To clarify the safety and efficacy of flow diverter (FD) treatment for blood blister–like aneurysm (BBA) through a systematic review and literature analyzing perioperative and long-term clinical and ...angiographic outcomes.
We performed a comprehensive review of the current literature for studies with >2 patients related to FD treatment of BBAs published. A random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurologic outcome.
We included 15 noncomparative studies with a total of 165 target BBAs. Complete occlusion rates were 72% (95% confidence interval CI, 0.59–0.85). Recurrence occurred in 13% (95% CI, 0.04–0.29) and rebleeding in 3% (95% CI, -0.02 to 0.07) of patients. Procedure-related morbidity and mortality were 26% (95% CI, 0.19–0.33) and 3% (95% CI, -0.01 to 0.07), respectively. The rate of long-term good outcomes was 83% (95% CI, 0.77–0.89). Subgroup analysis indicated that a single FD strategy for BBA seemed to have a higher rate of good outcomes compared with an overlapped FD strategy (89.9% vs. 61.9%; odds ratio, 1.42; 95% CI, 1.25–14.98, P = 0.02). Complete occlusion rate and procedure-related morbidity rate did not see any significant difference between these 2 strategies.
Our meta-analysis suggests that in selected cases, FD can be safe and effective. A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy. Ultimately, treatment of BBA should be considered on a case-by-case basis to maximize patient benefits and limit the risk of perioperative complications.
•Flow diverters (FDs) can be safe and effective in treating blood blister–like aneurysms.•A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy.•Treatment of blood blister–like aneurysm (BBA) should be considered on a case-by-case basis.
Abstract Objective To evaluate the safety and efficacy of overlapped stenting for blood blister-like aneurysms (BBAs) and to compare the outcomes between LVIS and non-LVIS stents. Methods A ...retrospective review of the aneurysm database identified 37 patients carrying internal carotid artery (ICA) BBAs treated by overlapped stenting in our institution from June 2013 to June 2016. The clinical characteristics and angiographic results were reviewed. Results Overlapped stenting combined with coiling were applied in 37 BBAs, including LVIS stents in 18 cases and non-LVIS stents in 19. For the LVIS group, angiographic results at 3-24 months were complete occlusion in 15 cases (83.3%), improved in 2 cases (11.1%), and recanalized in 1 case (5.6%). The modified Rankin Scale (mRs) scores at 3-36 months follow-up were 0-2 in 15 cases (83.3%) and 3-6 in 3 cases (16.7%). For the non-LVIS group, angiographic results at 3-46 months were complete occlusion in 12 cases (63.2%) and recanalized in 7 cases (36.8%). Clinical outcomes at 6-58 months were mRS scores of 0-2 in 17 cases (89.5%) and 3-6 in 2 cases (10.5%). Use of the LVIS stent was less likely to result in recanalization (OR=0.10, 95% CI: 0.01-0.93, P=0.042) than the non-LVIS stent. The LVIS group had a lower average number of stents than did the don-LVIS group (2.2 vs 2.6, P=0.016). In terms of complication rate (11.1% vs 5.3%, P=0.604), good outcome rate (83.3% vs 89.5%, P=0.660), and immediate angiographic result (P=0.424), no statistically significant difference between the two groups was found. Conclusions Overlapped LVIS stenting combined with coiling is feasible and safe for BBAs. Overall, the LVIS stent provided less risk of BBA recurrence compared with the non-LVIS stent and did not increase the risk of procedure-related complications.
Whether rupture risk of cerebral arteriovenous malformation (AVM) is higher during pregnancy and puerperium remains controversial. This study aimed to compare risk of rupture in pregnant and ...nonpregnant female patients with AVM in a singer-center series and assess current evidence regarding rupture risk of AVM during pregnancy and puerperium by pooled data analysis.
We retrospectively reviewed female patients with AVM in our center from January 2006 to August 2017. Hemorrhage events and patient-years were calculated during exposure period and nonexposure period, which was defined as either the interval from birth until AVM obliteration or last follow-up after subtracting the exposure period. Poisson rate ratio analysis was used to compare hemorrhage rate between the 2 periods. Pooled data analysis was performed by up-to-date literature review via PubMed and EMBASE databases.
