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Community greenhouses are important for the production of local food and reduction of food supply insecurities within cities. As we've seen with Covid-19, pandemics highlight the criticality of local food access to underprivileged urban districts. Since almost 60 % of the energy used in greenhouses is spent in heating and cooling, ground heat exchangers (GHEs) can play a significant role in supplying temperature regulation, but geothermal heat pump systems tend to be expensive for community organizations. An efficient way to reduce GHEs installation costs is to dig trenches to install the system horizontally and cover a part of heating and cooling loads only. In order to ensure cost effectiveness and optimize operations, this type of system was studied for urban greenhouses where ground space can be limited. Sizing calculations were performed for GHEs of a 7.62 m x 15.24 m greenhouse located on the Island of Montreal where the annual, monthly, and hourly energy consumption were estimated from previous building simulations. Three scenarios were used to specify sizing of the system in terms of excavation dimensions and percentage of the greenhouse peak loads covered;(1) number and length of trenches required for a horizontal GHE (HGHE) covering 100% of cooling and heating loads;(2) number and length of trenches required for an HGHE to cover 100% of peak heating loads and 60% of peak cooling loads and;(3) the percentage of heating and cooling peak loads that can be covered by an HGHE located under the greenhouse with similar dimensions (around 116 m2). Estimated excavation dimensions for cases 1 and 2 are 51.8 m x 8 m (414.4 m2) and 40.8 m x 8 m (326.4 m2). Estimated percentage of peak loads covered for case 3 is 40% of heating peak loads and 30% of cooling peak loads. © 2022 Geothermal Resources Council. All rights reserved.
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While COVID-19 has underlined many global interdependencies, it has also made clear the ways in which these globalised connections are structured by profound inequalities. Teaching in this context has been deeply challenging for many educators around the world. For related reasons, though, the pandemic has also created new provocations for global citizenship education (GCE) attuned specifically to the problems of health vulnerability and sub-citizenship caused by socio-economic inequalities. Describing one such educational opportunity, we examine the lessons learned from connecting two university courses across continents through a Collaborative Online International Learning (COIL) collaboration in the middle of the pandemic. Our courses brought together students from India and the US online to study how health vulnerabilities under COVID compared in the two countries. The collaborations of our Indian and American students helped them to develop practical skills in communication across a vast distance, while also offering cosmopolitical opportunities for learning ‘other-wise'. Based on their reflections on their learning in the course, we suggest that the COIL approach provided a useful set of lessons about how global citizenship education can be enhanced through transnational and collaborative, but also critical and comparative attention to sub-citizenship in the world at large. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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The small size and inherent superior electrical characteristics of a toroid has made it the first choice for many Original Equipment Manufacturers (OEMs). However, the lack of knowledge regarding the toroidal coil winding equipment is still hampering the growth of toroid as the first choice for transformers, inductors and other electrical applications. Additionally, due to Covid-19 pandemic and lockdown situation, small scale companies are lacking skilled manpower for the high precision task of toroidal core winding and taping. Although the machine is readily available in the market, the cost is still very high. Toroidal core winding machine is an equipment used for the purpose of winding toroidal cores which is used in various electrical machines such as current transformers, power transformers, isolation transformers, inductors and chokes, auto transformers, etc. This project aims to develop a low-cost toroidal winding machine with a user-friendly digital interface for selection of winding parameters as per the user input. The winding machine developed in this project is efficient and reliable with high-speed performance and negligible error. © 2022 IEEE.
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Pulmonary artery pseudoaneurysms (PAPs) are uncommon entities consisting of contained rupture of the pulmonary artery and are a potentially fatal cause of hemoptysis. We describe two index cases of left lower lobe PAPs and arterial ectasia post-COVID-19 pneumonitis and their endovascular treatment with Amplatzer vascular plug, coils, and glue.Copyright © 2022. Indian Society of Vascular and Interventional Radiology. All rights reserved.
