Circ_0008571 modulates the phenotype of vascular smooth muscle cells by targeting miR-145-5p in intracranial aneurysms.

BACKGROUND: The dysfunction of human vascular smooth cells (hVSMCs) is significantly connected to the development of intracranial aneurysms (IAs). By suppressing the activity of microRNAs (miRNAs), circular RNAs (circRNAs) participate in IA pathogenesis. Nevertheless, the role of hsa_circ_0008571 in IAs remains unclear. METHODS: circRNA sequencing was used to identify circRNAs from human IA tissues. To determine the function of circ_0008571, Transwell, wound healing, and cell proliferation assays were conducted. To identify the target of circ_0008571, the analyses of CircInteractome and TargetScan, as well as the luciferase assay were carried out. Furthermore, circ_0008571 knockdown and over-expression were performed to investigate its functions in IA development and the underlying molecular mechanisms. RESULTS: Both hsa_circ_0008571 and Integrin beta 8 (ITGB8) were downregulated, while miR-145-5p transcription was elevated in the aneurysm wall of IAs patients compared to superficial temporal artery tissues. In vitro, cell migration and growth were dramatically suppressed after hsa_circ_0008571 overexpression. Mechanistically, has_circ_0008571 could suppress miR-145-5p activity by direct sponging. Moreover, we found that ITGB8 expression and the activation of the TGF-ß-mediated signaling pathway were significantly enhanced. CONCLUSION: The hsa_circ_0008571-miR-145-5p-ITGB8 axis plays an essential role in IA progression.

Impact of premorbid hypertension and renin-angiotensin-aldosterone system inhibitors on the severity of aneurysmal subarachnoid haemorrhage: a multicentre study.

BACKGROUND: Hypertension is widely acknowledged as a significant contributory factor to the heightened risk of intracranial aneurysm rupture. Nevertheless, the impact of hypertension management on the outcomes subsequent to aneurysmal subarachnoid haemorrhage (aSAH), particularly concerning the severity of aSAH, remains an underexplored area. METHODS: We conducted a retrospective analysis using data from a prospectively multicentre cohort of 4545 patients with aSAH in China. Premorbid hypertension status and the utilisation of antihypertensive medications prior to admission were set as key exposure factors. The primary outcomes encompassed unfavourable clinical grading scales observed on admission. Employing multivariable logistic regression, we explored the association between premorbid hypertension status, preadmission use of renin-angiotensin-aldosterone system (RAAS) inhibitors and unfavourable clinical grading scales. RESULTS: In comparison to patients with normal blood pressure, only uncontrolled hypertension demonstrated a significant and independent association with an elevated risk of poor outcomes on the Hunt-Hess scale (OR=1.799, 95% CI 1.413 to 2.291, p<0.001) and the World Federation of Neurological Surgeons (WFNS) scale (OR=1.721, 95% CI 1.425 to 2.079, p<0.001). Furthermore, the antecedent use of RAAS inhibitors before admission was markedly and independently linked to a diminished risk of adverse outcomes on the Hunt-Hess scale (OR=0.653, 95% CI 0.430 to 0.992, p=0.046) and the WFNS scale (OR=0.656, 95% CI 0.469 to 0.918, p=0.014). CONCLUSIONS: Uncontrolled hypertension markedly elevates the risk of adverse clinical outcomes following an aSAH. Conversely, the preadmission utilisation of RAAS inhibitors demonstrates a noteworthy association with a favourable clinical outcome after aSAH.

A Whole-Process Visible Strategy for the Preparation of Rhizomucor miehei Lipase with Escherichia coli Secretion Expression System and the Immobilization.

