Variability patterns in dual antiplatelet therapy following endovascular repair of intracranial aneurysms: Insight into regimen heterogeneity and the need for a consensus.

This comprehensive review delves into the evolving field of neurointervention for intracranial aneurysms, exploring the critical adjunct of Dual Antiplatelet Therapy (DAPT) to endovascular coiling, stent-assisted coiling (SAC), flow-diversion stents, and flow-disruption (intrasaccular) devices. Despite growing evidence supporting the success of DAPT in reducing thromboembolic events, the lack of consensus on optimal regimens, doses, and duration is evident. Factors contributing to this variability include genetic polymorphisms affecting treatment response and ongoing debates regarding the clinical significance of hemorrhagic complications associated with DAPT. This review analyzes pre- and post-procedural antiplatelet usage across various interventions. The imperative lies in ongoing research to define optimal DAPT durations, ensuring a nuanced approach to the delicate balance between thrombosis and hemorrhage in intracranial aneurysm management.

Risk factors for perianeurysmal vasogenic oedema (pavo) following embolization therapy: literature review.

Perianeurysmal vasogenic oedema (PAVO) is a rare complication associated post-embolisation of intracranial aneurysms. The prevalence, risk factors predisposing to susceptibility, and pathologic mechanisms underlying this process are not clearly understood. Since this complication may be associated with poor clinical outcomes, the authors designed this study to describe possible risk factors, underlying mechanisms, and management of PAVO through published case reports. Developing a priori protocol according to PRISMA guidelines, we searched MEDLINE/PubMed, Embase and Web of Science to identify case studies and reports of adult patients with intracranial aneurysms who developed perianeurysmal oedema following coil embolization therapy. Data extracted from these studies included patient demographics, aneurysm characteristics, coil type, PAVO characteristics, treatment, and outcomes. Quality was assessed using a standardized tool. 21 eligible studies of acceptable quality were identified, comprising 40 unique cases from 9 countries. The mean patient age was 56.4 years and 25 (62.5%) were female. Aneurysm size ranged from 6 to 30 mm, with a mean size of 15.2 mm; only 6 (15%) of cases were giant intracranial aneurysm (≥ 25 mm). The more frequent locations of intracranial aneurysms associated with PAVO were the ICA (50%) and posterior circulation (32.5%), with 7.5% and 10% of cases occurring in MCA and anterior circulation, respectively. 16 cases (40%) were treated with bare platinum coils, and 14 (35%) with a combination of BPCs and bioactive coils; in 10 cases (25%), the coil type was not mentioned. PAVO presented between 0 days and 8 years of coil embolization, with 23 (57.5% cases) presenting symptomatically in relation to brain region affected. Management strategies for PAVO included conservative, steroids, re-embolization, clipping, stenting, parent artery occlusion either as monotherapy or as combination therapy. Of reported studies, 26 treated cases (65%) resolved, with 8 (20%) remaining stable, and 4 (10%) deteriorating. PAVO can be associated with small or large intracranial aneurysms, bare and bioactive platinum coils, and all regions of the intracranial circulation. The understanding of the risk factors of this complication lies in the underlying mechanisms, which will ultimately guide appropriate patient follow-up and subsequent optimal management.

Fucoidan's Molecular Targets: A Comprehensive Review of Its Unique and Multiple Targets Accounting for Promising Bioactivities Supported by In Silico Studies.

Fucoidan is a class of multifunctional polysaccharides derived from marine organisms. Its unique and diversified physicochemical and chemical properties have qualified them for potential and promising pharmacological uses in human diseases, including inflammation, tumors, immunity disorders, kidney diseases, and diabetes. Physicochemical and chemical properties are the main contributors to these bioactivities. The previous literature has attributed such activities to its ability to target key enzymes and receptors involved in potential disease pathways, either directly or indirectly, where the anionic sulfate ester groups are mainly involved in these interactions. These findings also confirm the advantageous pharmacological uses of sulfated versus non-sulfated polysaccharides. The current review shall highlight the molecular targets of fucoidans, especially enzymes, and the subsequent responses via either the upregulation or downregulation of mediators' expression in various tissue abnormalities. In addition, in silico studies will be applied to support the previous findings and show the significant contributors. The current review may help in understanding the molecular mechanisms of fucoidan. Also, the findings of this review may be utilized in the design of specific oligomers inspired by fucoidan with the purpose of treating life-threatening human diseases effectively.

