Endovascular treatment of intracranial dural arteriovenous fistulas with Onyx: A consecutive series of 62 patients from a single-center.

OBJECTIVE: Intracranial intracranial dural arteriovenous fistulas (DAVFs) are mainly treated with an endovascular approach and various embolic agents. The aim of this study was to investigate the efficacy and safety of Onyx embolization in the treatment of DAVFs and characterize the factors as sociated with complete obliteration. METHODS: This retrospective study was based on 62 patients with DAVFs who underwent endovascular treatment with Onyx alone or in combination with coils at our institution. Clinical and imaging data were collected and analyzed. RESULTS: A total of 62 patients with 64 DAVFs were treated with endovascular embolization. The most common primary symptom was ophthalmological signs with a rate of 37.1%. Cognard type III was the most commonly seen subtype (32.8%). The immediate complete occlusion and follow-up rate was 92.2% and 93.5%, respectively. Transvenous balloon-assisted sinus protection was used in 12 patients (18.8%). The pressure cooker technique was used in eight patients (12.5%). Complications were seen in five patients including intracerebral hemorrhage (n = 2), venous thrombotic events (n = 2), and glued microcatheter (n = 1). CONCLUSIONS: Endovascular Onyx alone or in combination with coils embolization is a safe and effective therapy for DAVFs. Favorable angiographic and clinical outcomes can be achieved using different endovascular approaches. Transvenous balloon-assisted sinus protection and the pressure cooker technique may help achieve complete occlusion of DAVFs.

Endovascular embolization for basal ganglia and thalamic arteriovenous malformations.

Background: Basal ganglia and thalamic arteriovenous malformations (AVMs) represent a special subset of malformations. Due to the involvement of vital brain structures and the specifically fine and delicate angioarchitecture of these lesions, it presents unique therapeutic challenges and technical difficulties that require thorough treatment planning, individualized treatment strategies, and advanced techniques for good clinical outcome. Method: In this study, we presented a series of ruptured basal ganglia and thalamic AVMs embolized via a transarterial, transvenous or combined approach. Herein, we summarized our treatment experience and clinical outcomes to further evaluate the effectiveness and safety of endovascular embolization for these AVMs as well as the indications, therapy strategies, and techniques of embolization procedures. Results: Twelve patients with basal ganglia and thalamus AVMs were included in the study. Their average age was 23.83 ± 16.51 years (range, 4-57 years) with a female predominance of 67% at presentation. The AVMs were located in the thalamus in 3 (25%) patients, in the basal ganglia in 3 (25%) patients, and in both sites of the brain in 6 (50%) patients. There were 5 AVMs located on the left side and 7 on the right. The mean nidus diameter was 3.32 ± 1.43 cm (range 1.3-6.1 cm). According to the Spetzler-Martin grading classification, 4 (33.3%) brain AVMs were Grade III, 7 (58.3%) were Grade IV, and 1 (8.3%) was Grade V. All of them presented with bleeding at admission: four of these patients presented with an intracerebral hemorrhage (ICH), 8 ICH in combination with intraventricular hemorrhage (IVH), and no patient with subarachnoid hemorrhage (SAH). Among these patients treated with endovascular embolization, 7 patients were treated by the transarterial approach, 4 patients transvenous approach, and 1 patient underwent the combined approach. A single embolization procedure was performed in 6 patients (50%) and the other 6 cases (50%) were treated in a staged manner with up to three procedures. Procedure-related complications occurred only in two patient (16.7%). Complete AVM obliteration was obtained in 7 patients (58.3%), and partial obliteration was in 4 patients (33.3%). Overall, good or excellent outcomes were obtained in 7 patients (58.3%), and poor functional outcome was observed in 5 patients (41.7%) at the last follow-up. All survived patients achieved anatomic stabilization and there was no postoperative bleeding or recurrence in the follow-up. Conclusion: The management of the basal ganglia and thalamic AVMs is a great challenge, which needs multimodal individualized treatment to improve the chances of radiographic cure and good outcomes. Endovascular therapy is safe and effective in the treatment of cerebral AVMs particularly for deep-seated AVMs such as the basal ganglia and thalamus. Our results demonstrate a high rate of anatomic obliteration with an acceptable rate of complications in the endovascular treatment of these vasculopathies via a transarterial approach or a transvenous approach.

