Novel radiopaque ethanol injection: physicochemical properties, animal experiments, and clinical application in vascular malformations.

BACKGROUND: Despite the efficacy of absolute ethanol (EtOH), its radiolucency introduces several risks in interventional therapy for treating vascular malformations. This study aims to develop a novel radiopaque ethanol injection (REI) to address this issue. METHODS: Iopromide is mixed with ethanol to achieve radiopacity and improve the physicochemical properties of the solution. Overall, 82 male New Zealand white rabbits are selected for in vivo radiopacity testing, peripheral vein sclerosis [animals were divided into the following 5 groups (n = 6): negative control (NC, saline, 0.250 ml/kg), positive control (EtOH, 0.250 ml/kg), low-dose REI (L-D REI, 0.125 ml/kg), moderate-dose REI (M-D REI, 0.250 ml/kg), and high-dose REI (H-D REI 0.375 ml/kg)], pharmacokinetic analyses (the blood sample was harvested before injection, 5 min, 10 min, 20 min, 40 min, 1 h, 2 h, 4 h, and 8 h after injection in peripheral vein sclerosis experiment), peripheral artery embolization [animals were divided into the following 5 groups (n = 3): NC (saline, 0.250 ml/kg), positive control (EtOH, 0.250 ml/kg), L-D REI (0.125 ml/kg), M-D REI (0.250 ml/kg), and H-D REI (0.375 ml/kg)], kidney transcatheter arterial embolization [animals were divided into the following 4 groups (n = 3): positive control (EtOH, 0.250 ml/kg), L-D REI (0.125 ml/kg), M-D REI (0.250 ml/kg), and H-D REI (0.375 ml/kg); each healthy kidney was injected with saline as negative control], and biosafety evaluations [animals were divided into the following 5 groups (n = 3): NC (0.250 ml/kg), high-dose EtOH (0.375 ml/kg), L-D REI (0.125 ml/kg), M-D REI (0.250 ml/kg), and H-D REI (0.375 ml/kg)]. Then, a prospective cohort study involving 6 patients with peripheral venous malformations (VMs) is performed to explore the clinical safety and effectiveness of REI. From Jun 1, 2023 to August 31, 2023, 6 patients [age: (33.3 ± 17.2) years] with lingual VMs received sclerotherapy of REI and 2-month follow-up. Adverse events and serious adverse events were evaluated, whereas the efficacy of REI was determined by both the traceability of the REI under DSA throughout the entire injection and the therapeutic effect 2 months after a single injection. RESULTS: The REI contains 81.4% ethanol (v/v) and 111.3 mg/ml iodine, which can be traced throughout the injection in the animals and patients. The REI also exerts a similar effect as EtOH on peripheral venous sclerosis, peripheral arterial embolization, and renal embolization. Furthermore, the REI can be metabolized at a similar rate compared to EtOH and Ultravist® and did not cause injury to the animals' heart, liver, spleen, lungs, kidneys and brain. No REI-related adverse effects have occurred during sclerotherapy of VMs, and 4/6 patients (66.7%) have achieved complete response at follow-up. CONCLUSION: In conclusion, REI is safe, exerts therapeutic effects, and compensates for the radiolucency of EtOH in treating VMs. TRIAL REGISTRATION: The clinical trial was registered as No. ChiCTR2300071751 on May 24 2023.

Ethanol embolotherapy of mandibular arteriovenous malformation-induced acute oral hemorrhage after tooth extraction.

BACKGROUND: Mandibular arteriovenous malformation (AVM) is rare. Our work aims to introduce the ethanol embolization of a patient suffering from acute oral hemorrhage induced by mandibular AVM. METHODS: A 35-year-old woman without coagulopathy underwent tooth extraction, and the acute oral bleeding occurred intraoperatively. Imaging examinations indicated the enhancement of vascular mass with bone destruction inside the mandible. Angiography finally confirmed the high blood flow nature and the diagnosis of AVM. RESULTS: During the interventional procedure, the coils were first applied into the dilated outflowing vein to slow down the blood flow rate of mandibular AVM. Absolute ethanol was injected in a multi-bolus modality to destroy the nidus of AVM. Her mandibular lesion had been stable in the 12-month re-examined angiography, no further bleeding occurred during the period. CONCLUSIONS: Ethanol embolotherapy was a less invasive, more precise, and quick-action approach managing AVM of the jaw and related emergency medicine.