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Purpose: This study aims to provide a case example of two partner institutions and business faculty who creatively used a collaborative online international learning (COIL) experience during the height of the COVID-19 pandemic and transition to online learning to internationalize an undergraduate business class and use existing technology to offer a case study project to further students' global mindset. Design/methodology/approach: Using open-ended qualitative comments from an American college and a Peruvian university, researchers uncovered key themes from a virtual COIL-based learning experience offered as part of an international business class. Findings: Student end-of-course evaluation comments from both countries validated the success of the learning experience and value of working together with other students and faculty in a virtual setting. Research limitations/implications: Areas for future research are provided to extend these initial exploratory findings. However, the implications are clear that the methodology is also appropriate in nonpandemic situations and can quickly bring a global mindset to remote corners of the globe and ensure all students experience the "virtual” study abroad, even when there are travel limitations or budget restrictions for students or the institutions. Practical implications: The implementation detail provided can be easily replicated by other institutions with a global mindset and internationalization goals. Social implications: The proliferation of COIL-based experiences will impact how study abroad experiences are defined and offered in the future. Originality/value: While researchers have documented COIL experiences in the academic literature, their use during the COVID-19 pandemic, as often the only solution for on-going internationalization, has not been thoroughly studied or documented. In addition, the class activities further used team-based international workplace pedagogy, authentic engagement and technology. © 2023, Emerald Publishing Limited.
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In the current global world, and also due to the CoVID-19 pandemic and the evolving digital technologies, education is changing faster and more dramatically now than at any time in history. In this context, education is drifting away from the traditional approaches and into the integration of international, intercultural and global dimensions in higher education, vocational education and training, as well as in secondary education. Thus, the purpose of this exploratory study is to unveil current trends and future needs of research and practice focused on Collaborative Online International Learning (COIL), to set conceptual foundations for further pedagogical innovation. Following the PRISMA 2020 statement, the corpus of the study integrates a final set of research studies (n = 135), published between 2019–2022. Considering the main key-terms of recent literature in the area, the collected data were analyzed by means of a bibliometric analysis, using VOSviewer's network and overlay visualization of most frequent terms. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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As COVID-19 impacted international higher education, collaborative online international learning (COIL) spread globally. Nevertheless, evaluations of the effect of online education have been scant. This study aimed to investigate changes in students' entrepreneurial competencies and cross-cultural knowledge, skills, and abilities before and after a course, as well as differences between physical classroom and COIL approaches. The courses investigated were collaborative educational projects jointly run by four Canadian universities and one Japanese university with international partner companies and organizations. Participants attended a global career course at the University of Toronto in person in 2020 or virtually in 2021. The questionnaire survey consisted of five main themes: knowledge, problem-solving skills, communication skills, cross-cultural understanding and teamwork skills, and confidence and motivation. The surveys were administered before and after the course, and the results revealed statistically significant differences in all themes before and after the courses in 2020 and 2021. Students performed well in all five themes in both the physical-classroom and COIL approaches. Personal development through self-reflection and collaborative learning with peers, instructors, companies, and organizations fostered co-creation and created social value. Considering the budget for and accessibility of the courses, students' learning outcomes in COIL positively affected global career education. Copyright © 2023 GMP Press and Printing.
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Endovascular coil embolization is a minimally invasive, rapid, and effective method for the treatment of intracranial aneurysms. However, complications associated with coil embolization, such as intraoperative aneurysm rupture or arterial occlusion, should be promptly managed during the procedure to avoid catastrophic consequences. This study presents a case of mechanical compression management of the right middle cerebral artery (MCA) inferior trunk during coil embolization for bilateral MCA aneurysms. The inferior trunk of the right MCA was abruptly occluded due to mechanical compression during coil embolization of the right MCA bifurcation aneurysm. A Solitaire AB stent (4 x 20 mm, Covidien/Medtronic, Dublin, Ireland) was implanted in the inferior trunk of the right MCA after tirofiban was injected via a microcatheter, and the right inferior trunk was recanalized. The patient also underwent coil embolization of the left MCA bifurcation aneurysm, without any complications. It is crucial to recognize compressive occlusion of adjacent aneurysm branches to avoid severe complications during intracranial aneurysm embolization. Stent placement is a rescue treatment option for recanalization of an occluded artery. Copyright © 2022 Shanghai Journal of Interventional Radiology Press
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There is a need for college students to develop global perspectives and gain cultural awareness to become responsible global citizens. Innovative ways to create such experiences are known as Collaborative Online International Learning (COIL experiences). COIL is a voluntary partnership between professors in different countries collaborating on jointly constructed learning experiences to enhance international and intercultural understanding. The purpose of this article is to highlight a successful COIL partnership between students from SUNY Oswego in New York and The Hague University of Applied Sciences in the Netherlands during the COVID-19 pandemic. 35 students participated in the experience that served as a platform to educate students through a health educator's unique cultural lens. Benefits from the experiences regarding global outcomes showed that both US students (n=70.6%) and Holland students (n=61.1%) felt they gained the appropriate skills and knowledge to use in their future careers. 70.6% of US and 61.2% of Holland students reported that the COIL experience introduced them to a new outlook and new ways of thinking about how they relate to the world. The current COVID-19 pandemic has created an opportunity to rethink education pathways and integrate global learning in our classrooms.