PiggyBac-based screening identified BEM4 as a suppressor to rescue growth defects in och1-disrupted yeast cells.

Glycoengineered yeast cells, which express human-compatible glycan structures, are particularly attractive host cells to produce therapeutic glycoproteins. Disruption of OCH1 gene, which encodes an α-1,6-mannosyltransferase required for mannan-type N-glycan formation, is essential for the elimination of yeast-specific N-glycan structures. However, the gene disruption causes cell wall defects leading to growth defects. Here, we tried to identify factors to rescue the growth defects of och1Δ cells by in vivo mutagenesis using piggyBac (PB)-based transposon. We isolated a mutant strain, named 121, which could grow faster than parental och1Δ cells. The PB element was introduced into the promoter region of BEM4 gene and upregulated the BEM4 expression. Overexpression of BEM4 suppressed growth defects in och1Δ cells. The slow grow phenotypes were partially rescued by expression of Rho1p, whose function is regulated by Bem4p. Our results indicate that BEM4 would be useful to produce therapeutic proteins in glycoengineered yeast without the growth defects.

A proposed One Health approach to control yellow fever outbreaks in Uganda.

Yellow Fever (YF) is an acute viral hemorrhagic disease. Uganda is located within the Africa YF belt. Between 2019 and 2022, the Ugandan Health Authorities reported at least one outbreak of YF annually with an estimated 892 suspected cases, on average per year. The persistent recurrence of this disease raises significant concerns about the efficacy of current response strategies and prevention approaches. YF has been recognized as a One Health issue due to its interrelatedness with the animal and environmental domains. Monkeys have been recognized as the virus primary reservoir. The YF virus is transmitted through bites of infected Aedes or Haemagogus species mosquitoes between monkeys and humans. Human activities, monkey health, and environmental health issues (e.g., climate change and land use) impact YF incidence in Uganda. Additionally, disease control programs for other tropical diseases, such as mosquitoes control programs for malaria, impact YF incidence.This review adopts the One Health approach to highlight the limitations in the existing segmented YF control and prevention strategies in Uganda, including the limited health sector surveillance, the geographically localized outbreak response efforts, the lack of a comprehensive vaccination program, the limited collaboration and communication among relevant national and international agencies, and the inadequate vector control practices. Through a One Health approach, we propose establishing a YF elimination taskforce. This taskforce would oversee coordination of YF elimination initiatives, including implementing a comprehensive surveillance system, conducting mass YF vaccination campaigns, integrating mosquito management strategies, and enhancing risk communication. It is anticipated that adopting the One Health approach will reduce the risk of YF incidence and outbreaks.

Effective pickering emulsifiers based on submicron carboxymethyl cellulose/chitosan polymer particles.

In this study, cross-linked carboxymethyl cellulose/chitosan submicron particles were employed to facilitate the stabilization of Pickering emulsion. The polymer particles were prepared using the polyelectrolyte self-assembly method in conjunction with isocyanide based multicomponent reactions and the characteristics were obtained using: nuclear magnetic resonance, Fourier-transform infrared spectroscopy and dynamic light scattering. Atomic force microscopy revealed the heterogeneous structure of the resulting submicron particles with domains of 20-30 nm in size. The average diameter was found to be in the range of 229-378 nm and they were found to be suitable for the fabrication of oil/water Pickering emulsion when proceeded via the homogenization method followed by sonication. The results obtained revealed that carboxymethyl cellulose/chitosan particles significantly stabilized the droplets at the oil/water interface. Even at low particle concentrations of 0.3 g/L (which is close to that of low molecular weight surfactants) stable Pickering emulsions have been obtained. Additionally, the resulting emulsions showed a high level of stability with regard to changes in pH, temperature and ionic strength. The natural alkaloid piperine was used as a model compound to load the resulting particles, which possessed encapsulation efficiency of 90.6±0.4%. Furthermore, the in vitro release profile of piperine from the Pickering emulsion revealed a much-controlled release in both acidic and neutral media as compared to the unformulated piperine. Additional findings in this work revealed important information on the application of carboxymethyl cellulose/chitosan submicron particles as Pickering stabilizers for creation of new delivery systems.