Study on the secondary oxidation behavior and microscopic characteristics of oxidized coal gangue.

Spontaneous combustion of coal gangue (CG) hills has caused varieties of secondary disasters that seriously endanger the ecological environment of the world. The emission law of index gases and their oxidation kinetics during the secondary oxidation process of CG with different ranks of oxidation were studied by using the temperature programmed device and online mass spectrometer (MS). Fourier transform infrared spectroscopy (FTIR) was used to reveal the changes of the CG internal active functional groups. The results showed that the energy required for the combustion of CG with low rank of pre-oxidation was significantly lower than that of the raw sample. However, as the oxidation rank increased, due to amounts of volatile components were released in the process of oxidation reaction, the CG in the combustion process of the emission of index gases and its oxygen consumption rate gradually reduced; the rapid oxidation stage shifted to the direction of the high temperature. In this study, the risk of spontaneous combustion of CG after oxidation at 80 â„ƒ under 3% oxygen concentration was the strongest. The results of this paper are of great guiding significance for exploring the spontaneous combustion characteristics of CG hills and their prevention by traditional covering method.

Fern-like Plants Establishing the Understory of the Late Devonian Xinhang Lycopsid Forest.

Forests appeared during the Middle to Late Devonian, but Devonian forests and their compositions are still rarely known. Xinhang forest was reported as the largest Devonian forest, with lycopsid trees of Guangdedendron micrum Wang et al. A fern-like plant Xinhangia spina Yang and Wang with shoots and anatomy, was previously described from this forest, but its habit and ecology remain unclear. From Xinhang forest, we now report more specimens of fern-like plants including X. spina and some unnamed plants in several beds. Prominent adventitious roots, spines and secondary xylem indicate that the stems of X. spina are largely procumbent to function as anchorage, absorption and support. Other fern-like plants with distinct roots or multiple slender branches also suggest procumbent habits. Xinhang forest is thus reconsidered as multispecific with a canopy of lycopsid trees and understory of diverse fern-like plants, which are adapted to the disturbed coastal environment. The composition of Xinhang forest may indicate a structural transition of the early forests' dominator from fern-like plants to lycopsids.

The relationship between landscape pattern and plant species diversity in east Dongting lake wetland based on different Eco-environment.

Exploring the impact factors associated with biodiversity and the relationship between them has always been a concerned issue in recent years. However, the previous research mostly focus on theoretical layer. Accordingly, the relationship between landscape pattern and biodiversity is to be analyzed in this research. The landscape pattern determines the function and ecological process of the landscape, and affects the species flow, information flow and energy flow in the landscape. Land use patterns has inevitably left an impact on the landscape pattern. Landscape pattern determines the function and ecological process of landscape and thus plays a significant role in biodiversity. East Dongting Lake National Nature Reserve is taken as the research object of the paper, and the remote sensing image data of three different time periods are collected, including 2000, 2010 and 2020. With an interpretation of the vegetation landscape pattern changes inside the protected area to collect and analyze the vegetation coverage. By comparing landscape patterns and the dynamic changes of land use in different periods of time, the correlation between landscape pattern characteristics and regional biodiversity is to be analyzed. Research shows: (1) From 2000 to 2020, the vegetation coverage of East Dongting Lake increased, but the landscape shape, scale, diversity and uniformity index decreased to varying degrees. (2) At the class level of landscape type, the relationship between landscape index and biodiversity is different. A complex relationship between farmland landscape and biodiversity. There is a significant positive correlation between the index of grassland landscape type and the index of regional biodiversity. (3) The correlation analysis results at the landscape level show that the landscape characteristic index is positively correlated with the regional biodiversity index. The grassland landscape in the area is the main habitat of biological species. At the same time, as the main grain producing area, the impact of farmland landscape cannot be ignored. This study has certain theoretical guiding significance for the protection and management of biodiversity in the region in terms of maintaining landscape pattern in particular the grassland landscape area and increasing vegetation coverage in the process of land use.

Ethanol embolization of arteriovenous malformations in the buttock: ten-year experiences in diagnoses and treatment options.