BACKGROUND: Rhizomucor miehei (RM) lipase is a regioselective lipase widely used in food, pharmaceutical and biofuel industries. However, the high cost and low purity of the commercial RM lipase limit its industrial applications. Therefore, it is necessary to develop cost-effective strategies for large-scale preparation of this lipase. The present study explored the high-level expression of RM lipase using superfolder green fluorescent protein (sfGFP)-mediated Escherichia coli secretion system. RESULTS: The sfGFP(-15) mutant was fused to the C-terminus of RM lipase to mediate its secretion expression. The yield of the fusion protein reached approximately 5.1 g/L with high-density fermentation in 5-L fermentors. Unlike conventional secretion expression methods, only a small portion of the target protein was secreted into the cell culture while majority of the fusion protein was still remained in the cytoplasm. However, in contrast to intracellular expression, the target protein in the cytoplasm could be transported efficiently to the supernatant through a simple washing step with equal volume of phosphate saline (PBS), without causing cell disruption. Hence, the approach facilitated the downstream purification step of the recombinant RM lipase. Moreover, contamination or decline of the engineered strain and degradation or deactivation of the target enzyme can be detected efficiently because they exhibited bright green fluorescence. Next, the target protein was immobilized with anion-exchange and macropore resins. Diethylaminoethyl sepharose (DEAE), a weak-basic anion-exchange resin, exhibited the highest bind capacity but inhibited the activity of RM lipase dramatically. On the contrary, RM lipase fixed with macropore resin D101 demonstrated the highest specific activity. Although immobilization with D101 didn't improve the activity of the enzyme, the thermostability of the immobilized enzyme elevated significantly. The immobilized RM lipase retained approximately 90% of its activity after 3-h incubation at 80 °C. Therefore, D101 was chosen as the supporting material of the target protein. CONCLUSION: The present study established a highly efficient strategy for large-scale preparation of RM lipase. This innovative technique not only provides high-purity RM lipase at a low cost but also has great potential as a platform for the preparation of lipases in the future.

High-Power-Density Rechargeable Hybrid Alkali/Acid Zn-Air Battery Performance Through Value-Added Conversion Charging.

Rechargeable Zn-air batteries (ZABs) are considered highly competitive technologies for meeting the energy demands of the next generation, whether for energy storage or portable power. However, their practical application is hindered by critical challenges such as low voltage, CO2 poisoning at the cathode, low power density, and poor charging efficiency Herein, a rechargeable hybrid alkali/acid Zn-air battery (h-RZAB) that effectively separates the discharge process in an acidic environment from the charging process in an alkaline environment, utilizing oxygen reduction reaction (ORR) and glycerol oxidation reaction (GOR) respectively is reported. Compared to previously reported ZABs, this proof-of-concept device demonstrates impressive performance, exhibiting a high power density of 562.7 mW cm-2 and a high operating voltage during discharging. Moreover, the battery requires a significantly reduced charging voltage due to the concurrent utilization of biomass-derived glycerol, resulting in practical and cost-effective advantages. The decoupled system offers great flexibility for intermittently generated renewable power sources and presents cost advantages over traditional ZABs. As a result, this technology holds significant promise in opening avenues for the future development of renewable energy-compatible electrochemical devices.

Advanced Hollow Cubic FeCo-N-C Cathode Electrocatalyst for Ultrahigh-Power Aluminum-Air Battery.

The exploration of electrocatalysts toward oxygen reduction reaction (ORR) is pivotal in the development of diverse batteries and fuel cells that rely on ORR. Here, a FeCo-N-C electrocatalyst (FeCo-HNC) featuring with atomically dispersed dual metal sites (Fe-Co) and hollow cubic structure is reported, which exhibits high activity for electrocatalysis of ORR in alkaline electrolyte, as evidenced by a half-wave potential of 0.907 V, outperforming that of the commercial Pt/C catalyst. The practicality of such FeCo-HNC catalyst is demonstrated by integrating it as the cathode catalyst into an alkaline aluminum-air battery (AAB) paring with an aluminum plate serving as the anode. This AAB demonstrates an unprecedented power density of 804 mW cm-2 in ambient air and an impressive 1200 mW cm-2 in an oxygen-rich environment. These results not only establish a new benchmark but also set a groundbreaking record for the highest power density among all AABs reported to date. Moreover, they stand shoulder to shoulder with state-of-the-art H2-O2 fuel cells. This AAB exhibits robust stability with continuous operation for an impressive 200 h. This groundbreaking achievement underscores the immense potential and forward strides that the present work brings to the field.