A comparison of Atlas and Leo Baby stents-assisted coiling of intracranial aneurysms with small parent vessels.

Some studies have reported the efficacy and safety of the Atlas stent and the Leo Baby stent-assisted coiling (SAC) of intracranial aneurysms arising from small cerebral vessels. The authors aimed to compare the clinical performance of the Atlas and the Leo Baby stents in small parent arteries. Methods and materials: Between January 2019 and November 2022, 56 patients at our centre were treated using either Atlas or Leo Baby SAC of intracranial aneurysms arising from small parent vessels (<2 mm). The clinical and angiographic imaging data of the two cohorts were retrospectively collected and comparatively analyzed. Results: A total of 56 patients were included in this study. Thirty-two patients were treated with the Atlas SAC, and 24 patients were treated with the Leo Baby SAC. The mean age of the Atlas stent cohort was older, and the mean aneurysm size was smaller than the Leo Baby stent. The immediate complete occlusion rate was 68.6% in the Atlas stent cohort and 62.5% in the Leo Baby stent cohort. The mean angiographic follow-up time for Atlas stent cohort was 8.9±2.5 months, and the final aneurysm complete occlusion rate was 81.0%. The mean follow-up time for Leo Baby stent cohort was 18.9±6.0 months, and the final aneurysm complete occlusion rate was 83.3%. Conclusions: At the final follow-up, the Atlas or the Leo baby stent SAC of intracranial aneurysms with small parent vessels resulted in favourable angiographic results and clinical outcomes, with a low rate of associated complications.

Hybrid surgery recanalization for high-level chronic internal carotid artery occlusion.

Objective: Although endovascular recanalization is considered a more effective treatment for chronic internal carotid artery occlusion (CICAO), the success rate of complex CICAO remains inadequate. We present hybrid surgery (carotid endarterectomy combined with carotid stenting) for complex CICAO and explore the influential factors and effects of hybrid surgery recanalization. Methods: We retrospectively analyzed the clinical, imaging, and follow-up data of 22 patients with complex CICAO treated by hybrid surgery at the Zhongnan Hospital of Wuhan University from December 2016 to December 2020. We also summarize the technical points related to hybrid surgery recanalization. Results: A total of 22 patients with complex CICAO underwent hybrid surgery recanalization. There were no postoperative deaths in all patients after hybrid surgery recanalization. Nineteen patients successfully underwent recanalization with a success rate of 86.4% and three cases with a failure rate of 13.6%. Patients were divided into success and failure groups. Significantly different radiographic classification of lesions was observed between the success group and the failure group (P = 0.019). The rates of CICAO with reverse ophthalmic artery blood flow in the internal carotid artery (ICA) preoperatively were 94.7% in the success group and 33.3% in the failure group (P = 0.038). Three cases of hybrid surgery recanalization failure were transferred for EC-IC bypass and had good neurological recovery. Postoperative average KPS scores of the 19 patients were improved compared to the preoperative ones (P < 0.001). Conclusion: Hybrid surgery for complex CICAO is safe and effective with a high recanalization rate. The recanalization rate is related to whether the occluded segment surpasses the ophthalmic artery.

Efficiency of endovascular management with a combination of Onyx and coils for direct and indirect carotid cavernous fistula treatment: Experience of a single center.

BACKGROUND: To evaluate the safety and efficacy of endovascular treatment with a combination of Onyx and coils for carotid cavernous fistulas (CCFs), and to characterize the factors associated with clinical and angiographic outcomes for direct and indirect CCFs. METHODS: This retrospective study included 31 patients with CCF treated with an endovascular procedure between December 2017 and March 2022. RESULTS: Direct and indirect CCFs were found in 14 (45.2%) and 17 (54.8%) cases, respectively. Direct CCFs included eleven traumatic carotid cavernous fistulas. The most common symptom on admission was chemosis, which was seen in 17 (54.8%) patients. Eight (25.7%) cases were treated by the transarterial approach. Fourteen (45.2%) cases were treated using the femoral vein-inferior petrosal sinus approach. Seven (22.6%) were treated by direct puncture of the superior ophthalmic vein. Two (6.5%) were treated by the femoral vein-facial vein approach. Immediate complete occlusion and follow-up rates were 93.5% and 96.7%, respectively. Twenty-nine (96.7%) patients experienced an improvement in their symptoms at clinical follow-up. Chemosis was significantly improved or resolved in 15 patients. Ophthalmoplegia was improved or resolved in 10 patients. Visual impairment was improved in 6 patients. Proptosis was improved or resolved in 5 patients. One case (3.2%) experienced procedure-related complication presented with transient oculomotor nerve palsy. In univariate subgroup analysis, use of balloon, treatment approach, and history of head trauma were significantly different between the direct and indirect CCF groups. CONCLUSIONS: Endovascular treatment with a combination of Onyx and coils is a safe and effective therapy for CCFs. In this study, the transarterial approach was a favorable option for embolization of direct CCFs. In contrast, the transvenous approach may be the first choice of treatment for indirect CCFs.

