Construction of a Column Line Chart-Based Predictive Model for Postoperative Pulmonary Infection Severity in Tracheostomized Patients with Cranial Brain Injuries.

Objective: To explore the construction of a column line chart-based predictive model for postoperative pulmonary infection severity in tracheostomized patients with cranial brain injuries. Methods: The study included 187 patients with cranial brain injuries who underwent tracheostomy between December 2021 and June 2023. These patients were categorized into moderate-to-severe and mild groups based on the severity of postoperative pulmonary infections. Logistic regression analysis was employed to pinpoint the autonomous risk elements for the severity of postoperative pulmonary infection in tracheostomized patients with cranial brain injuries, and a column line chart predictive model was established using these identified independent risk factors. Receiver Operating Characteristic (ROC) curves and calibration curves were used to assess the predictive performance and clinical application potential of the column line chart model for postoperative pulmonary infection risk in tracheostomized patients with cranial brain injuries. Results: Among the 187 patients, 83 (44.39%) experienced moderate-to-severe pulmonary infection. Factors such as age ≥60 years, GCS score <8, a history of long-term smoking, ASA >II, non-washable tracheal tubes, malnutrition, using a ventilator, and longer operative time were more prevalent in the moderate-to-severe group compared to the mild group (P < .05). Multivariate logistic regression analysis revealed that age ≥60 years, GCS score <8, a history of long-term smoking, ASA >II, non-washable tracheal tubes, malnutrition, using a ventilator, and longer operative time were independent risk factors for moderate-to-severe pulmonary infection in tracheostomized patients with cranial brain injuries (P < .05). Build a predictive model based on the above six independent risk factors and plot the ROC curve. ROC curve analysis demonstrated that the AUC values for age ≥60 years, GCS score <8, a history of long-term smoking, ASA >II, non-washable tracheal tubes, malnutrition, using a ventilator, and longer operative time in the column line chart model were 0.578, 0.654, 0.711, 0.652, 0.892, 0.598, 0.712, and 0.752, respectively, indicating good predictive performance of the model. Conclusion: The column line chart-based predictive model for postoperative pulmonary infection severity in tracheostomized patients with cranial brain injuries has a high discriminative power and predictive accuracy. It provides a reliable and intuitive means of predicting the severity of postoperative pulmonary infections in these individuals, enabling healthcare personnel to implement timely intervention measures, thus reducing the occurrence of pulmonary infections.

Causal relationships between gut microbiota and Aneurysmal Subarachnoid Hemorrhage: A Bidirectional Mendelian Randomization Study.

BACKGROUND AND PURPOSE: Aneurysmal Subarachnoid Hemorrhage (aSAH) poses a significant health burden globally, necessitating a deeper understanding of its etiology and potential preventive strategies. Recent research has suggested a possible link between gut microbiota composition and the risk of vascularity, prompting investigation into this association using Mendelian Randomization (MR) analysis. Here, we aimed to elucidate the causal relationship between gut microbiota composition and aSAH risk utilizing MR analysis. METHODS: We employed four distinct MR methodologies, including inverse variance weighted (IVW), MR-Egger, weighted median, and weighted mode, to assess the causal nexus between gut microbiota composition and aSAH risk. Genetic instrumental variables (IVs) associated with gut microbiome composition were selected from a comprehensive multiethnic genome-wide association study (GWAS) involving 18,473 individuals across diverse geographic regions. Sensitivity analyses were conducted to detect potential heterogeneity and pleiotropy. RESULTS: Our Mendelian Randomization (MR) analyses unveiled a substantial and statistically significant causal relationship between gut microbiota composition and the risk of Aneurysmal Subarachnoid Hemorrhage (aSAH). Employing the Inverse Variance Weighted (IVW) method, we observed negative associations between aSAH and specific taxonomic levels of gut microbiota. Specifically, the IVW approach identified significant associations with one order, Victivallales (PIVW=0.047, OR: 0.78, 95 % CI: 0.62-0.99), one family, Porphyromonadaceae (PIVW=0.03, OR: 0.64, 95 % CI: 0.43-0.95), one class, Lentisphaeria (PIVW=0.047, OR: 0.78, 95 % CI: 0.62-0.99), and three genera: Bilophila (PIVW=0.02, OR: 0.68, 95 % CI: 0.50-0.93), Fusicatenibacter (PIVW=0.04, OR: 0.69, 95 % CI: 0.49-0.98), and Ruminococcus1 (PIVW=0.01, OR: 0.51, 95 % CI: 0.32-0.84). These findings were consistent across various MR methodologies, underscoring the robustness of our results. Sensitivity analyses further validated the stability of our findings, with no evidence of heterogeneity or pleiotropy detected. CONCLUSION: Our study provides compelling evidence supporting a causal relationship between gut microbiota composition and the risk of aSAH. These findings underscore the potential therapeutic implications of modulating gut microbiota to prevent and manage aSAH. Further research is warranted to explore the underlying mechanisms and develop targeted interventions aimed at mitigating aSAH risk through gut microbiota modulation.