Nomograms for assessing the rupture risk of anterior choroid artery aneurysms based on clinical, morphological, and hemodynamic features.

Background and purpose: A notable prevalence of subarachnoid hemorrhage is evident among patients with anterior choroidal artery aneurysms in clinical practice. To evaluate the risk of rupture in unruptured anterior choroidal artery aneurysms, we conducted a comprehensive analysis of risk factors and subsequently developed two nomograms. Methods: A total of 120 cases of anterior choroidal artery aneurysms (66 unruptured and 54 ruptured) from 4 medical institutions were assessed utilizing computational fluid dynamics (CFD) and digital subtraction angiography (DSA). The training set, consisting of 98 aneurysms from 3 hospitals, was established, with an additional 22 cases from the fourth hospital forming the external validation set. Statistical differences between the two data sets were thoroughly compared. The significance of 9 clinical baseline characteristics, 11 aneurysm morphology parameters, and 4 hemodynamic parameters concerning aneurysm rupture was evaluated within the training set. Candidate selection for constructing the nomogram models involved regression analysis and variance inflation factors. Discrimination, calibration, and clinical utility of the models in both training and validation sets were assessed using area under curves (AUC), calibration plots, and decision curve analysis (DCA). The DeLong test, net reclassification index (NRI), and integrated discrimination improvement (IDI) were employed to compare the effectiveness of classification across models. Results: Two nomogram models were ultimately constructed: model 1, incorporating clinical, morphological, and hemodynamic parameters (C + M + H), and model 2, relying primarily on clinical and morphological parameters (C + M). Multivariate analysis identified smoking, size ratio (SR), normalized wall shear stress (NWSS), and average oscillatory shear index (OSIave) as optimal candidates for model development. In the training set, model 1 (C + M + H) achieved an AUC of 0.795 (95% CI: 0.706 ~ 0.884), demonstrating a sensitivity of 95.6% and a specificity of 54.7%. Model 2 (C + M) had an AUC of 0.706 (95% CI: 0.604 ~ 0.808), with corresponding sensitivity and specificity of 82.4 and 50.3%, respectively. Similarly, AUCs for models 1 and 2 in the external validation set were calculated to be 0.709 and 0.674, respectively. Calibration plots illustrated a consistent correlation between model evaluations and real-world observations in both sets. DCA demonstrated that the model incorporating hemodynamic parameters offered higher clinical benefits. In the training set, NRI (0.224, p = 0.007), IDI (0.585, p = 0.002), and DeLong test (change = 0.089, p = 0.008) were all significant. In the external validation set, NRI, IDI, and DeLong test statistics were 0.624 (p = 0.063), 0.572 (p = 0.044), and 0.035 (p = 0.047), respectively. Conclusion: Multidimensional nomograms have the potential to enhance risk assessment and patient-specific treatment of anterior choroidal artery aneurysms. Validated by an external cohort, the model incorporating clinical, morphological, and hemodynamic features may provide improved classification of rupture states.

RAGE plays key role in diabetic retinopathy: a review.

RAGE is a multiligand receptor for the immunoglobulin superfamily of cell surface molecules and is expressed in Müller cells, vascular endothelial cells, nerve cells and RPE cells of the retina. Diabetic retinopathy (DR) is a multifactorial disease associated with retinal inflammation and vascular abnormalities and is the leading cause of vision loss or impairment in older or working-age adults worldwide. Therapies aimed at reducing the inflammatory response and unnecessary angiogenesis can help slow the progression of DR, which in turn can save patients' vision. To maximize the efficacy and minimize the side effects, treatments that target key players in the pathophysiological process of DR need to be developed. The interaction between RAGE and its ligands is involved in a variety of cytopathological alterations in the retina, including secretion of inflammatory factors, regulation of angiogenesis, oxidative stress, structural and functional changes, and neurodegeneration. In this review, we will summarize the pathologic pathways mediated by RAGE and its ligand interactions and discuss its role in the progression of diabetic retinopathy to explore potential therapeutic targets that are effective and safe for DR.