Advances and trends in meningioma research over the last decade: A scientometric and visual analysis.

Objective: We conducted a scientometric and visual analysis of meningioma studies in the past ten years and discussed the current status and trends of meningioma research to provide a reference basis for conducting relevant clinical practice or research. Method: A search of the topic of meningioma in the Web of Science Core Collection database was conducted for January 2012-December 2021. The scientometric tools CiteSpace (version 5.8.R3), VOS viewer (version 1.6.17), and the Bibliometrix package of R software (version 4.2.1) were used to visualize and analyze the country of publication, institution, author, keywords, and cited literature of meningioma. Results: A total of 10,397 documents related to meningioma were collected, of which 6,714 articles were analyzed. The annual analysis shows an increase in published articles, with an annual growth rate of 8.9%. 26,696 authors from 111 countries or regions were involved in publishing relevant studies. The country with the highest number of publications was the United States (1671), and the institution with the highest number of publications was the University of California, San Francisco (242). The keyword clustering of current studies can be grouped into five groups: meningioma characteristics and basic research, surgical treatment, radiation therapy, stereotactic radiosurgery, and management of complications. Keyword trend analysis shows that meningioma classification and molecular characteristics are emerging hotspots for meningioma research in recent years. Conclusion: The scientometric and visual analysis demonstrated the research status and trends of meningioma. Over the past decade, meningioma research has focused on managing meningiomas with a predominance of surgical treatment and radiation therapy. At the same time, meningioma classification and molecular characteristics are emerging as current and possible research hotspots in the coming period.

The impact of Allgower-Donati suture pattern and postoperative sweet foods on wound suture breakage in experimental rats.

Background: Wound gnawing and/or scratching in rats often occurs in experimental models, causing suture breakage and wound dehiscence, and consequently affecting experimental results and wasting resources. This study aimed to investigate the impact of the combined postoperative use of the Allgower-Donati (A-D) suture pattern and sweet foods on suture breakage, inflammation, and healing in wounds. Materials and methods: Sprague Dawley (SD) rats (n = 48) were treated for linear wounds on the back by four procedures: simple suture, simple suture with postoperative sweet foods, A-D suture, and A-D suture with postoperative sweet foods. Additionally, CD68 immunofluorescence and CD31 immunohistochemistry were used to analyze wound inflammation and vascularization, respectively, on postoperative day 7. Sirius red staining was used to assess collagen deposition on postoperative day 14. Results: Gnawing and scratching of wound sutures were significantly reduced in treated rats (P < 0.01). Neovascularization and collagen deposition were significantly increased (P < 0.001), and inflammatory responses were significantly reduced (P < 0.001) in animals receiving AD sutures and postoperative sweet foods. CD31/CD68 analyses showed that A-D suture and postoperative sweet foods regulated wound angiogenesis and attenuated wound inflammation. Conclusions: Sweet food provision after A-D suture union surgery could reduce wound gnawing and/or scratching, suture breakage, incisional dehiscence, wound inflammation, and promote wound healing in rats.

Prognostic analysis of posterior fossa decompression with or without cerebellar tonsillectomy for Chiari malformation type I: a multicenter retrospective study.

