Endovascular treatment of intracranial dural arteriovenous fistulas with Onyx: A consecutive series of 62 patients from a single-center.

OBJECTIVE: Intracranial intracranial dural arteriovenous fistulas (DAVFs) are mainly treated with an endovascular approach and various embolic agents. The aim of this study was to investigate the efficacy and safety of Onyx embolization in the treatment of DAVFs and characterize the factors as sociated with complete obliteration. METHODS: This retrospective study was based on 62 patients with DAVFs who underwent endovascular treatment with Onyx alone or in combination with coils at our institution. Clinical and imaging data were collected and analyzed. RESULTS: A total of 62 patients with 64 DAVFs were treated with endovascular embolization. The most common primary symptom was ophthalmological signs with a rate of 37.1%. Cognard type III was the most commonly seen subtype (32.8%). The immediate complete occlusion and follow-up rate was 92.2% and 93.5%, respectively. Transvenous balloon-assisted sinus protection was used in 12 patients (18.8%). The pressure cooker technique was used in eight patients (12.5%). Complications were seen in five patients including intracerebral hemorrhage (n = 2), venous thrombotic events (n = 2), and glued microcatheter (n = 1). CONCLUSIONS: Endovascular Onyx alone or in combination with coils embolization is a safe and effective therapy for DAVFs. Favorable angiographic and clinical outcomes can be achieved using different endovascular approaches. Transvenous balloon-assisted sinus protection and the pressure cooker technique may help achieve complete occlusion of DAVFs.

Mechanistic insight into glioma through spatially multidimensional proteomics.

Characterizing the tumor microenvironment at the molecular level is essential for understanding the mechanisms of tumorigenesis and evolution. However, the specificity of the blood proteome in localized region of the tumor and its linkages with other systems is difficult to investigate. Here, we propose a spatially multidimensional comparative proteomics strategy using glioma as an example. The blood proteome signature of tumor microenvironment was specifically identified by in situ collection of arterial and venous blood from the glioma region of the brain for comparison with peripheral blood. Also, by integrating with different dimensions of tissue and peripheral blood proteomics, the information on the genesis, migration, and exchange of glioma-associated proteins was revealed, which provided a powerful method for tumor mechanism research and biomarker discovery. The study recruited multidimensional clinical cohorts, allowing the proteomic results to corroborate each other, reliably revealing biological processes specific to gliomas, and identifying highly accurate biomarkers.

A Precise Frequency Recognition Method of Short-Time SSVEP Signals Based on Signal Extension.

OBJECTIVE: Improving the Information Transfer Rate (ITR) is a popular research topic in steady-state visual evoked potential (SSVEP)-based brain-computer interfaces (BCIs). The higher recognition accuracy of short-time SSVEP signal is critical to improving ITR and achieving high-speed SSVEP-BCIs. However, the existing algorithms have unsatisfactory performance on recognizing short-time SSVEP signals, especially for calibration-free methods. METHOD: This study for the first time proposed improving the recognition accuracy of short-time SSVEP signals based on the calibration-free method by extending the SSVEP signal length. A signal extension model based on Multi-channel adaptive Fourier decomposition with different Phase (DP-MAFD) is proposed to achieve signal extension. Then the Canonical Correlation Analysis based on signal extension (SE-CCA) is proposed to complete the recognition and classification of SSVEP signals after extension. RESULT: The similarity study and SNR comparison analysis on public SSVEP datasets demonstrate that the proposed signal extension model has the ability to extend SSVEP signals. The classification results show that the proposed method outperforms Canonical Correlation Analysis (CCA) and Filter Bank Canonical Correlation Analysis (FBCCA) significantly in the measure of classification accuracy and information transmission rate (ITR), especially for short-time signals. The highest ITR of SE-CCA is improved to 175.61 bits/min at around 1s, while CCA is 100.55 bits/min at 1.75s and FBCCA is 141.76 bits/min at 1.25s. CONCLUSION: The signal extension method can improve the recognition accuracy of short-time SSVEP signals and further improve the ITR of SSVEP-BCIs.

Long-term deposition of fly ash regulates bacterial communities in different disturbance zones: Evidence from diversity, network complexity and predictive metabolic function.

