Vertebral Artery Access Considerations in Coil Embolization of Small Superior Cerebellar Artery Aneurysm

BACKGROUND

Coiling of small superior cerebellar artery aneurysms (sSCAAs) is challenging. We aimed to describe anatomic considerations in the vertebral and basilar artery (VA and BA) morphology for decision making in the coiling of sSCAAs.

METHODS

Eleven patients with sSCAAs (<5 mm) treated at our institution between April 2015 and February 2022 were included to show our concept of deciding access routes in the coiling of sSCAAs. The access route was decided on the basis of VA characteristics, BA curvature, and aneurysm laterality. Adequate aneurysm occlusion on angiography (Raymond-Roy grading scale I and II), good outcome (modified Rankin Score 0-2) at the last follow-up, and adverse outcomes were evaluated.

RESULTS

Simple coiling (n = 2), a balloon-assisted technique (n = 3), and stent-assisted technique (n = 6) were selected. At the last follow-up (median 13.0 months), adequate aneurysm occlusion and good outcome were obtained in all 9 patients (n = 10). Adverse outcomes were not observed. When VA dominance was equal, in the straight BA, the microcatheter insertion into the ipsilateral VA to the aneurysm was favorable to form a "fulcrum" on the contralateral side and obtain microcatheter stability. When an aneurysm was on the concave aspect of the curved BA, microcatheter insertion into the ipsilateral VA was favorable. As for the convex aspect's aneurysm location, the microcatheter insertion into the contralateral VA can be favored. Further, we described the VA origin classification as it relates to ease of access from a transradial approach.

CONCLUSIONS

Vertebrobasilar morphology may be important in deciding access routes in the coiling of sSCAAs.

Comparative analysis of microplastic organization and pollution risk before and after thawing in an urban river in Beijing, China

Urban rivers are potential sinks for microplastic (MP) contamination in the environment. However, the footprint of MPs in urban rivers is not well understood because it is influenced by natural and anthropogenic factors. This study focused on the occurrence, pollution risk, and potential sources of MPs in surface water and sediments before and after thawing in Shahe River, Beijing. The size distribution, morphological characteristics and polymer types of MPs were analyzed using a micro-Raman spectroscopy. The results showed that the average abundance of MP obviously increased after river thawing, from 1772 ± 1668 items·m^-3 to 3877 ± 2517 items·m^-3 in surface water and 4776 ± 4817 items·kg^-1 to 14,004 ± 5371 items·kg^-1 in sediments. The MP polymer types were more diverse after thawing. The main MP type in surface water changed from polyethylene terephthalate (PET) to polypropylene (PP). Moreover, PP was the most common type in sediments. Small-sized MPs (SMPs, 10-300 μm) were dominant in Shahe River, with the proportion increasing from 48.5% to 83.3% in surface water and from 84.3% to 94.4% in sediments after thawing. Although the MP pollution risk increased after thawing, it was still low in the Shahe River. Unfortunately, changes in polymer types caused by thawing and the emergence of toxic polymers increased the ecological risk in the urban river. These results revealed the information of MP contamination before and after thawing, and highlighted the barrier influence of river icing on the migration of MPs. Overall, the results presented a new perspective on the environmental behavior of microplastics in urban rivers, suggesting that the occurrence and dominance of SMPs and the emergence of toxic polymers in urban environmental media require close attention in the future.

Efficient and sustainable phosphate removal from water by small-sized Al(OH)3 nanocrystals confined in discarded Artemia Cyst-shell: Ultrahigh sorption capacity and rapid sequestration

We reported a new strategy for efficient phosphate removal from wastewaters, it relies on the discarded Artemia Cyst-shell in-situ growth of Al(OH)₃ nanocluster, the charged amino-acids components of skeleton make available for the small size of Al(OH)₃ formation (< 10 nm) with high activity, and the three-dimensional porous structure of discarded matrix provides fast kinetics and efficient Al(OH)₃ nanoparticles utilization. These hybrid adsorbents exhibit ultrahigh capacity (850.5 mg/g) and fast kinetics (~2 min) by recent ten-years (2011-2020) survey, the superior selectivity against various foreign ions, with a distribution coefficient (K_d) as high as 4820 mL/g, the porous structure and fast kinetics also accelerate the phosphate accessibility, yielding a satisfactory capacity of ~3000 L/kg sorbent (Artemia CS-Al) for the application, even varying at high feeding-speeds. The saturated adsorbent can be readily regenerated and reused without decrease in performance, this technology is promising for mitigating the contamination problem of excess phosphate worldwide.

Arthroscopic knotless repair: an effective technique for small-sized supraspinatus tendon tears

PURPOSE

The purpose was to evaluate the clinical and radiological results of knotless repair with flat-braided suture in full small-sized supraspinatus tendon tears (< 1 cm).

