Atlantic origin of the increasing Asian westerly jet interannual variability.

The summer Eurasian westerly jet is reported to become weaker and wavier, thus promoting the frequent weather extremes. However, the primary driver of the changing jet stream remains in debate, mainly due to the regionality and seasonality of the Eurasian jet. Here we report a sharp increase, by approximately 140%, in the interannual variability of the summertime East Asian jet (EAJ) since the end of twentieth century. Such interdecadal change induces considerable changes in the large-scale circulation pattern across Eurasia, and consequently weather and climate extremes including heatwaves, droughts, and Asian monsoonal rainfall regime shifts. The trigger mainly emerges from preceding February North Atlantic seesaw called Scandinavian pattern (contributing to 81.1 ± 2.9% of the enhanced EAJ variability), which harnesses the "cross-seasonal-coupled oceanic-atmospheric bridge" to exert a delayed impact on EAJ and thus aids relevant predictions five months in advance. However, projections from state-of-the-art models with prescribed anthropogenic forcing exhibit no similar circulation changes. This sheds light on that, at the interannual timescale, a substantial portion of recently increasing variability in the East Asian sector of the Eurasian westerly jet arises from unforced natural variability.

Aneurysmoraphy or bypass? Surgical strategy for large M1 bifurcation aneurysm involving two branches based on vessel wall high-resolution MRI and intraoperative angiography.

BACKGROUND: Middle cerebral artery (MCA) M1 bifurcation aneurysms are common because of hemodynamic. For regular-shaped and small aneurysms, direct clipping is optimal. Aneurysmoraphy or bypass blood flow reconstruction are most commonly used in large aneurysm clipping. Based on preoperative vessel wall high-resolution magnetic resonance imaging (VW-HRMRI) and intraoperative angiography, an appropriate surgery strategy could be decided. METHOD: We report a case of large MCA M1 bifurcation aneurysm aneurysmoraphy according to preoperative VW-HRMRI. Intraoperative digital subtraction angiography (DSA) showed an aneurysm neck remnant, and we adjusted clips according to intraoperative DSA. This patient recovered well with a modified Rankin scale of 0 at discharge. CONCLUSION: This case demonstrates that preoperative VWHRMRI could supply more aneurysm characteristics for direct aneurysmoraphy. Intraoperative DSA effectively reduces the possibility of aneurysm remnant.

Initial experience of the treatment of large glioma with microwave ablation-assisted surgical resection.

Aim: This study aimed to investigate the preliminary clinical outcomes of microwave ablation (MWA)-assisted surgical treatment for large glioma. Materials and Methods: In total, six cases of large glioma (diameter >4 cm) were described. All cases were treated with MWA-assisted surgical resection, which was performed using ultrasound to guide the accurate placement of the antenna in the central region of the tumor. The MWA power was 40-45 W, and 6 min was applied. Changes in the ablation area were observed using intraoperative Doppler ultrasound and contrast-enhanced ultrasound (CEUS). Ten patients treated with surgical resection alone were included in the control group. Data on surgical times (i.e., the time from the incision of the dura to the removal of the tumor), intraoperative blood loss, and complications were recorded. Results: The median patient age was 45 years (range: 36.5-60.3 years). The median lesion diameter was 4.9 cm (range: 4.3-5.8). The microwave power was 40-45 W, and the median ablation time was 240 s (range: 208-297 s). The intra-tumoral vascular flow was significantly reduced after MWA. The median surgical time was shorter (38.5 min [range: 34.3-42.8 min]) and the median intraoperative blood loss was less (400 mL, [range: 400-450 mL]) in the combination treatment group than in the surgery-alone group. During the ablation process, no obvious additional neurological deficits were detected; however, a tube-shaped carbonide was found after the operation. Conclusion: MWA may be a useful complement to conventional techniques for the surgical resection of large glioma.

One-step solution for angioplasty, low-profile stent delivery, and intrastent dilation using a dual-lumen angioplasty balloon microcatheter: technical advances, limitations, outcomes, and literature review.

