Intracranial Aneurysms Managed by Parent Artery Reconstruction Using Tubridge Flow Diverter study: 1-year outcomes.

OBJECTIVE: Previous randomized controlled trials have reported a significantly higher occlusion rate of large and giant aneurysms when utilizing the Tubridge flow diverter (FD). In the present trial, the safety and efficacy of the Tubridge FD in treating unruptured internal carotid artery (ICA) or vertebral artery (VA) aneurysms were assessed in a real-world setting. METHODS: The Intracranial Aneurysms Managed by Parent Artery Reconstruction Using Tubridge Flow Diverter (IMPACT) study is a prospective, multicenter, single-arm clinical trial assessing the efficacy of the Tubridge FD in the management of unruptured aneurysms located in the ICA or VA. The primary endpoint was the complete occlusion (Raymond-Roy class 1) rate at the 1-year follow-up. The secondary endpoints included the technical success rate, the successful occlusion rate of the aneurysm, which is the degree of aneurysm embolization scored as Raymond-Roy class 1 or 2, major (> 50%) in-stent stenosis, and incidence of disabling stroke or neurological death associated with the target aneurysms. RESULTS: This study included 14 interventional neuroradiology centers, with 200 patients and 240 aneurysms. According to angiographic core laboratory assessment, 205 (85.4%) aneurysms were located in the ICA, 34 (14.2%) in the VA, and 1 (0.4%) in the middle cerebral artery. Additionally, 189 (78.8%) aneurysms were small (< 10 mm). At the 12-month follow-up, the total occlusion rate was 79.0% (166/210, 95% CI 72.91%-84.34%). Additionally, the occurrence of disabling stroke or neurological death related to the specified aneurysms was 1% (2/200). CONCLUSIONS: The 1-year results from the IMPACT trial affirm the safety record of use of the Tubridge FD in the treatment of intracranial aneurysms in real-world scenarios. These results reveal low morbidity and mortality rates of 3.5% and 1.5%, respectively. Furthermore, they provide evidence of the effectiveness of the Tubridge FD, as demonstrated by the complete occlusion achieved in 166 of 210 (79%) cases.

Computer-assisted microcatheter shaping for intracranial aneurysm embolization: evaluation of safety and efficacy in a multicenter randomized controlled trial.

BACKGROUND: This study aimed to evaluate the efficacy, stability, and safety of computer-assisted microcatheter shaping (CAMS) in patients with intracranial aneurysms. METHODS: A total of 201 patients with intracranial aneurysms receiving endovascular coiling therapy were continuously recruited and randomly assigned to the CAMS and manual microcatheter shaping (MMS) groups. The investigated outcomes included the first-trial success rate, time to position the microcatheter in aneurysms, rate of successful microcatheter placement within 5 min, delivery times, microcatheter stability, and delivery performance. RESULTS: The rates of first-trial success (96.0% vs 66.0%, P<0.001), successful microcatheter placement within 5 min (96.04% vs 72.00%, P<0.001), microcatheter stability (97.03% vs 84.00%, P=0.002), and 'excellent' delivery performance (45.54% vs 24.00%, P<0.001) in the CAMS group were significantly higher than those in the MMS group. Additionally, the total microcatheter delivery and positioning time (1.05 minutes (0.26) vs 1.53 minutes (1.00)) was significantly shorter in the CAMS group than in the MMS group (P<0.001). Computer assistance (OR 14.464; 95% CI 4.733 to 44.207; P<0.001) and inflow angle (OR 1.014; 95% CI 1.002 to 1.025; P=0.021) were independent predictors of the first-trial success rate. CAMS could decrease the time of microcatheter position compared with MMS, whether for junior or senior surgeons (P<0.001). Moreover, computer assistance technology may be more helpful in treating aneurysms with acute angles (p<0.001). CONCLUSIONS: The use of computer-assisted procedures can enhance the efficacy, stability, and safety of surgical plans for coiling intracranial aneurysms.

Identification of LDLR mutation in cerebral venous sinus thrombosis co-existing with dural arteriovenous fistulas: a case report.

