Pipeline Embolization Device and Flow Re-Direction Endoluminal Device for Intracranial Aneurysms: A Comparative Systematic Review and Meta-Analysis Study.

BACKGROUND: When it comes to intracranial aneurysms, the quest for more effective treatments is ongoing. Flow diversion represents a growing advancement in this field. This review seeks to compare 2 variants of the endovascular flow diversion method: the Flow Re-Direction Endoluminal Device (FRED) and the Pipeline Embolization Device (PED). METHODS: A systematic review was conducted according to the PRISMA guideline using PubMed, Scopus, Web of Science, and Embase, using appropriate terms to compare PED and FRED in double-arm studies from conception until October 8th, 2023. RESULTS: The meta-analysis encompassed 1769 patients, with a predominance of females (75.5%), among whom 973 patients underwent FRED procedures, while 651 received PED interventions. At 6 months, complete occlusion rates were 0.62 for FRED and 0.68 for PED (P = 0.68). At 1 year and the last follow-up, no significant differences were observed between FRED and PED, respectively. Adequate occlusion rates were similar between FRED and PED (0.82 vs. 0.79, P = 0.68). FRED showed a statistically significant higher rate of good mRS scores at follow-up (1.00 vs. 0.97, P = 0.03). Hemorrhage and re-treatment rates were higher in PED (P < 0.01) without considering the rupture status of the aneurysms due to the lack of data. CONCLUSIONS: This meta-analysis suggests comparable efficacy but different safety profiles between FRED and PED in treating intracranial aneurysms. FRED demonstrated a higher rate of good modified Rankin scores, while PED showed increased hemorrhage and re-treatment rates. Understanding these differences is crucial for informed decision-making in clinical practice.

The safety and efficacy of bevacizumab in treatment of recurrent low-grade glioma: a systematic review and meta-analysis.

BACKGROUND: Central nervous system (CNS) tumors are among the most common malignancies in various age ranges. Low-grade glioma (LGG) can account for nearly 30% of pediatric CNS malignancies. Progression or recurrence after the first-line treatments is common among these patients. Therefore, more treatments are required. Bevacizumab as an anti-VEGF antibody has come into the spotlight recently and is especially used in relapse or recurrence settings. This review aims to study the safety and efficacy of bevacizumab for patients with recurrent LGG. METHODS: This study was conducted according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Scopus, Web of Science, and Embase were comprehensively searched using the relevant key terms until 24th August 2023 to retrieve the studies that investigated clinical outcomes of bevacizumab in patients with recurrent LGG. All statistical analysis was performed by STATA v.17. RESULTS: A total of 1306 papers were gathered, out of which 13 were incorporated in the meta-analysis. The pooled incidence rate of treatment according to the RANO scale was 70% (95% CI = 43-98%) for objective response rate, 26% (95% CI = 58-96%) for partial response, 21% (95% CI = 15-28%) for minor response, 14% (95% CI = 3-24%) for complete response, 48% (95% CI = 37-59%) for stable disease, and 8% (95% CI = 4-11%) for progressive disease. Furthermore, according to progressive survival after treatment, it was 4% (95% CI = -1 to 9%) for 6-month PFS, 41% (95% CI = 32-50%) for 2-year PFS, and 29% (95% CI = 22-35%) for 3-year PFS. CONCLUSION: According to the RANO scale and PFS, clinicians should be aware that Bevacizumab could be a favorable alternative therapy for recurrent LGG. Furthermore, bevacizumab exhibits minimal toxicity and high tolerability in recurrent LGG.

Prediction of the treatment response and local failure of patients with brain metastasis treated with stereotactic radiosurgery using machine learning: A systematic review and meta-analysis.

