C by grading the inflammation and staging the fibrosis using Ishak’s modified histological activity index. IP-10 was measured in serum samples collected at baseline, prior to initiation of treatment, using the commercially available Quantikine human CXCL10/IP-10 immunoassay (R&D Systems). All samples were diluted 1:2 and analyzed in duplicate. The linear dynamic range of the IP-10 measurement in this assay was 8-500 pg/mL, with a detection limit at 7.8 pg/mL. Samples with IP-10 concentration above 1,000 pg/mL were diluted 1:5 and reanalyzed. The IL28B polymorphic marker rs12979860 was analyzed using the ABI TaqMan allelic discrimination kit and the ABI7900HT Sequence Detection System (Applied Biosystems) as described by Thomas and colleagues.

The design and primary outcomes of the VIRAHEP-C trial have been reported elsewhere.8 Adults who were treatment-naïve, infected with genotype 1, had detectable HCV RNA, and had histological evidence of chronic HCV were eligible to participate. Patients were classified by race as either African American or Caucasian, and by ethnicity as either Hispanic or non-Hispanic, based on self-report. All participants were required to have

been born in the United States. From eight clinical centers across the United States, 401 patients were enrolled and began therapy between July 2002 and December 2003. For the present study, serum samples were acquired from a subset of 272 patients from the total VIRAHEP-C cohort, comprising 157 responders www.selleckchem.com/products/Vorinostat-saha.html (104 CA, 53 AA) and 115 nonresponders (34 CA, 81 AA). All specimens analyzed were obtained under Institutional Review Board–approved protocols for which participants

provided written informed consent, including consent for genetic testing. Patients received peginterferon alfa-2a (Pegasys; Roche Pharmaceuticals, Nutley, NJ) 180 μg/week and ribavirin (Copegus; Roche Pharmaceuticals) 1,000-1,200 mg/day for at least 24 weeks. Patients who became HCV RNA–negative by week 24 continued treatment for a total of 48 weeks, whereas patients who remained HCV RNA–positive stopped treatment and were considered nonresponders. The primary endpoint of the trial was SVR, defined as the absence of detectable HCV RNA for at least 24 weeks after stopping therapy. HCV RNA testing was performed at a central laboratory (SeraCare BioServices, Gaithersburg, MD) selleck screening library using the Cobas Amplicor Assay (sensitivity, 50 IU/mL; Roche Molecular Diagnostics, Alameda, CA). Selected samples were tested for HCV RNA levels using the Cobas Amplicor Monitor Assay and for HCV RNA genotype using MCE公司 the Versant HCV Genotype Assay (Bayer, Tarrytown, NY). All patients had undergone liver biopsy within 18 months of screening, and

the biopsy specimens were assessed by a blinded central pathologist. All biopsies were assessed for severity of hepatitis C by grading the inflammation and staging the fibrosis using Ishak’s modified histological activity index. IP-10 was measured in serum samples collected at baseline, prior to initiation of treatment, using the commercially available Quantikine human CXCL10/IP-10 immunoassay (R&D Systems). All samples were diluted 1:2 and analyzed in duplicate. The linear dynamic range of the IP-10 measurement in this assay was 8-500 pg/mL, with a detection limit at 7.8 pg/mL. Samples with IP-10 concentration above 1,000 pg/mL were diluted 1:5 and reanalyzed. The IL28B polymorphic marker rs12979860 was analyzed using the ABI TaqMan allelic discrimination kit and the ABI7900HT Sequence Detection System (Applied Biosystems) as described by Thomas and colleagues.

4 One such proteins is S100A4, a member of the S100

family of small calcium-binding proteins, expressed by mesenchymal cells, macrophages,5 Y-27632 in vivo and by epithelial cells in mesenchymal transition (EMT). Expression of S100A4 was shown to be a predictor of metastasization in colon cancer.6, 7 The mechanisms of action of A100A4 depends on the cellular localization of the protein. In the cytoplasm S100A4 interacts with a number of partner proteins in cytoskeleton and in the plasma membrane (such as myosin IIa or liprin-β1). When localized in the nucleus, S100A4 may exert transcriptional functions that affect several genes, including matrix metalloproteinase (MMP)-98 and E-cadherin.9 However, the mechanism of action of S100A4 remains largely unknown, as it remains unclear whether S100A4 is just a biomarker of cancer cell aggressiveness or actually represents a functional target amenable of therapeutic intervention. While examining the expression of EMT markers in CCA specimens, we noticed that a subgroup of CCAs expressed S100A4 in the nucleus. In this