Endothelial Progenitor Cells: A Review of Molecular Mechanisms in the Pathogenesis and Endovascular Treatment of Intracranial Aneurysms.

This comprehensive review explores the multifaceted role of endothelial progenitor cells (EPCs) in vascular diseases, focusing on their involvement in the pathogenesis and their contributions to enhancing the efficacy of endovascular treatments for intracranial aneurysms (IAs). Initially discovered as CD34+ bone marrow-derived cells implicated in angiogenesis, EPCs have been linked to vascular repair, vasculogenesis, and angiogenic microenvironments. The origin and differentiation of EPCs have been subject to debate, challenging the conventional notion of bone marrow origin. Quantification methods, including CD34+ , CD133+ , and various assays, reveal the influence of factors, like age, gender, and comorbidities on EPC levels. Cellular mechanisms highlight the interplay between bone marrow and angiogenic microenvironments, involving growth factors, matrix metalloproteinases, and signaling pathways, such as phosphatidylinositol-3-kinase (PI3K) and mitogen-activated protein kinase (MAPK). In the context of the pathogenesis of IAs, EPCs play a role in maintaining vascular integrity by replacing injured and dysfunctional endothelial cells. Recent research has also suggested the therapeutic potential of EPCs after coil embolization and flow diversion, and this has led the development of device surface modifications aimed to enhance endothelialization. The comprehensive insights underscore the importance of further research on EPCs as both therapeutic targets and biomarkers in IAs.

Preliminary investigation on the occurrence and health risk assessment of antibiotics in cultured tilapia retailed at a commercial outlet in Tema, Ghana.

In Ghana, Nile tilapia is one of the most commonly cultivated fish species. Bacterial infections, which mostly occur in intensive fish farming, are considered to be the most significant health issue facing these culture systems in Ghana's aquaculture industry. To prevent, and treat bacterial infections and promote fish growth, antimicrobials are often used, and in most cases at unregulated doses. However, this misuse and neglect of withdrawal durations for such antimicrobials may result in drug residues showing up in fish edible tissue, posing a risk to human consumers. To evaluate the risk to consumers, this study screened for antibiotic residues in popular tilapia fish sold at a retail outlet in Tema. Using ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC/MS/MS), the study analysed the levels of 12 antibiotics present in 24 tilapia samples sold at a retail outlet in Tema. Erythromycin, tetracycline, oxytetracycline, and amoxicillin were detected at varying levels, with frequencies of 20.8 %, 62.5 %, 58.3 %, and 54.2 %, respectively. The highest concentration of 3.521 ± 0.32 µg/kg was found for oxytetracycline, while erythromycin had the lowest concentration (0.276 ± 0.11 µg/kg) in the samples. According to the study, the levels of antibiotics detected in the sampled tilapia were lower than the maximum residue limits (MRL) recommended by the WHO. Additionally, both the hazard quotient (HQ) and hazard index (HI) values were less than one. Therefore, consuming retail farmed tilapia purchased from the commercial outlet in Tema metropolis was deemed to pose no significant risk to human health. However, regular monitoring of antibiotics and other contaminants is necessary to minimise their potential impacts on human health.

Protocol for an evaluation of the initiation of an integrated longitudinal outpatient care model for severe chronic non-communicable diseases (PEN-Plus) at secondary care facilities (district hospitals) in 10 lower-income countries.

