Feasibility, safety, and efficacy of endovascular treatment of anterior cranial fossa dural arteriovenous fistulas: a systematic review and meta-analysis with a subanalysis for Onyx.

Dural Arteriovenous Fistulas (dAVFs) of the anterior cranial fossa (ACF) are uncommon but carry a high risk of hemorrhage and pose substantial treatment challenges. Recent advancements in endovascular treatment (EVT), including the introduction of novel liquid embolic agents, have markedly bolstered EVT's role in managing ACF-dAVFs, with notable series published in the last five years. We aimed to assess the feasibility, safety, and efficacy of EVT for ACF-dAVFs. We searched Medline, Scopus, Web of Science, and Cochrane Library databases following PRISMA guidelines. Eligible studies included those with ≥ 5 patients undergoing embolization of ACF-dAVFs, detailing both angiographic and clinical outcomes. We used single proportion analysis with 95% confidence intervals under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Publication bias was assessed by funnel-plot analysis and Egger's test. Outcomes included complete occlusion following embolization, unsuccessful endovascular embolization attempts, incomplete occlusion following embolization, symptom resolution or clinical improvement following embolization, recurrence; procedure-related complications, morbidity, and mortality. Additionally, a subanalysis for studies exclusively utilizing Onyx™ embolic system was done. Eighteen studies comprising 231 ACF-dAVF were included. Unsuccessful endovascular embolization attempts rate was 2%. Complete occlusion rate was 85%, with 4% of complications. Incomplete occlusion rate was 10%. Successfully embolized patients experienced either symptom resolution or clinical improvement in 94% of cases. Morbidity and mortality rates were 1% and 0%, respectively. Onyx subanalyses showed an overall rate of 0% for unsuccessful attempts, 95% for complete occlusion, and 5% for incomplete occlusion. Symptom resolution or clinical improvement was 98% and recurrence rate was 0%. EVT for ACF-dAVF is highly feasible, effective, and safe, with a low rate of complications, morbidity, and mortality. The subanalyses focusing on Onyx embolizations revealed superior efficacy and safety outcomes compared to the findings of the primary analyses involving all included studies.

Depthgram: Visualizing outliers in high-dimensional functional data with application to fMRI data exploration.

Functional magnetic resonance imaging (fMRI) is a non-invasive technique that facilitates the study of brain activity by measuring changes in blood flow. Brain activity signals can be recorded during the alternate performance of given tasks, that is, task fMRI (tfMRI), or during resting-state, that is, resting-state fMRI (rsfMRI), as a measure of baseline brain activity. This contributes to the understanding of how the human brain is organized in functionally distinct subdivisions. fMRI experiments from high-resolution scans provide hundred of thousands of longitudinal signals for each individual, corresponding to brain activity measurements over each voxel of the brain along the duration of the experiment. In this context, we propose novel visualization techniques for high-dimensional functional data relying on depth-based notions that enable computationally efficient 2-dim representations of fMRI data, which elucidate sample composition, outlier presence, and individual variability. We believe that this previous step is crucial to any inferential approach willing to identify neuroscientific patterns across individuals, tasks, and brain regions. We present the proposed technique via an extensive simulation study, and demonstrate its application on a motor and language tfMRI experiment.

Optimizing resources: financial evaluation of flow diverters versus stent assisted coiling in large and giant cerebral aneurysm management in Brazil public health system.