study we addressed: (1) the prognostic significance of S100A4 nuclear expression in a large series of patients undergoing surgical resection, and (2) the functional relevance of S100A4 expression on the metastatic potential, motility, and invasiveness this website of CCA cell lines in vivo and in vitro. Our results show that nuclear expression of S100A4 by neoplastic bile ducts significantly correlated with increased metastasization and reduced survival after surgery, that human CCA cells with nuclear expression of S100A4 have a much stronger metastatic ability when xenotransplanted into severe combined immunodeficiency (SCID) mice, and that silencing S100A4 in CCA cells that originally overexpressed S100A4 significantly reduced motility and invasive capabilities in vitro. A total of 93 samples of CCA, obtained from subjects undergoing surgical resection between 1989 and 2009, in three different medical centers in northern Italy (Bergamo n = 23, Padova n = 49, Treviso n = 21) were considered for the immunohistochemical

study; among them, matched MCE peritumoral liver samples were available in 23 cases. To adjust for possible effects on survival related to surgical complications, rather than tumor prognosis, we excluded subjects who died during the first 30 days after surgery; thus, the follow-up period started from 30 days after resection. Taking this approach, 86 subjects out of the original 93 subjects were considered for statistical analysis. The follow-up period ranged from 0.13 to 195.67 months (median: 13.37 months). Clinical, epidemiological, anatomical (hepatic localization), and histopathological (staging, grade, margin involvement) data of CCA patients according to S100A4 expression are reported in Table 1.

4 One such proteins is S100A4, a member of the S100

family of small calcium-binding proteins, expressed by mesenchymal cells, macrophages,5 KU-57788 ic50 and by epithelial cells in mesenchymal transition (EMT). Expression of S100A4 was shown to be a predictor of metastasization in colon cancer.6, 7 The mechanisms of action of A100A4 depends on the cellular localization of the protein. In the cytoplasm S100A4 interacts with a number of partner proteins in cytoskeleton and in the plasma membrane (such as myosin IIa or liprin-β1). When localized in the nucleus, S100A4 may exert transcriptional functions that affect several genes, including matrix metalloproteinase (MMP)-98 and E-cadherin.9 However, the mechanism of action of S100A4 remains largely unknown, as it remains unclear whether S100A4 is just a biomarker of cancer cell aggressiveness or actually represents a functional target amenable of therapeutic intervention. While examining the expression of EMT markers in CCA specimens, we noticed that a subgroup of CCAs expressed S100A4 in the nucleus. In this

study we addressed: (1) the prognostic significance of S100A4 nuclear expression in a large series of patients undergoing surgical resection, and (2) the functional relevance of S100A4 expression on the metastatic potential, motility, and invasiveness MLN0128 of CCA cell lines in vivo and in vitro. Our results show that nuclear expression of S100A4 by neoplastic bile ducts significantly correlated with increased metastasization and reduced survival after surgery, that human CCA cells with nuclear expression of S100A4 have a much stronger metastatic ability when xenotransplanted into severe combined immunodeficiency (SCID) mice, and that silencing S100A4 in CCA cells that originally overexpressed S100A4 significantly reduced motility and invasive capabilities in vitro. A total of 93 samples of CCA, obtained from subjects undergoing surgical resection between 1989 and 2009, in three different medical centers in northern Italy (Bergamo n = 23, Padova n = 49, Treviso n = 21) were considered for the immunohistochemical

study; among them, matched 上海皓元 peritumoral liver samples were available in 23 cases. To adjust for possible effects on survival related to surgical complications, rather than tumor prognosis, we excluded subjects who died during the first 30 days after surgery; thus, the follow-up period started from 30 days after resection. Taking this approach, 86 subjects out of the original 93 subjects were considered for statistical analysis. The follow-up period ranged from 0.13 to 195.67 months (median: 13.37 months). Clinical, epidemiological, anatomical (hepatic localization), and histopathological (staging, grade, margin involvement) data of CCA patients according to S100A4 expression are reported in Table 1.