OBJECTIVE: The purpose of this study was to compare the prognosis of patients with Chiari malformation type I (CM-I) treated with posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression with resection of tonsils (PFDRT). METHODS: The clinical data of patients with CM-I treated using these two procedures in three medical centers between January 2016 and June 2021 were retrospectively analyzed and divided into PFDD and PFDRT groups according to the procedures. The Chicago Chiari Outcome Scale (CCOS) was used to score the patients and compare the prognosis of the two groups. RESULTS: A total of 125 patients with CM-I were included, of whom 90 (72.0%) were in the PFDD group, and 35 (28.0%) were in the PFDRT group. There was no significant difference in the overall essential characteristics of the two groups. Moreover, there was no significant difference in complication rates (3.3% vs 8.6%, p = 0.348), CCOS scores (13.5 ± 1.59 vs 14.0 ± 1.21, p = 0.111), and the probability of poor prognosis (25.6% vs 11.4%, p = 0.096) between the two groups. Nevertheless, a subgroup of patients who had CM-I combined with syringomyelia (SM) revealed higher CCOS scores (13.91 ± 1.12 vs 12.70 ± 1.64, p = 0.002) and a lower probability of poor prognosis (13.0% vs 40.4%, p = 0.028) in the PFDRT than in the PFDD group. Also, SM relief was more significant in patients in the PFDRT compared to the PFDD group. A logistic multifactor regression analysis of poor prognosis in patients with CM-I and SM showed that the PFDRT surgical approach was a protective factor compared to PFDD. Furthermore, by CCOS analysis, it was found that the main advantage of PFDRT in treating patients with CM-I and SM was to improve patients' nonpain and functionality scores. CONCLUSIONS: Compared with PFDD, PFDRT is associated with a better prognosis for patients with CM-I and SM and is a protective factor for poor prognosis. Therefore, the authors suggest that PFDRT may be considered for patients with CM-I and SM.

Visualization balloon occlusion-assisted technique in the treatment of large or giant paraclinoid aneurysms: A study of 17 cases series.

Objective: Although balloon-assisted techniques are valuable in aneurysm clipping, repeated angiography and fluoroscopy are required to understand the location and shape of the balloon. This study investigated the value of visualization balloon occlusion-assisted techniques in aneurysm hybridization procedures. Methods: We propose a visualization balloon technique that injects methylene blue into the balloon, allowing it to be well visualized under a microscope without repeated angiography. This study retrospects the medical records of 17 large or giant paraclinoid aneurysms treated by a visualization balloon occlusion-assisted technique in a hybrid operating room. Intraoperative surgical techniques, postoperative complications, and immediate and long-term angiographic findings are highlighted. Results: All 17 patients had safe and successful aneurysm clipping surgery with complete angiographic occlusion. Under the microscope, the balloon injected with methylene blue is visible through the arterial wall. The position and shape of the balloon can be monitored in real time without repeated angiography and fluoroscopic guidance. Two cases of intraoperative visualization balloon shift and slip into the aneurysm cavity were detected in time, and there were no cases of balloon misclipping or difficult removal. Of 17 patients, four patients (23.5%) experienced short-term complications, including pulmonary infection (11.8%), abducens nerve paralysis (5.9%), and thalamus hemorrhage (5.9%). The rate of vision recovery among patients with previous visual deficits was 70% (7 of 10 patients). The mean follow-up duration was 32.76 months. No aneurysms or neurological deficits recurred among all patients who completed the follow-up. Conclusion: Our study indicates that microsurgical clipping with the visualization balloon occlusion-assisted technique seems to be a safe and effective method for patients with large or giant paraclinoid aneurysms to reduce the surgical difficulty and simplify the operation process of microsurgical treatment alone.

Tubridge flow diverter alone vs. Tubridge flow diverter and coils for the treatment of intracranial aneurysms: A propensity score matching analysis.

Background: The study was designed to assess the clinical performance of a tubridge flow diverter (TFD) in the treatment of intracranial aneurysms and to compare the efficacy and safety between intracranial aneurysms treated with TFD alone and TFD combined with coiling. Methods: In this retrospective study, patients treated with the TFD alone or TFD combined with coiling between June 2018 to November 2022 were included. The patient demographics, the characteristics of the aneurysm, and the treatment outcomes between the two groups were compared. Propensity score matching was performed to match the variables with a significant difference between groups. Results: In the current study, data from 93 consecutive patients including 104 aneurysms treated with TFD were analyzed. In total, 43 patients with 49 aneurysms were treated with TFD alone, and 50 patients with 55 aneurysms were treated with TFD combined with coiling. Aneurysms in the TFD combined with the coiling group were larger (12.9 ± 8.6 vs. 8.7 ± 8.8 mm, P = 0.016) and more likely to be saccular (92.7% vs. 75.5%, P = 0.027) than in the TFD alone group. No significant difference was observed between the two groups in terms of perioperative complication rate. During the follow-up period, the complete occlusion rate in the TFD combined with the coiling group was higher (80.0% vs. 43.8%, P = 0.001) than in the TFD alone group. These results were further confirmed using a propensity score matching analysis. Conclusion: TFD combined with coiling can be a safe and effective alternative option for the treatment of complex aneurysms. Given the potential risks of these therapeutic modalities, thus very careful consideration is required on an individual patient basis.