METHODS

A consecutive series of 54 patients with isolated small supraspinatus tendon tear (< 1 cm and Goutallier index < 2) was evaluated in the study. Patients underwent a knotless arthroscopic repair using flat-braided suture (2 mm wide). Minimal follow-up required was 5 years. Changes in Murley-Constant score, ASES score, strength, and pain relief were assessed. The Sugaya score was used to confirm the tendon repair on MRI. Data were analyzed in two subgroups: technique with additional U point for dog ear deformity (group 1) and technique without additional U point (group 2). The immobilization period was 3 weeks long. Passive mobilization was immediate.

RESULTS

Fifty-four patients were included. Mean age was 57 ± 4 years. The average follow-up was 68 ± 10 months. Average preoperative score of Constant was 51.2 ± 8.5 and 83.1 ± 14.6 at the end of the follow-up (p < 0.001). Mean VAS went from 5.8 ± 1.8 to 1.9 ± 2.1 (p < 0.001). Average forward elevation of the shoulder went from 86.3° ± 9 preoperatively to 169.6° ± 15.9 at the end of the follow-up (p < 0.001). The strength score was significantly higher post-operatively (18.4 vs. 8.3, p < 0.001.). The ASES score was significantly improved 49.1 ± 13.1 vs. 88.6 ± 15.8, p < 0.001). The MRI assessment revealed 94% of Sugaya 1-2. No significant difference was observed between group 1 and 2 regarding all clinical outcomes. Two complex regional pain syndromes were described with a favorable evolution. Three patients presented a retear requiring an iterative arthroscopic repair.

CONCLUSION

The use of a knotless arthroscopic construct with flat-braided suture for small supraspinatus repair achieved excellent structural and clinical results. This technique is fully adequate for the arthroscopic treatment of such tears, enabling early mobilization.

LEVEL OF EVIDENCE

Level III.

Endoscopic ultrasound with fine needle aspiration is useful in pancreatic cysts smaller than 3 cm

Background

In current guidelines, endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is recommended in pancreatic cystic lesions (PCLs) with worrisome features (size ≥ 3 cm, mural nodule, or Wirsung dilation).

Objective

To evaluate the diagnostic ability and assess the accuracy of EUS-FNA in PCLs smaller than 3 cm.

Methods

Retrospective study of PCLs < 3 cm (2007–2016) undergoing EUS-FNA. Clinical, EUS and pancreatic cystic fluid (PCF) data were prospectively registered. Performance of EUS-FNA with PCF analysis for the detection of malignancy and accuracy in surgical cohort were analyzed.

Results

We evaluated 115 patients with PCLs < 3 cm who underwent EUS-FNA. 19 patients underwent surgery, 7 had malignant, 8 pre-malignant, and the remaining 4 benign lesions. Mass/mural nodule was present in 27% of the cysts, CEA level was higher than 192 ng/mL in 39.4% of patients, and only 35% of cytologic samples were informative. Nevertheless, additional FNA for PCF analysis improved the diagnostic performance of EUS imaging—AUC = 0.80 versus AUC = 60.

Conclusion

EUS-FNA has good accuracy in PCLs < 3 cm. It confirmed malignancy even in lesions without worrisome features (nodule/mass), with two in every five resections showing high-risk/malignant lesions. EUS-FNA was also useful to diagnose benign cysts, possibly allowing surveillance to be stopped in one in every five patients.

Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer?

In 1995, Ginsberg et al. compared lobectomy with limited resection including segmentectomy and wide-wedge resection for stage I lung cancer in a randomized controlled trial and found that limited resection should not be applied to otherwise healthy patients with clinical stage IA lung cancer who can tolerate lobectomy. However, recent advances in diagnostic technology have improved the precision of detecting early-stage and small lung cancers. Therefore, whether radical segmentectomy, anatomical segmentectomy with hilar and mediastinal lymph node dissection (that is more valuable than wedge resection in terms of oncological aspects) and lobectomy are comparable in terms of curative intent for patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. The role of segmentectomy differs according to tumor or patient characteristics. High resolution computed tomography findings of tumor size, location, and the presence or ratio of a ground glass opacity (GGO) component and the maximum of standardized uptake value on fluorine-18-2-deoxy-D-glucose positron emission tomography are important for selecting surgical procedures because the malignant potential of even early-stage NSCLC is variable. The ongoing JCOG0802/WJOG4607L, JCOG1211, and CALGB140503 trials will disclose the influence of segmentectomy for patients with early-staged NSCLCs that are small peripheral tumors based on preoperative high-resolution computed tomography findings about preserved pulmonary function and long-term prognosis. Segmentectomy is a key surgical procedure that general thoracic surgeons will need to master considering that it can be converted to lobectomy if the surgical margin is insufficient or lymph node metastasis is intraoperatively confirmed.