BACKGROUND: Clinically, arteriovenous malformations in the buttocks (bAVMs) are extremely rare. Our study aimed to evaluate the efficacy and safety of ethanol embolotherapy in managing bAVMs. RESULTS: A total of 32 patients with bAVMs (14 females and 18 males) from 2012 to 2021 were included in this study. All patients underwent complete clinical and imaging examinations. Further, the AVMs lesions were analyzed according to Schöbinger staging and Yakes classification. Each patient had undergone a multistage ethanol embolization. The amelioration of clinical symptoms and devascularization on angiography were evaluated at regular follow-ups. In the present cohort, the 11-20 age group had the most patients (15/32; 46.88%). A total of 124 embolization procedures were performed (average 3.88 procedures per patient), and the average dose of absolute ethanol was 18.96 mL per procedure. Thirteen patients with dominant draining veins underwent additional coil deployment before ethanol embolization (13/32; 40.63%). During follow-ups, clinical improvement was found in 23 of 27 who presented with a pulsating mass (85.19%), 17 of 20 with abnormal local skin temperature (85%), 5 of 6 with bleeding (83.33%), and 5 of 5 patients treated for pain (100%). More than 75% angiographic devascularization was achieved in 18 patients (18/32; 56.25%). Finally, 12 out of 13 patients (92.31%) reduced from Schöbinger Stage III to a lower grade, and ten patients exhibited a complete response (10/32; 31.23%). There was a single serious complication of local necrosis, while neither paranesthesia nor infection was observed postoperatively. CONCLUSIONS: Ethanol embolization assisted with coils can treat bAVMs effectively and safely. The Yakes classification contributed to the optimal ethanol embolotherapy of bAVMs.

CRISPR-Cas9-mediated deletion of carbonic anhydrase 2 in the ciliary body to treat glaucoma.

The carbonic anhydrase 2 (Car2) gene encodes the primary isoenzyme responsible for aqueous humor (AH) production and plays a major role in the regulation of intraocular pressure (IOP). The CRISPR-Cas9 system, based on the ShH10 adenovirus-associated virus, can efficiently disrupt the Car2 gene in the ciliary body. With a single intravitreal injection, Car2 knockout can significantly and sustainably reduce IOP in both normal mice and glaucoma models by inhibiting AH production. Furthermore, it effectively delays and even halts glaucomatous damage induced by prolonged high IOP in a chronic ocular hypertension model, surpassing the efficacy of clinically available carbonic anhydrase inhibitors such as brinzolamide. The clinical application of CRISPR-Cas9 based disruption of Car2 is an attractive therapeutic strategy that could bring additional benefits to patients with glaucoma.

Relay protection sensitivity integrated optimal placement and capacity of inverter interfaced distributed generators in distribution networks.

The relay protection sensitivity is one of the determined factors in the power system, however, it is often overlooked in current distribution network (DN) planning. The relay protection sensitivity can be decreased to below the minimum values, failing to meet the requirements for electrical installations. To address this challenge, a new optimization model integrated with the relay protection sensitivity to maximize the inverter interfaced distributed generator (IIDG) penetration level while minimizing IIDG investment was proposed in this paper. The IIDG effect on the relay protection sensitivity was analysed and the relay protection sensitivity re-evaluation method was developed. The relay protection sensitivity evaluation was integrated into the proposed model and the particle swarm optimization (PSO) algorithm was developed to solve the nonlinear issue. The proposed optimization method was tested on different cases, and results confirmed the effectiveness of the method. Furthermore, the relay sensitivity profiles obtained through the proposed method and the optimization without considering the relay sensitivity limits were compared. The proposed method improves the average and minimum sensitivity factors by 28.77 % and 51.76 %, respectively, when the DTO protection functions as the backup for the protected line in the thirty-three-node system. When DTO acts as the backup for the adjacent line, the average and minimum values increase by 29.91 % and 50.95 %, respectively. Comparative analysis confirms the efficacy of the proposed method. The new method extends the power system panning approaches and can be integrated into the DN planning tools to support the low-carbon initiatives.

Micromirror Array with Adjustable Reflection Characteristics Based on Different Microstructures and Its Application.

