Hierarchical Self-Assembly of Nanowires on the Surface by Metallo-Supramolecular Truncated Cuboctahedra.

Parastichy, the spiral arrangement of plant organs, is an example of the long-range apparent order seen in biological systems. These ordered arrangements provide scientists with both an aesthetic challenge and a mathematical inspiration. Synthetic efforts to replicate the regularity of parastichy may allow for molecular-scale control over particle arrangement processes. Here we report the packing of a supramolecular truncated cuboctahedron (TCO) into double-helical (DH) nanowires on a graphite surface with a non-natural parastichy pattern ascribed to the symmetry of the TCOs and interactions between TCOs. Such a study is expected to advance our understanding of the design inputs needed to create complex, but precisely controlled, hierarchical materials. It is also one of the few reported helical packing structures based on Platonic or Archimedean solids since the discovery of the Boerdijk-Coxeter helix. As such, it may provide experimental support for studies of packing theory at the molecular level.

Acid-Activated Motion Switching of DB24C8 between Two Discrete Platinum(II) Metallacycles.

The precise operation of molecular motion for constructing complicated mechanically interlocked molecules has received considerable attention and is still an energetic field of supramolecular chemistry. Herein, we reported the construction of two tris[2]pseudorotaxanes metallacycles with acid-base controllable molecular motion through self-sorting strategy and host-guest interaction. Firstly, two hexagonal Pt(II) metallacycles M1 and M2 decorated with different host-guest recognition sites have been constructed via coordination-driven self-assembly strategy. The binding of metallacycles M1 and M2 with dibenzo-24-crown-8 (DB24C8) to form tris[2]pseudorotaxanes complexes TPRM1 and TPRM2 have been investigated. Furthermore, by taking advantage of the strong binding affinity between the protonated metallacycle M2 and DB24C8, the addition of trifluoroacetic acid (TFA) as a stimulus successfully induces an acid-activated motion switching of DB24C8 between the discrete metallacycles M1 and M2. This research not only affords a highly efficient way to construct stimuli-responsive smart supramolecular systems but also offers prospects for precisely control multicomponent cooperative motion.

[Endovascular Treatment of Blood Blister-like Aneurysms in Internal Carotid Artery].

OBJECTIVES: To study the feasibility and effectiveness of endovascular treatment to blood blister-like aneurysms (BBA) in internal carotid artery. METHODS: Retrospective analyzed the clinical features, outcomes, and complications of 20 cases of BBA treated with endovascular intervention techniques from 2013-2015 in our center. RESULTS: The patients were treated with covered stent, internal carotid artery balloon occlusion, and stents assisted coiling, respectively. One death occurred after the patient accepted covered stent treatment, another 2 death was due to vasospasm after internal carotid artery balloon occlusion, and double stents assisted coiling, respectively. The modified Rankin Scale (mRS) score when patients being discharged were 0-2 in 15 cases, and 3-4 in 2 cases. There were 17 cases with clinical follow-up from 1 to 26 months (9.3 months on average), the mRS scores were all less than 2 points. 16 cases accepted angiographic review. 14 cases had BBA totally occluded, 1 case had stable neck residue, and 1 case had incompleted occlusion and the aneurysm dwindled at follow-up. CONCLUSIONS: Stent-assisted coiling is feasible and effective in the treatment of BBA in internal carotid artery.

Construction of π-Surface-Metalated Pillar[5]arenes which Bind Anions via Anion-π Interactions.

By simple ligand exchange of the cationic transition-metal complexes [(Cp*)M(acetone)3 ](OTf)2 (Cp*=pentamethylcyclopentadienyl and M=Ir or Rh) with pillar[5]arene, mono- and polynuclear pillar[5]arenes, a new class of metalated host molecules, is prepared. Single-crystal X-ray analysis shows that the charged transition-metal cations are directly bound to the outer π-surface of aromatic rings of pillar[5]arene. One of the triflate anions is deeply embedded within the cavity of the trinuclear pillar[5]arenes, which is different to the host-guest behavior of most pillar[5]arenes. DFT calculation of the electrostatic potential revealed that the metalated pillar[5]arenes featured an electron-deficient cavity due to the presence of the electron-withdrawing transition metals, thus allowing encapsulation of electron-rich guests mainly driven by anion-π interactions.