BACKGROUND: Cerebral venous sinus thrombosis (CVST) is typically associated with a prothrombotic state of the blood, with its causative factors varying widely. Prior research has not reported the simultaneous occurrence of CVST and dural arteriovenous fistulas (DAVFs) as potentially resulting from genetic mutations. In this case report, we introduce a unique occurrence wherein a patient with a heterozygous mutation of the low-density lipoprotein receptor (LDLR) gene presented with CVST in conjunction with DAVFs. CASE: Presentation: A male patient, aged 51, sought treatment at our facility due to a consistent decline in cognitive functions accompanied by recurrent headaches. Comprehensive evaluations were administered, including neurological examinations, laboratory tests, magnetic resonance imaging, digital subtraction angiography, and whole exome sequencing. Digital subtraction angiography identified DAVFs in the patient's right sigmoid sinus and an occlusion within the left transverse sinus. The whole exome sequencing of blood samples pinpointed a heterozygous mutation in the LDLR gene (NM_000527:exon12:c.C1747T:p.H583Y). Following the confirmed diagnosis of CVST and DAVFs, the patient underwent anticoagulant therapy combined with endovascular procedures - these comprised embolization of the arteriovenous fistula in the right sigmoid sinus and balloon dilation with stent implantation in the left transverse sinus. A six-month follow-up indicated a significant abatement in the patient's symptoms. CONCLUSIONS: This report marks the first documented case of an LDLR gene mutation that could be associated with the onset of CVST and DAVFs. The mutation in the LDLR gene might foster a prothrombotic environment, facilitating the gradual emergence of CVST and the subsequent genesis of DAVFs.

Computer-Assisted Microcatheter Shaping for Intracranial Aneurysm Embolization.

BACKGROUND: This study investigates the accuracy, stability, and safety of computer-assisted microcatheter shaping for intracranial aneurysm coiling. METHODS: Using the solid model, a microcatheter was shaped using computer-assisted techniques or manually to investigate the accuracy and delivery of microcatheter-shaping techniques in aneurysm embolization. Then, forty-eight patients were randomly assigned to the computer-assisted microcatheter-shaping (CAMS) group or the manual microcatheter-shaping (MMS) group, and the accuracy, stability, and safety of microcatheter in the patients were compared between the CAMS and MMS groups. RESULTS: The speed of the successful microcatheter position was significantly faster in the CAMS group than in the MMS group (114.4 ± 23.99 s vs. 201.9 ± 24.54 s, p = 0.015) in vitro. In particular for inexperienced operators, the speed of the microcatheter position with the assistance of computer software is much faster than manual microcatheter shaping (93.6 ± 29.23 s vs. 228.9 ± 31.27 s, p = 0.005). In vivo, the time of the microcatheter position in the MMS group was significantly longer than that in the CAMS group (5.16 ± 0.46 min vs. 2.48 ± 0.32 min, p = 0.0001). However, the mRS score at discharge, the 6-month follow-up, and aneurysm regrowth at the 6-month follow-up were all similar between the groups. CONCLUSIONS: Computer-assisted microcatheter shaping is a novel and safe method for microcatheter shaping that introduces higher accuracy in microcatheter shaping during the treatment of intracranial aneurysms. SIGNIFICANT: Endovascular coiling of intracranial aneurysms can be truly revolutionized through computer assistance, which could improve the endovascular treatment of aneurysms.

Biomimetic method of emergency life channel urban planning in Wuhan using slime mold networks.

This study investigated a bio-inspired approach to planning optimal routes for urban hospital life channels to enable better responses to urban public security incidents. An experimental slime mold network and an origin-destination (OD) network model in which the nodes were tertiary hospitals in Wuhan were constructed. Correlation metrics of the two network models were used for network analysis and visualization. The experimental results showed that the slime mold network was better than the OD network in terms of global optimization. Furthermore, significant polarization of the influence value of urban hospital nodes resulted in a power-law distribution. This paper presents an urban planning method in which the biological mechanism of slime mold foraging is applied to construct shortest path networks in an emergency life channels. The results can be used to examine the relationship between urban roads and hospital nodes and the rational of global optimization distribution when planning the locations of new hospitals. A set of replicable and sustainable methods for conducting a biomimetic slime mold experiment to model real environments are presented. This approach provides a novel perspective for modeling emergency life channels.