In 264 female patients with AVM, overall annual hemorrhage rate for 222 total hemorrhages during an average of 7484 patient-years was 2.97%. Eight hemorrhages occurred in exposure periods, 214 hemorrhages occurred in nonexposure periods, and 155 hemorrhages occurred in nonexposure periods of reproductive-age patients, translating to annual hemorrhage rates of 5.40% in exposure periods, 2.92% in nonexposure periods, and 3.82% in nonexposure periods of reproductive-age patients. Pooled data analysis showed a higher annual hemorrhage rate in exposure periods than in nonexposure periods (5.59% vs. 2.52%; 95% confidence interval 1.52–6.70, P = 0.002).
This study demonstrated an increase in annual rate of cerebral AVM hemorrhage during pregnancy and puerperium. Female reproductive-age patients with cerebral AVM may have higher risks of AVM rupture. Further evaluation by well-designed prospective or randomized cohort studies is needed.
Background
Flow diverters (FDs) for the treatment of basilar artery (BA) aneurysms remain controversial. In this study, we report our initial experience of flow diversion for treatment of this ...pathology.
Methods
Consecutive patients with an aneurysm of the BA that was treated by implantation of the FD were included in our retrospective study. Procedural complications, aneurysm occlusion, and a functional outcome were evaluated. FD placement in BA for aneurysm treatment reported in the literature was also reviewed and summarized.
Results
Sixteen patients with 16 BA aneurysms were treated by FD implantation with (
n
= 8) or without (
n
= 8) adjunctive coiling. The Tubridge was used in 13 (81.3%) and Pipeline in 3 (18.8%) procedures. Average aneurysm size was 15.7 mm. Four aneurysms were located at the basilar apex, six at the basilar trunk, and six at the vertebrobasilar junction. Three patients experienced procedural complications (18.8%), including two ischemic strokes and one hydrocephalus, with resultant mortality in one case (6.3%). Median follow-up was 7.7 months and available for 15 aneurysms. Complete/near-complete occlusion was seen in 13 (86.7%) aneurysms.
Conclusion
In our initial experience, flow diversion is feasible and safe in the treatment of BA aneurysms with promising occlusion rates at mid-term follow-up. Larger cohort studies are required to validate these results.
To clarify the safety and efficacy of flow diverter (FD) treatment for aneurysm in small cerebral vessels, we conducted a systematic review of the literature analyzing perioperative and long-term ...clinical and angiographic outcomes.
A comprehensive review of the up-to-date literature for studies with ≥10 patients related to FD treatment of small vessel aneurysms published was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical procedural success, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, all complications, long-term mortality, and overall good outcome.
We included 26 noncomparative studies with 572 target aneurysms. The technical procedural success rate was 96% (95% confidence interval CI 0.93–1.00). At final follow-up, the complete occlusion rate was 70% (95% CI 0.64–0.76). The all-cause morbidity rate was 20% (95% CI 0.14–0.25). Procedure-related morbidity and mortality rates were 9% (95% CI 0.07–0.12) and 4% (95% CI 0.00–0.08), respectively. Overall long-term good outcome rate was 96% (95% CI 0.93–0.99). In the 3 subgroup analyses, complete occlusion rate of saccular aneurysms was lower than that of nonsaccular aneurysms (55% vs. 73%, respectively; odds ratio 0.40, 95% CI 0.17–0.98, P = 0.04). The procedure-related morbidity rate and the good outcome rate were not significantly different in this subgroup. In the other 2 subgroups in which we compared anterior circulation aneurysms with posterior circulation aneurysms and single FD strategy with overlapped FD strategy, the rates were also not significantly different.
Our meta-analysis demonstrated that FD treatment of small vessel aneurysms is technically feasible and effective with a high rate of complete occlusion. Although the comorbidities of patients cannot be neglected, the FD approach was associated with an acceptable rate of procedure-related morbidity and a satisfactory rate of overall good outcome.