Exploring the causal links between cigarette smoking, alcohol consumption, and aneurysmal subarachnoid hemorrhage: a two-sample Mendelian randomization analysis.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) represents a critical health concern characterized by elevated mortality and morbidity rates. Although both genetic predisposition and lifestyle choices influence aSAH susceptibility, understanding the causative associations between cigarette smoking, alcohol consumption, and aSAH risk remains imperative. Mendelian randomization (MR) offers a robust methodological framework for dissecting these associations, leveraging genetic variants as instrumental variables. Objective: In this study, a two-sample Mendelian randomization (TSMR) approach was employed to elucidate the causal connections between genetically determined cigarette smoking, alcohol consumption, and aSAH risk. Methods: Genetic instruments associated with cigarette smoking and alcohol consumption were sourced from the genome-wide association study (GWAS) and Sequencing Consortium of Alcohol and Nicotine use (GSCAN). Using a genome-wide association study (GWAS) dataset that encompassed aSAH cases and controls of European ancestry, TSMR, which utilized the inverse variance weighting (IVW) method, was employed to estimate the causal effects. Rigorous criteria were applied for selecting instrumental variables to ensure a robust Mendelian randomization analysis. Results: A significant causal association was found between genetically determined cigarette smoking and an increased risk of aSAH, with a 1-standard deviation (SD) increase in cigarette use genetically linked to a 96% relative risk elevation [OR-IVW = 1.96, 95% confidence interval (CI) = 1.28-3.01, p = 0.0021]. However, genetically determined alcohol consumption did not exhibit a statistically significant association with aSAH risk (OR-IVW = 1.22, 95% CI = 0.61-2.45, p = 0.578). Conclusion: The Mendelian randomization analysis revealed a causal nexus between cigarette smoking and an increased risk of aSAH, advocating for targeted smoking cessation interventions within genetically predisposed cohorts. The results regarding the relationship between alcohol consumption and aSAH were affected by insufficient statistical power. A prudent interpretation of the findings highlights the limitations of Mendelian randomization in elucidating intricate genetic epidemiological relationships. Ongoing research involving larger cohort sizes and advanced methodological approaches is essential for comprehending the genetic underpinnings of aSAH.

Modeling and evaluation of biomechanics and hemodynamic based on patient-specific small intracranial aneurysm using fluid-structure interaction.

BACKGROUND AND OBJECTIVE: Rupture of small intracranial aneurysm (IA) often leads to the development of highly fatal clinical syndromes such as subarachnoid hemorrhage. Due to the patient specificity of small IA, there are many difficulties in evaluating the rupture risk of small IA such as multiple influencing factors, high clinical experience requirements and poor reusability. METHODS: In this study, clinical methods such as transcranial doppler (TCD) and magnetic resonance imaging (MRI) are used to obtain patient-specific parameters, and the fluid-structure interaction method (FSI) is used to model and evaluate the biomechanics and hemodynamics of patient-specific small IA. RESULTS: The results show that a spiral vortex stably exists in the patient-specific small IA. Due to the small size of the patient-specific small IA, the blood flow velocity still maintains a high value with maximum reaching 3 m/s. The inertial impact of blood flow and vortex convection have certain influence on hemodynamic and biomechanics parameters. They cause three high value areas of WSSM on the patient-specific small IA with maximum of 180 Pa, 130 Pa and 110 Pa, respectively. They also cause two types of WSS concentration points, positive normal stress peak value areas and negative normal stress peak value areas to appear. CONCLUSION: This paper found that the factors affecting hemodynamic parameters and biomechanical parameters are different. Unlike hemodynamic parameters, biomechanical parameters are also affected by blood pressure in addition to blood flow velocity. This study reveals the relationship between the flow field distribution and changes of patient-specific small IA, biomechanics and hemodynamics.

Surgical cannulation of the superior ophthalmic vein for the treatment of previously embolized cavernous sinus dural arteriovenous fistulas: serial studies and angiographic follow-up.