Reference-based genome compression using the longest matched substrings with parallelization consideration.

BACKGROUND: A large number of researchers have devoted to accelerating the speed of genome sequencing and reducing the cost of genome sequencing for decades, and they have made great strides in both areas, making it easier for researchers to study and analyze genome data. However, how to efficiently store and transmit the vast amount of genome data generated by high-throughput sequencing technologies has become a challenge for data compression researchers. Therefore, the research of genome data compression algorithms to facilitate the efficient representation of genome data has gradually attracted the attention of these researchers. Meanwhile, considering that the current computing devices have multiple cores, how to make full use of the advantages of the computing devices and improve the efficiency of parallel processing is also an important direction for designing genome compression algorithms. RESULTS: We proposed an algorithm (LMSRGC) based on reference genome sequences, which uses the suffix array (SA) and the longest common prefix (LCP) array to find the longest matched substrings (LMS) for the compression of genome data in FASTA format. The proposed algorithm utilizes the characteristics of SA and the LCP array to select all appropriate LMSs between the genome sequence to be compressed and the reference genome sequence and then utilizes LMSs to compress the target genome sequence. To speed up the operation of the algorithm, we use GPUs to parallelize the construction of SA, while using multiple threads to parallelize the creation of the LCP array and the filtering of LMSs. CONCLUSIONS: Experiment results demonstrate that our algorithm is competitive with the current state-of-the-art algorithms in compression ratio and compression time.

Use of 3D-printing cerebral aneurysm model assisting microcatheter shaping in neurovascular intervention technique training.

BACKGROUND: Microcatheter shaping plays a vital role in coil embolization of cerebral aneurysms, while the complicated method and insufficient training opportunities make it difficult for junior neurovascular clinicians to master this technique. In this program, we constructed a novel training method and assessment system for microcatheter shaping in coil embolization of cerebral aneurysms with 3D technique, and evaluated its efficacy for microcatheter shaping training in junior neurovascular clinicians. METHODS: Patient-specific models for cerebral aneurysms in different locations and with different morphologies were selected by experienced senior neurovascular clinicians. The solid polylactic acid model and the soft hollow crystal silicone model of intracranial aneurysms were then made separately for shaping reference and assessment in the training course. Twelve residents without prior experience of microcatheter shaping and 25 neurovascular clinicians who have in vivo experience of microcatheter shaping on 3-5 occasions were selected for this training program and randomly divided into the traditional training group and the experimental training group. Four senior neurovascular clinicians assisted and guided the trainees in two groups and evaluated the time and accuracy of microcatheter shaping. RESULTS: Eighteen trainees were assigned to the traditional training group, among which 4 had prior experience in microcatheter shaping. The other 19 were assigned to the experimental training group, including 8 with prior experience. No statistical difference in the distribution of experienced students between the two groups was noted(P = 0.295). After the training session, the shaping time was found shorter in the experimental training group than that in the traditional training group (40.3.5 ± 16.2 s vs. 54.2 ± 16.4 s, P = 0.014), while the shaping score was found higher in the experimental training group than that in the traditional training group (4.4 ± 0.5 vs. 2.6 ± 1.2, P < 0.001). Specifically, for the trainees without prior experience, the experimental training group also showed less time consumption and higher score (Time: 52.7 ± 7.7 vs. 61.5 ± 9.5, P = 0.02; Score 4.1 ± 0.5 vs. 2.3 ± 1.1, P < 0.01). Meanwhile, for the trainees with prior experience, the advantage was noted in shaping score (4.7 ± 0.3 vs. 3.9 ± 0.6, P < 0.01) but not in time consumption (23.3 ± 4.4 vs. 28.5 ± 3.9, P = 0.07). CONCLUSION: This training program is quite effective at teaching junior neurovascular physicians the essential surgical abilities required for coiling cerebral aneurysms.