BACKGROUND: Cerebral aneurysms, especially large and giant aneurysms, pose challenges in neurointerventional surgery. Treatment choices involve clinical presentation, aneurysm details, and global resource variations. Neurointerventional methods, while innovative, may be cost restrictive in certain regions. In public healthcare, cost is crucial, notably in countries like Brazil. This study examines the device specific cost estimation of flow diverters (FD) and traditional stent assisted coiling (SAC) for large and giant cerebral aneurysms, providing insights into optimizing neurosurgical interventions within the Brazilian public health system's unique challenges. METHODS: A comprehensive retrospective analysis was conducted at our medical center of cases of large and giant aneurysms treated between 2013 and 2023. Determination of the estimated number of coils for aneurysms previously treated with FDs at our center was made, with the cost of each case, and the difference between both treatments was calculated. RESULTS: We investigated the profiles of 77 patients: 40 had large aneurysms (51.9%) and 37 had giant aneurysms (48.1%). Large aneurysms had a mean cost difference of US$274 (standard deviation (SD) $2071), underscoring the device specific cost estimation of FDs over SAC in their treatment. For giant aneurysms, the mean cost difference increased to $6396 (SD $2694), indicating FDs as the more economically sound choice. CONCLUSION: Our study indicated that, for the treatment of giant aneurysms and some large aneurysms, the FD intervention was more economical than SAC.

Transradial access for the endovascular treatment of intracranial aneurysms using the Woven EndoBridge device: A systematic review and pooled analysis.

BACKGROUND: The Woven EndoBridge (WEB) device is a minimally invasive endovascular treatment option for patients with cerebral aneurysms. Transradial access (TRA) is a technique that involves accessing the arterial system through the radial artery in the wrist rather than the femoral artery in the groin. Several studies have investigated the use of TRA for WEB device deployment in treating intracranial aneurysms. METHODS: A systematic review was conducted to evaluate the TRA for WEB device deployment in treating intracranial aneurysms. The databases PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. To reduce the risk of bias, this systematic review only included studies reporting on using TRA in WEB device deployment for intracranial aneurysm treatment with a minimum of four patients. RESULTS: In this systematic review, 186 patients were included across five studies, with TRA used in 183 cases analyzed. The study population had a higher proportion of females (n = 118%-69%) than males, with a mean age of 62 years old. Among the aneurysms treated, 46 were ruptured, and 119 were located at bifurcation sites, with a mean maximum diameter/width of 6.6 mm and mean height of 5.9 mm. Adjunctive coiling was used in three cases, and adjunctive stenting was used in nine cases. In two cases, conversion to a femoral artery access was necessary. CONCLUSION: The available results suggest TRA with the WEB device is a safe and effective alternative. However, using TRA versus TFA should be individualized based on patient factors and operator experience.

Evaluating the efficacy of stent retriever and catheter aspiration combination in refractory cerebral venous sinus Thrombosis: A comprehensive Meta-Analysis.

BACKGROUND: Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially life-threatening condition, often associated with specific risk factors. The primary treatment for CVST is anticoagulation, but some cases progress to Refractory CVST (rCVST), requiring endovascular treatment. A combination of stent retriever and catheter aspiration is emerging as a promising technique to enhance treatment effectiveness. We conducted a systematic review and meta-analysis to assess the safety and efficacy of this approach, aiming to improve recanalization success and neurological outcomes while reducing complications in rCVST patients. METHODS: A search following PRISMA guidelines was conducted across Pubmed, Embase, Web of Science, and Cochrane databases to identify studies on the use of stent retrievers and catheter aspiration for rCVST. Pooled analysis with 95 % confidence intervals was used to assess the effects. Heterogeneity was evaluated using I2 statistics and a random-effects model was used. Complete recanalization. good clinical outcomes (mRS ≤ 2), hemorrhagic, neurological, ischemic, and total complications, poor clinical outcomes (mRS > 2), and mortality were assessed. RESULTS: A meta-analysis of five retrospective studies involving 55 patients examined outcomes in CVST. The median mean age was 40 years. Complete recanalization rate: 36 % (95 % CI: 9 % to 62 %, I2 = 90 %). Good clinical outcomes: 72 % (95 % CI: 50 % to 94 %, I2 = 76 %). Hemorrhagic complications: 2 % (95 % CI: 0 % to 8 %, I2 = 15 %). Ischemic complications: 0 % (95 % CI: 0 % to 6 %, I2 = 0 %). Neurological complications: 7 % (95 % CI: 0 % to 14 %, I2 = 0 %). Poor clinical outcomes: 26 % (95 % CI: 6 % to 46 %, I2 = 70 %). Total complications: 6 % (95 % CI: 0 % to 15 %, I2 = 10 %). Mortality rate: 5 % (95 % CI: 0 % to 13 %, I2 = 19 %). CONCLUSION: This systematic review and meta-analysis scrutinized the efficacy of combining Stent Retriever and Catheter Aspiration for rCVST. Findings highlighted varied outcomes, including recanalization rates, complications, and mortality. The dichotomy between good and poor outcomes underscores the necessity for personalized therapeutic decisions. While offering a comprehensive overview, the study emphasizes literature heterogeneity, suggesting a need for more rigorous and standardized research to optimize therapeutic strategies in clinical practice.