The structural diversity and metabolic pathways formed by soil microbial-environmental factor interactions can be used to predict the differences in microbial ecological functions. The storage of fly ash (FA) has caused potential harm to the surrounding soil environment, whereas little is known about bacterial communities and environmental factor interactions in FA-disturbed areas. In this study, we selected two disturbed areas (DW: dry-wet deposition zone, LF: leachate flow zone) and two nondisturbed areas (CSO: control point soil, CSE: control point sediment) as the test areas and used high-throughput sequencing technology to investigate the bacterial communities. The results indicated that (1) FA disturbance significantly increased the electrical conductivity (EC), geometric mean diameter (GMD), soil organic carbon (SOC) and some potentially toxic metals (PTMs) (Cu, Zn, Se and Pb) of DW and LF and significantly decreased the AK of DW and the pH of LF (p < 0.05). (2) The relative abundance of Proteobacteria was significantly increased in the DW (p < 0.05). Similarly, the relative abundances of Proteobacteria and Firmicutes obviously increased in the LF (p < 0.001). Interestingly, the α and ß diversity of LF flora and the ß diversity of DW flora changed. (3) The order of influence of bacterial community structure was nutrient characteristics > physical properties > PTMs. Among all factors, AK (33.9 %) and pH (44.3 %) were the key environmental limiting factors for the bacterial community in the DW and the LF, respectively. (4) FA perturbation reduced the complexity, connectivity and modularity of the interaction network between bacteria and disturbed them by increasing the metabolic pathways that degrade pollutants. In conclusion, our results revealed the changes in the bacterial community and the main environmental driving factors under different pathways of FA disturbance; this information provides a theoretical basis for ecological environment management.

Endovascular Treatment of a Traumatic Carotid Cavernous Fistula Concomitant with Intracranial Pseudoaneurysm by Flow Diverter, 2-Dimensional Operative Video.

Traumatic carotid cavernous fistulas (TCCFs) and traumatic intracranial pseudoaneurysms are uncommon vascular anomalies associated with head trauma.1,2 Detachable balloons, covered stents, or liquid embolic agents can be used to treat TCCFs in some conditions.3,4 TCCF concomitant with pseudoaneurysm is an extremely rare occurrence in the literature.5,6 In Video 1, we present a unique case of a TCCF concomitant with a giant pseudoaneurysm of the posterior communicating segment of the left internal carotid artery in a young patient. Both lesions were successfully managed with an endovascular treatment using a Tubridge flow diverter (MicroPort Medical Company, Shanghai, China), coils, and Onyx 18 (Medtronic, Bridgeton, Missouri, USA). No neurologic complications occurred due to the procedures. Six-month follow-up angiography illustrated complete resolution of fistula and pseudoaneurysm. This video shows a new treatment method for TCCF concomitant with a pseudoaneurysm. The patient consented to the procedure.

Efficiency of endovascular management with a combination of Onyx and coils for direct and indirect carotid cavernous fistula treatment: Experience of a single center.

BACKGROUND: To evaluate the safety and efficacy of endovascular treatment with a combination of Onyx and coils for carotid cavernous fistulas (CCFs), and to characterize the factors associated with clinical and angiographic outcomes for direct and indirect CCFs. METHODS: This retrospective study included 31 patients with CCF treated with an endovascular procedure between December 2017 and March 2022. RESULTS: Direct and indirect CCFs were found in 14 (45.2%) and 17 (54.8%) cases, respectively. Direct CCFs included eleven traumatic carotid cavernous fistulas. The most common symptom on admission was chemosis, which was seen in 17 (54.8%) patients. Eight (25.7%) cases were treated by the transarterial approach. Fourteen (45.2%) cases were treated using the femoral vein-inferior petrosal sinus approach. Seven (22.6%) were treated by direct puncture of the superior ophthalmic vein. Two (6.5%) were treated by the femoral vein-facial vein approach. Immediate complete occlusion and follow-up rates were 93.5% and 96.7%, respectively. Twenty-nine (96.7%) patients experienced an improvement in their symptoms at clinical follow-up. Chemosis was significantly improved or resolved in 15 patients. Ophthalmoplegia was improved or resolved in 10 patients. Visual impairment was improved in 6 patients. Proptosis was improved or resolved in 5 patients. One case (3.2%) experienced procedure-related complication presented with transient oculomotor nerve palsy. In univariate subgroup analysis, use of balloon, treatment approach, and history of head trauma were significantly different between the direct and indirect CCF groups. CONCLUSIONS: Endovascular treatment with a combination of Onyx and coils is a safe and effective therapy for CCFs. In this study, the transarterial approach was a favorable option for embolization of direct CCFs. In contrast, the transvenous approach may be the first choice of treatment for indirect CCFs.