Antibacterial, cytotoxic and genotoxic activity of nitrogenated and haloid derivatives of C50-C60 and C70-C120 polyprenol homologs.

BACKGROUND: Polyprenol is an important lipid with many bioactive effects. The study on differences in bioactive effects of polyprenol derivatives having different isoprene units are seldom reported and it is helpful to find out which type of polyprenol derivatives are effective for treating A549/HepG2 cells and E. coli /S. aureus. METHODS: All tested polyprenol derivatives were measured with inhibition halos by Oxford cup assays. MIC values were assessed by the broth dilution method. Time-killing curve studies were conducted in duplicate on separate days. Cytotoxicity study was measured by the MTT assay and genotoxic study was evaluated by comet assay. RESULTS: With regard to antibacterial activity, the sensitivities to the quaternary polyprenyl ammonium salt derivatives GAS and MAS were 31.3 µg/mL and 15.6-31.3 µg/mL, respectively. GAS and MAS exhibited cytotoxic activity toward HepG2 cells (IC50 of 10.1-11.6 µg/mL), which was stronger than that exhibited toward A549 cells (IC50 of 13.8-13.9 µg/mL). The bactericidal activity of MAS was stronger than that of GAS at the same concentration at least 48 h. The DNA damage in A549 and HepG2 cells exposed to all 10, 20 and 40 µg/mL MAS was statistically significant in comparison to the control. Our results indicate a dose-dependent increment in DNA damage in A549 and HepG2 cells exposed to 10, 20 and 40 µg/mL MAS for both the percentage of DNA in the tail and tail moment. CONCLUSION: The quaternary ammonium salt derivatives GAS and MAS exhibited higher antibacterial (E. coli and S. aureus) and cytotoxic activity (A549 and HepG2 cells) than the other derivatives evaluated in this study. The DNA damage in HepG2 cells suggests that MAS induced A549 and HepG2 cells death via apoptotic pathway. Our results provide new evidence supporting the medical use of polyprenol derivatives against bacterial and tumor diseases.

Prognosis research of delayed facial palsy after microvascular decompression for hemifacial spasm.

BACKGROUND: Although microvascular decompression (MVD) surgery has been widely accepted as an effective treatment for hemifacial spasm (HFS), delayed facial palsy (DFP) is not an unusual complication, but it has only been sporadically described in the literature. The purpose of this study was to examine the probability of occurrence, the risk/predisposing factors, and the prognosis and timing of DFP. METHODS: A prospective cohort study was conducted that included patients diagnosed with HFS and treated by MVD at our institution. All patients were followed up at the outpatient department or by telephone from December 2009 to December 2014. Categorical variables were analyzed using the Pearson's Chi-square test or Fisher's exact test. Continuous variables were compared using the independent Student's t test. The Spearman rank test was used to determine the correlation between the time of onset and the duration of DFP. The risk/predisposing factors were analyzed by the logistic regression method. RESULTS: We enrolled 248 patients who were treated by MVD for HFS. During the follow-up period, 16 patients (6.5 %) developed DFP. Fifteen of those patients had a complete recovery, and in one patient the facial palsy did not resolve. The average onset time was 10.2 days (range, 2-30 days) after surgery, and the mean duration of DFP after MVD, with exclusion of the permanent facial palsy patient, was 59.7 days (range, 7-220 days). The time of onset was correlated with the duration of DFP after MVD (p = 0.036). Furthermore, hypertension contributed to DFP (odds ratio [OR] 4.226, 95 % confidence interval [CI] 1.089-16.401, p = 0.037). CONCLUSIONS: Although the degree of facial palsy was variable, most patients experienced a complete recovery without requiring any special treatment. DFP may be a self-healing disease that resolves spontaneously without any treatment. The time of onset was correlated with the duration of DFP; i.e., an earlier development of DFP corresponded with a shorter duration, whereas a later development of DFP corresponded with a longer duration. Our results also suggest that hypertension contributes to DFP.