Applications of Programmable Endonucleases in Sequence- and Ligation-Independent Seamless DNA Assembly.

Programmable endonucleases, such as Cas (Clustered Regularly-Interspaced Short Repeats-associated proteins) and prokaryotic Argonaute (pAgo), depend on base pairing of the target DNA with the guide RNA or DNA to cleave DNA strands. Therefore, they are capable of recognizing and cleaving DNA sequences at virtually any arbitrary site. The present review focuses on the commonly used in vivo and in vitro recombination-based gene cloning methods and the application of programmable endonucleases in these sequence- and ligation-independent DNA assembly methods. The advantages and shortcomings of the programmable endonucleases utilized as tools for gene cloning are also discussed in this review.

Role of Circulating Exosomes in Cerebrovascular Diseases: A Comprehensive Review.

Exosomes are lipid bilayer vesicles that contain multiple macromolecules secreted by the parent cells and play a vital role in intercellular communication. In recent years, the function of exosomes in cerebrovascular diseases (CVDs) has been intensively studied. Herein, we briefly review the current understanding of exosomes in CVDs. We discuss their role in the pathophysiology of the diseases and the value of the exosomes for clinical applications as biomarkers and potential therapies.

Development of high-efficiency alkaline OER electrodes for hybrid acid-alkali electrolytic H2 generation.

The development of high-efficiency oxygen evolution reaction (OER) electrocatalysts is of great importance for electrolytic H2 generation. In this work, we report in-situ growth of MnCo2O4 nanoneedles and NiFeRu layered double hydroxide (LDH) nanosheets on nickel foam (NF) (MnCo2O4@NiFeRu-LDH/NF) that can function a highly efficient electrode toward electrocatalysis of OER. Such electrode demands an overpotential of as low as 205 mV to reach 10 mA cm-2 in alkaline electrolyte and can run stably over 120-hours continuous operation. A hybrid flow acid/alkali electrolyzer is set up by using the Pt/C as the acidic cathode coupling with the MnCo2O4@NiFeRu-LDH/NF as the alkaline anode, which only requires an applied voltage of 0.59 V and 0.94 V to attain an electrolytic current density of 10 mA cm-2 and 100 mA cm-2, respectively. The present work could push forward the further development of the electricity-saving electrolytic technique for H2 generation.

Aqueous OH- /H+ Dual-Ion Zn-Based Batteries.

Aqueous Zn-based batteries hold multiple advantages of eco-friendliness, easy accessibility, high safety, easy fabrication, and fast kinetics, while their widespread applications have been greatly limited by the relatively narrow thermodynamically stable potential windows (i. e., 1.23 V) of water and the mismatched pH conditions between cathode and anode, which presents challenges regarding how to maximize the output voltage and the energy density. Recently, aqueous OH- /H+ dual-ion Zn-based batteries (OH- /H+ -DIZBs), where the Zn anode reacts with hydroxide ions (OH- ) in alkaline electrolyte while hydrogen ions (H+ ) are involved in the cathode reaction in the acidic electrolyte, have been reported to be capable of broadening the working voltage and improving the energy density, which offers practical feasibility toward overcoming the above limitations. This Review thus takes this chance to investigate the recent progress on aqueous OH- /H+ -DIZBs. First, the concept and the history of such OH- /H+ -DIZBs are introduced, and then special emphasis is put on the working mechanisms, the progress of the development of new batteries, and how the electrolytes improve their performance. Finally, the challenges and opportunities in this field are discussed.