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In response to the COVID-19 pandemic in 2020, there was a worldwide pivot of education to online communication and the utilization of diverse digital technologies to enhance global learning and foster cultural understanding. Within higher education, educators faced unprecedented challenges in the conversion of face-to-face interactions into online, virtual classrooms, with many educators unprepared and untrained to do so. Yet, the introduction of online digital technologies for pedagogical interactions expanded the internationalization of previously limited curriculum prospects, to create global interconnectedness with the potential to invoke Students' awareness and appreciation of cultural differences in communication, leadership, and conflict. The development of international knowledge, pedagogical knowledge, and the linkage between the two is key for the internationalization of the curriculum. With the growth of new digital communication, learning opportunities such as Collaborative Online International Learning (COIL), aims to foster the development of intercultural competencies (ICC) in our students for future career advancement in an expanding global community. Despite the acknowledgment that faculty are underprepared and lack pedagogical knowledge to translate their lived experiences into their curriculum, there remains a tenable lack of available tools for educators to facilitate students actively participating in objective, equitable and inclusive intercultural communication. Herein, is proposed the novel application of a conceptual tool, a "content representation" or CoRe matrix, which explicitly separates a particular topic into divergent, yet linked dimensions of the knowledge and skills attributed to its content, teaching, and learning. It was hypothesized the CoRe tool could be applied to enhance an educator's PCK of ICC, providing the valuable link between international and pedagogical knowledge, for effective internationalization of the curriculum. The novel ICC CoRe matrix successfully addressed the 4 dimensions of ICC demonstrating the robust nature of the application of the CoRe matrix in the development of an educator's ICC PCK in the COIL classroom. With the exponential increase in digital technologies creating dynamic worldwide networks in education and the workplace, the development of conceptual tools such as the ICC CoRe matrix has the potential to develop and integrate an educator's pedagogical knowledge with ICC, to support the development of effective, objective and inclusive student participation in global twenty-first-century classrooms and beyond.
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SESSION TITLE: Lessons Learned from Critical Care Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Air outside the lungs, bowel, or paranasal cavities suggests critical pathology. Pneumoperitoneum is a classic example in which free abdominal air may signify hollow viscus injury and the need for emergent surgical management. Ectopic gas can also be secondary to barotrauma secondary to mechanical ventilation and concurrent lung injury;the latter being findings often observed in COVID pneumonia (1,2,3). Our case of extensive intramedullary gas in the setting of COVID pneumonia is an example of extensive dissecting air related to barotrauma, but also illustrates how it mimics dire cases of pneumoperitoneum. Therefore, it is an imaging finding that intensivists caring for COVID pneumonia patients should be aware of. CASE PRESENTATION: A 52-year-old male with mild restrictive lung disease from congenital scoliosis developed COVID pneumonia and hypoxic respiratory failure requiring intubation. Clinical course was complicated by renal failure, deep venous thromboses, and radial artery occlusion. CT evaluation revealed large volume upper abdominal pre-peritoneal gas, pneumoperitoneum, soft tissue and intramedullary gas within bilateral ribs and multiple vertebral bodies. Despite reassuring abdominal exams, the patient deteriorated. The patient was placed on comfort care and expired. DISCUSSION: Intramedullary gas refers to the presence of air within the cortical or trabecular bone, bone marrow, or medullary cavity. It is an exceedingly rare imaging finding which was first described in ischemic vertebral