BACKGROUND: Stereotactic radiosurgery (SRS) effectively treats brain metastases. It can provide local control, symptom relief, and improved survival rates, but it poses challenges in selecting optimal candidates, determining dose and fractionation, monitoring for toxicity, and integrating with other modalities. Practical tools to predict patient outcomes are also needed. Machine learning (ML) is currently used to predict treatment outcomes. We aim to investigate the accuracy of ML in predicting treatment response and local failure of brain metastasis treated with SRS. METHODS: PubMed, Scopus, Web of Science (WoS), and Embase were searched until April 16th, which was repeated on October 17th, 2023 to find possible relevant papers. The study preparation adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The statistical analysis was performed by the MIDAS package of STATA v.17. RESULTS: A total of 17 articles were reviewed, of which seven and eleven were related to the clinical use of ML in predicting local failure and treatment response. The ML algorithms showed sensitivity and specificity of 0.89 (95% CI: 0.84-0.93) and 0.87 (95% CI: 0.81-0.92) for predicting treatment response. The positive likelihood ratio was 7.1 (95% CI: 4.5-11.1), the negative likelihood ratio was 0.13 (95% CI: 0.08-0.19), and the diagnostic odds ratio was 56 (95% CI: 25-125). Moreover, the pooled estimates for sensitivity and specificity of ML algorithms for predicting local failure were 0.93 (95% CI: 0.76-0.98) and 0.80 (95% CI: 0.53-0.94). The positive likelihood ratio was 4.7 (95% CI: 1.6-14.0), the negative likelihood ratio was 0.09 (95% CI: 0.02-0.39), and the diagnostic odds ratio was 53 (95% CI: 5-606). CONCLUSION: ML holds promise in predicting treatment response and local failure in brain metastasis patients receiving SRS. However, further studies and improvements in the treatment process can refine the models and effectively integrate them into clinical practice.

Woven endo bridge device for recurrent intracranial aneurysms: A systematic review and meta-analysis.

BACKGROUND: Recurrent intracranial aneurysms present a significant clinical challenge, demanding innovative and effective treatment approaches. The Woven EndoBridge (WEB) device has emerged as a promising endovascular solution for managing these intricate cases. This study aims to assess the safety and efficacy of the WEB device in treating recurrent intracranial aneurysms. METHODS: We conducted a comprehensive search across multiple databases, including PubMed, Scopus, Embase, and Web of Science, from inception to June 5, 2023. Eligible studies focused on evaluating WEB device performance and included a minimum of five patients with recurrent intracranial aneurysms. The complete and adequate occlusion rates, neck remnant rates, and periprocedural complication rates were pooled using SATA V.17. RESULTS: Our analysis included five studies collectively enrolling 73 participants. Participant ages ranged from 52.9 to 65 years, with 64.4% being female. Aneurysms were wide-necked and predominantly located in the middle cerebral artery, basilar artery, and anterior cerebral artery. Previous treatments encompassed coiling, clipping, and the use of WEB devices. Our study found an overall adequate occlusion rate of 0.80 (95% CI 0.71-0.89), a complete occlusion rate of 0.39 (95% CI 0.28-0.50), and a neck remnant rate of 0.38 (95% CI 0.27-0.48). Periprocedural complications were reported at a rate of 0%, although heterogeneity was observed in this data. Notably, evidence of publication bias was identified in the reporting of periprocedural complication rates. CONCLUSION: Our findings suggest that the WEB device is associated with favorable outcomes for treating recurrent wide-neck intracranial aneurysms.

2,4-D adsorption from agricultural subsurface drainage by canola stalk-derived activated carbon: insight into the adsorption kinetics models under batch and column conditions.