Analysis on the Physicochemical Properties of Ginkgo biloba Leaves after Enzymolysis Based Ultrasound Extraction and Soxhlet Extraction.

In this study, high performance liquid chromatography (HPLC), ultraviolet (UV), thermagravimetric analyzer (TGA), pyrolysis-gas chromatography-mass spectrometry (Py-GC-MS), and scanning electron microscope (SEM) were used as measurement techniques, contents of chemical composition, pyrolytic products, thermal stability, morphological characterization of Ginkgo biloba leaves (GBL) acted as the index, and physicochemical properties of GBL after enzymolysis based ultrasound extraction (EBUE) and Soxhlet extraction were studied. The detection results of chemical composition revealed that contents of general flavone, soluble protein, soluble total sugar and protein in the GBL declined significantly after EBUE, and contents of polyprenols and crude fat obviously reduced as well after Soxhlet extraction. Py-GC-MS results indicated that total GC contents of micromolecules with carbon less than 12 from 54.0% before EBUE decline to 8.34% after EBUE. Total GC contents of long-chain fatty acids with carbon less than 20 from 43.0% before EBUE reduced to 27.0% after Soxhlet extraction. Thermal stability results showed that GBL after Soxhlet extraction was easier to decompose than GBL before EBUE. SEM results illustrated that surface structure of GBL was damaged severely after EBUE, compared with GBL before EBUE, while organic solvent extraction had little influence on the morphological characterization of GBL after Soxhlet extraction compared with GBL after EBUE.

Cross-linked supramolecular polymer gels constructed from discrete multi-pillar[5]arene metallacycles and their multiple stimuli-responsive behavior.

A new family of discrete hexakis-pillar[5]arene metallacycles with different sizes have been successfully prepared via coordination-driven self-assembly, which presented very few successful examples of preparation of discrete multiple pillar[n]arene derivatives. These newly designed hexakis-pillar[5]arene metallacycles were well characterized with one-dimensional (1-D) multinuclear NMR ((1)H and (31) P NMR), two-dimensional (2-D) (1)H-(1)H COSY and NOESY, ESI-TOF-MS, elemental analysis, and PM6 semiempirical molecular orbital methods. Furthermore, the host-guest complexation of such hexakis-pillar[5]arene hosts with a series of different neutral ditopic guests G1-6 were well investigated. Through host-guest interactions of hexakis-pillar[5]arene metallacycles H2 or H3 with the neutral dinitrile guest G5, the cross-linked supramolecular polymers H2⊃(G5)3 or H3⊃(G5)3 were successfully constructed at the high-concentration region, respectively. Interestingly, these cross-linked supramolecular polymers transformed into the stable supramolecular gels upon increasing the concentrations to a relatively high level. More importantly, by taking advantage of the dynamic nature of metal-ligand bonds and host-guest interactions, the reversible multiple stimuli-responsive gel-sol phase transitions of such polymer gels were successfully realized under different stimuli, such as temperature, halide, and competitive guest, etc. The mechanism of such multiple stimuli-responsive processes was well illustrated by in situ multinuclear NMR investigation. This research not only provides a highly efficient approach to the preparation of discrete multiple pillar[n]arene derivatives but also presents a new family of multiple stimuli-responsive "smart" soft matters.

Efficacy of endovascular therapy for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