The conventional reflective optical surface with adjustable reflection characteristics requires a complex external power source. The complicated structure and preparation process of the power system leads to the limited modulation of the reflective properties and difficulty of use in large-scale applications. Inspired by the biological compound eye, different microstructures are utilized to modulate the optical performance. Convex aspheric micromirror arrays (MMAs) can increase the luminance gain while expanding the field of view, with a luminance gain wide angle > 90° and a field-of-view wide angle close to 180°, which has the reflective characteristics of a large gain wide angle and a large field-of-view wide angle. Concave aspheric micromirror arrays can increase the luminance gain by a relatively large amount of up to 2.66, which has the reflective characteristics of high gain. Industrial-level production and practical applications in the projection display segment were carried out. The results confirmed that convex MMAs are able to realize luminance gain over a wide spectrum and a wide range of angles, and concave MMAs are able to substantially enhance luminance gain, which may provide new opportunities in developing advanced reflective optical surfaces.

Diagnostic performance of wide-field optical coherence tomography angiography in detecting open-angle glaucoma in high myopia.

PURPOSE: To compare the diagnostic performance of the capillary density (CD) of the central 1-6 mm and peripheral 6-12 mm annular regions in detecting open-angle glaucoma in high myopia (HM) using 15 × 12 mm wide-field swept-source optical coherence tomography angiography (WF SS-OCTA). METHODS: The study enrolled 206 and 103 eyes with HM and highly myopic open-angle glaucoma (HM-OAG), respectively. WF SS-OCTA images centred on the fovea were obtained to analyse the changes in the CD in the 1-3 mm, 3-6 mm, 6-9 mm, and 9-12 mm annular regions. CD of the superficial capillary plexus (SCP) was measured with the built-in software. The area under the receiver operating characteristic curve (AUROC) of each region was compared. RESULTS: The diagnostic performance of the SCP CD in the central 1-6 mm annular region (AUROC = 0.849) was better than that in the peripheral 6-12 mm annular region (AUROC = 0.756, p = 0.001). The annular AUROCs of SCP CD peaked in the 3-6 mm annular region (AUROC = 0.858) and gradually decreased with increasing diameter and were lower than the corresponding AUROCs of the ganglion cell-inner plexiform layer thickness (p < 0.05 for all comparisons). SCP CD of the inferior quadrant in the 3-6 mm annular region had the best diagnostic performance (AUROC = 0.859). CONCLUSION: The SCP CD in the central 1-6 mm annular region exhibited better diagnostic performance for the detection of HM-OAG in HM. The assessment of more peripheral regions has no added value in detecting glaucoma in HM.

Foliar spraying of exogenous uniconazole (S3307) at the flowering stage as an effective method to resist low-temperature stress on mung bean [Vigna radiata (L.) Wilczek].

Low temperature is one of the major constraints on agricultural productivity worldwide and is likely to further increase. Several adaptations and mitigation strategies are required to cope with low-temperature stress. Uniconazole (S3307) could play a significant role in the alleviation of abiotic stress in plants. In this study, the effects of S3307 on the reactive oxygen species (ROS) and antioxidant metabolism were studied in the leaves of mung bean [Vigna radiata (L.) Wilczek]. The experimental results showed that the low-temperature induced accumulation of superoxide anion (O2-) production rate, and malonaldehyde (MDA) contents. Increased proline content and enzymatic antioxidants, including superoxide dismutase (SOD), catalase (CAT), and peroxidase (POD), were found to alleviate oxidative damage under low temperatures. While, S3307 could reduce O2- production rate and MDA contents and increase the activities of SOD, POD, and CAT, slowed the decrease in ascorbic acid (AsA), dehydroascorbic acid (DHA), glutathione (GSH), and oxidized glutathione (GSSG), and promoted increase in soluble sugars (SS), soluble proteins (SP), and proline (Pro) content under low-temperature. At the same time, low temperature leads to lower 100 grain weight and number of grains per plant, which eventually causes yield reduction decreased. Foliar spraying of S3307 could alleviate the yield loss caused by low temperature, and the increase of S3307 treatment was 5.1%-12.5% and 6.3%-32.9% for the two varieties, respectively, compared with CK. In summary, exogenous S3307 pretreatment enhances plant tolerance to low-temperature by improving the antioxidant enzyme activities, increased non-enzymatic antioxidants content, and decreased O2- production rate and MDA contents and inducing alterations in endogenous S3307, and reduce the decrease in mung bean yield.

Effects of neutrophil fate on inflammation.