In this study, the experimental and kinetic modeling investigations were performed to evaluate the ability of mesoporous and microporous canola stalk-derived activated carbon (CSAC) on 2,4-dichlorophenoxyacetic acid (2,4-D) removal from synthetic and natural water in both batch and continuous systems. Three empirical models (pseudo-first-order equation (PFOE), pseudo-second-order equation (PSOE), and the Elovich equation (EE)) and three theoretical models (film diffusion model (FDM), particle diffusion model (PDM), and second-order chemical reaction rate model (SOCRRM)) were compared in terms of diffusion coefficients, maximum 2,4-D adsorption, and rate constants at various operating conditions. CSAC was prepared at 600 °C and activated with water steam under a controlled flow and subsequently characterized by various analytical methods. The results showed that the maximum 2,4-D uptake by CSAC was achieved as 135.8 mg g-1 under a pH of 2 and an initial 2,4-D concentration of 150 mg L-1. The CSAC removed 38.3% of Na+, 43.49% of K+, 8.96% of Mg2+, 45.14% of Ca2+, 17.2% of Cl-1, 39.48% of HCO3-, 63.74% of SO42-, and 100% of the herbicide from agricultural subsurface drainage water and also retained its usability after regenerated by acetone for five cycles. It was concluded that the 2,4-D was adsorbed on the surface of the CSAC through its aromatic ring interaction with the reactive functional groups of the adsorbent. The model result indicated that the PDM is the best-fitting kinetic model for the adsorption of 2,4-D by CSAC, followed by FDM, SOCRRM, PSOE, PFOE, and EE. The mass balance equation based on PDM describes the dynamic behavior of the column satisfactorily. Graphical abstract.

A Spiderweb-Like Metal-Organic Framework Multifunctional Foam.

Processing metal-organic frameworks (MOFs) into hierarchical macroscopic materials can greatly extend their practical applications. However, current strategies suffer from severe aggregation of MOFs and limited tuning of the hierarchical porous network. Now, a strategy is presented that can simultaneously tune the MOF loading, composition, spatial distribution, and confinement within various bio-originated macroscopic supports, as well as control the accessibility, robustness, and formability of the support itself. This method enables the good dispersion of individual MOF nanoparticles on a spiderweb-like network within each macrovoid even at high loadings (up to 86 wt %), ensuring the foam pores are highly accessible for excellent adsorption and catalytic capacity. Additionally, this approach allows the direct pre-incorporation of other functional components into the framework. This strategy provides precise control over the properties of both the hierarchical support and MOF.

Covalent polybenzimidazole-based triazine frameworks: A robust carrier for non-steroidal anti-inflammatory drugs.

Covalent triazine-based polymers (CTPs) are a new class of porous materials that can be used for the intercalation of therapeutic agents. The main purposes of designing new drug carriers include protecting them from degradation, enhancing their poor aqueous solubility, and investigating their controlled release properties. In this context, a novel polybenzimidazole-based CTP (BZ-CTP) was prepared by a solvothermal reaction between 4,4',4″-((1,3,5-triazine-2,4,6-triyl) tris(azanediyl)) tribenzoic acid (TCA) and 3,3'-diaminobenzidine. Piroxicam (PRX) and mefenamic acid (MFA) were loaded thoroughly into the CTP by using ultrasonication to form MFA-loaded CTP (MFA@BZ-CTP) and PRX-loaded CTP (PRX@BZ-CTP) with drug loading efficiencies of 49% and 53%, respectively. We attribute the increased loading efficiencies to the formation of π-π stacking forces between the aromatic rings present in the CTP structure and drugs. The in vitro release experiments were assessed in simulated physiological conditions using the dialysis method. Moreover, the release mechanisms were evaluated by Korsmeyer-Peppas kinetic studies and the obtained results showed excellent sustained releases of 81% after 96 h and 87% after 24 h for the PRX@BZ-CTP and MFA@BZ-CTP hybrids, respectively.

A Robust Aqueous Core-Shell-Shell Coconut-like Nanostructure for Stimuli-Responsive Delivery of Hydrophilic Cargo.