Dual-lumen angioplasty balloon microcatheters make it possible to perform percutaneous transluminal angioplasty (PTA), low-profile stent delivery, and intrastent dilation without the microcatheter exchange technique. This technique has shown many advantages in recent years. We reviewed the techniques and applications in different intracranial vascular diseases and summarized the outcomes and indications. Gateway dual-lumen angioplasty balloon was used for PTA and kept in situ. Stent was delivered and deployed via Gateway microcatheter. Intrastent balloon dilation was performed after stent deployment. We retrospectively reviewed the clinical and imaging data, surgical procedures, technique application, and follow-up outcomes of six patients treated from 2020 to 2023. Neurological function was assessed by the modified Rankin scale (mRS). A literature review was performed using PubMed. All seven patients (4 males, 3 females; mean age, 62.6 ± 6.9 years) underwent percutaneous transluminal angioplasty and stent deployment using a balloon microcatheter. There was one middle cerebral artery (MCA) aneurysm with parent artery stenosis, two MCA dissections, and four intracranial atherosclerotic stenoses (ICASs). The mRS score was 0 in five patients and 1 in two patients. Cerebral dissection with stenosis is the best indication, and its application in stent-assisted aneurysm coiling is inappropriate. This technique is controversial in ICAS treatment.

The comparison of the watertight and non-watertight dural closure in supratentorial craniotomy: A single-institute 10-year experience with 698 patients.

Watertight dural closure (WTDC) is considered crucial by many neurosurgeons in cranial base surgery, infratentorial craniotomy, and spinal intradural procedure. Whether WTDC also reduce complications remains controversial in supratentorial craniotomy. The objective of this study is to investigate the relationship between WTDC and CSF-related complications in supratentorial craniotomy for the resection of space-occupying lesions. A retrospective analysis of patients who suffered from intracranial space-occupying lesions at Beijing Ditan Hospital between January 2011 and December 2021 was conducted. A total of 698 cases were reviewed with attention to the operative approach, subgaleal fluid collection, wound healing impairment, postoperative infection, and post-craniotomy headaches. The study included a total of 423 patients with WTDC and 275 patients without WTDC. Patients without WTDC had a significantly higher rate of infection (10.9% vs 4.5% with WTDC, P = .001). The rate of subgaleal fluid collection was 9.7% in the WTDC group and 11.3% in the non-WTDC group, but this difference was not statistically significant (P = .502). They suffered from a greater incidence of post-craniotomy headaches in the WTDC group (13.5% vs 9.5% in the non-WTDC group), but without statistical significance (P = .109). We also found no difference in wound healing impairment (P = .719). There is less postoperative infection associated with WTDC during intracranial space-occupying lesion removal than without WTDC in supratentorial craniotomy.

Angioarchitectural features of arteriovenous fistulas at craniocervical junction predicting clinical presentation and unfavorable neurological function: insight from a multicenter cohort and pooled analysis.

Arteriovenous fistulas (AVFs) at the craniocervical junction (CCJ) are uncommon conditions with complex angioarchitecture. The objective of this study was to identify the angioarchitectural features of CCJ-AVF that were predictive of clinical presentation and neurological function. The study encompassed a total of 68 consecutive patients with CCJ-AVF at two neurosurgical centers between 2014 and 2022. Additionally, a systematic review was conducted, including 68 cases with detailed clinical data obtained via PubMed database spanning 1990 to 2022. Clinical and imaging data were collected and pooled together to analyze factors associated with subarachnoid hemorrhage (SAH), myelopathy, and modified Rankin scale (mRS) at presentation. The mean age of the patients was 54.5 ± 13.1 years, with 76.5% of them being male. The most common feeding arteries were V3-medial branches (33.1%), and drainage was frequently through the anterior or posterior spinal vein/perimedullary vein (72.8%). SAH was the most common presentation (49.3%), and an associated aneurysm was identified as a risk factor for SAH (adjusted OR, 7.44; 95%CI, 2.89-19.15). Anterior or posterior spinal vein/perimedullary vein (adjusted OR, 2.78; 95%CI, 1.00-7.72) and male gender (adjusted OR, 3.76; 95%CI, 1.23-11.53) were associated with higher risk for myelopathy. Myelopathy at presentation was an independent risk factor for unfavorable neurological status (adjusted OR per score, 4.73; 95%CI, 1.31-17.12) in untreated CCJ-AVF. The present study identifies risk factors associated with SAH, myelopathy, and unfavorable neurological status at presentation in patients with CCJ-AVF. These findings may help treatment decisions for these complex vascular malformations.