•FD treatment for aneurysm in small vessels is technically feasible and effective with a high rate of complete occlusion.•Complete occlusion rate of saccular aneurysms mostly located at artery bifurcations was lower than nonsaccular aneurysms.•FD treatment for these lesions had a relatively high rate of complications, but the long-term outcomes was satisfactory.
Copper (Cu) and tetracyclines (TCs) often coexist in agricultural soils because of the use of manures on farmland; however, the influence of Cu on the bioavailability of TCs is still unclear, ...especially for cases with aging Cu. The freely dissolved concentrations (FDCs) of TCs are believed to be directly related to their bioavailability. In the present study, the FDCs of TCs were determined using organic-diffusive gradients in thin films (o-DGT), and the influence of Cu on the FDCs of TCs in soils was evaluated. The results showed that the FDCs of tetracycline (TC), oxytetracycline (OTC), and chlortetracycline (CTC) were 0.11–0.93, 0.28–1.02, and 0.24–0.53 μg/kg in the CK groups (no Cu added) and accounted for 0.09–0.58, 0.10–1.40, and 0.05–1.19‰ of their total concentrations which ranged from 0.2 to 10.0 mg/kg for TC, OTC, and CTC, respectively. The co-contamination of Cu reduced the FDCs of TCs in most cases, and aging increased the influence of Cu. The presence of Cu resulted in a decrease in the TC FDC by 35.48–95.04% in aged soils and 3.42–87.19% in newly prepared soils. FTIR analysis revealed that aging facilitated the bonding of Cu to soil particles via Cu-O, and Cu bonded to groups such as hydroxyl groups (-OH) in TCs. Our results suggested that the presence of Cu might reduce the bioavailability of TCs, and aging would enhance these effects. This is helpful for the bioavailability analysis of TCs under co-contamination of heavy metals.
Graphical Abstract
Abstract Background Trans-radial (TRA) access has become increasingly prevalent in neurointervention. Nonetheless, mediastinal hematoma after TRA is an infrequent yet grave complication associated ...with a notably elevated mortality rate. While our review found no reported mediastinal hematoma cases managed conservatively within neuro-interventional literature, similar complications are documented in cardiac and vascular interventional radiology, indicating its potential occurrence across disciplines. Case Presentation Carotid computed tomography angiography (CTA) showed calcified plaques with stenosis (Left: Severe, Right: Moderate) in the bilateral internal carotid arteries (ICAs) of an 81-year-old male presented with paroxysmal weakness in the right upper limb. Dual antiplatelet therapy with aspirin and clopidogrel was administered. On day 7, DSA of the bilateral ICAs was performed via TRA. Post-DSA, the patient experienced transient loss of consciousness, chest tightness, and other symptoms without ECG or MRI abnormalities. Hemoglobin level decreased from 110 g/L to 92 g/L. Iodinated contrast-induced laryngeal edema was suspected, and the patient was treated with intravenous methylprednisolone. Neck CT indicated a possible mediastinal hemorrhage, which chest CTA confirmed. The patient’s treatment plan involved discontinuing antiplatelet medication as a precautionary measure against the potential occurrence of an ischemic stroke instead of the utilization of a covered stent graft and surgical intervention. Serial CTs revealed hematoma absorption. Discharge CT showed a reduced hematoma volume of 35 × 45 mm. Conclusions This case underscores the need for timely identification and precise manipulation of guidewires and guide-catheters through trans-radial access. The critical components of successful neuro-interventional techniques include timely examination, rapid identification, proper therapy, and diligent monitoring.