Pb induces ferroptosis in choroid plexus epithelial cells via Fe metabolism.

Pb can enhance blood-cerebrospinal fluid barrier (BCSFB) permeability and accumulate in brain tissue, leading to central nervous system (CNS) dysfunction. Choroid plexus (CP) epithelial cells are the main components of the BCSFB with crucial functions in BCSFB maintenance. However, the mechanism by which Pb exposure affects CP epithelial cells remains unclear. Here, ferroptosis was identified as the major programmed cell death modality by sophisticated high-throughput sequencing and biochemical investigations in primary cultured CP epithelial cells following Pb exposure. Bioinformatics analysis using the ferroptosis database revealed that 16 ferroptosis-related genes were differentially expressed in primary cultured CP epithelial cells following Pb exposure. Among them, Gpx4, Slc7a11, Tfrc, and Slc40a1 were hub ferroptosis-related genes. In addition, CP epithelial cells can be impaired when the concentration of the Pb2+ reached 2050 µg/L (10 µM PbAc), which included the decrease of cell viability, Gpx4 and Slc7a11 proteins expression, etc. Moreover, inhibition of ferroptosis enhanced CP epithelial cell viability and reduced BCSFB permeability in vitro following Pb exposure. In summary, ferroptosis of CP epithelial cells is involved in BCSFB dysfunction following Pb exposure. Gpx4, Slc7a11, Tfrc, and Slc40a1 are hub ferroptosis-related genes in CP epithelial cells.

Tubridge flow diverter alone vs. Tubridge flow diverter and coils for the treatment of intracranial aneurysms: A propensity score matching analysis.

Background: The study was designed to assess the clinical performance of a tubridge flow diverter (TFD) in the treatment of intracranial aneurysms and to compare the efficacy and safety between intracranial aneurysms treated with TFD alone and TFD combined with coiling. Methods: In this retrospective study, patients treated with the TFD alone or TFD combined with coiling between June 2018 to November 2022 were included. The patient demographics, the characteristics of the aneurysm, and the treatment outcomes between the two groups were compared. Propensity score matching was performed to match the variables with a significant difference between groups. Results: In the current study, data from 93 consecutive patients including 104 aneurysms treated with TFD were analyzed. In total, 43 patients with 49 aneurysms were treated with TFD alone, and 50 patients with 55 aneurysms were treated with TFD combined with coiling. Aneurysms in the TFD combined with the coiling group were larger (12.9 ± 8.6 vs. 8.7 ± 8.8 mm, P = 0.016) and more likely to be saccular (92.7% vs. 75.5%, P = 0.027) than in the TFD alone group. No significant difference was observed between the two groups in terms of perioperative complication rate. During the follow-up period, the complete occlusion rate in the TFD combined with the coiling group was higher (80.0% vs. 43.8%, P = 0.001) than in the TFD alone group. These results were further confirmed using a propensity score matching analysis. Conclusion: TFD combined with coiling can be a safe and effective alternative option for the treatment of complex aneurysms. Given the potential risks of these therapeutic modalities, thus very careful consideration is required on an individual patient basis.

The prognostic value of hyperglycemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