How I do it? Basilar bifurcation and left anterior choroidal artery aneurysms clipping.

BACKGROUND: Despite advancements in endovascular techniques, microsurgical treatment for posterior circulation aneurysms remains challenging. METHOD: This report highlights the successful clipping surgery of a 17-year-old female patient with an aneurysm located at the basilar artery (BA) bifurcation and left anterior choroidal artery (AChoA). To improve exposure, the posterior communicating artery was transected. A straight fenestrated clip was then placed to repair the BA bifurcation aneurysm, followed by a curved mini clip for the AChoA aneurysm. CONCLUSION: This report demonstrates the nuances of microsurgery in the treatment of select complex cases, which can benefit from microsurgery to achieve optimal treatment outcomes.

Identification and gene expression profiling of human gonadotrophic pituitary adenoma stem cells.

BACKGROUND: Gonadotrophic pituitary adenoma is a major subtype of pituitary adenoma in the sellar region, but it is rarely involved in the hypersecretion of hormones into blood; thus, it is commonly regarded as "non-functioning." Its tumorigenic mechanisms remain unknown. The aim of this study was to identify human gonadotrophic pituitary adenoma stem cells (hPASCs) and explore the underlying gene expression profiles. In addition, the potential candidate genes involved in the invasive properties of pituitary adenoma were examined. METHODS: The hPASCs from 14 human gonadotrophic pituitary adenoma clinical samples were cultured and verified via immunohistochemistry. Genetic profiling of hPASCs and the matched tumor cells was performed through RNA-sequencing and subjected to enrichment analysis. By aligning the results with public databases, the candidate genes were screened and examined in invasive and non-invasive gonadotrophic pituitary adenomas using Real-time polymerase chain reaction. RESULTS: The hPASCs were successfully isolated and cultured from gonadotrophic pituitary adenoma in vitro, which were identified as positive for generic stem cell markers (Sox2, Oct4, Nestin and CD133) via immunohistochemical staining. The hPASCs could differentiate into the tumor cells expressing follicle-stimulating hormone in the presence of fetal bovine serum in the culture medium. Through RNA-sequencing, 1352 differentially expressed genes were screened and identified significantly enriched in various gene ontologies and important pathways. The expression levels of ANXA2, PMAIP1, SPRY2, C2CD4A, APOD, FGF14 and FKBP10 were significantly upregulated while FNDC5 and MAP3K4 were downregulated in the invasive gonadotrophic pituitary adenomas compared to the non-invasive ones. CONCLUSION: Genetic profiling of hPASCs may explain the tumorigenesis and invasiveness of gonadotrophic pituitary adenoma. ANXA2 may serve as a potential therapeutic target for the treatment of gonadotrophic pituitary adenoma.

Reconstruction of both M2 blood flow with a "Y" fashion anastomosis after excision of a large M1 bifurcation aneurysm: advantages and challenges.

BACKGROUND: Middle cerebral artery (MCA) M1 aneurysms with M2 branches originating from the aneurysm neck are difficult to treat because of blood flow reconstruction method selection, graft blood volume matching and various anastomoses. METHOD: We report a case of MCA M1 bifurcation aneurysm resection and reconstruction of the bifurcation using "Y" fashion anastomosis. Intraoperative DSA showed anastomotic stoma patency. This patient suffered transient left temporal ischemia and recovered well with a modified Rankin scale of 0 at discharge. CONCLUSION: This case demonstrates the application of "Y" fashion anastomosis after the excision of a large M1 bifurcation aneurysm. This bifurcation reconstruction method showed advantages and challenges in specific situations.

Clinical characteristics, endovascular choices, and surgical outcomes of intracranial vertebral artery dissecting aneurysms: a consecutive series of 196 patients.