Examining the role of BRICS countries at the global economic and environmental resources nexus.

The BRICS countries (Brazil, Russia, India, China and South Africa) are central to future global economic development. However, they are facing both environmental and natural resource stresses due to their rapid economic growth. This study examines the balance between economic benefits and cost of environmental emissions and resource usage in BRICS countries so that future sustainable development insights can be provided. The historical trends of carbon dioxide (CO2), sulfur dioxide (SO2), water, land, energy and material footprints of these countries from 1995 to 2015 are evaluated with a multi-regional input-output model. Also, whether a decoupling relationship exists between economic development, environmental emissions and resources consumption, is examined. In addition, whether environmental emissions and resource usage costs to obtain identical economic gains of these countries in global trade are explored. The major results show that in congruence with economic development, the average annual growth rates of footprint indicators ranged from 0.2% in 1995 to 9.8% in 2015. A decoupling effect did not occur for CO2 emissions or water consumption but did exist for other indicators. Global trade across the supply chain shows to achieve a unit of USD economic benefit from trade, BRICS countries tend to use relatively greater environmental emissions and resource consumption to high income countries, when compared to other income level countries. These emergent economies did receive relatively greater benefits per environmental emissions and resource usage cost from lower-middle and low-income countries.

G protein-coupled receptor kinase 6 is overexpressed in glioma and promotes glioma cell proliferation.

The expression and potential biological functions of G protein-coupled receptor kinase 6 (GRK6) in human glioma are tested in this study. We show that protein and mRNA expression of GRK6 in human glioma tissues was significantly higher than that in the normal brain tissues. Further immunohistochemistry assay analyzing total 118 human glioma tissues showed that GRK6 over-expression was correlated with glioma pathologic grade and patients' Karnofsky performance status (KPS) score. At the molecular level, in the GRK6-low H4 glioma cells, forced over-expression of GRK6 promoted cell proliferation. Reversely, siRNA-mediated knockdown of GRK6 in the U251MG (GRK6-high) cells led to proliferation inhibition and cell cycle arrest. Intriguingly, GRK6 could also be an important temozolomide resistance factor. Temozolomide-induced cytotoxicity was prominent only in GRK6-low H4 glioma cells. On the other hand, knockdown of GRK6 by targeted siRNA sensitized U251MG cells (GRK6-high) to temozolomide. Thus, GRK6 over-expression in glioma is important for cell proliferation and temozolomide resistance.

Classification of insular-basal ganglia gliomas based on the displacement of corticospinal tracts evaluated by diffusion tensor imaging.

BACKGROUND: Resection of insula-basal ganglia (IBG) gliomas is challenging because of their deep location and vicinity to critical structures, whereas diffusion tensor tractography (DTT) can noninvasively delineate the tracks of white matter fibers. This study aims to evaluate the role of cortico-spinal tract (CST) positions in prediction of the prognosis of patients with IBG gliomas. METHODS: We retrospectively reviewed 34 patients with IBG gliomas. DTT was used to reconstruct the CSTs for all patients, and the IBG gliomas were classified into three types (type I-III) based on the shifted patterns of the CSTs. RESULTS: The number of patients with type I IBG gliomas was 12 (35.3%), which was equal to the number of patients with type II IBG gliomas, and 10 cases (29.4%) presented with type III IBG gliomas. The six-month KPS score was significantly lower in the type III IBG group than that in the type I group (t=-11.43, P=0.013) and the type II group (t=-9.97, P=0.033). Postoperative MRI demonstrated that gross total or near total resection was achieved in 76.5% (26 cases) of all of the patients. CONCLUSIONS: The results suggest that the proposed classification of IBG gliomas can be used for predicting the long-term postoperative outcome profiles of IBG glioma patients.