Mind the gender gap: COVID-19 lockdown effects on gender differences in preprint submissions.

The gender gap is a well-known problem in academia and, despite its gradual narrowing, recent estimations indicate that it will persist for decades. Short-term descriptive studies suggest that this gap may have actually worsened during the months of confinement following the start of the COVID-19 pandemic in 2020. In this work, we evaluate the impact of the COVID-19 lockdown on female and male academics' research productivity using preprint drop-off data. We examine a total of 307,902 unique research articles deposited in 5 major preprint repositories during the period between January and May each year from 2017 to 2020. We find that the proportion of female authors in online repositories steadily increased over time; however, the trend reversed during the confinement and gender parity worsened in two respects. First, the proportion of male authors in preprints increased significantly during lockdown. Second, the proportion of male authors in COVID-19-related articles was significantly higher than that of women. Overall, our results imply that the gender gap in academia suffered an approximately 1-year setback during the strict lockdown months of 2020, and COVID-related research areas suffered an additional 1.5-year setback.

Os impactos da pandemia da covid-19 no lazer de adultos e idosos / Impacts of the covid-19 pandemic on adult and elderly leisure

A pandemia da Covid-19 tem sido marcada por um período de isolamento social. Por isso, há uma tendência das atividades de lazer se alterarem ou se adaptarem às opções dentro das residências. Por meio de uma pesquisa bibliográfica e da aplicação de um questionário online, buscamos comparar as atividades de lazer vivenciadas antes e durante a pandemia e, ainda, procuramos compreender a importância atribuída por adultos e idosos ao lazer. Como resultados, constatamos que os (as) participantes alteraram significativamente seus hábitos de lazer, principalmente no que se refere aos interesses sociais, físico-esportivos e turísticos. Além disso, a grande maioria entende o lazer como algo fundamental na vida e uma parcela dos (as) pesquisados (as) tem percebido menos tempo livre para usufruí-lo no período de isolamento social, pois o trabalho e as tarefas do dia a dia estão cada vez mais imbricados.

The Covid-19 pandemic has been marked by a period of social isolation. Therefore, there is a tendency for leisure activities to change or adapt to options within the homes. Through a bibliographic search and the application of an online questionnaire, we seek to compare the leisure activities experienced before and during the pandemic and, still, we try to understand the importance attributed by adults and elderly people to leisure. As a result, we found that the participants significantly changed their leisure habits, especially with regard to social, physical-sporting and tourist interests. In addition, the vast majority understand leisure as something fundamental in life and a portion of those surveyed has perceived less free time to enjoy it in the period of social isolation, as work and day-to-day tasks are increasingly imbricated.

Síndrome de encefalopatía posterior reversible en preeclampsia grave / Posterior reversible encephalopathy syndrome in severe preeclampsia

El síndrome de encefalopatía reversible posterior (PRES), es una entidad clínico radiológica caracterizada por déficit neurológico, convulsiones, pudiendo llegar a un estado de coma. Requiere diagnóstico por imagen para evidencia de edema vasogénico proceso fisiopatológico reversible, apoyados por tomografía computarizada o resonancia magnética, esta última con mayor sensibilidad para diferenciarla del edema citotóxico que es irreversible. Fisiopatológicamente está asociada a mala autorregulación cerebral secundaria varios factores, en este caso, preeclampsia grave, donde destaca el compromiso clínico e imagenológico del tronco encefálico. La instauración de un tratamiento adecuado y oportuno permite visualizar la regresión de las lesiones, que de no ser así terminaran infartándose.