OBJECTIVE: The authors aimed to evaluate the clinical features, endovascular strategy selection, and outcomes of vertebral artery (VA) dissecting aneurysms (VADAs) near the origin of the posterior inferior cerebellar artery (PICA). METHODS: Clinical data were obtained from 196 patients with 202 VADAs who had been surgically treated at the authors' hospital between 2005 and 2021. The patients' medical records, imaging data, and follow-up outcomes were retrospectively analyzed. RESULTS: All 196 patients (148 male, 48 female; mean age 53 years) underwent endovascular therapy for VADA. The most common chief complaints were headache (56.6%), dizziness (40.8%), and other occasional symptoms (18.4%). Twenty-six patients experienced posterior circulation ischemia, and 25 patients experienced subarachnoid hemorrhage (SAH). On DSA images, 37 aneurysms were found in the dominant VA, and 165 aneurysms were found on the nondominant side. Eighty-eight VADAs had stenosis. Regarding the VADA location, there were 59 distal, 51 proximal, 23 ventral, 64 PICA, and 5 obliteration types. Single-stent implantation (10.9%), overlapping stent implantation (23.8%), flow diverter (FD) implantation (11.9%), single stent-assisted coil (SAC) embolization (31.7%), overlapping SAC embolization (12.9%), parent artery occlusion (PAO) (8.4%), and FD-assisted coil embolization (0.5%) were chosen. The follow-up rate was 82.7%. The modified Rankin Scale (mRS) score was 0.5 ± 1.1. Ninety-six patients underwent DSA. The complete occlusion rates were 100%, 81.4%, 56.7%, and 76.5% in the PAO group, SAC reconstruction group, stent implantation group, and FD implantation group, respectively. CONCLUSIONS: Young patients showed a higher probability of SAH, and elderly patients showed a higher probability of posterior circulation infarction. The surgical plan selection should be based on the SAH history, VA dominant side, and PICA origin location.

Treatment of high-grade brain arteriovenous malformations using a hybrid operating room: A prospective single-arm study.

BACKGROUND: Optimal treatment of patients with high Spetzler-Martin (S-M) grade brain arteriovenous malformations (BAVMs) remains controversial. Few studies have investigated outcomes in such patients treated in a hybrid operating room (hOR). OBJECTIVE: To examine outcomes of one-stop hybrid BAVM treatment in patients with high-grade lesions. METHODS: We prospectively enrolled patients with high-grade BAVMs (S-M grade ≥3) aged 18-65 years who underwent one-stop hybrid BAVM treatment at our hospital between October 2016 and March 2021. High-grade BAVM patients who underwent surgery from 2010 to 2016 served as historical controls. RESULTS: Forty-one high-grade BAVM patients underwent one-stop hybrid treatment in a hOR. Sixty-one propensity score-matched patients comprised the historical control group. The groups did not significantly differ in patient and BAVM characteristics. Intraoperative angiography in four patients of the hOR group demonstrated residual nidus that required further immediate resection. Main procedural complications included hemorrhage, neurologic deficit, and seizure. In the historical control group, diffuse angioarchitecture and arteriovenous fistula were independent risk factors for incomplete resection. CONCLUSIONS: One-stop hybrid BAVM treatment is safe and effective for removal of high-grade BAVMs, especially those with diffuse or complex angioarchitecture. Preoperative embolization can effectively reduce blood flow while preserving motor and language function. The combined application of functional magnetic resonance imaging, electrophysiological monitoring, and awake craniotomy can successfully avoid causing neurological injury.

Formation Behaviors of Coated Reactive Explosively Formed Projectile.

The formation behavior of coated reactive explosively formed projectiles (EFP) is studied by the combination of experiments and simulations. The results show that the coated EFP can be obtained by explosively crushing the double-layer liners, and the simulation agrees with the experiment well. Then, the interaction process between the two liners is discussed in detail, and the formation and coating mechanism are revealed. It can be found that there are three phases in the formation process, including the impact, closing and stretching phases. During the impact phase, the velocities of two liners rise in turns with the kinetic energy exchange. In the closing phase, the copper liner is collapsed forward to the axis and completely coats the reactive liner. It is mentioned that the edge of the copper liner begins to form a metal precursor penetrator in this stage. During the stretching phase, the coated reactive EFP is further stretched and fractured, resulting in the separation of the metal precursor penetrator and the following coated reactive projectile. Further studies show both the edge thickness and the curvature radius of the copper liner have significant influences on formation behaviors. By decreasing the edge thickness or the curvature radius, the difficulty of closing decreases, but the tip velocity and the length of precursor penetrator increases. As the thickness and diameter of the reactive liner decrease, the coating velocity increases slightly, but the total length of coated reactive EFP tends to decrease.