INTRODUCTION: The Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus) is a strategy decentralising care for severe non-communicable diseases (NCDs) including type 1 diabetes, rheumatic heart disease and sickle cell disease, to increase access to care. In the PEN-Plus model, mid-level clinicians in intermediary facilities in low and lower middle income countries are trained to provide integrated care for conditions where services traditionally were only available at tertiary referral facilities. For the upcoming phase of activities, 18 first-level hospitals in 9 countries and 1 state in India were selected for PEN-Plus expansion and will treat a variety of severe NCDs. Over 3 years, the countries and state are expected to: (1) establish PEN-Plus clinics in one or two district hospitals, (2) support these clinics to mature into training sites in preparation for national or state-level scale-up, and (3) work with the national or state-level stakeholders to describe, measure and advocate for PEN-Plus to support development of a national operational plan for scale-up. METHODS AND ANALYSIS: Guided by Proctor outcomes for implementation research, we are conducting a mixed-method evaluation consisting of 10 components to understand outcomes in clinical implementation, training and policy development. Data will be collected through a mix of quantitative surveys, routine reporting, routine clinical data and qualitative interviews. ETHICS AND DISSEMINATION: This protocol has been considered exempt or covered by central and local institutional review boards. Findings will be disseminated throughout the project's course, including through quarterly M&E discussions, semiannual formative assessments, dashboard mapping of progress, quarterly newsletters, regular feedback loops with national stakeholders and publication in peer-reviewed journals.

Motivators and impediments to mushroom commercialisation in Ghana: Implication for policymakers, development partners and extension agents.

Waste (organic waste) management is a major challenge for urban and peri-urban areas all over the world. This is because landfilling raises greenhouse gas emissions, whereas indiscriminate refuse dumping wastes valuable nutrients and energy that are still present in the refuse. Fungi, such as mushrooms, have the unique ability to decompose and transform obstinate organic substances into protein. The government, private sector, and foreign development partners in Ghana's Greater Accra region have invested in mushroom (oyster) production to boost commercialization for economic development. However, commercialization remains low, and significant income gains from mushroom commercialization have yet to be realised. Psychosocial factors are imperative for agricultural commercialization because they create a thriving environment and incentive for agricultural commercialization in general, and mushroom commercialization in specific. To determine the motivations and impediments to mushroom commercialization, we used a questionnaire to survey 153 oyster mushroom producers censused from the Ga East and the Adentan municipalities in the Greater Accra region. The data was analyzed using Principal Component Analysis (PCA), means and standard deviations. Our results showed three [3] motivators: social awareness, economic value, and market incentives, and three [3] impediments: institutional and personal weakness, market uncertainty, and value chain challenges. The major motivators to mushroom commercialization are social awareness (M = 3.94) and economic value (M = 3.93) whereas the major impediments comprised market uncertainty (M = 3.59) and institutional and personal weaknesses (M = 3.29). We recommend that policy effort to create enabling institutional environment and social awareness of mushroom coupled with development partners' and extension agents' effort to train farmers on mushroom production management are key to enhancing commercial mushroom production in Ghana. NB: M=Mean.

Visualization and analysis of mapping knowledge domains for the global transition towards clean cooking: a bibliometric review of research output from 1990 to 2020.

Current statistics report that 2.6 billion households across the globe rely on polluting and inefficient cooking fuels and technologies, posing death-threatening health risks to people mainly from developing countries/regions. Several studies on clean cooking have been conducted with the emergence of international organizations such as the Clean Cooking Alliance to raise awareness. In the current study, a bibliometric tool, CiteSpace, was employed to analyze the 877 documents retrieved from the SCI-EXPANDED, SSCI, and A&HCI databases on clean cooking research from 1990 to 2020. The results reveal that interest in clean cooking research took a sharp rise in the last decade, especially after 2016. The research field has become increasingly interdisciplinary but has mostly centered on environment, energy, and health. The most productive countries/regions in this field are the USA, India, England, and China. The keyword and citation analyses indicate that research in this field mostly focuses on adverse impacts of household air pollution from unclean cooking fuels and technologies on the environment and public health particularly, in developing countries/regions. Also, the drivers and barriers to the large-scale adoption of clean cooking fuels and technologies have become a topic of interest in recent years. The three most studied clean cooking fuels among various regions are LPG, biogas, and electricity. This study synthesizes global research on clean cooking and may be beneficial to other researchers in understanding current trends in this field and serve as a guide for concentrating on the most important topics.