Background: Cerebral vasospasm (CV) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH), leading to increased morbidity and mortality rates. Endovascular therapy, particularly intra-arterial vasodilator infusion (IAVI), has emerged as a potential alternative treatment for CV. Methods: A systematic review and meta-analysis were conducted to compare the efficacy of endovascular therapy with standard treatment in patients with CV following aSAH. The primary outcomes assessed were in-hospital mortality, discharge favorable outcome, and follow-up favorable outcome. Secondary outcomes included major infarction on CT, ICU stay duration, and total hospital stay. Results: Regarding our primary outcomes of interest, patients undergoing intervention exhibited a significantly lower in-hospital mortality compared to the standard treatment group, with the intervention group having only half the mortality risk (RR = 0.49, 95% CI [0.29, 0.83], p = 0.008). However, there were no significant differences between the two groups in terms of discharge favorable outcome (RR = 0.99, 95% CI [0.68, 1.45], p = 0.963) and follow-up favorable outcome (RR = 1.09, 95% CI [0.86, 1.39], p = 0.485). Additionally, there was no significant difference in major infarction rates (RR = 0.79, 95% CI [0.34, 1.84], p = 0.588). It is important to note that patients undergoing endovascular treatment experienced longer stays in the ICU (MD = 6.07, 95% CI [1.03, 11.12], p = 0.018) and extended hospitalization (MD = 5.6, 95% CI [3.63, 7.56], p < 0.001). Subgroup analyses based on the mode of endovascular treatment further supported the benefits of IAVI in lowering in-hospital mortality (RR = 0.5, 95% CI [0.27, 0.91], p = 0.023). Conclusion: Endovascular therapy, particularly IAVI, holds promising potential in reducing in-hospital mortality for patients with CV following aSAH. However, it did not show significant improvement in long-term prognosis and functional recovery. Further research with larger sample sizes and randomized controlled trials is necessary to validate these findings and optimize the treatment strategy for cerebral vasospasm in aSAH patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42023451741.

Case report: Delayed quadriplegia from traumatic carotid cavernous fistula: a rare case with perimedullary venous drainage.

Background: Carotid cavernous fistula (CCF) refers to the abnormal arteriovenous communication between the carotid system at the skull base and the sphenoid cavernous sinus, which is caused by trauma in almost 75% of cases. The drainage of venous blood to the spinal cord represents a distinctive mechanism, which is commonly observed in dural arteriovenous fistula (DAVF), and typically manifests clinically as progressive myelopathy. However, it is a rare occurrence in clinical practice that traumatic carotid cavernous fistula (TCCF) causes delayed quadriplegia through perimedullary venous drainage. Case presentation: We report the case of a 29-year-old male patient who was admitted to the hospital with a sudden onset of headache and quadriplegia. The patient had previously lost his right eye in a traffic accident 5 years ago. Cerebral angiography showed a high-flow direct CCF on the right side, accompanied by obvious drainage of cerebellar and perimedullary veins. We successfully performed coil embolization for the CCF, and the symptoms of the patient gradually improved after the operation. During follow-up at sixth-months, the patient regained the ability to walk independently. Conclusion: We experienced a rare case of TCCF with quadriplegia. Utilizing coil embolization, we achieved successful improvement in the patient's condition. However, the mechanism and the best treatment of CCF drainage through the perimedullary vein are still unclear. We need to further explore the pathophysiological information of CCF venous drainage.

Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study.

Objective: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality rates. Although research on BBAs is well documented in different populations, the study of BBAs in the Tibetan population is extremely rare. This study aimed to evaluate the characteristics of BBAs and analyze the treatment modalities and long-term outcomes in the Tibetan population in comparison with the Han population. Methods: The characteristics of patients with BBAs of the ICA from January 2009 to January 2021 at our institution were reviewed. The features of aneurysms, treatment modalities, complications, and follow-up outcomes were retrospectively analyzed. Results: A total of 130 patients (41 Tibetan and 89 Han patients) with BBAs of the ICA who underwent treatment were enrolled. Compared with the Han group, the Tibetan group significantly demonstrated a high ratio of BBAs among ICAs (8.6%, 41/477 vs. 1.6%, 89/5563; p<0.05), a high ratio of vasospasm (34.1%, 14/41 vs. 6.7%, 6/89; p=0.001), a high risk of ischemic events (43.9%, 18/41 vs. 22.5%, 20/89; p<0.05), and a low ratio of good outcomes (modified Rankin Scale, 0-2) at the 1-year follow-up (51.2%, 21/41 vs. 74.2%, 66/89; p<0.05). The multivariate regression model showed that ischemic events significantly contributed to the prediction of outcomes at 1 year. Further analysis revealed that microsurgery and vasospasm were associated with ischemic events. Conclusion: In comparison with Han patients, the Tibetan population had a high ratio of BBA occurrence, a high incidence of ischemic events, and a high ratio of poor outcomes. The endovascular approach showed more benefits in BBA patients.