Diagnostic value of EBV-DNA in CSF for PCNSL in AIDS patients with focal brain lesions: A meta-analysis of diagnostic test.

BACKGROUND: Epstein-Barr virus (EBV) infection plays a crucial role in the progression of acquired immunodeficiency syndrome related primary central nervous system lymphoma (AR-PCNSL). This study aimed at evaluating the diagnostic value of cerebrospinal spinal fluid (CSF) EBV-deoxyribonucleic acid (DNA) for PCNSL in patients with infection of human immunodeficiency (HIV) virus through a meta-analysis of diagnostic test. METHODS: A systematic search in PubMed, Embase, Web of Science, Wanfang, Chinese Biomedical Database and Chinese National Knowledge Infrastructure was conducted before May 10, 2022. Heterogeneity among the studies was assessed using Q test and I2 statistics. Publication bias was assessed using the Deek's funnel plot asymmetry test. Statistical analyses were performed using Stata 16.0 software. The pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratios (DOR) and 95% confidence intervals (CI) were caculated to evaluate the diagnostic value. A symmetric receiver operating characteristic (SROC) curve and the area under the SROC curve (AUC) were constructed to evaluate the test-performance. RESULTS: Twelve studies were included in the final analyses, with a total of 141 patients with AR-PCNSL and 590 controls. The pooled diagnostic values were sensitivity of 0.83 (95% CI: 0.73-0.90), specificity of 0.95 (95%CI: 0.89-0.98), PLR of 17.8 (95%CI: 6.8-46.1), NLR of 0.17 (95%CI: 0.10-0.30), DOR of 102 (95%CI: 28-379), and AUC of 0.94 (95%CI: 0.91-0.96). CONCLUSION: In summary the overall diagnostic value of CSF EBV-DNA is very high and it can be a reliable diagnostic biomarker for AR-PCNSL.

The Vascular Architecture of Cavernous Sinus Dural Arteriovenous Fistula and Its Impact on Endovascular Treatment Approach Selection and Outcome.

BACKGROUND: A cavernous sinus (CS) dural arteriovenous fistula (DAVF) is a form of abnormal arteriovenous communication that can be treated with endovascular embolization. Establishing an optimal access route should be based on vascular architecture. We reviewed 64 patients with CS-DAVF who underwent endovascular embolization and report the endovascular treatment approach selection and outcome. METHODS: Clinical data were obtained from 64 patients with CS-DAVF who had been surgically treated at the authors' hospital between 2009 and 2022. Patients' medical records, imaging data, and follow-up outcomes were retrospectively analyzed. RESULTS: All 64 patients (15 male, 49 female; mean age, 50 years) underwent CS-DAVF embolization. The most common symptoms were exophthalmos (39.1%), chemosis (35.9%), and headache (28.1%). On digital subtraction angiography images, 34.4% of the DAVFs were unilateral, and 82.8% were fed by both the external carotid artery and internal carotid artery. Of the patients' inferior petrosal sinuses (IPSs), 54.7% were nonopacified. The most common intravascular approaches included trans-IPS (37.5%) and trans-artery (28.1%) approaches. More than half of the CS-DAVFs were embolized by both coils and Onyx (62.5%). A total of 85.9% of the fistulas were completely embolized, and the follow-up rate was 76.6%. The modified Rankin Scale score was 0.9 ± 1.0. CONCLUSIONS: The vascular architecture of CS-DAVF is closely related to endovascular treatment approach selection and outcome. Combined with the modified IPS recanalization technique, the trans-IPS approach is the safest and most effective approach. Dual microcatheter and balloon assistance techniques ensure the safety and completeness of embolization.

Case report: Endovascular treatment of two scalp arteriovenous malformation cases via direct percutaneous catheterization: A case series.