Conventional delivery systems for hydrophilic material still face critical challenges toward practical applications, including poor retention abilities, lack of stimulus responsiveness, and low bioavailability. Here, we propose a robust encapsulation strategy for hydrophilic cargo to produce a wide class of aqueous core-shell-shell coconut-like nanostructures featuring excellent stability and multifunctionality. The numerous active groups (-SH, -NH2, and -COOH) of the protein-polysaccharide wall material enable the formation of shell-cross-linked nanocapsules enclosing a liquid water droplet during acoustic cavitation. A subsequent pH switch can trigger the generation of an additional shell through the direct deposition of non-cross-linked protein back onto the cross-linked surface. Using anthocyanin as a model hydrophilic bioactive, these nanocapsules show high encapsulation efficiency, loading content, tolerance to environmental stresses, biocompatibility, and high cellular uptake. Moreover, the composite double shells driven by both covalent bonding and electrostatics provide the nanocapsules with pH/redox dual stimuli-responsive behavior. Our approach is also feasible for any shell material that can be cross-linked via ultrasonication, offering the potential to encapsulate diverse hydrophilic functional components, including bioactive molecules, nanocomplexes, and water-dispersible inorganic nanomaterials. Further development of this strategy should hold promise for designing versatile nanoengineered core-shell-shell nanoplatforms for various applications, such as the oral absorption of hydrophilic drugs/nutraceuticals and the smart delivery of therapeutics.

A simple route to renewable high internal phase emulsions (HIPEs) strengthened by successive cross-linking and electrostatics of polysaccharides.

We demonstrate a simple synthesis of renewable high internal phase emulsions (HIPEs) featuring great stability and processability, by centrifuging ultrasonication-produced oil-filled polysaccharide microspheres without the aid of any surfactant or synthetic particles. The properties of HIPEs and corresponding porous structure (closed-/open-cell) are controllable by simply adjusting the ultrasonic intensity and ionization of polysaccharides.

Selective Electrochemical Capture and Release of Heparin Based on Amine-Functionalized Carbon/Titanium Dioxide Nanotube Arrays.

Heparin (HEP) is a sulfated glycosaminoglycan that is a clinical anticoagulant agent. Commercially derived from porcine intestinal mucosa, HEP is challenging to separate from this complex biological mixture for additional purification. This study aimed to raise the purity of isolated HEP using electrochemical potential to increase its selective capture and release. We demonstrate an electrochemical platform featuring an anode composed of amine-functionalized carbon/titanium dioxide nanotube arrays on titanium foil (Ti/C-TNTAs-NH2) and a cathode made of expanded graphite. Our results show that Ti and Ti/C-TNTAs control plates do not adsorb HEP, even while applying an external potential to the cell. However, when the Ti/C-TNTAs electrode is modified by 3 aminopropyltriethoxysilane, the terminal NH2 groups provide a high density of positive charges that serve as binding sites, enabling the adsorption of HEP. This attraction is further strengthened by applying an external potential to the anode. Subsequent release of the HEP molecules and regeneration of the Ti/C-TNTAs-NH2 electrode are easily accomplished by applying an anodic potential to the plate, as well as by increasing the concentration of NaCl in solution. This electrochemical system demonstrates the good selectivity of HEP, even within a mixture of other probable interfering species (e.g., bovine serum albumin and chondroitin sulfate). Additionally, it maintains 90.11% of its initial electrosorption efficiency after ten repeated HEP adsorption/desorption cycles, indicating this system's promising stability and reusability for HEP purification.

The Effect of Recorded Mum's Lullaby and Brahm's Lullaby on Oxygen Saturation in Preterm Infants: a Randomized Double-Blind Clinical Trial.

INTRODUCTION: Music stimulation has been shown to provide significant benefits to preterm infants. Thus the aim of this study was determine the effect of recorded mum's lullaby and Brahm's lullaby on oxygen saturation in preterm infants. METHODS: This double-blind randomized controlled trial was carried out on 66 premature newborns with the postnatal age of ≥3 days and weight ≤ 2800 grams at Taleghani Hospital. Infants were randomly divided into three groups: control, Brahm's lullaby and Mum's lullaby groups. Infants were continuously monitored for primary outcome of percutaneous oxygen saturation, for three consecutive sessions. RESULTS: There were significant difference in neonate oxygen saturation between the Brahm's lullaby and Mum's lullaby as compared with control groups in the 15 minutes after intervention. CONCLUSION: This study showed beneficial effects of Brahm's lullaby and Mum's lullaby sound. Therefore; it may be used for improving short term outcomes in premature infants.