INTRODUCTION: Neutrophils are important participants in the innate immune response. They rapidly and efficiently identify and clear infectious agents by expressing large numbers of membrane receptors. Upon tissue injury or pathogen invasion, neutrophils are the first immune cells to reach the site of injury and participate in the inflammatory response. MATERIALS AND METHODS: A thorough search on PubMed related to neutrophil death or clearance pathways was performed. CONCLUSION: Inflammatory response and tissue damage can be aggravated when neutrophils are not removed rapidly from the site of injury. Recent studies have shown that neutrophils can be cleared through a variety of pathways, including non-inflammatory and inflammatory death, as well as reverse migration. Non-inflammatory death pathways include apoptosis and autophagy. Inflammatory death pathways include necroptosis, pyroptosis and NETosis. This review highlights the basic properties of neutrophils and the impact of their clearance pathways on the inflammatory response.

[Clinical analysis of interventional embolization for 9 cases with frontal arteriovenous malformation].

PURPOSE: To investigate the efficacy and safety of interventional embolization in the treatment of frontal arteriovenous malformation (AVM). METHODS: A retrospective study was used to analyze 9 patients with frontal AVM who were treated in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The patients were treated with interventional embolization under the guidance of DSA. The scope of lesions was observed through DSA, and the injection dose of sclerosing agent was predicted so that the drug could be injected into the lesion cavity. The efficacy, adverse reactions and complications of all patients were observed and analyzed. RESULTS: Among the 9 patients, there were 7 males(77.8%) and 2 females(22.2%), aged from 1.5-20 years old. Local swelling or mass was the main reported symptom(66.7%). The blood supply arteries of the cases involved in this study included superficial temporal artery and ophthalmic artery. All patients received interventional embolization treatment under general anesthesia, a total of 19 times (each patient received 1-6 times, average 2.1 times/person), and the average single dose of absolute ethanol was 9.0 mL. A total of 80 coils (4.2 coils/time on average) were used for 5 times (80 coils/19 times) with absolute ethanol embolization. In addition, bleomycin was used 3 times, pingyangmycin was used 2 times, and 3% polydocanol was used 1 time to assist embolization. Among the 9 cases included in this study, 4 cases were cured, 3 cases were basically cured, 2 cases were improved, and the effective rate of treatment was 100%. No local or systemic complications were reported in all patients. CONCLUSIONS: In the treatment of frontal arteriovenous malformation, correct diagnosis according to clinical and imaging manifestations, and interventional embolization with anhydrous ethanol according to DSA angiography results can reduce trauma, improve symptoms, control lesions, and obtain relatively satisfactory treatment results. This scheme is safe and effective.

Give Me a Straight Answer: Response Ambiguity Diminishes Likability.

Across nine experiments (eight preregistered) involving Western and Asian samples, we showed that people providing ambiguous (vs. specific) responses to questions in various social scenarios are seen as less likable. This is because, depending on the social context, response ambiguity may be interpreted as a way to conceal the truth and as a sign of social disinterest. Consequently, people reported lower inclination to befriend or date individuals who appeared to provide ambiguous responses. We also identified situations in which response ambiguity does not harm likability, such as when the questions are sensitive and the responder may need to "soften the blow." A final exploratory study showed that response ambiguity also impacts personality perceptions-individuals providing ambiguous responses are judged as less warm, less extraverted, less gullible, and more cautious. We discuss theoretical implications for the language psychology and person perception literatures and practical implications for impression management and formation.

A Fully Integrated RFID Reader SoC.

The traditional RFID reader module relies on a discrete original design. This design integrates a microcontroller, high-frequency RFID reader IC and other multiple chips onto a PCB board, leading to bottlenecks in cost, power consumption, stability and reliability. To align with the trend towards high integration, miniaturization and low power consumption in RFID reader, this paper introduces a fully integrated RFID Reader SoC. The SoC employs the open-source Cortex-M0 core to integrate the RF transceiver, analog circuits, baseband protocol processing, memory and interface circuits into one chip. It's compatible with ISO/IEC 14443 A-type and B-type and ISO/IEC 15693 transmission protocols and rates. Manufactured using a 0.18 µm process, the chip is compatible with multiple standards. The optimized design of the digital baseband control circuit results in a chip area of only 11.95 mm2 offering clear advantages in both area and integration compared to similar work.

Angiographic Types of Palpebral Arteriovenous Malformations and Relevant Therapeutic Options Based on Ethanol Embolization: A Multicenter Study.