Background: Scalp arteriovenous malformations (AVM) are rare vascular malformations reported only in small case series. Scalp AVMs usually present with symptoms, including headache, tinnitus, epilepsy, cerebral ischemia, and necrosis of the scalp, which can cause functional, cosmetic, and psychological problems. There are many difficulties in the treatment of scalp AVM because of its complex characteristics of vascular anatomy, non-uniform structure, and intracranial-extracranial anastomosis. Case description: To illustrate the endovascular treatment of scalp AVM via direct percutaneous puncture while traditional arterial and venous approaches were not available. In this report, access was obtained through a direct puncture of the enlarged frontal vein. Onyx-18 was injected through a microcatheter to occlude draining veins, fistulous connection, and the feeders. An 18-gauge indwelling needle was inserted into draining veins directly. Postembolization angiography demonstrated complete sAVM occlusion immediately and no non-targeted embolization. At a 1-year follow-up, no procedure-related complications and evidence of recurrence were observed. Conclusion: The technique of endovascular embolization via direct percutaneous puncture approach is safe, rapid, and effective for specific sAVM. Treatment options should be made in terms of size, vascular anatomical characteristics of the lesions, patient's preference, cosmetic factors, and available expertise.

Microsurgical treatment of posterior inferior cerebellar aneurysms based on angioarchitecture supplemented by high-resolution vessel wall MRI: a case series report.

BACKGROUND: Surgical treatment of posterior inferior cerebellar artery (PICA) aneurysms is challenging because many are nonsaccular and atherosclerotic. We report our tailored approach to PICA aneurysms, which is based on angioarchitecture supplemented by high-resolution vessel wall MRI (HR-VW MRI) findings. METHODS: From March 2010 to September 2020, 27 patients with 29 PICA aneurysms underwent surgical treatment in our institution. Since October 2016, HR-VW MRI has been used for aneurysmal wall assessment. Clinical characteristics, radiological data and surgical outcomes were analysed. RESULTS: Nineteen proximal PICA aneurysms (vertebral artery (VA), P1, P2 and P3) were treated using the far-lateral approach. Ten distal PICA aneurysms (P4, P5) were treated using the suboccipital midline approach. Direct clipping or clip reconstruction was achieved in 19 aneurysms. Ten were trapped in conjunction with extracranial-intracranial or intracranial-intracranial bypass, including three occipital artery-PICA reimplantations, three PICA-VA reimplantations, two PICA-PICA side-to-side anastomoses, one PICA-PICA reimplantation and one PICA-PICA reanastomosis. All aneurysms were eventually completely obliterated and all bypasses remained patent. At the last follow-up, 26 patients (96.2%) achieved a good outcome (modified Rankin Scale score <3). Eight patients underwent HR-VW MRI. Among these, the six aneurysms with focal wall enhancement required bypass and the two with negative enhancement were successfully clipped. CONCLUSION: PICA aneurysms have a higher frequency of complex features such as large or giant size and fusiform or dissecting morphology. Favourable outcomes were achieved with individualised microsurgical strategies based on angioarchitecture. HR-VW MRI may be used as a promising technique to predict aneurysmal atherosclerosis.

Consistency of pituitary adenomas: Amounts of collagen types I and III and the predictive value of T2WI MRI.

Pituitary adenomas, the most common type of lesion in the sellar region, rank third among all brain tumors, with an incidence of 73-94 cases per 100,000 individuals. Due to its high resolution, MRI is highly efficient in brain imaging and has emerged as the most appropriate method for tumor consistency evaluation. The present study aimed to assess the levels of collagen types I and III in pituitary adenomas with different consistencies and to determine the value of T2-weighted imaging (T2WI) MRI for predicting tumor consistency. A total of 55 patients with pituitary adenomas were divided into the soft and firm tumor groups according to intraoperative tumor consistency. The ratio of the tumor to Pons' signal intensities on T2WI scans was determined. A receiver operating characteristic curve was plotted to assess the specificity and sensitivity of T2WI in predicting tumor consistency. Average optical density (AOD) values for collagen types I (0.046±0.008 vs. 0.052±0.012, P=0.033) and III (0.044±0.008 vs. 0.050±0.010, P=0.016) were significantly lower in the soft tumor group compared with those in the firm tumor group. There was no significant difference in the ratio of the tumor to Pons' signal intensities on T2WI scans. The area under the ROC curve was 0.595±0.078 (P=0.250). The maximum tumor diameter significantly differed between the soft and firm tumor groups (P=0.001). AOD values for collagen types I and III were significantly correlated with the maximum tumor diameter (P<0.001). The amounts of collagen types I and III were elevated in firm pituitary tumors compared with the soft ones. The ratio of tumor to Pons' signal intensities on T2WI scans was not able to accurately predict tumor consistency. The size of pituitary adenomas may be associated with the expression levels of collagen types I and III.