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of transorbital puncture for the retreatment of previously embolized cavernous sinus dural arteriovenous fistulas (DAVFs) via a superior ophthalmic vein (SOV) approach. MATERIALS AND METHODS: During a 12-year period, 9 consecutive patients with previously embolized cavernous sinus DAVFs underwent retreatment via the transorbital SOV approach. RESULTS: All of the nine cases of previously embolized cavernous sinus DAVFs were successfully embolized. Clinical follow-ups were conducted in all nine cases at the duration of 17-141 months (61.22 ± 39.13 months). No recanalization occurred during the follow-up period. A subtle ptosis appeared in two patients and disappeared in one of the two cases after a 4-year follow-up. One patient suffered from paroxysmal positional vertigo and bruit for nearly 2 years after the treatment, but the follow-up angiography demonstrated no recurrence. One patient had persistent visual impairment caused by the initial venous stasis retinopathy. One patient with a history of a procedure-related transient decrease in visual acuity had it return to the normal level. The remaining four cases had clear improvement in the ocular symptoms and became completely asymptomatic during the follow-up period. No patient worsened or developed new symptoms. CONCLUSION: The approach of surgical cannulation of the SOV for the retreatment of previously embolized cavernous sinus DAVFs was proved feasible and efficient, especially when the transarterial and transfemoral venous approaches were inaccessible. However, if the SOV is not dilated enough or is located deeply in the orbit, transorbital venous puncture access may not be possible.

Development of multi-generation lower respiratory tract model and insights into the transport and deposition characteristics of inhalable particles.

Airborne particles can spread quickly and enter human respiratory system via inhalation, causing chronic diseases, even cancer. Although recent studies have informed of toxicity of various pollutants, understanding the transport and deposition characteristics of particles in lower respiratory tract is still challenging. The current study proposes a novel model to simulate flow field change from the entrance of lower respiratory tract to pulmonary acinus, while studying particle transport and deposition characteristics. This model for lower respiratory tract with several bronchial extensions containing virtual pulmonary acinus is calculated using computational fluid dynamics and dynamics mesh. The results showed that in the first 10 generations of the lower respiratory tract, vortices and gravity interfered with particles' trajectory, affecting particle deposition distribution. For the first to the tenth-generation respiratory tract, coarse particles were deposited throughout almost the whole respiratory tract model. In contrast, ultrafine particles did not deposit in the higher-generation respiratory tract. The particle enrichment ability of various lobes was uneven with three particle deposition fraction variation patterns. Virtual pulmonary acinus influenced particle deposition and distribution because of vortex ring's trapped ability during expansion and contraction. This new attempt to build a virtual pulmonary acinus model to simulate particle deposition effects in human respiratory system may provide a reference for studying the toxicities of inhalable particles in the exposed human body.

Wnt/ß-catenin signaling pathway inhibits the proliferation and apoptosis of U87 glioma cells via different mechanisms.

The Wnt signaling pathway is necessary for the development of the central nervous system and is associated with tumorigenesis in various cancers. However, the mechanism of the Wnt signaling pathway in glioma cells has yet to be elucidated. Small-molecule Wnt modulators such as ICG-001 and AZD2858 were used to inhibit and stimulate the Wnt/ß-catenin signaling pathway. Techniques including cell proliferation assay, colony formation assay, Matrigel cell invasion assay, cell cycle assay and Genechip microarray were used. Gene Ontology Enrichment Analysis and Gene Set Enrichment Analysis have enriched many biological processes and signaling pathways. Both the inhibiting and stimulating Wnt/ß-catenin signaling pathways could influence the cell cycle, moreover, reduce the proliferation and survival of U87 glioma cells. However, Affymetrix expression microarray indicated that biological processes and networks of signaling pathways between stimulating and inhibiting the Wnt/ß-catenin signaling pathway largely differ. We propose that Wnt/ß-catenin signaling pathway might prove to be a valuable therapeutic target for glioma.

The effect of Neuroform stent-assisted coil embolization of wide-necked intracranial aneurysms and clinical factors on progressive aneurysm occlusion on angiographic follow-up.