Design of an open-shell nitrogen-centered diradicaloid with tunable stimuli-responsive electronic properties.

Organic diradicaloids usually display an open-shell singlet ground state with significant singlet diradical character (y0) which endow them with intriguing physiochemical properties and wide applications. In this study, we present the design of an open-shell nitrogen-centered diradicaloid which can reversibly respond to multiple stimuli and display the tunable diradical character and chemo-physical properties. 1a was successfully synthesized through a simple and high-yielding two-step synthetic strategy. Both experimental and calculated results indicated that 1a displayed an open-shell singlet ground state with small singlet-triplet energy gap (ΔES-T = -2.311 kcal mol-1) and a modest diradical character (y0 = 0.60). Interestingly, 1a was demonstrated to undergo reversible Lewis acid-base reaction to form acid-base adducts, which was proven to effectively tune the ground-state electronic structures of 1a as well as its diradical character and spin density distributions. Based on this, we succeeded in devising a photoresponsive system based on 1a and a commercially available photoacid merocyanine (MEH). We believe that our studies including the molecular design methodology and the stimuli-responsive organic diradicaloid system will open up a new way to develop organic diradicaloids with tunable properties and even intelligent-responsive diradicaloid-based materials.

Transcatheter embolization of a ruptured internal pudendal artery pseudoaneurysm in a patient with neurofibromatosis type 1.

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder. Pseudoaneurysms formation and rupture is an unusual complication of neurofibromatosis. To date, pseudoaneurysm of the internal pudendal artery associated with NF-1 has not been reported. In this article, we present a 62-yr-old man with NF-1 suffering from spontaneous hematoma of the perinea and scrotum. A digital substraction angiography disclosed a ruptured pseudoaneurysm of the right internal pudendal artery, which was successfully managed with transcatheter embolization.

A chromosome-level reference genome of non-heading Chinese cabbage [Brassica campestris (syn. Brassica rapa) ssp. chinensis].

Non-heading Chinese cabbage (NHCC) is an important leafy vegetable cultivated worldwide. Here, we report the first high-quality, chromosome-level genome of NHCC001 based on PacBio, Hi-C, and Illumina sequencing data. The assembled NHCC001 genome is 405.33 Mb in size with a contig N50 of 2.83 Mb and a scaffold N50 of 38.13 Mb. Approximately 53% of the assembled genome is composed of repetitive sequences, among which long terminal repeats (LTRs, 20.42% of the genome) are the most abundant. Using Hi-C data, 97.9% (396.83 Mb) of the sequences were assigned to 10 pseudochromosomes. Genome assessment showed that this B. rapa NHCC001 genome assembly is of better quality than other currently available B. rapa assemblies and that it contains 48,158 protein-coding genes, 99.56% of which are annotated in at least one functional database. Comparative genomic analysis confirmed that B. rapa NHCC001 underwent a whole-genome triplication (WGT) event shared with other Brassica species that occurred after the WGD events shared with Arabidopsis. Genes related to ascorbic acid metabolism showed little variation among the three B. rapa subspecies. The numbers of genes involved in glucosinolate biosynthesis and catabolism were higher in NHCC001 than in Chiifu and Z1, due primarily to tandem duplication. The newly assembled genome will provide an important resource for research on B. rapa, especially B. rapa ssp. chinensis.

Separation of polyprenols from Ginkgo biloba leaves by a nano silica-based adsorbent containing silver ions.

Polyprenols extracted from Ginkgo biloba leaves is a kinds of unsaturated compound containing double bonds. Traditionally, the separation methods for the polyprenols are lack of selectivity and their separation efficiency are low. We synthesized two kinds of functional nano-silica containing silver ions materials (AgTCM and AgTCN) which have selectivity for unsaturated compounds to separate Ginkgo biloba leaves polyprenols for the first time. AgTCN displays exceptionally high selectivity for polyprenols and high stability under extended heat and light exposure, while silver is virtually immobile during solvent elution. Importantly, the exceptional stability of AgTCN gives rise to much higher polyprenols recovery than conventional silica gel during the chromatographic elution. In addition, we found that the adsorption of polyprenols onto the AgTCN conforms to pseudo-second-order kinetic model and AgTCN has strong affinity with polyprenols by analyzing Langmuir, Freundlich, Temkin-Pyzhev, and Dubinin-Radushkevich isotherms. The calculation results of thermodynamic parameters demonstrate that decrease of temperature in favor of increasing the adsorbing capacity of polyprenols onto the AgTCN, and the adsorption process of which is exothermic reaction. Our results pave the way for the novel separation methods of polyprenols from Ginkgo biloba leaves.