Recent studies have demonstrated that hyperglycemia may result in a poor prognosis following aneurysmal subarachnoid hemorrhage (aSAH). However, the association between hyperglycemia and the clinical outcome of aSAH has not been clearly established thus far. Therefore, we performed a systematic review and meta-analysis to investigate the association between hyperglycemia and the development of aSAH. We completed a literature search in four databases (PubMed, EMBASE, Cochrane Library, and Web of Science) up to November 1, 2021, including all eligible studies investigating the prognostic value of hyperglycemia in patients with aSAH. We performed a quality assessment of included studies using the Newcastle-Ottawa Quality Assessment Scale. The pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to assess the association of hyperglycemia in aneurysmal subarachnoid hemorrhage. A total of 35 studies with 11,519 patients were finally included in the meta-analysis. Nineteen studies reported the association between hyperglycemia and poor outcome, 12 studies reported the association between hyperglycemia and all-cause mortality, 7 studies reported the association between hyperglycemia and cerebral vasospasm, and 9 studies reported the association between hyperglycemia and cerebral infarction. The pooled data of these studies suggested that hyperglycemia was significantly associated with poor functional outcomes (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.17-1.42; P < 0.00001; I2 = 83%), all-cause mortality (OR, 1.02; 95% CI, 1.01-1.04; P = 0.0006; I2 = 89%), cerebral vasospasm (OR, 1.02; 95% CI, 1.01-1.02; P = 0.0002; I2 = 35%), and cerebral infarction (OR, 1.16; 95% CI, 1.09-1.23; P < 0.00001; I2 = 10%) in aSAH patients. These findings suggested that assessing for hyperglycemia at admission may help clinicians to identify critically ill patients and complete patient stratification early, which may achieve better management and improve the prognosis of patients with aSAH.

Does Oblique Effect Affect SSVEP-Based Visual Acuity Assessment?

This study aimed to explore whether there was an effect on steady-state visual evoked potential (SSVEP) visual acuity assessment from the oblique effect or the stimulus orientation. SSVEPs were induced by seven visual stimuli, e.g., the reversal sinusoidal gratings with horizontal, two oblique, and vertical orientations, reversal checkerboards with vertical and oblique orientations, and oscillating expansion-contraction concentric-rings, at six spatial frequency steps. Ten subjects participated in the experiment. Subsequently, a threshold estimation criterion was used to determine the objective SSVEP visual acuity corresponding to each visual stimulus. Taking the SSVEP amplitude and signal-to-noise-ratio (SNR) of the fundamental reversal frequency as signal characteristics, both the SSVEP amplitude and SNR induced by the reversal sinusoidal gratings at 3.0 cpd among four stimulus orientations had no significant difference, and the same finding was also shown in the checkerboards between vertical and oblique orientation. In addition, the SSVEP visual acuity obtained by the threshold estimation criterion for all seven visual stimuli showed no significant difference. This study demonstrated that the SSVEPs induced by all these seven visual stimuli had a similarly good performance in evaluating visual acuity, and the oblique effect or the stimulus orientation had little effect on SSVEP response as well as the SSVEP visual acuity.

Uncertainties of urban flood modeling: Influence of parameters for different underlying surfaces.

Rapid urbanization has dramatically increased the impermeable surface in urban area, which led to urban severe flooding and waterlogging in the world, especially in China and southeast Asia. There are more than 100 cities that suffered from urban flood every year since 2006, and more than 100 million citizens are involved in China. Urban flood mitigation is one of the most critical issues for both water administration and city management agency, in which urban flood modeling is vital and necessary. Whereas, there are relatively few data of waterlogging and runoff in urban area during flooding episodes to calibrate and validate the models, for there are usually few observation facilities installed in the cities. This paper used a combination of experiment and modelling to overcome the lack of reliable discharge data and be able to characterize the urban flooding problems in Xiamen Island, China. This paper simulated the urban flooding in Xiamen Island based on a hydrodynamic model coupled with hydrological model. The datasets of underlying surfaces were input to the model, including the terrain data, building plan, land use, etc. The uncertainty of the urban flood model was analyzed based on the generalized likelihood uncertainty estimation (GLUE) method with shuffled complex evolution Metropolis (SCEM-UA) sampling algorithm. The key parameters were evaluated by on-site experiment to reduce the uncertainties of the model, which could improve the accuracy of the model. If using the recommended parameter value range, the average relative error of flood depth was less than 27.2% at 90% confidence level. A typical rain pattern of 50 years return event was used for flood simulation. The results show that the main inundated areas (flooded depth more than 40 cm) are located in three groups: southeast to the Yundang Lake, around the Hubian Reservoir, along the Exhibition Road. The other inundated areas that less than 40 cm deep are scattered in some low-lying land of Xiamen Island. The main inundated areas simulated are consistent with the point survey of urban flooding, which verifies that the suggested model and the on-site experiment is effective and reliable for urban flood prediction.