Stent-assisted coil embolization is an endovascular treatment for wide-necked intracranial aneurysms, but the durability of this treatment is not well known. The aim of this study is to investigate the effect of the Neuroform stent (Boston Scientific/Target, Fremont, CA, USA) in progressive occlusion of wide-necked intracranial aneurysms, and to assess any correlation between clinical factors and angiographic follow-up results. The records of 52 patients treated with a Neuroform stent were retrieved for analysis of population characteristics, initial and follow-up angiographic results, and clinical outcomes. Initial angiographic results showed complete occlusion in 21 (40.4%), neck remnants in 22 (42.3%), and residual aneurysms in nine (17.3%). Angiographic follow-up was available in 45 of 52 (86.5%) patients: complete occlusion was achieved in 32 (71.1%), neck remnants were present in eight (17.8%) and residual aneurysms in five (11.1%). Of 31 patients with immediate incomplete obliteration, progressive complete occlusion was achieved in 16 of 28 (57.1%) patients. Clinical follow-up showed good outcomes according to the modified Rankin Scale score. A univariate analysis showed that there was no effect of the tested clinical variables of patient age (p=0.823), gender (p=0.419), aneurysm location (p=0.394), size (p=0.625) and rupture status (p=0.721) on aneurysm occlusion at follow-up. We conclude that the Neuroform stent-assisted neck remodelling technique improves progressive occlusion of wide-necked intracranial aneurysms with good clinical outcomes.

Factors responsible for poor outcome after intraprocedural rerupture of ruptured intracranial aneurysms: identification of risk factors, prevention and management on 18 cases.

PURPOSE: The paper mainly involved the retrospective approach to risk factors of intraprocedual rerupture (IPR) and illustration of our empirical prevention and management on this event as well as its postembolization outcomes evaluation. MATERIALS AND METHODS: Endovascular treatment was performed in 1308 patients with 1308 ruptured intracranial aneurysms, and IPR occurred in 18 cases. We retrospectively reviewed their clinical records and images, and analysis risk factors of IPR by using multivariate logistic regression. RESULTS: The morbidity of IPR was 1.38% and mortality was 33.33%. Nine patients survived from rapid completion of coiling with immediate reversal of heparin anticoagulation with protamine sulfate, and 3 from emergent external ventricular drainage (EVD). However, 9 of them presented with different degrees of disability and 3 were fully recovered. Small aneurysms (diameter ≤ 3.0mm) (OR 284.212, 95% C.I. 17.368-4650.780, P=0.000), atherosclerosis (OR 7.866, 95% C.I. 1.113-55.570, P=0.039), Fisher Grade III (OR 82.099, 95% C.I. 1.563-431.696, P=0.029), vasospasm (grade I) (OR 32.269, 95% C.I. 2.393-435.132, P=0.009) and vasospasm (grade II) (OR 30.238, 95% C.I. 1.770-516.552, P=0.019) are risk factors of IPR. Aneurysms at proximal part of internal carotid artery (ICA), bifurcation and basilar artery (BA) stem (OR 0.003, 95% C.I. 0.000-0.101, P=0.001) and Hunt and Hess Grade II (OR 0.010, 95% C.I. 0.000-0.346, P=0.011) are identified as protective factors. CONCLUSIONS: Small aneurysms, atherosclerosis, Fisher Grade of SAH and cerebral vasospasm are the predictors of IPR. Aneurysms at proximal part of ICA bifurcation and BA stem and Hunt and Hess Grade II are less associated with IPR. Rapid completion of coiling combined with immediate reversal of heparin anticoagulation is confirmed to be the best strategy in our series.

Recovery of posterior communicating artery aneurysm-induced oculomotor nerve paresis after endovascular treatment.

OBJECTIVE: Recovery of aneurysm-induced oculomotor nerve paresis (ONP) after endosaccular coiling has not yet been adequately assessed. The aim of this study was to investigate the factors that affect the outcome of ONP after endovascular treatment of posterior communicating artery (PcomA) aneurysms. MATERIALS AND METHODS: We retrospectively evaluated the clinical characteristics and the outcome of oculomotor nerve function in a series of 36 patients with ONP due to PcomA aneurysms treated by endovascular coiling. Univariate analysis was applied to test the association between ONP recovery and clinical variables. RESULTS: Thirty-six consecutive patients (20 women, 16 men; mean age, 54.3±9 years) presenting with ONP underwent endosaccular coiling were enrolled in this study. Subarachnoid hemorrhage was present in 21 patients. The mean size of the aneurysms was 9.3±3.9mm. ONP was complete in 14 patients (38.9%) and partial in 22 patients (61.1%) at admission. Seventeen patients (47.2%) had complete recovery of oculomotor nerve function, 15 had incomplete recovery (41.7%), and 4 (11.1%) remained unchanged after treatment. Factors showing significant association with recovery of oculomotor nerve function were the length and degree of ONP before treatment (P=0.035 and P=0.019, respectively). CONCLUSIONS: Endosaccular coiling of PcomA aneurysms in patients with ONP resulted in cure or improvement of oculomotor nerve dysfunction in the majority of patients. The length and degree of preoperative ONP were the statistically significant predictors of complete ONP recovery.