Obstructive hydrocephalus associated with spontaneous dural arteriovenous fistula: A case report.

RATIONALE: Dural arteriovenous fistulae (DAVF) are vascular disorders depicted with direct interconnection between dural arteries and cerebral venous sinuses and/or cortical veins. Only a hand full of cases have been reported in literature. DAVF obstructing the 3rd ventricle and quadrigeminal cistern resulting in hydrocephalus is very rare. PATIENT CONCERNS: We present a 55-year-old female with 2 years history of headaches and blurring of vision. Cranial nerves examinations were unremarkable. DIAGNOSES: Magnetic Resonance Imaging (MRI) and digital subtraction angiography showed multiple tortuous vascular malformation in the 3rd ventricle and quadrigeminal cistern resulting in obstructive hydrocephalus (OHC). INTERVENTIONS: We utilized endovascular embolization treatment option to obliterate the lesion. We used Onyx embolization agent (ev3 Neurovascular, Irvine, CA) to embolize the lesion via the transarterial route. OUTCOMES: The OHC resolved spontaneously after the endovascular embolization of the DAVF. The patient recovered with no further neurologic complication. Two years follow-up reveal no recurrence of the DAVF as well as hydrocephalus. LESSONS: Adequate knowledge on the vascular anatomy is very crucial in managing DAVF.

Dural Arteriovenous Fistulas with Perimedullary Venous Drainage Successfully Managed Via Endovascular Electrocoagulation.

BACKGROUND: Dural arteriovenous fistulas (DAVFs) with perimedullary venous drainage are very rare intracranial DAVFs. Treating DAVF via an endovascular electrocoagulation technique, to the best of our knowledge, has not been reported in the literature. We therefore report the first successful case. CASE DESCRIPTION: We report a rare case of Cognard type V DAVF. The feeding arteries were the middle meningeal artery, the recurrent meningeal branch of ophthalmic artery, and the meningohypophyseal trunk. The patient presented with paresthesia and weakness in the lower limbs. T2-weighted magnetic resonance imaging revealed a high signal in the medulla oblongata and upper cervical spinal cord. Our first procedure via the middle meningeal artery with Onyx 18 (ev3 Neurovascular) as the embolization agent failed to occlude the fistula. We finally occluded the fistula with the endovascular electro-coagulation technique. Two-year follow-up revealed total disappearance of the fistula and relieve of patient's symptoms. CONCLUSIONS: The endovascular electrocoagulation technique is very effective in the management of complex DAVFs with perimedullary venous drainage.

Application of the Willis Covered Stent in the Treatment of Blood Blister-Like Aneurysms: A Single-Center Experience and Systematic Literature Review.