Retreatment with a flow diverter for recurrent blood blister-like aneurysms after embolization: A single-center case series.

Background and purpose: Treatment of blood blister-like aneurysms (BBAs) has been a significant challenge mainly due to their high recurrence rate even after stent-assisted coiling (SAC) embolization. This study aims to evaluate the safety and efficacy of treating recurrent BBAs after SAC with a flow diverter (FD). Methods: A retrospective series of patients with recurrent BBAs who underwent the retreatment with the FD from June 2018 to December 2021 was included to analyze perioperative safety and immediate postoperative and follow-up outcomes. Results: The study enrolled 13 patients with recurrent BBAs previously treated with SAC. Within previous stents, an FD was deployed for retreatment, including eight Tubridge FDs and five PEDs. The time interval between initial treatment and FD implantation was 14-90 days. A total of 11 cases were treated with a single FD alone; two cases were treated with further endovascular coiling embolization, followed by FD implantation. The angiographic follow-up (6-12 months) was available in 12 patients, and all 12 recurrent BBAs were completely occluded. No perioperative complication was detected, and no rebleeding was found during the clinical follow-up (6-36 months). Conclusion: The use of the FD to manage recurrent BBAs after SAC is technically feasible, safe, and effective. The key to the success of the procedure is to ensure that the FD stent is fully open and has good apposition with the previously implanted stent.

Crack Localization in Operating Rotors Based on Multivariate Higher Order Dynamic Mode Decomposition.

A novel output-only crack localization method is proposed for operating rotors based on an enhanced higher-order dynamic mode decomposition (HODMD), in which the nonlinear breathing crack-induced super-harmonic characteristic components from multiple vibration measurement points are simultaneously extracted to compose the corresponding super-harmonic transmissibility damage indexes. Firstly, the theoretical background of the HODMD is briefly reviewed. Secondly, the proposed crack localization method is dedicated which improving the HODMD for multivariate signals by casting the total least square method into standard HODMD and adaptively selecting the order parameter of Koopman approximation by optimizing the super-harmonic frequency vector. In addition, the super-harmonic characteristic components are evaluated and harnessed to derive the damage index based on super-harmonic transmissibility and fractal dimension. Finally, the proposed method is investigated and demonstrated by numerical simulations and experiments. Both numerical and experimental results show that the proposed method is powerful in realizing multi-crack localization for running rotors accurately and robustly in the case of no baseline information on intact rotors. Moreover, the interferences from commonly existing steps and misalignment can also be eliminated.

CMIC: an efficient quality score compressor with random access functionality.

BACKGROUND: Over the past few decades, the emergence and maturation of new technologies have substantially reduced the cost of genome sequencing. As a result, the amount of genomic data that needs to be stored and transmitted has grown exponentially. For the standard sequencing data format, FASTQ, compression of the quality score is a key and difficult aspect of FASTQ file compression. Throughout the literature, we found that the majority of the current quality score compression methods do not support random access. Based on the above consideration, it is reasonable to investigate a lossless quality score compressor with a high compression rate, a fast compression and decompression speed, and support for random access. RESULTS: In this paper, we propose CMIC, an adaptive and random access supported compressor for lossless compression of quality score sequences. CMIC is an acronym of the four steps (classification, mapping, indexing and compression) in the paper. Its framework consists of the following four parts: classification, mapping, indexing, and compression. The experimental results show that our compressor has good performance in terms of compression rates on all the tested datasets. The file sizes are reduced by up to 21.91% when compared with LCQS. In terms of compression speed, CMIC is better than all other compressors on most of the tested cases. In terms of random access speed, the CMIC is faster than the LCQS, which provides a random access function for compressed quality scores. CONCLUSIONS: CMIC is a compressor that is especially designed for quality score sequences, which has good performance in terms of compression rate, compression speed, decompression speed, and random access speed. The CMIC can be obtained in the following way: https://github.com/Humonex/Cmic .