Cerebral ischemia after treatment of posterior communicating artery aneurysms: clipping versus coiling.

OBJECTION: This study aimed to compare the incidence of cerebral ischemia and outcomes between surgical clipping and endovascular coiling in patients with posterior communicating artery (PCoA) aneurysms. METHODS: Clinical and imaging data of patients with at least one PCoA aneurysm who underwent surgical clipping or endovascular coiling in our institution from January 2017 to December 2019 were analyzed. RESULTS: Three hundred sixty-three aneurysms in 353 patients were included for analysis, 257 in the clipping group, and 106 in the coiling group. The groups did not differ in terms of baseline characteristics. The incidence of postoperative cerebral ischemia (23.35% vs. 11.32%, p = 0.029) was higher in the clipping group. The proportion of patients with a modified Rankin Scale score ≥ 2 was significantly higher in the clipping group at discharge (35.80% vs. 15.09%; p < 0.05) but not six months after discharge (15.56% vs. 8.49%; p > 0.05). In the clipping group, the mean age was significantly higher in patients who developed cerebral ischemia than in those who did not. In the coiling group, modified Fisher grade and incidence of fetal PCoA were significantly higher in patients who developed ischemia. CONCLUSION: The incidence of postoperative cerebral ischemia was higher after PCoA aneurysm clipping than after coiling. The causes and characteristics of postoperative cerebral ischemia after PCoA clipping and coiling are different; therefore, treatment should be selected accordingly.

Identification of an Immune-Related Prognostic Signature for Glioblastoma by Comprehensive Bioinformatics and Experimental Analyses.

BACKGROUND: Glioblastoma (GBM), which has a poor prognosis, accounts for 31% of all cancers in the brain and central nervous system. There is a paucity of research on prognostic indicators associated with the tumor immune microenvironment in GBM patients. Accurate tools for risk assessment of GBM patients are urgently needed. METHODS: In this study, we used weighted gene co-expression network analysis (WGCNA) and differentially expressed gene (DEG) methods to screen out GBM-related genes among immune-related genes (IRGs). Then, we used survival analysis and Cox regression analysis to identify prognostic genes among the GBM-related genes to further establish a risk signature, which was validated using methods including ROC analysis, stratification analysis, protein expression level validation (HPA), gene expression level validation based on public cohorts, and RT-qPCR. In order to provide clinicians with a useful tool to predict survival, a nomogram based on an assessment of IRGs and clinicopathological features was constructed and further validated using DCA, time-dependent ROC curve, etc. Results: Three immune-related genes were found: PPP4C (p < 0.001, HR = 0.514), C5AR1 (p < 0.001, HR = 1.215), and IL-10 (p < 0.001, HR = 1.047). An immune-related prognostic signature (IPS) was built to calculate risk scores for GBM patients; patients classified into different risk groups had significant differences in survival (p = 0.006). Then, we constructed a nomogram based on an assessment of the IRG-based signature, which was validated as a potential prediction tool for GBM survival rates, showing greater accuracy than the nomogram without the IPS when predicting 1-year (0.35 < Pt < 0.50), 3-year (0.65 < Pt < 0.80), and 5-year (0.65 < Pt < 0.80) survival. CONCLUSIONS: In conclusion, we integrated bioinformatics and experimental approaches to construct an IPS and a nomogram based on IPS for predicting GBM prognosis. The signature showed strong potential for prognostic prediction and could help in developing more precise diagnostic approaches and treatments for GBM.

Identification of Diagnostic Genes and Effective Drugs Associated with Osteoporosis Treatment by Single-Cell RNA-Seq Analysis and Network Pharmacology.

