Effectiveness of tranexamic acid on chronic subdural hematoma recurrence: a meta-analysis and systematic review.

Objectives: Our objective was to compare the effectiveness of TXA in improving recurrence in patients with chronic subdural hematoma (CSDH). Methods: Eligible randomized controlled trials (RCTs), prospective trials and retrospective cohort studies were searched in PubMed, Cochrane Library, Embase, and CNKI from database inception to December 2023. After the available studies following inclusion and exclusion criteria were screened, the main outcome measures were strictly extracted. Reman v5.4. was used to assess the overall recurrence rate. A random-effects model was used to assess pooled ORs, with the Mantel-Haenszel estimation method applied. Cochran Q (Chi-square) test and I2 statistics were used to assess inter-study heterogeneity. Funnel plots were used to evaluate publication bias. Results: From the 141 articles found during initial citation screening, 9 literatures were ultimately included in our study. Our NMA results illustrated that patients with newly diagnosed Chronic subdural hematoma revealed a significantly improved recurrence rate when patients were treated with Tranexamic acid (OR: 0.33; 95% CI 0.26-0.41; p < 0.00001) compared with standard neurosurgical treatment. There was no significant difference in the incidence rates of thrombosis (OR: 0.84; 95% CI 0.63-1.12; p = 0.23) and mortality (OR: 1.0; 95% CI 0.57-11.76; p = 0.99), Occurrence of myocardial infarction was significantly less frequent in TXA users than in nonusers (OR: 0.18; 95% CI 0.04-0.82; p = 0.03). Conclusion: TXA can effectively improve the recurrence rate of CDSH. It provides a high level of evidence-based medicine for clinical treatment. In addition, multicenter randomized controlled trials, with dose adjustments, are still needed to determine whether TXA intervention improves neurological function or prognosis.

Solvent-Directed Hierarchical Self-Assembly of Tetraphenylpyrazine-Cholesterol with Amplified Circularly Polarized Luminescence.

It is important to identify the effect of assembly and aggregation on the chirality transfer and energy transmission in supramolecular polymer system, since the unordered aggregation is insufficient to promote luminescence enhancement and chirality transfer, even causing the negative effect. Another key issue is to identify the solvent effect on hierarchically chiral self-assembly. Herein, we designed an AIE-core based building block, tetraphenylpyrazine-cholesterol (TPP-Chol), to explore how the solvent component influences chirality transfer and energy transmission of its aggregates and/or assemblies. Interestingly, the hierarchical assembly behavior was realized in the mixture of MeOH/CHCl3 highly dependent on the MeOH content. During the solvent-directed hierarchical assembly, the morphologic transformations, such as nanoribbons with a width of 150 nm, twisted nanoribbons with helical pitch of 420 nm, nanoribbon clusters, and microflowers with an average diameter of 5.5 µm, were realized with obvious chirality amplification for both circular dichroism (CD) and circularly polarized luminescence (CPL) measurements. The hierarchical assembly of TPP-Chol was also demonstrated by a time-dependent CD test. The work points out the complexity and dynamic of hierarchically chiral self-assembly regulated by the solvent effect, which would be helpful for the development of supramolecular materials with enhanced CPL performance and dynamic chirality.

Comparison of microsurgical clipping with intravascular interventional embolization in the treatment of ruptured aneurysms and risk factors for intraoperative rupture and bleeding.