OBJECTIVE: The purpose of the present study was to introduce our initial experience with the use and feasibility of the Willis covered stent (WCS) in the treatment of blood blister-like aneurysms (BBAs) and to present a systematic review of the reported data on the treatment of BBAs with covered stents. METHODS: Fourteen consecutive patients with BBAs had been treated with WCSs at West China Hospital from January 2015 to August 2017. The patient medical records, angiographic findings, and endovascular treatment reports were reviewed by interventional neuroradiologists and neurosurgeons to obtain relevant clinical and angiographic information. We conducted a systematic review of all reports of BBAs treated with covered stents. We searched the reported data using PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases and commercial Internet search engines. We included BBAs located at nonbranching portions of the internal carotid artery (ICA). RESULTS: The present study included 9 men and 5 women, with a mean age of 54.5 years (range, 30-79). All patients had complete occlusion found on immediate postoperative angiography. The ophthalmic artery was occluded in 2 patients (14.3%). No mortality or morbidity had occurred during the procedure. Two patients (14.3%) experienced a mild recurrence. One patient (7.1%) had developed mild in-stent stenosis. The clinical follow-up period was 6-15 months for all the patients. Of the 14 patients, 11 (78.6%) had a modified Rankin scale score of 0, and 1 (7.1%) had a modified Rankin scale score of 1 during the follow-up period. One patient (7.1%) experienced subarachnoid hemorrhage at 7 days postoperatively and had died 10 days after surgery. None of the patients experienced visual defects. Of our 14 patients, 13 (92.9%) survived, as determined by outpatient department visits or telephone interviews. A total of 8 reports, including 38 patients, met our criteria. Of these 38 patients, 37 (97.3%) had successful delivery to the diseased ICA, and 34 (89.5%) had experienced complete occlusion during follow-up. The overall rate of complete occlusion was 83.0% (95% confidence interval, 68%-91%). CONCLUSIONS: Patients with ruptured BBAs treated with WCSs can achieve satisfactory clinical results. Therefore, for BBAs, the implementation of the WCS could be safe and feasible. This strategy could be a promising option for this type of high-risk aneurysm. However, patients with tortuous ICAs or aneurysms close to essential branch arteries should be carefully evaluated before the WCS is used.

Complete obliteration of a spontaneous pediatric vertebral arteriovenous fistula with patency of the parent vertebral artery: A case report.

RATIONALE: Vertebral arteriovenous fistulas (VAVFs) are depicted with anomalous connections between the vertebral artery, or its branches, and the adjacent venous system. Most VAVFs occur as a result of direct trauma during accidents, whereas others have iatrogenic origin. PATIENT CONCERNS: We report a case of 11-year-old male who presented with right limb weakness and walking instability. DIAGNOSIS: Magnetic resonance angiography as well as digital subtraction angiogram (DSA) of the neck demonstrated a right VAVF. The cervical medulla was compressed by a dilated vein in vertebral canal. The blood supply of the fistula was from the right vertebral artery, whereas drainage was via epidural and paraspinal venous plexus. INTERVENTIONS: We introduced the TransForm Occlusion Balloon Catheter into right vertebral artery, identified the VAVF, and occluded it with the balloon. OUTCOMES: We successfully obliterated the VAVF with patency of parent vertebral artery with a balloon. The symptoms of the patient were relieved after the procedure. Two years' follow-up revealed no recurrence of the fistula. The patient is currently well. LESSONS: Patency of the parent artery following obliteration a VAVF is still a challenge. Obliteration of the VAVF with a balloon while the parent vertebral artery is still patent is very possible.

Reactive in-stent stenosis of a pipeline embolization device in a child: A case report.

RATIONALE: Pipeline embolization device pipeline embolization device (PLED) is one of the most preferred flow-diverting devices used in treating giant and complex intercranial aneurysms. The occurrence of in-stent stenosis (ISS), which is a partially reversible complication, has been associated with PLED. Trauma around the neck of the aneurysm during our attempts to implant the PLED across the aneurysm resulted into inflammatory reactions, endotheliazation, granular tissue formation, and subsequent ISS. PATIENT CONCERNS: We present an 11-year-old girl with dizziness of 6 days duration on account of which she was admitted at our institution. Physical as well as neurological examinations did not yield much. DIAGNOSES: Cerebral angiography revealed a right cavernous segment giant aneurysm. INTERVENTIONS: We initially implanted Pipeline embolization devices (PLEDs) (ev3, Irvine, California, USA) across the neck of the aneurysm which resulted into ISS 6 months after the operation. OUTCOMES: We also attempted balloon angioplasty which failed during our second operation. She was finally treated with Neuroform stent (Stryker Neurovascular, USA) with no further complication and two years follow-up revealed no ISS. LESSONS SUBSECTIONS AS PER STYLE: A combination of multiple kinds of flow diverting devices could reduce the incidence of ISS in selected patients with complex aneurysms. Minimal trauma caused by PLED at aneurysm site could also reduce incidence of ISS.