collapse and osteomyelitis (4,5). Differential diagnosis includes infection, trauma, degenerative and iatrogenic causes (5,6). Embryologically, fascial layers of the thorax and periosteal coverings of the thoracic osseous structures are derived from the mesoderm, thus creating a continuum between the lungs, surrounding soft tissues, peritoneum, and surrounding osseous structures, and therefore allowing gas to travel between the lung and intramedullary space (7). As cases of COVID pneumonia with ARDS increase, we are becoming aware of the increasing incidence of ectopic air, and the poor prognosis and increased mortality that results (1). Therefore, the finding of intramedullary gas is an important prognostic indicator that the clinician should be aware of. CONCLUSIONS: Several recent studies demonstrate increased mortality in COVID patients who develop ectopic gas as a result of barotrauma and/or acute lung injury (1,2,3). As such the clinician should be aware of these findings, which include pneumomediastinum, subcutaneous emphysema, pneumoperitoneum, pre-peritoneal air, and intramedullary gas for early recognition. Reference #1: 1. Lemmers DHL, Abu Hilal M, Bnà C, Prezioso C, Cavallo E, Nencini N, Crisci S, Fusina F, Natalini G. Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty? ERJ Open Res. 2020 Nov 16;6(4):00385-2020. doi: 10.1183/23120541.00385-2020. PMID: 33257914;PMCID: PMC7537408. Reference #2: 2. Guven BB, Erturk T, Kompe Ö, Ersoy A. Serious complications in COVID-19 ARDS cases: pneumothorax, pneumomediastinum, subcutaneous emphysema and haemothorax. Epidemiol Infect. 2021 Jun 8;149:e137. doi: 10.1017/S0950268821001291. PMID: 34099076;PMCID: PMC8207553. Reference #3: 3. Tetaj N, Garotto G, Albarello F, Mastrobattista A, Maritti M, Stazi GV, Marini MC, Caravella I, Macchione M, De Angelis G, Busso D, Di Lorenzo R, Scarcia S, Farina A, Centanni D, Vargas J, Savino M, Carucci A, Antinori A, Palmieri F, D'Offizi G, Ianniello S, Taglietti F, Campioni P, Vaia F, Nicastri E, Girardi E, Marchioni L, Icu Covid-Study Group. Incidence of Pneumothorax and Pneumomediastinum in 497 COVID-19 Patients with Moderate-Severe ARDS over a Year of the Pandemic: An Observational Study in an Italian Third Level COVID-19 Hospital. J Clin Med. 2021 Nov 29;10(23):5608. doi: 10.3390/jcm10235608. PMID: 34884310;PMCID: PMC8658701. DISCLOSURES: Researc support relationship with 4D Medical Please note: March 2021 Added 04/04/2022 by Anu Brixey, value=Grant/Research Support No relevant relationships by raluca mccallum
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SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: One of the greatest challenges of the coronavirus (COVID-19) pandemic has been deciphering its unique properties, such as the propensity to infect and damage lung epithelium, thereby increasing susceptibility to pulmonary complications.(1, 2) A 2020 cohort study comparing patients with acute respiratory distress syndrome (ARDS) from COVID-19 and ARDS from other causes showed a significantly higher rate of subcutaneous emphysema and pneumomediastinum in the COVID-19 group, suggesting these diagnoses may be due to direct viral damage rather than exposure to positive pressure alone.(3) Presented here is a patient with no underlying lung pathology who was diagnosed with COVID-19 and developed severe subcutaneous emphysema, pneumomediastinum, and pneumothorax. CASE PRESENTATION: A 74 year old male with a history of hypertension presented to the emergency room with a 5-day history of difficulty breathing, cough, fever, chills, and weakness. He tested positive for COVID-19, required non-invasive positive pressure ventilation (NIPPV), and was started on ceftriaxone, doxycycline, and daily dexamethasone. He received a five-day course of remdesivir and one dose of convalescent plasma. By day 9, a chest x-ray revealed a left apical pneumothorax, bilateral subcutaneous emphysema, and pneumomediastinum. On day 12, his respiratory status deteriorated, necessitating invasive mechanical ventilation. A chest CT showed extensive subcutaneous emphysema involving the chest, supraclavicular and axillary regions, and abdominal wall, as well as extensive pneumomediastinum and a moderate left pneumothorax. A left-sided thoracostomy tube was placed and he was proned per ICU protocol. He required placement