Recent advances in high-throughput metabolic engineering: Generation of oligonucleotide-mediated genetic libraries.

The preparation of genetic libraries is an essential step to evolve microorganisms and study genotype-phenotype relationships by high-throughput screening/selection. As the large-scale synthesis of oligonucleotides becomes easy, cheap, and high-throughput, numerous novel strategies have been developed in recent years to construct high-quality oligo-mediated libraries, leveraging state-of-art molecular biology tools for genome editing and gene regulation. This review presents an overview of recent advances in creating and characterizing in vitro and in vivo genetic libraries, based on CRISPR/Cas, regulatory RNAs, and recombineering, primarily for Escherichia coli and Saccharomyces cerevisiae. These libraries' applications in high-throughput metabolic engineering, strain evolution and protein engineering are also discussed.

Deep Learning in the Management of Intracranial Aneurysms and Cerebrovascular Diseases: A Review of the Current Literature.

Intracranial aneurysms are a common asymptomatic vascular pathology, the rupture of which is a devastating event with a significant risk of morbidity and mortality. Aneurysm detection and risk stratification before rupture events are, therefore, imperative to guide prophylactic measures. Artificial intelligence has shown great promise in the management pathway of aneurysms, through automated detection, the prediction of rupture risk, and outcome prediction after treatment. The complementary use of these programs, in addition to clinical practice, has demonstrated high diagnostic and prognostic accuracy, with the potential to improve patient outcomes. In the present review, we explored the role and limitations of deep learning, a subfield of artificial intelligence, in the aneurysm patient journey. We have also briefly summarized the application of deep learning models in automated detection and prediction in cerebral arteriovenous malformations and Moyamoya disease.

Skull Base Neurosurgery Eponyms: A Review of Notable Anatomical Landmarks.

Eponyms highlight the contributions made to medicine over the years, and celebrate individuals for their work involving diseases, pathologies, and anatomical landmarks. We have compiled an in-depth report of eponyms used in skull base neurosurgery, as well as the historical contexts of the personalities behind the names. A literature search identified 36 eponyms of the bones, foramina and ligaments of the skull base named after anatomists and physician-scientists. The 36 eponymous structures pinpointed include Arnold's canal, the foramen of Arnold, Bill's bar, Bertin's bones, Civinini's canal, Civinini's ligament, Civinini's process, sinodural angle of Citelli, Clivus of Blumenbach, Dorello's canal, the Eustachian tube, the eponymous cavernous sinus triangles of Parkinson, Kawase, Mullan, Dolenc, Glasscock and Hakuba, the Fallopian canal, the Glasserian fissure, Gruber's ligament, Haller cells, the spine of Henle, Highmore's antrum, the foramen of Huschke, Hyrtl's fissure, the Ingrassia process, Jacobson's canal, the MacEwen triangle, Meckel's cave, the Onodi air cell, the Pacchionian foramen, Fossa of Rosenmuller, the foramen of Vesalius, the Vidian canal, Trautman's triangle and the annular tendon of Zinn. Knowledge of the relevant eponyms enables succinct descriptions of important skull base structures, provides an understanding of associated clinical implications, and reminds us of the vast history of contributions to neurosurgery made by prominent figures in the field.

Toward improved terpenoids biosynthesis: strategies to enhance the capabilities of cell factories.

