Endovascular Treatment of Ruptured Intracranial Blister Aneurysms: A Systematic Review and Meta-analysis.

BACKGROUND: Endovascular treatment of blister aneurysms is a promising approach, even though they are vascular lesions challenging to treat due to their angioarchitectural characteristics. PURPOSE: Our aim was to investigate clinical and radiologic outcomes after endovascular treatment of ruptured blister aneurysms. DATA SOURCES: PubMed, Ovid MEDLINE, Ovid EMBASE, Scopus, and the Web of Science were screened. STUDY SELECTION: We performed a comprehensive review of the literature from 2010 to 2019 reporting series of patients with blister aneurysms treated with an endovascular approach. DATA ANALYSIS: Event rates were pooled across studies using a random effects meta-analysis. DATA SYNTHESIS: A total of 32 studies reporting on 684 patients (707 aneurysms) were included. Stent placement, stent-assisted coiling, and flow diversion were the most commonly described treatments (282, 256, and 155 patients, respectively). The long-term complete occlusion rate was 76.9% (95% CI, 69.2%-83.9%). The perioperative complication rate was 8.9%, and clinical outcome at final follow-up was mRS <2 in 76.6% (95% CI, 68.2%-84.2%) of patients. The mortality rate was 4.7% (95% CI, 2.30%-7.80%). Among the different techniques, stent-assisted coiling is the one that had the higher rate of immediate occlusion (63.4%); however, the occlusion rate at the final follow-up was comparable among the different techniques. LIMITATIONS: Different techniques were described and data were reported in a nonhomogeneous way, possibly representing a bias in the present study. CONCLUSIONS: This study suggests that endovascular treatment of blister aneurysms is associated with good long-term occlusion rates and reasonable complication and mortality rates. There is no consensus on the best endovascular techniques in blister aneurysm management.

Reconstruction of artery wall in experimental giant aneurysms.

AIM: This study describes five experimental techniques for the surgical treatment of giant aneurysms based on the resection of the aneurysm sac and reconstruction of the arterial wall. METHODS: The aneurysm was realized with a venous graft implanted with end-to-side anastomosis on the common carotid artery on 50 rabbits (with each technique realized in 10 rabbits). The first two experimental techniques (A and B) involve the reconstruction of the artery wall by a synthetic dural patch and by direct suture reinforced by a venous patch, respectively. In the model C a collateral branch arising from the aneurysm is resected and reimplanted on the parent artery after aneurysm resection. In the experimental model D the arterial defect is closed by a venous patch surrounding the whole arterial wall and sutured with the aid of fibrin glue. In the model E clamping of the parent artery proximal to the aneurysm site and termino-lateral anastomosis with the contralateral artery lead to the thrombosis of the aneurysm fulled only by refluent flow. RESULTS AND CONCLUSION: The venous pouch experimental models are useful to realize giant aneurysms. The above described techniques allow to realize the reconstruction of the arterial wall without stenosis and shortening the clamping time.

Proteomic characterization of EPCs and CECs "in vivo" from acute coronary syndrome patients and control subjects.

BACKGROUND: Circulating endothelial cells (CECs) and endothelial progenitor cells (EPCs) represent two scarce blood populations that are thought to play important roles in tissue vascularization. They have also been proposed as potential markers for more than a dozen pathologies. Moreover, EPCs have arisen as a new therapeutic option for cardiovascular disease. However nowadays there is certain controversy about their roles and a better understanding of EPC biology is required to develop new strategies for forthcoming therapies. METHODS: Flow cytometry analysis was performed on freshly isolated mononuclear cells from control subjects and Acute Coronary Syndrome (ACS) patients. EPCs and CECs for both groups were isolated and quantified. Statistical analyses were performed to test the potential biomarker usefulness of both populations in ACS together with the first "in vivo" proteomic characterizations of these populations. RESULTS: Our results do not show statistical differences in the quantification of CECs and EPCs in control subjects and ACS patients. The proteomic characterization allowed us to identify 673 proteins associated to CECs (389 in controls and 462 in ACS patients), and another 502 proteins in EPCs (350 in controls and 274 in ACS patients). CONCLUSIONS: Our data show the necessity to obtain a more accurate and specific phenotype of CECs and EPCs cells as well as a flow cytometry "golden standard" protocol, before they can be considered useful clinical markers. GENERAL SIGNIFICANCE: The proteomic data suggest a potential effect of ACS in the protein profiles of these cells.

An optimal protocol to analyze the rat spinal cord proteome.

Since the function of the spinal cord depends on the proteins found there, better defing the normal Spinal Cord Proteome is an important and challenging task. Although brain and cerebrospinal fluid samples from patients with different central nervous system (CNS) disorders have been studied, a thorough examination of specific spinal cord proteins and the changes induced by injury or associated to conditions such as neurodegeneration, spasticity and neuropathies has yet to be performed. In the present study, we aimed to describe total protein content in the spinal cord of healthy rats, employing different proteomics tools. Accordingly, we have developed a fast, easy, and reproducible sequential protocol for protein extraction from rat spinal cords. We employed conventional two dimensional electrophoresis (2DE) in different pH ranges (eg. 4-7, 3-11 NL) combined with identification by mass spectrometry (MALDI-TOF/TOF), as well as first dimension protein separation combined with Liquid Chromatography Mass Spectrometry/Mass Spectrometry (LC-MS/MS) to maximise the benefits of this technology. The value of these techniques is demonstrated here by the identification of several proteins known to be associated with neuroglial structures, neurotransmission, cell survival and nerve growth in the central nervous system. Furthermore this study identified many spinal proteins that have not previously been described in the literature and which may play an important role as either sensitive biomarkers of dysfunction or of recovery after Spinal Cord Injury.

Therapeutic effect of gonadotropins with and without a GnRH analogue (D6-tryptophan) in male infertility due to idiopathic oligoasthenospermia.

The authors evaluate the response to treatment with gonadotropins alone and in association with D6-tryptophan (a Gn-RH analogue) in a group of infertile men affected by idiopathic oligo-asthenospermia. An improvement of fast straight motility of spermatozoa at second hour from ejaculation have been observed in our patients, even if a larger number of cases is necessary to make definitive conclusion.

[Hysteroscopy as a diagnostic method in postmenopausal metrorrhagia]. / L'isteroscopia come metodica diagnostica nelle metrorragie della post-menopausa.

We performed 215 hysteroscopies for post-menopausal bleeding. The most common abnormalities found were endometrial hypoatrophy and low-risk hyperplasia, the less common high-risk hyperplasia and adenocarcinoma of the endometrium. The correlation between hysteroscopic view and endometrial sampling was always very high. Hysteroscopy seems to be a very accurate method for evaluating patients with post-menopausal bleeding especially if associated with endometrial sampling.