The contribution of ocean-based solutions to carbon reduction in China.

Climate change has become a great challenge for humanity. However, the current climate change mitigation measures, primarily concentrate on land, more or less neglecting the vital role of the ocean-based solutions. While the ocean is a crucial regulator of the global climate, ocean-based solutions could also play an essential role in climate change mitigation and policymaking. This paper developed an Ocean-based Solutions Carbon Reduction Assessment Model (OSCRAM) that addresses coastal ecosystems, ocean energy, marine transportation, fishery, and seabed to estimate the oceanic contribution to climate change mitigation. It has been applied to evaluate the capacity of carbon emission reduction through oceans in China. We found that the total contribution for carbon emission reduction was about 6.86 Tg CO2 per year, and it may reach 139.39 Tg in 2030 under the target scenario. The results indicated that the ocean has huge potential to reduce carbon emissions. The development of marine energy and low-carbon marine shipping may have more potential for emission reduction in China, and the government should also protect and restore coastal wetlands for their enormous carbon storage. It can also provide a reference for the globe and other nations in achieving emission reduction goals.

How I do it? Posterior inferior cerebellar artery-intracranial vertebral artery reimplantation bypass and trapping of dissecting aneurysm involving the proximal posterior inferior cerebellar artery.

BACKGROUND: Proximal posterior inferior cerebellar artery (PICA) aneurysms are surgically challenging due to the high variability in the anatomy of the PICA origin, their deep-seated nature, and their entanglement with the lower cranial nerves. Direct or reconstructive clipping may not be achievable if the aneurysm is large, or dissecting, or exhibits atherosclerosis or calcification. METHOD: We present a case of a proximal PICA lateral medullary segment (P2) aneurysm that was successfully cured by trapping the aneurysm and reconstructing the PICA using the PICA-intracranial vertebral artery (PICA-V4) via end-to-side reimplantation bypass with the far lateral approach. CONCLUSION: This case demonstrates the feasibility and safety of PICA-V4 reimplantation bypass, especially if the origin of the PICA is highly seated and the intracranial VA, or V4 segment, is long enough and well-exposed supra or under hypoglossal nerves.

Microsurgical intracranial hypervascular tumor resection immediately after endovascular embolization in a hybrid operative suite: A single-center experience.

BACKGROUND: This study was performed to investigate the safety and outcome of one-stage hybrid endovascular and microsurgical treatment of intracranial hypervascular tumors. METHODS: The blood supply of the tumor was endovascularly embolized just before microsurgery in a one-stage fashion. Clinical data regarding the preoperative neurological status, tumor characteristics, hybrid treatment details and complications, intraoperative blood loss, and postoperative outcomes were collected prospectively and then analyzed. RESULTS: Beginning in July 2016, 13 patients (5 women, 8 men) with intracranial hypervascular tumors were enrolled in this study, with a mean age of 48.2 ± 10.9 years. The patients' tumors comprised seven hemangioblastomas, three hemangiopericytomas, two meningiomas, and one mesenchymal chondrosarcoma. The mean maximum tumor diameter was 54.9 ± 21.5 mm. No major procedural complications occurred except catheterization-related bleeding in one patient. The mean percentage of tumor devascularization was 65.0%±17.5%. Gross total resection was achieved in 12 patients (92.3%). The mean blood loss volume during microsurgical resection was 703.8 ± 886.8 mL (range, 150-3600 mL). Symptoms improved in three patients and remained stable in six patients. CONCLUSIONS: One-stage hybrid embolization before intracranial hypervascular tumor resection is a safe and effective procedure to decrease intraoperative blood loss. It can prevent or treat embolization-related complications in a timely manner and avoid the risk of multiple surgical procedures.