The posterior reversible encephalopathy syndrome (PRES) is a clinical radiological entity characterized by neurological deficit, seizures, and may reach a coma. It requires diagnostic imaging for evidence of vasogenic edema reversible pathophysiological process, supported by computerized tomography or magnetic resonance, the latter with greater sensitivity to differentiate it from cytotoxic edema that is irreversible. Pathophysiologically, several factors are associated with poor cerebral self-regulation, in this case, severe preeclampsia, which highlights the clinical and imaging involvement of the brainstem. The establishment of an appropriate and timely treatment allows visualizing the regression of the lesions, which otherwise would end up infracting.

Supervivencia de pacientes con linfoma no-Hodgkin y síntomas neurológicos según inmunofenotipo del líquido cefalorraquídeo / Survival in non-Hodgkin´s lymphoma patients with neurological symptoms according to the cerebrospinal fluid immunophenotype

Introducción: Los linfomas no-Hodgkin pueden infiltrar el sistema nervioso central y producir síntomas neurológicos, lo cual incrementa la mortalidad. El diagnóstico de esta infiltración se puede realizar mediante el estudio del líquido cefalorraquídeo por la técnica de citometría de flujo, con una mayor sensibilidad que la citología convencional. Objetivo: Estimar la supervivencia global de pacientes con Linfoma no-Hodgkin y síntomas neurológicos según el inmunofenotipo celular del líquido cefalorraquídeo. Métodos: Se realizó un estudio analítico y prospectivo en 15 pacientes con diagnóstico confirmado de linfoma no-Hodgkin y síntomas neurológicos, con citología negativa del líquido cefalorraquídeo, tratados en el servicio de oncología del Instituto Nacional de Oncología y Radiobiología, durante los años 2017 y 2018. El inmunofenotipo fue caracterizado mediante citometría de flujo multiparamétrica. Resultados: El 60,0 por ciento de los pacientes fue del sexo femenino y el 53,4 por ciento mayor de 60 años. Hubo una mortalidad del 26,7 por ciento. Se realizaron 17 inmunofenotipos, el 58,9 por ciento fue normal, el 23,4 por ciento reactivo y el 17,7 por ciento sospechoso de malignidad. La supervivencia global fue mayor en pacientes con líquido cefalorraquídeo con inmunofenotipo normal (HR. 0.04). Conclusiones: La citometría de flujo pudo discriminar células sospechosas de malignidad, en pacientes cuyas citologías fueron negativas. La presencia en el líquido cefalorraquídeo de células atípicas, de pleocitosis y de un índice de linfocito-monocito alto se asoció con una supervivencia global menor(AU)

Introduction: When non-Hodgkin lymphomas infiltrate the central nervous system increases mortality. The diagnosis of this infiltration can be made by the study of cerebrospinal fluid using flow cytometry, with a higher sensitivity than conventional cytology. Objective: To estimate the relationship between the cellular immunophenotype of the cerebrospinal fluid and the overall survival of patients with non-Hodgkin lymphoma and neurological symptoms. Methods: An analytical and prospective study was conducted in 15 patients with confirmed diagnosis of non-Hodgkin lymphoma and neurological symptoms, with negative cytology of the cerebrospinal fluid. Patients cared at Oncology Department of the National Institute of Oncology and Radiobiology, during the years 2017-2018. The immunophenotype was characterized by multiparametric flow cytometry. Results: 60.0 percent of the patients was female and 53.4 percent older than 60 years. There was an overall mortality of 26.7 percent 17 immunophenotypes were found, 58.9 percent of them was normal, 23.4 percent reactive and 17.7 percent suspected of malignancy. Overall survival advantage was obtained in patients with cerebrospinal fluid with normal immunophenotype (HR 0.04). Conclusions: Flow cytometry could discriminate cells suspected of malignancy, in patients whose cytologies were negative. The presence in the cerebrospinal fluid of atypical cells, pleocytosis and a high lymphocyte-monocyte index were associated with a lower overall survival(AU)

Large pericardial effusion due to peritoneopericardial fistula.