Background: Osteoporosis is a common bone metabolic disease with increased bone fragility and fracture rate. Effective diagnosis and treatment of osteoporosis still need to be explored due to the increasing incidence of disease. Methods: Single-cell RNA-seq was acquired from GSE147287 dataset. Osteoporosis-related genes were obtained from chEMBL. Cell subpopulations were identified and characterized by scRNA-seq, t-SNE, clusterProfiler, and other computational methods. "limma" R packages were used to identify all differentially expressed genes. A diagnosis model was build using rms R packages. Key drugs were determined by proteins-proteins interaction and molecular docking. Results: Firstly, 15,577 cells were obtained, and 12 cell subpopulations were identified by clustering, among which 6 cell subpopulations belong to CD45+ BM-MSCs and the other subpopulations were CD45-BM-MSCs. CD45- BM-MSCs_6 and CD45+ BM-MSCs_5 were consider as key subpopulations. Furthermore, we found 7 genes were correlated with above two subpopulations, and F9 gene had highest AUC. Finally, five compounds were identified, among which DB03742 bound well to F9 protein. Conclusions: This work discovered that 7 genes were correlated with CD45-BM-MSCs_6 and CD45+ BM-MSCs_5 subpopulations in osteoporosis, among which F9 gene had better research value. Moreover, compound DB03742 was a potential inhibitor of F9 protein.

Amplitude-Time Dual-View Fused EEG Temporal Feature Learning for Automatic Sleep Staging.

Electroencephalogram (EEG) plays an important role in studying brain function and human cognitive performance, and the recognition of EEG signals is vital to develop an automatic sleep staging system. However, due to the complex nonstationary characteristics and the individual difference between subjects, how to obtain the effective signal features of the EEG for practical application is still a challenging task. In this article, we investigate the EEG feature learning problem and propose a novel temporal feature learning method based on amplitude-time dual-view fusion for automatic sleep staging. First, we explore the feature extraction ability of convolutional neural networks for the EEG signal from the perspective of interpretability and construct two new representation signals for the raw EEG from the views of amplitude and time. Then, we extract the amplitude-time signal features that reflect the transformation between different sleep stages from the obtained representation signals by using conventional 1-D CNNs. Furthermore, a hybrid dilation convolution module is used to learn the long-term temporal dependency features of EEG signals, which can overcome the shortcoming that the small-scale convolution kernel can only learn the local signal variation information. Finally, we conduct attention-based feature fusion for the learned dual-view signal features to further improve sleep staging performance. To evaluate the performance of the proposed method, we test 30-s-epoch EEG signal samples for healthy subjects and subjects with mild sleep disorders. The experimental results from the most commonly used datasets show that the proposed method has better sleep staging performance and has the potential for the development and application of an EEG-based automatic sleep staging system.

[Effectiveness analysis of modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering in treatment of diabetic foot].

Objective: To investigate the effectiveness of modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering in the treatment of diabetic foot (DF). Methods: The clinical data of 22 DF patients treated with modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering between October 2019 and December 2021 were retrospectively analyzed. There were 13 males and 9 females with an average age of 61.3 years (range, 41-74 years). The duration of diabetes mellitus was 8-30 years, with an average of 12.5 years, and the duration of DF was 10-42 days, with an average of 28.2 days. There were 2 cases of grade 3 and 20 cases of grade 4 according to Wagner classification. CT angiography was performed on both lower extremities of the patients, and the blood vessels of the affected extremities were narrowed to varying degrees and the blood supply was poor. The preoperative skin temperature of affected foot was (28.27±0.91)°C, the ankle brachial index (ABI) was 0.42±0.11, and the visual analogue scale (VAS) score was 7.7±0.6. Preoperative size of DF ulcer ranged from 2.5 cm×2.0 cm to 3.5 cm×3.0 cm. The skin temperature of affected foot, ABI, VAS score, and skin wound healing of the affected foot were recorded and compared between before operation and at 3 months after operation. Results: All patients were followed up 3-18 months, with an average of 10.5 months. The infection of 1 patient with Wagner grade 4 did not improve significantly after operation, and there was a trend of further deterioration, and the amputation of the left leg was finally performed at 22 days after operation.The remaining 21 patients recovered well after operation, the external fixator was removed at 1 month after operation, the wound healed at 3 months after operation, and there was no recurrence of ulcer in situ or other sites during follow-up. At 3 months after operation, the skin temperature of affected foot was (31.76±0.34)°C, the ABI was 0.94±0.08, and the VAS score was 2.1±0.3, which significantly improved when compared with those before operation ( t=25.060, P<0.001; t=32.412, P<0.001; t=-51.746, P<0.001). Conclusion: Modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering for DF patients can effectively improve the blood supply of the affected limb, promote wound healing, and improve effectiveness.