Effect of Renin-Angiotensin-Aldosterone System Inhibitors on the Rupture Risk Among Hypertensive Patients With Intracranial Aneurysms.

BACKGROUND: Mounting experimental evidence supports the concept that the RAAS (renin-angiotensin-aldosterone system) is involved in the pathogenesis of intracranial aneurysm rupture. However, whether RAAS inhibitors could reduce the rupture risk of intracranial aneurysms remains unclear. METHODS: We performed a chart review of a multicenter, prospectively maintained database of 3044 hypertensive patients with intracranial aneurysms from 20 medical centers in China. The patients were separated into ruptured and unruptured groups. Univariable and multivariable logistical regression analyses were performed to determine the association between the use of RAAS inhibitors and the rupture risk. Sensitivity analyses and subgroup analyses were performed to verify the robustness of the results. RESULTS: In multivariable analyses, female sex, passive smoking, uncontrolled, or unmonitored hypertension, use of over 2 antihypertensive medications, RAAS inhibitors use, antihyperglycemic agents use, hyperlipidemia, ischemic stroke, and aneurysmal location were independently associated with the rupture risk. The use of RAAS inhibitors was significantly associated with a reduced rupture risk compared with the use of non-RAAS inhibitors (odds ratio, 0.490 [95% CI, 0.402-0.597]; P=0.000). Compared with the use of non-RAAS inhibitors, the use of ACE (angiotensin-converting enzyme) inhibitors (odds ratio, 0.559 [95% CI, 0.442-0.709]; P=0.000) and use of ARBs (angiotensin receptor blockers; odds ratio, 0.414 [95% CI, 0.315-0.542]; P=0.000) were both significantly associated with a reduced rupture risk. The negative association of the rupture risk with RAAS inhibitors was consistent across 3 analyzed data and the predefined subgroups (including controlled hypertension). CONCLUSIONS: The use of RAAS inhibitors was significantly associated with a decreased rupture risk independent of blood pressure control among hypertensive patients with intracranial aneurysms.

Effect of Proximal Parent Artery Stenosis on the Outcomes of Posterior Communicating Artery Aneurysms: A Preliminary Study Based on Case-Specific Hemodynamic Analysis.

OBJECTIVE: The objective of the study was to evaluate the effect of proximal parent artery stenosis on the hemodynamics of aneurysms in the internal carotid artery-posterior communicating artery (ICA-Pcom). METHODS: A retrospective study of 74 patients with aneurysms in the ICA-Pcom who underwent treatment at the Department of Neurosurgery of Changhai Hospital was conducted between January and June 2018. Patients with proximal parent artery stenosis were included. Case-specific three-dimensional images were reconstructed, and software-based simulations of different stenosis morphologies were performed, focusing on stenosis severity and the distance from the aneurysm to the stenosis. The wall shear stress (WSS) of the aneurysms and blood flow velocity of the aneurysm neck plane were calculated. We performed simulations to evaluate the outcomes of postballoon angioplasty by considering a virtual operation group. To further assess whether WSS after balloon angioplasty increases the risk of aneurysm rupture, a control group of ruptured ICA-Pcom aneurysms without parent artery stenosis was matched with the virtual operation group based on sex, age, history of hypertension, and aneurysm size. Thereafter, the normalized WSS of the 2 groups was calculated. RESULTS: Eight patients with parent artery stenosis were included (2 men and 6 women; average age: 64 ± 15 years). The patients were divided into eccentric and concentric stenosis groups according to the stenotic morphologies, with 4 patients in each group. In both groups, the average WSS of the aneurysm and average blood flow velocity at the neck plane increased with the severity of parent artery stenosis, whereas the WSS did not correlate with distance. In the concentric stenosis group, the average blood flow velocity generally decreased as the distance between stenosis and aneurysm increased; however, no such trend was observed in the eccentric stenosis group. The normalized WSS of aneurysms after virtual balloon angioplasty was higher than that of the ruptured aneurysms (0.599 [0.548, 0.800] vs. 0.367 [0.324, 0.407]; P = 0.007). CONCLUSIONS: Intensified severity of proximal stenosis increases the blood flow velocity and aneurysmal WSS, which may lead to the progression of ICA-Pcom aneurysms. Treatment of the stenosis can reduce the WSS of aneurysms; however, its effect on the prognosis of ICA-Pcom aneurysms requires more concrete evidence.