Endovascular treatment of ruptured sausage-shaped intracranial aneurysms with the "interlacing ball" technique.

We applied the "interlacing ball" technique to 18 ruptured sausage-shaped intracranial aneurysms (SSIA) with Hunt and Hess Grades I to III in 18 patients. Coils were joined to form the first three-dimensional ball-like structure at the dome of the aneurysm. A segment of the last coil was purposely left out of the first ball so that it could be joined with the next coil used to form a second "ball". This second ball was woven into the neck portion in a net-like fashion to prevent coil protrusion into the parent artery. An immediate post-procedural angiogram showed complete occlusion in 16 aneurysms (88.9%) and near-complete occlusion in two aneurysms with no complications. Sixteen patients were discharged with a Glasgow Outcome Scale (GOS) score of 5, and two with a GOS score of 4. One patient developed an enlarging aneurysm neck as visualized on an angiogram, while 17 aneurysms (94.4%) demonstrated no recurrence, within 3 months to 37 months of follow-up. We report that this technique is useful for the successful embolization of SSIA.

Impact of ultra-early coiling on clinical outcome after aneurysmal subarachnoid hemorrhage in elderly patients.

RATIONALE AND OBJECTIVES: The incidence of aneurysmal subarachnoid hemorrhage is increasing in the elderly as life expectancy increases. The purpose of this study was to analyze whether ultra-early coiling of ruptured intracranial aneurysms improves clinical outcomes in elderly patients. MATERIALS AND METHODS: Records of patients (aged ≥ 70 years) with aneurysmal subarachnoid hemorrhage treated with endovascular coiling were retrieved. Patients were classified into two groups: group A (patients coiled within 24 hours of subarachnoid hemorrhage) and group B (patients coiled ≥24 hours after subarachnoid hemorrhage). For each group, patient demographics, World Federation of Neurological Surgeons clinical grade, Fisher computed tomographic grade, aneurysm characteristics, and clinical outcomes were recorded. Outcomes were measured using the Modified Rankin Scale at 6 months. RESULTS: Fifty-six patients were coiled within 24 hours of subarachnoid hemorrhage (group A) and 40 patients at ≥24 hours after subarachnoid hemorrhage (group B). Groups A and B had similar clinical and angiographic characteristics. Clinical outcomes showed that a total of 87.5% of patient (49 of 56) in group A were independent (Modified Rankin Scale score 0-2) compared with 70.0% of patients (28 of 40) in group B (P = .034). In multivariate logistic regression analysis, ultra-early coiling (odds ratio, 3.860; 95% confidence interval, 1.125-13.249; P = .032) proved to be an independent predictor of better clinical outcome (Modified Rankin Scale score 0-2). CONCLUSIONS: Ultra-early (<24 hours after subarachnoid hemorrhage) coiling of ruptured aneurysms was marginally associated with improved clinical outcomes compared to coiling at ≥24 hours in elderly patients. Larger, prospective studies are required to adequately assess outcome differences between these two groups.

[A modified endovascular treatment for longitudinal intracranial aneurysm].

OBJECTIVE: To study the surgical approach and curative effect of the "interlocking basket" technique in interventional therapy for longitudinal intracranial aneurysm. METHODS: Thirty-eight Hunt and Hess Grade I-III patients with longitudinal intracranial aneurysm underwent interventional therapy using the "interlocking basket" technique. During the operation, the aneurysm was divided into two segments based on its length and occluded with two coils. The first coil with a transverse diameter matching that of the aneurysm was deployed to form a "basket", which was densely occluded, and a portion of this coil out of the "basket" was interlocked with the second coil to form another "basket" crossing the aneurysmal neck to prevent the coils from escaping till the neck of the aneurysm was densely occluded. RESULTS: Thirty-five aneurysms (92.1%) were completely embolized, and 3 (7.9%) were 95% embolized. No coil escaping from the aneurysm neck or other complications occurred. Twenty-five patients were discharged with a GOS score of 5 (65.8%), 7 (18.4%) with a score of 4, and 6 (15.8%) had a score of 3. In the follow-up for 3-25 months after the embolization, angiography was performed in 28 cases, and recurrence was found in 2 cases (7.14%). CONCLUSION: The "interlocking basket" technique can increase the coil stability in longitudinal intracranial aneurysm and allows reliable block of the aneurysm neck and dense embolization of the aneurysm to improve the clinical outcomes of the patients.