Safety and efficacy of dual antiplatelet therapy combining aspirin and ticagrelor in patients with undergoing intracranial stenting procedures.

BACKGROUND: Thromboembolic complications are one of the major periprocedural complications following neuroendovascular procedures. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel remain the principal agents for prevention of thromboembolic complications. However, clopidogrel resistance is associated with higher risk of thromboembolic complications. This study investigated the safety and efficacy of DAPT with ticagrelor and aspirin in patients undergoing intracranial stenting procedures. METHODS: This retrospective study was based on patients with intracranial aneurysms who undergoing intracranial stenting procedures at our institution between August 2017 and July 2020. These patients received DAPT with ticagrelor and aspirin were included. DAPT with 90 mg ticagrelor twice-daily and aspirin 100 mg daily was continued for 3 months after the intracranial stenting procedure and aspirin continued for 1 year. RESULTS: In this study, 151 patients were identified. The most common aneurysm location was the internal carotid artery with 127 (71.8%) patients. Of the 151 cases with 160 treated aneurysms, 30 (18.8%) patients were treated by flow diverters (FDs), and 130 (81.2%) by stent-assisted coiling. Five (3.3%) patients had thromboembolic complications. Intraprocedural aneurysmal rupture was observed in one patient as a result of coil extrusion during coil insertion. None of the patients showed a newly DAPT-related intracerebral hemorrhage. Two patients developed dyspnea, and the symptom resolved without intervention. Furthermore, ecchymoma and gastrointestinal bleeding occurred in one patient respectively. DAPT-related thromboembolic and hemorrhagic complications were not significantly different between the FD group and stent-assisted coiling group. CONCLUSIONS: In our study, DAPT combining ticagrelor and aspirin seems to be a safe and efficient treatment for preventing thromboembolic complications in patients with intracranial aneurysms, without any increase in hemorrhagic complications. Ticagrelor may be an effective alternative for patients undergoing neurointervention.

The prognostic value of hyperglycemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

Recent studies have demonstrated that hyperglycemia may result in a poor prognosis following aneurysmal subarachnoid hemorrhage (aSAH). However, the association between hyperglycemia and the clinical outcome of aSAH has not been clearly established thus far. Therefore, we performed a systematic review and meta-analysis to investigate the association between hyperglycemia and the development of aSAH. We completed a literature search in four databases (PubMed, EMBASE, Cochrane Library, and Web of Science) up to November 1, 2021, including all eligible studies investigating the prognostic value of hyperglycemia in patients with aSAH. We performed a quality assessment of included studies using the Newcastle-Ottawa Quality Assessment Scale. The pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to assess the association of hyperglycemia in aneurysmal subarachnoid hemorrhage. A total of 35 studies with 11,519 patients were finally included in the meta-analysis. Nineteen studies reported the association between hyperglycemia and poor outcome, 12 studies reported the association between hyperglycemia and all-cause mortality, 7 studies reported the association between hyperglycemia and cerebral vasospasm, and 9 studies reported the association between hyperglycemia and cerebral infarction. The pooled data of these studies suggested that hyperglycemia was significantly associated with poor functional outcomes (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.17-1.42; P < 0.00001; I2 = 83%), all-cause mortality (OR, 1.02; 95% CI, 1.01-1.04; P = 0.0006; I2 = 89%), cerebral vasospasm (OR, 1.02; 95% CI, 1.01-1.02; P = 0.0002; I2 = 35%), and cerebral infarction (OR, 1.16; 95% CI, 1.09-1.23; P < 0.00001; I2 = 10%) in aSAH patients. These findings suggested that assessing for hyperglycemia at admission may help clinicians to identify critically ill patients and complete patient stratification early, which may achieve better management and improve the prognosis of patients with aSAH.

Lysosomal-associated transmembrane protein 5 deficiency exacerbates cerebral ischemia/reperfusion injury.