PURPOSE: The present work aimed to determine the different angio-architectural types of palpebral arteriovenous malformations (pAVMs) and appropriate ethanol embolotherapy for each type. MATERIALS AND METHODS: This was a multi-center comparative effectiveness research retrospectively conducted from November 2012 to October 2021. A total of 70 patients with pAVMs were included, which was classified into cystic pAVMs (n=29) and diffuse pAVMs (n=41) based on the angio-architecture. Of the included patients, 17 with cystic pAVMs and 13 with diffuse pAVMs underwent ethanol embolization combined with coils (CE). The remaining participants underwent no-coil ethanol embolization (NCE). Participants had undergone 60 months of follow-up. Normality of data was tested by the D'Agostino and Pearson test. Correlation was tested by the Pearson χ2 test. Deterioration-free survival (DFS) rate was estimated using the Kaplan-Meier survival analysis. Multivariate Cox regression models included variables that were significant at a p value<0.05 in the univariate analysis to screen the prognostic factor. RESULTS: The local symptoms of pAVMs, including pulsation, warmth, red plaque, blepharoptosis, bleeding, and visual blurring, along with the devascularizational grade of angiography were recorded before and after the respective procedures. Post-treatment complications were either evaluated at the 3-month routine follow-up or were self-reported by patients. Cystic pAVMs presented with significantly different clinical and angiographic features compared with diffuse pAVMs. With CE, patients with cystic pAVMs obtained a higher devascularizational grade (p<0.0001) and better clinical outcomes (p=0.0009) than those with diffuse pAVMs. Contrarily, with NCE, patients with diffuse pAVM had better outcomes than those with cystic pAVMs (p=0.0248). Moreover, the overall DFS rate was higher in patients with cystic pAVMs (p=0.0006). Finally, the angio-architecture of pAVMs was found to independently influence its prognosis (p=0.02). CONCLUSIONS: In pAVMs, the angio-architectural type was associated with the relative prognostic status. Ethanol embolization combined with coils was an effective method to treat cystic pAVMs, whereas NCE was more suitable for the diffuse type, further emphasizing the importance of a type-based therapeutic strategy for pAVMs. CLINICAL IMPACT: Palpebral arteriovenous malformations (pAVMs) are rare and tricky in clinical practices. The present study has divided the pAVMs into cystic and diffuse types according to their angiographic characteristics. Ethanol embolization with (CE) or without coils (NCE) was performed on both types. CE was suitable for cystic pAVMs; whereas NCE was a better choice for diffuse pAVMs. The five-year survival analyses provided evidence of the safety and efficacy of ethanol application in pAVMs. Finally, our work demonstrated that both the short- and long-term clinical outcomes of diffuse pAVMs were poor compared to those of cystic pAVM.

Coil-assisted ethanol embolotherapy for refractory head and neck arteriovenous malformations with Onyx recrudescence: 10-Year experiences.

OBJECTIVE: This study aimed to evaluate the outcomes of coil-assisted ethanol embolotherapy in recanalized head and neck arteriovenous malformations (HNAVMs) with dilated outflowing veins after Onyx treatment. METHODS: Thirty-six patients with HNAVMs (18 females and 18 males with a mean age of 26.83 years) who experienced recurrence after Onyx embolization from October 2007 to October 2017 were included in this study. All patients underwent complete clinical and angiographic examinations. Further, each patient was classified based on the Schobinger stage before undergoing staged ethanol embolization. All patients were followed up for 5 years in-person at an interval of 3 months after discharge. The Kaplan-Meier method was used to perform the recurrence-free survival analysis. RESULTS: Sixteen patients (44.4%) had Schobinger stage II HNAVMs, and the remaining patients had Schobinger stage III or IV (20/36 patients [55.6%]) HNAVMs. A total of 116 embolization procedures were performed, coils were applied in 107 procedures (92.2%) among patients with dilated outflowing veins. The dose of absolute ethanol was 16.39 mL per procedure in patients with Schobinger II HNAVMs, and 22.45 mL per procedure in patients with Schobinger III and IV HNAVMs (P = .024, 95% confidence interval, 1.128-5.009). During the 3-month evaluation, complete response was observed in 13 of 36 patients (36.1%), and partial response was observed in 23 of 36 patients (63.9%). The 5-year recurrence-free survival rate for patients who underwent Onyx treatment had improved 58.3% after ethanol embolization (95% confidence interval, 2.853-9.595; P < .0001). CONCLUSIONS: Coil-assisted ethanol embolotherapy could treat refractory HNAVMs with Onyx recrudescence effectively.