Terpenoids form the most diversified class of natural products, which have gained application in the pharmaceutical, food, transportation, and fine and bulk chemical industries. Extraction from naturally occurring sources does not meet industrial demands, whereas chemical synthesis is often associated with poor enantio-selectivity, harsh working conditions, and environmental pollutions. Microbial cell factories come as a suitable replacement. However, designing efficient microbial platforms for isoprenoid synthesis is often a challenging task. This has to do with the cytotoxic effects of pathway intermediates and some end products, instability of expressed pathways, as well as high enzyme promiscuity. Also, the low enzymatic activity of some terpene synthases and prenyltransferases, and the lack of an efficient throughput system to screen improved high-performing strains are bottlenecks in strain development. Metabolic engineering and synthetic biology seek to overcome these issues through the provision of effective synthetic tools. This review sought to provide an in-depth description of novel strategies for improving cell factory performance. We focused on improving transcriptional and translational efficiencies through static and dynamic regulatory elements, enzyme engineering and high-throughput screening strategies, cellular function enhancement through chromosomal integration, metabolite tolerance, and modularization of pathways.

Individual and Community Factors Associated with Household Insecticide-Treated Bednet Usage in the Sunyani West District of Ghana Two Years after Mass Distribution.

Purpose: In the year 2015, the Ghana Health Service launched a free mass insecticide-treated net (ITN) distribution campaign in the Sunyani West district of Ghana with the aim of improving household ownership to increase usage. This study determined the level of ownership and usage of ITNs and associated factors among households in the Sunyani West district two years after the mass distribution campaign. Methods: Study participants were identified using the systematic approach in all five subdistricts of the Sunyani West district and interviewed, and data were collected on household ITN ownership. Data were also collected on the source of the ITN and whether the respondent slept under an ITN the previous night. Data on individual and community factors associated with ITN ownership and usage were also collected. Pearson chi-square tests and logistic regression were performed to determine factors significantly associated with ITN ownership and usage. Results: The level of ITN ownership was 78.93% and usage was 55.93%. Most of the participants (73.62%) received their nets during the 2015 mass distribution campaign, 39 (11.96%) received their ITNs during antenatal care visits, whilst 27 (8.28%) bought the nets from the store. People who experience irritation (χ 2 = 23.32; p < 0.001) and respondents who did not perceive themselves as likely to be beaten by mosquitoes or get malaria (χ 2 = 26.61; p < 0.001) were less likely to use ITNs. Respondents who used other malaria/mosquito bite prevention methods were also less likely to use the ITNs (χ 2 = 206.26; p = 0.001), but individuals who received free nets were likely to use them. Conclusion: ITN ownership was high, but usage was low and far below the national target. Intense health education emphasizing the fact that everybody is susceptible to malaria may help improve usage.

Ebola virus disease surveillance in the absence of a confirmed case; the case of the Rwenzori region of Uganda.

INTRODUCTION: the August 2018 ebola outbreak in the Democratic Republic of Congo turns out to be second largest outbreak of ebola in public health history. The response to the outbreak which would have halted wider spread to neighboring countries failed. Hence, high risk districts in Uganda initiated preparedness activities in the wake of a possible inflow of cases. This study was therefore designed to identify, describe and assess surveillance activities and preparedness in the Kasese, Ntoroko and Bundibugyo districts of Uganda. METHODS: the study employed the mixed method approach. The qualitative arm involved the use of participant observation to describe surveillance activities that were carried out as part of the ebola preparedness surveillance in the high-risk districts. The quantitative arm included assessment of 102 health facilities on ebola virus disease preparedness with a WHO standard checklist hosted on the Open Data Kit software. Descriptive statistics were performed using STATA (version 14). RESULTS: the study showed that high risk districts employed numerous interlocking public health emergency activities which included readiness assessment, risk mapping and temperature-based screening for ebola at points of entry. Most health workers (91.18%) could correctly state the case definition of ebola although only 56.86% of them were trained on ebola surveillance. CONCLUSION: health worker knowledge on ebola virus disease case definition was high but training and logistics were inadequate. Continuous efforts are required to sustain health workers knowledge on ebola surveillance through trainings and supportive supervision whiles addressing gaps in the operation of ebola screening posts.