The 8-year single-center experience of telescoping flow diverter for complex intracranial aneurysms treatment.

OBJECTIVE: Treatment of complex intracranial aneurysms (IAs) is still a challenging thing and this study aims to summarize the experience of telescoping flow diverters (FDs) in treating complex intracranial aneurysms. METHOD: Between April 2013 to November 2020, 381 IA cases treated by flow diverters (FD) were retrieved from the database of 4988 IA cases, and finally 20 cases treated by telescoping FDs were enrolled for further analysis. RESULT: Among 20 patients, 15 patients (75.0%) received Tubridge telescoping while 5 patients (25.0%) received PED telescoping. The technical success rate was 100%. The immediate occlusion results were: 7 cases of OKM grade A (35.0%), 11 cases of OKM grade B (55.0%), and 2 cases of OKM grade C (10.0%). No perioperative complications occurred. The clinical follow-up was available in 20 patients (100%) and the follow-up time was 6-96 months. One patient developed massive infarction and the other 19 patients were range between 0 and 2. The angiographic follow-up was available in 17 patients (85%) and the follow-up time was 6-27 months. The occlusion results were: 1 case of OKM grade B (5.9%), 6 cases of OKM grade C (35, 0.3%), and 10 cases of OKM grade D (58.8%). 2 patients (11.8%) developed occlusion of the patent artery. CONCLUSION: Telescoping flow diverters showed low perioperative complications and high IA occlusion rate when treating complex intracranial aneurysms in follow-up time, which provides an alternative manner beyond conventional strategy for neurosurgeons.

Association Between Regular Blood Pressure Monitoring and the Risk of Intracranial Aneurysm Rupture: a Multicenter Retrospective Study with Propensity Score Matching.

Although hypertension is a known risk factor for intracranial aneurysm rupture, the benefit of the management of blood pressure in reducing the rupture risk of intracranial aneurysms remains largely unknown, especially for regular blood pressure monitoring. We conducted a retrospective analysis of a prospectively maintained database of 3965 patients with saccular intracranial aneurysms from 20 medical centers in China. The patients were divided into the non-hypertensive group and hypertensive group. Propensity score matching was applied to identify a cohort of patients with similar baseline characteristics. Univariable and multivariable logistic regression analyses were performed to determine the association between intracranial aneurysm rupture and the management of blood pressure. After matching, hypertension was significantly associated with an increased rupture risk of intracranial aneurysms (OR = 2.559, 95%CI = 2.161-3.030, P = 0.000). For the management of blood pressure, controlled hypertension (OR = 1.803, 95%CI = 1.409-2.307, P = 0.000), uncontrolled hypertension (OR = 2.178, 95%CI = 1.756-2.700, P = 0.000), and hypertension without regular blood pressure monitoring (OR = 5.000, 95%CI = 3.823-6.540, P = 0.000) were all significantly associated with a higher rupture risk compared with the absence of hypertension. Moreover, hypertension without regular blood pressure monitoring was associated with a higher rupture risk compared with either controlled hypertension (OR = 3.807, 95%CI = 2.687-5.395, P = 0.000) or hypertension with regular blood pressure monitoring (including controlled and uncontrolled hypertension) (OR = 2.893, 95%CI = 2.319-3.609, P = 0.000). The absence of regular blood pressure monitoring was significantly associated with an increased risk of intracranial aneurysm rupture, emphasizing the importance of implementation of regular blood pressure monitoring in hypertensive patients with intracranial aneurysms.