OBJECTIVE: To investigate the effectiveness of microsurgical clipping compared with intravascular interventional embolization in the treatment of ruptured aneurysms and the risk factors for intraoperative rupture and bleeding. METHODS: The data of 116 patients with ruptured aneurysms admitted to the People's Hospital of China Three Gorges University from January 2020 to March 2021 were collected for retrospective analysis. Among them, 61 cases with microsurgical clipping were classified as the control group (CG), and the rest 55 with intravascular interventional embolization were the observation group (OG), and the treatment effects in the two groups were compared. The general conditions of operation (operation time, postoperative hospital stay and intraoperative blood loss) were compared between the two groups. The intraoperative rupture of cerebral aneurysm during operation was counted, and the incidence of complications between the groups was compared. Risk factors affecting intraoperative rupture of cerebral aneurysms were analyzed by logistic regression. RESULTS: The total clinical treatment efficiency was dramatically higher in the OG than that in the CG (P<0.05). The operative time, postoperative hospital stays, and intraoperative bleeding were all higher in the CG than those in the OG (all P<0.001). There was no statistical difference in the incidence of wound infection, hydrocephalus, and cerebral infarction between the two groups (all P>0.05). However, the incidence of intraoperative rupture was markedly higher in the CG than that in the OG (P<0.05). Multifactorial logistic regression analysis revealed that history of subarachnoid hemorrhage, history of hypertension, large diameter of aneurysm, irregular morphology, and anterior communicating artery aneurysm were independent risk factors for intraoperative rupture in patients. CONCLUSION: Intravascular interventional embolization for middle cerebral artery aneurysm rupture is a less invasive procedure with faster recovery time, and history of subarachnoid hemorrhage, history of hypertension, large diameter of aneurysm, irregular morphology, and anterior communicating artery aneurysm are independent risk factors affecting patients with intraoperative rupture.

Metallophilic Interaction-Mediated Hierarchical Assembly and Temporal-Controlled Dynamic Chirality Inversion of Metal-Organic Supramolecular Polymers.

The study of dynamic supramolecular chirality inversion (SMCI) not only helps to deepen the understanding of chiral transfer and amplification in both living organizations and artificially chemical self-assembly systems but also is useful for the development of smart chiral nanomaterials. However, it is still challenging to achieve the dynamic SMCI of the self-aggregation of metal-organic supramolecular polymers with great potential in asymmetric synthesis, chiroptical switches, and circular polarized luminescence. Here, we successfully developed a hierarchical coassembly system based on the mPAzPCC and various metal ions with effective chirality transfer and temporal-controlled SMCI. Due to the dynamic self-assembly and hierarchical chirality transfer of the Ag+/mPAzPCC complex driven by metallophilic interaction and coordination, morphological transition with nanoribbons, helical nanoribbons, and chiral nanotubules was successively obtained. Interestingly, the SMCI of chiral nanoaggregates was precisely regulated by solvents and metal ions in the Cu2+/mPAzPCC and Mn2+/mPAzPCC system. Besides, temporal-controlled dynamic SMCI switching from helix to bundled helix was clearly revealed in the aggregation of Cu2+/mPAzPCC, Mn2+/mPAzPCC, and Bi3+/mPAzPCC systems. This work provides a metallophilic interaction-mediated helical assembly pathway to dynamically modulate the chirality of metal-organic complex-based assemblies and deepen the understanding of the hierarchically dynamic self-assembly process, which would be of great potential in metal ion-mediated supramolecular asymmetric catalysis and bioinspired chiral sensing.

Azilsartan protects against hyperglycemia-induced hyperpermeability of the blood-brain barrier.

Diabetes mellitus (DM) is a complex metabolic disease with significant neurological complications and is reported to be closely related to the blood-brain barrier (BBB) disruption. Azilsartan is an antagonist of the Angiotensin II receptor developed for the treatment of hypertension, and it has been recently reported to have neuroprotective effects. The present study aims to investigate the protective effect of Azilsartan against hyperglycemia-induced BBB disruption and its underlying mechanism. Male db/db mice were treated with Azilsartan (20 µg/day) for 10 consecutive days. Compared to the control group, increased BBB permeability, suppressed occludin expression, excessive release of inflammatory factors, and downregulation of krüppel-like factor 2 (KLF2) were observed in diabetic mice, all of which were dramatically reversed by Azilsartan treatment. In the in vitro experiments, elevated endothelial permeability and decreased expression of occludin and KLF2 were observed in high glucose-challenged endothelial cells, which were significantly alleviated by Azilsartan. Lastly, the silencing of KLF2 abolished the protective effects of Azilsartan against the high glucose-induced expression of occludin and endothelial monolayer permeability in bEnd.3 brain endothelial cells. Based on these observations, we concluded that Azilsartan protected against hyperglycemia-induced hyperpermeability of BBB via the KLF2/occludin axis.