Purpose
The co-contamination of soil with heavy metals (HMs) and tetracyclines (TCs) is an environmental issue of great concern globally. The interactive effects of HMs (Cd and Cu) and TCs ...(tetracycline, oxytetracycline, and chlortetracycline, labeled with TC, OTC, and CTC, respectively) on contaminant removal from soil planted with
Mirabilis jalapa
L. were evaluated.
Materials and methods
Pot experiment was carried out in co-contaminated soils with HMs at four rates (Cd/Cu: 0/0, 2.5/200, 5.0/400, and 10/600 mg kg
−1
) and TCs at four rates (0, 0.5, 2.5, and 5.0 mg kg
−1
). The bioavailability of HM was evaluated via subsequent planting with
Zea mays
L., ex situ extraction by diethylenetriaminepentaacetic acid (DTPA) and in situ extraction (diffusive gradients in thin films, DGT).
Results and discussion
The results showed that a low level of contaminants increased the growth of
M. jalapa
. The biomass of
M. jalapa
increased by 30.31% and 38.70% in treatments with TC concentrations of 0.5 mg kg
−1
and Cd/Cu concentrations of 2.5/200 mg kg
−1
, respectively. The concentration and accumulation of HMs in the plant tissue were significantly higher (
p
< 0.05) in the co-contamination treatments, especially in the low HM treatments. The mean concentrations of the residual TC, OTC, and CTC in the presence of
M. jalapa
decreased by 28.18–36.86%, 20.93–42.27%, and 16.36–28.94%, respectively. However, phytoremediation increased the bioavailability of Cd and Cu. In treatments with addition of HMs, the Cd concentrations in subsequent
Z. mays
increased from 14.25 to 18.04 mg kg
−1
in roots and 2.62–3.31 mg kg
−1
in shoots in treatments without phytoremediation to 14.67–22.44 mg kg
−1
in roots and 2.77–4.18 mg kg
−1
in shoots in phytoremediation treatments; Cu concentrations increased from 288.77 to 372.61 mg kg
−1
in roots and 27.76 to 32.49 mg kg
−1
in shoots in treatments without phytoremediation to 291.47–384.33 mg kg
−1
in roots and 32.61–49.69 mg kg
−1
in shoots in phytoremediation treatments. In addition, the HM concentrations in soils of phytoremediation treatments extracted by DTPA and measured by DGT increased by 2.86–3.76% and 11.35–15.24% for Cd, respectively, and 1.22–4.56% and 3.13–10.95% for Cu, respectively, compared with non-phytoremediation treatments with same concentrations of pollutants.
Conclusions
Our results indicated that co-contamination with TCs increased the adsorption of HMs and that phytoremediation improved the degradation of TCs. However, one season of phytoremediation also increased the bioavailability of HMs. Thus, phytoremediation should be applied continuously.
Graphic Abstract
In the present study, the aim was to investigate the role of microRNA-1180 (miR-1180) in the growth and apoptosis of prostate cancer, as well as to identify its direct targets. Initially, reverse ...transcription-quantitative polymerase chain reaction (RT-qPCR) was performed to examine the expression of miR-1180 in the prostate cancer tissues and adjacent normal prostate tissues of 30 patients, as well as in DU145 and RWPE-1 cells. Next, DU145 cells were transfected with miR-1180 mimics, and the expression levels of associated proteins were determined by western blot assay. In addition, the role of miR-1180 in the proliferation, apoptosis, invasion and migration of DU145 cells was investigated by MTT, flow cytometry, cell invasion and wound healing assays, respectively. A dual-luciferase reporter assay was also performed to examine whether TNF receptor associated factor 1 (TRAF1) and B-cell lymphoma-2-associated athanogene 2 (BAG2) are direct targets of miR-1180. It was observed that miR-1180 expression was significantly decreased in the prostate cancer tissues compared with the normal prostate tissues, and was also inhibited in DU145 cells compared with RWPE-1 cells. Furthermore, transient overexpression of miR-1180 inhibited the proliferation, migration and invasion, and promoted the apoptosis of DU145 cells, as well as alleviated expression of associated proteins. The dual-luciferase reporter assay confirmed that TRAF1 and BAG2 are direct targets of miR-1180. These results suggested that miR-1180 contributed to prostate cancer by targeting TRAF1/BAG2 and by nuclear factor-κB signaling pathway activation.
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