of a second left-sided chest tube due to persistent worsening pneumothorax. On day 28, despite all aggressive measures, he expired from acute hypoxemia. DISCUSSION: Although this patient was exposed to NIPPV, the severe degree of lung pathology was inconsistent with the amount of positive pressure administered. Furthermore, he lacked underlying pulmonary disease that would compromise his lung compliance to this magnitude. Combining evidence that COVID-19 can cause epithelial lung damage, the patient's absence of pulmonary risk factors, and his severe degree of lung damage incongruent with his exposure to positive pressure, is reasonable to extrapolate that a significant portion of his lung pathology was a result of direct damage from COVID-19. CONCLUSIONS: Patients with COVID-19 may be at higher risk for the development of subcutaneous emphysema, pneumomediastinum, and pneumothorax, likely due to direct viral effect. Lung damage seen may be disproportionate to exposure of positive pressure and may also be seen in the absence of any underlying pulmonary comorbidities. Awareness of this observed pathophysiology may help guide clinicians to optimize ventilator management as well as anticipate potential complications. Reference #1: Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19 [published correction appears in Nat Rev Microbiol. 2022 Feb 23;:]. Nat Rev Microbiol. 2021;19(3):141-154. doi:10.1038/s41579-020-00459-7 Reference #2: Miró Ò, Llorens P, Jiménez S, et al. Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study. Chest. 2021;159(3):1241-1255. doi:10.1016/j.chest.2020.11.013 Reference #3: Lemmers DHL, Abu Hilal M, Bnà C, et al. Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty?. ERJ Open Res. 2020;6(4):00385-2020. Published 2020 Nov 16. doi:10.1183/23120541.00385-2020 DISCLOSURES: No relevant relationships by Shanaz Azad No relevant relationships by Sarah Monaghan No relevant relationships by Brandon Nance No relevant relationships by Samantha Peterson
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Due to the rapid spread of COVID-19 around the world, people's diet environment has also changed, and gastrointestinal diseases have become a common disease around us so far, and the prevalence is on the rise. But because traditional treatments for gastrointestinal diseases are unfriendly to patients, they often require the administration of anesthetics, which can cause side effects. Wireless capsule endoscope is a kind of medical robot that can alleviate the pain of patients, and the research on wireless capsule endoscope has been gradually mature at home and abroad, this paper designed a new four-page propeller-driven biopsy capsule robot. The optimal number of propeller pages is obtained by comparing the velocity of three different numbers of propeller blades in the pipeline. The three axis Helmholtz coil driving system and biopsy module based on CAM structure are also introduced. At the same time, the anchoring module used for precise biopsy of the robot is introduced, so as to ensure that the biopsy capsule robot can reach the specified position quickly and accurately and complete the biopsy task. Finally, we use simulation software to simulate the velocity and pressure of different propeller blades in the same liquid. © 2022 IEEE.
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The small molecule belumosudil was initially identified as a selective inhibitor of Rho-associated coiled-coil kinase 2 (ROCK2) and has recently been approved for the treatment of graft-versus-host disease. However, recent studies have shown that many of the phenotypes displayed upon treatment with belumosudil were due to CK2α inhibition. CK2α is in itself a very promising therapeutic target for a range of conditions and has recently been put forward as a potential treatment for COVID-19. Belumosudil presents a promising starting point for the development of future CK2α inhibitors as it provides a safe, potent and orally bioavailable scaffold. Therefore, several of the major hurdles in drug development have already been overcome. Here, the crystal structure of belumosudil bound to the ATP site of CK2α is presented. This crystal structure combined with modelling studies further elucidates how belumosudil could be developed into a selective and potent CK2α or ROCK2 inhibitor.