To gain a clear image of the taxonomic changes in obese and NASH gut microbiomes, abundant families and genera with >1% average abundance in any of the groups were examined (Table 2). Within phylum Actinobacteria (Table

2), the only abundant family Bifidobacteriaceae and the only abundant genus Bifidobacterium were differently represented in the study groups. A progressive decreased abundance was observed from the healthy group to the obese group and then to the NASH group. Within phylum Bacteroidetes (Table 2), family Prevotellaceae exhibited a >6-fold increase in the obese group and NASH group, compared to the healthy group, accounting for most of the increased abundance in Bacteroidetes phylum in the obese and NASH groups. Most of the Prevotellaceae sequences belonged to a single-genus Prevotella. Another noteworthy fact selleck chemical in this phylum was that there was a ∼20 fold increase of abundance in the genus Porphyromonas (family Porphyromonadaceae), http://www.selleckchem.com/products/abt-199.html but statistical significance was not achieved because of the large intragroup variances with the obese group and the NASH group. In contrast, a small, but significant, decrease was observed with Rikenellaceae, in which most of the sequences belonged to a single-genus Alistipes. The decreased representation of Firmicutes in the obese group and the NASH group were mostly explained by the decreased abundance

in two families: Lachanospiraceae and Ruminococcaceae (Table 2). Although most of the genera in these two families exhibited a similar trend (i.e., decreased abundance in the obese group and the NASH group, compared to the healthy group), it is noteworthy that the often pathogenic genus, Clostridium, exhibited similar representation among all groups. Also worth

noting is that the most abundant genera in the Firmicutes medchemexpress phylum, Blautia and Faecalibacterium, showed the greatest reduction in abundance in the obese group and the NASH group. Increased abundance of Proteobacteria in the obese and NASH groups was mainly explained by the increased abundance of Enterobacteriaceae (Table 2). Importantly, Enterobacteriaceae was the only abundant family (within the whole bacteria domain) exhibiting a significant difference between the obese group and the NASH group (Table 2; Fig. 3C). Most of the Enterobacteriaceae sequences belonged to Escherichia (Table 2; Fig. 3D), which is the only abundant genus within the whole bacteria domain exhibiting a significant difference between the obese group and the NASH group. Furthermore, the OTUs within Escherichia were examined. A single OTU was found to dominate the sequences in Escherichia: OTU #20341 was found to account for 83%, 88%, and 90% of the Escherichia sequences in the healthy, obese, and NASH groups, respectively. The representative sequence of this OTU was then used to BLAST against the 16S rRNA sequences (Bacteria and Archaea) on the National Center for Biotechnology Information website (available at: http://blast.ncbi.nlm.nih.gov).

Neointimal hyperplasia can be reduced by intravenous transfusion of EPCs and analyzed on in vivo MR imaging after vascular injury. “
“To investigate the role of preoperative magnetic resonance tomographic angiography (MRTA) in predicting the clinical outcomes of trigeminal neuralgia (TN) patients following microvascular decompression (MVD). Preoperative MRTA imaging was performed on 167 consecutive patients with TN. The characteristics of offending vessels were determined by MRTA prior to MVD. The relationship

of neurovascular contact Raf inhibition was classified into 3 types: positive, negative, and contralateral positive, which were compared with the surgical findings and clinical outcomes. MRTA showed obvious neurovascular Depsipeptide chemical structure compression in accordance with surgical findings in 144 patients. Among the remaining 23 patients with negative finding

on preoperative MRTA images, neurovascular compression (vein alone or in combination with artery) were found in 16, no definite vascular compression in 7. The sensitivity of MRTA on the symptomatic side was therefore 90%, the specificity was 100% in our series. A correlation was found between clinical outcomes and preoperative findings on MRTA. In 144 MRTA-positive patients, 136 achieved “excellent” or “good” outcomes after MVD and were significantly better than the MRTA-negative group (P < .01). The outcomes of patients with a single artery compression were significantly better than those with venous compression, vein in combination with artery compression, or without obvious neurovascular contact (P < .01). Seven of 23 MRTA-negative patients obtained poor outcomes after operation, venous compression were identified intraoperatively in 4 of them, no definite offending vessel was found in 3 patients. This study suggests that the curative rate of TN following MVD is higher in the MRTA-positive group. Venous compression and no neurovascular contact that were negative on MRTA image are poor prognostic factors for surgical outcome of TN. Thus, preoperative MRTA

serves as a useful tool in patient selection and outcome prediction. “
“Fenestrations involving aneurysms have been well documented. Only sporadic papers have been reported on fenestrations associated with AVMs (arteriovenous malformations) with few cases. Our study is to determine the rate of co-occurrence medchemexpress of fenestrations and AVMs and to analyze the possible relationship between them by CTA. Between January 2006 and February 2012, the CTA data of 5,657 consecutive patients were retrospectively reviewed. A total of 12 cases (.21%) of fenestrations associated with AVMs were found. Of these, single-fenestrations were identified in 9 cases, and multifenestrations were found in 3 cases. Among 349 fenestrations, there were 15 cases of multifenestrations. The frequency of multifenestrations among fenestrated patients without AVMs was 3.6%.