Lysosomal-associated transmembrane protein 5 (LAPTM5) has been demonstrated to be involved in regulating immunity, inflammation, cell death, and autophagy in the pathophysiological processes of many diseases. However, the function of LAPTM5 in cerebral ischemia-reperfusion (I/R) injury has not yet been reported. In this study, we found that LAPTM5 expression was dramatically decreased during cerebral I/R injury both in vivo and in vitro. LAPTM5 knockout (KO) mice were compared with a control, and they showed a larger infarct size and more serious neurological dysfunction after transient middle cerebral artery occlusion (tMCAO) treatment. In addition, inflammatory response and apoptosis were exacerbated in these processes. Furthermore, gain- and loss-of-function investigations in an in vitro model revealed that neuronal inflammation and apoptosis were aggravated by LAPTM5 knockdown but mitigated by its overexpression. Mechanistically, combined RNA sequencing and experimental verification showed that the apoptosis signal-regulating kinase 1 (ASK1)-c-Jun N-terminal kinase (JNK)/p38 pathway was mainly involved in the detrimental effects of LAPTM5 deficiency following I/R injury. Specifically, LAPTM5 directly interacts with ASK1, leading to decreased ASK1 N-terminal dimerization and the subsequent reduced activation of downstream JNK/p38 signaling. In conclusion, LAPTM5 was demonstrated to be a novel modulator in the pathophysiology of brain I/R injury, and targeting LAPTM5 may be feasible as a stroke treatment.

Clinical Efficacy of Endoscopic Infratentorial Supracerebellar Approach for Pineal Region Tumors: A Retrospective Case-Control Study.

Tumors in the pineal region are deep, with complex surrounding anatomy, adjacent to important blood vessels and nerve structures, and surgical resection is difficult and risky. In this paper, we reviewed the literature to understand the epidemiology and clinical manifestations of pineal region tumors in the country and study the clinical indications, related problems, and successful experiences of patients with pineal region tumors treated by the transtentorial-superior approach. The clinical data of 80 patients with pineal region tumors were selected as the retrospective research objects and divided into the control group and the treatment group, with 40 cases in each group, according to the random number table method. The control group was treated using the endoscopic transtentorial approach (Poppen approach), while the treatment group was treated with the endoscopic supratentorial approach (Krause approach). The inflammatory factors, inflammatory stress response, postoperative neurological dysfunction, clinical efficacy, and poor prognosis were observed and compared between the two groups. Tumor resection and recurrence were used to compare the clinical outcomes of tumors in the pineal region. The extent of surgical resection was 100% higher in both groups, and the treatment group was comparable to the control group. The prognosis of patients after the operation was poor. Nausea and vomiting, visual disturbance, upper vision paralysis, and ataxia in the treatment group were significantly lower than those in the control group, with no statistical significance (P > 0.05). At the same time, the bone window can be reduced to reduce trauma and provide a certain reference for patients to choose a safe and complete resection method.

Single-Center Retrospective Analysis of Risk Factors for Hydrocephalus After Lateral Ventricular Tumor Resection.

Objective: There is no general consensus on the placement of preoperative and intraoperative external ventricular drainage (EVD) in patients with lateral ventricular tumors (LVTs). The aim of this study was to identify the predictors of postoperative acute and persistent hydrocephalus need for postoperative cerebrospinal fluid (CSF) drainage and guide the management of postoperative EVD in patients with LVTs. Methods: We performed a single-institution, retrospective analysis of patients who underwent resection of LVTs in our Department between January 2011 and March 2021. Patients were divided between one group that required CSF drainage and another group without the need for CSF drainage. We analyzed the two groups by univariate and multivariate analyses to identify the predictors of the requirement for postoperative CSF drainage due to symptomatic intracranial hypertension caused by hydrocephalus. Results: A total of 97 patients met the inclusion criteria, of which 31 patients received preoperative or intraoperative EVD. Ten patients without prophylactic EVD received postoperative EVD for postoperative acute hydrocephalus. Eleven patients received postoperative ventriculoperitoneal(VP) shunt subsequently. Logistic regression analysis showed that tumor invasion of the anterior ventricle (OR = 7.66), transependymal edema (OR = 8.76), and a large volume of postoperative intraventricular hemorrhage (IVH) (OR = 6.51) were independent risk factors for postoperative acute hydrocephalus. Perilesional edema (OR = 33.95) was an independent risk factor for postoperative VP shunt due to persistent hydrocephalus. Conclusion: Postoperative hydrocephalus is a common complication in patients with LVTs. These findings might help to determine whether to conduct earlier interventions.