Subject(s)
COVID-19 , Casein Kinase II/metabolism , rho-Associated Kinases , Acetamides , Adenosine Triphosphate , Crystallography, X-Ray , Humans , rho-Associated Kinases/geneticsABSTRACT
BACKGROUND: An essential component of becoming a professional nurse is a perspective of global health issues and an awareness of diverse populations. Collaborative online international learning (COIL) using digital technologies, offers meaningful and rewarding opportunities to develop international partnerships between nurses from other countries, without economic, organisational or geographical barriers. Despite reported advantages of using COIL, few COIL interventions have been identified in the nursing literature. The aims of this study are to develop, implement and evaluate a COIL program between Australian and Canadian pre-registration nursing students. METHODS: The study will utilize a mixed methods approach incorporating pre and post-test surveys, focus groups, and semi-structured interviews of key stakeholders. The design will adhere to The State University of New York (SUNY) COIL's criteria for intercultural/international learning opportunities. Participants will be recruited from nursing programs at an Australian Training and Further Education Institute and a Canadian college. Bennett's stages of intercultural competence will provide the theoretical framework for the research. Four specific research interventions will be developed for this project. For students, there will be an online virtual community to allow students and teachers to communicate, socially connect and share resources with each other. Virtual reality simulations will be employed within a virtual global classroom to promote collaborative, intercultural learning. For faculty, a virtual community of practice will provide a platform for faculty to share education and research ideas and participate in collaborate research opportunities. DISCUSSION: This study will evaluate the outcomes of a nursing COIL program. It will measure participants' views on COIL, its contribution to student learning, changes in cultural awareness, organisational impact and research productivity. It will provide nursing students with the opportunity to become global leaders in nursing care and for faculty to develop international research skills and outputs. The findings from the study will allow further refinement of future nursing COIL programs.
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Virtual exchange (VE) is a technology-enabled, collaborative international pedagogy that has been growing over the past two decades as an alternative to traditional study abroad. Instead of students travelling to another country to experience a different culture, they can engage in intercultural learning by collaborating on an online project with their peers around the world. During the COVID-19 pandemic, institutions of higher learning made VE a larger part of their curriculum, leading to greater access to global education for many students. This chapter describes how VE projects allow professors from different countries to bring their students together using simple, relatively accessible technological tools at a reasonably low cost. Illustrative examples show how students develop soft skills such as intercultural competence and digital literacy by exchanging ideas and working together in teams. Faculty and students participating in VE also share their feedback on this novel pedological model. © 2022 Elsevier Ltd. All rights reserved.
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In the Spring of 2021, the authors of this paper collaborated on a co-Taught Virtual Exchange (or Collaborative Online International Learning, COIL) module titled "The International System and the Transformation of Democracy in the 21st Century". Students in Italy and in the United States were brought together virtually to explore the changing international order of the post-Cold War era, and to investigate ways in which 21st century democratic institutions of the United States and Italy are affected. This paper describes the qualitative experiences of the professors and their students in this virtual exchange and argues that the practice can offer a unique learning environment which despite not being a substitute for international mobility enhances, to a certain degree, students' intercultural awareness and flexibility, organizational and collaborative skills, and ability to learn and operate in diverse environments using an array of technological tools. © HEAd 2022. All Rights Reserved.
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Cerebral Salt Wasting Syndrome (CSW) is an uncommon cause of hypotonic hyponatremia associated to central nervous system disease (especially subarachnoid hemorrhage) and characterized by hypovolemia due to renal sodium loss. The main differential diagnosis is SIADH, a much more common form of hyponatremia without signs of hypovolemia. The treatment is based on filling with isotonic or hypertonic saline. We report the case of a 50-year-old chinese man with a history of arterial hypertension presenting to the ER for headache and fever after vaccination for SARS-CoV-2. In the ER he was hemodynamically stable without neurological deficits. Blood tests showed severe hypoosmolar hyponatremia. Brain CT revealed multiple hypodense oval areas of uncertain nature with peripheral contrast enhancement. The main microbiological tests were negative. In the suspicion of paraneoplastic SIADH, water restriction was prescribed and a total body CT scan was performed, resulting normal. Nevertheless, hyponatremia got worse. Brain MRI revealed signs of subacute intracranial bleeding and angiography showed an anterior cerebral artery aneurysm. An echocardiography revealed collapse of the inferior vena cava, therefore, given the hypovolemia, hypotonic hyponatremia and the signs of recent brain injury, diagnosis of CSW was made. Treatment was based on endovascular coiling of the aneurysm and correction of hypovolemic hyponatremia using isotonic saline. It is essential to differentiate between CWS and SIADH since the treatment is categorically different. Their key distinguishing feature is volemia.
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OBJECTIVE: Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes. METHODS: We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid-ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: type A, OA originating separate from the aneurysm; type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment. RESULTS: The median follow-up time was 6.8 months (range, 5.3-20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.854, 95% confidence interval [CI] 1.878-12.548, P = 0.001). Visual symptoms at final follow-up correlated with preoperative visual symptoms (OR 22.777, 95% CI 3.115-166.555, P = 0.002). CONCLUSIONS: Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.