A 50 years old male with previous history of dilated cardiomyopathy was admitted to cardio-intensive unit with dyspnea, cough, ascites and lower limb edema ascending to the inguinal region. 2D-Ecocardiogram revealed large pericardial effusion, without signs of diastolic restriction. The patient underwent pericardial drainage, which rapidly recollected in the following day. Abdominal ultrasound showed fibrotic and reduced size liver and subsequent radionuclide scan demonstrated direct communication between peritoneal and pericardial spaces. With the resolution of ascites, pericardial effusion did not recur. Embryologic explanation of this rare condition is still elusive, but incomplete closure of diaphragmatic muscle and thoracic-abdominal communication may represent the model of this anatomic functional anomaly.

Mordida cruzada com assimetria facial: tratamento combinado, ortodontia fixa e aparelhos removíveis / Crossbite and facial asymmetry: a combined treatment with fixed and removable appliances

O presente trabalho tem como finalidade demonstrar de forma prática a interaçäo entre a ortopedia e a ortodontia, levando ao novo conceito de tratamento Bi-Fásico. Apresentaremos um caso clínico de mordida cruzada, com séria assimetria facial e inclinaçäo do plano oclusal. Dentre as várias possibilidades de tratamento para este caso, mostraremos um planejamento com uma boa relaçäo custo/benefício e veremos que, as melhoras na fase ortopédica e na fase ortodôntica combinadas, alcançaram os objetivos propostos

Estudo oftalmológico em 85 pacientes nos diferentes grupos biológicos do climatério / Ophthalmogical study in 85 patients in different biological groups of climacteric

Realizou-se avaliaçäo oftalmológica em 85 pacientes do Ambulatório de Climatério do Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto-USP. O exame oftalmológico constou de medida de acuidade visual, exame ocular externo, tonometria de aplanaçäo, biomicroscopia, fundoscopia e refratometria. Nenhuma das pacientes estava utilizando terapêutica hormonal. Foram realizadas dosagens (no sangue) de FSH, LH, PRL, RT3, T4I, ITL, cortisol, 17 KGS, lipidograma e HDL colesterol. A idade das pacientes variou de 31 a 70 anos, com média de 49,58 anos. Das 85 pacientes examinadas, somente três näo apresentavam nenhum problema oftalmológico. Das 82 pacientes com problemas 74 tinham presbiopia, associada ou näo a patologias ou vícios de refraçäo. A pressäo intra-ocular média foi de 16,3 mmHg. Após a terapêutica hormonal ocorreu pequena queda na pressäo intra-ocular, que näo foi estatisticamente significante. É enfatizada a importância da prevençäo da cegueira e da integraçäo entre os diversos especialistas

Prêmio em economia da saúde. 1o. prêmio nacional, 2004: coletânea premiada / Prize in economy of the health: first national prize, 2004: prize-winning collection

Reúne doze trabalhos selecionados no Prêmio em Economia da Saúde, agrupados de acordo com as áreas temáticas indicadas pelo regulamento: avaliação econômica; financiamento e gasto em saúde; e integralidade, eficiência e eqüidade em sistemas de saúde

Prêmio em economia da saúde : 1º Prêmio Nacional - 2004 : coletânea premiada

Reúne doze trabalhos selecionados no Prêmio em Economia da Saúde, agrupados de acordo com as áreas temáticas indicadas pelo regulamento: avaliação econômica; financiamento e gasto em saúde; e integralidade, eficiência e eqüidade em sistemas de saúde.