Analysis for risk factors of 12-month neurological worsening in patients with surgically treated small-to-moderate size unruptured intracranial aneurysms

The risk associated with surgical treatment for small-to-moderate size unruptured intracranial aneurysms (SMUIAs, defined as <15 mm) has not been well characterized. Authors aimed to investigate risk factors for poor outcome in surgical treatment of SMUIAs. The data of prospectively collected 801 consecutive patients harboring 971 surgically treated SMUIAs was evaluated. Neurological worsening (NW) was defined as an increase in 1 or more modified Rankin Scale at 12-month. Clinical and radiological characteristics were compared. Neurological worsening was observed in 45 (4.6%). In multivariate analysis, only perforator territory infarction (PTI) on postoperative diffusion-weighted imaging (odds ratio (OR), 13; 95% confidence interval (CI), 4.9-32, p < 0.0001), and aneurysm locations (paraclinoid (OR, 6.9; 95% CI, 3.1-15, p < 0.0001), basilar artery (OR, 4.5; 95% CI, 1.5-14, p = 0.008), vertebral artery (OR, 11; 95% CI, 3.3-34, p < 0.0001)) were related to neurological worsening. Multivariate analysis showed that statin use (OR, 12; 95% CI, 3.8-39, p < 0.0001) and aneurysm locations (internal carotid artery-posterior communicating artery (OR, 3.9; 95% CI, 1.8-8.2, p < 0.0001) and basilar artery (OR, 6.3; 95% CI, 2.3-17, p = 0.008)), and aneurysm size >10 mm (OR, 5.3; 95% CI, 1.8-15, p = 0.003) were related to PTI. Although all SMUIAs should be carefully considered whether to be treated, those with statins, specific locations, and larger sizes should perhaps be more meticulously contemplated, and neurosurgeons should continue to avoid PTI.

Early Gastroenteropancreatic Neuroendocrine Tumors: Endoscopic Therapy and Surveillance

Neuroendocrine neoplasias (NEN) of the stomach, duodenum, pancreas, appendix, or rectum that are ≤1 cm in size as well as well-differentiated with World Health Organization grade 1 (G1) can be considered 'early' neuroendocrine tumors; they have a very good prognosis. Regarding prognosis, neuroendocrine tumors (NET) G1 must be distinguished from well-differentiated NET G2 and poorly differentiated neuroendocrine carcinomas (NEC) G3. NET are increasing, with a rise in the age-adjusted incidence in the USA by about 700% in the last 40 years. Earlier diagnosis of NET is one of the main epidemiological changes of clinically detected NEN. The general availability of high-resolution endoscopy and advanced radiological imaging techniques has contributed to a shift in the discovery to smaller-sized (≤10 mm) gastrointestinal and pancreatic NET and earlier tumor stages at diagnosis. Thus, screening colonoscopy is effective in the early diagnosis not only of colorectal adenomas and adenocarcinomas but also of rectal NET. Endoscopic resection is the treatment of choice in NET G1 of the stomach, duodenum (despite gastrinoma), and rectum that are ≤10 mm in size, do not infiltrate the muscularis propria (T1), and do not show angioinvasion (V0, L0). Similarly, histologically proven, early pancreatic NET G1 (≤10 mm) may be managed conservatively by regular surveillance. In contrast, small (≤1 cm) NET G1 of the jejunum or ileum are not 'early' tumors and have to be resected surgically with lymph node dissection.

Small size mesoporous organosilica nanorods with different aspect ratios: Synthesis and cellular uptake

In the work, small size thioether-bridged mesoporous organosilica nanorod (MONRs) are successfully synthesized using cetyltrimethylammonium bromide (CTAB) as structure-directing agent and bis[3-(triethoxysilyl)propyl]tetrasulfide (TETS) and tetraethoxysilane (TEOS) as co-precursors. The MONRs have tunable aspect ratios of 2, 3, and 4 (denoted as MONRs-2, MONRs-3, and MONRs-4), small and controllable lengths (75-310nm), high surface area (570-870cm²g^-1), uniform mesopores (2.4-2.6nm), large pore volume (0.34cm³g^-1), and excellent biocompatibility. The uptake of the MONRs by multidrug resistant human breast cancer MDR-MCF-7 cells is related to their aspect ratios. The MONRs-3 shows a faster and higher cellular internalization compared to the MONRs-4 and MONRs-2, respectively. Thanks to the high cellular uptake, doxorubicin (DOX) loaded MONRs-3 show obviously improved chemotherapeutic effect on MDR-MCF-7 cancer cells. It is expected that the MONRs provide a useful platform for drug delivery and therapeutics.

Prevalence and Predictors of "Small Size" Babies in Ethiopia: In-depth Analysis of the Ethiopian Demographic and Health Survey, 2011

Background

Low Birth Weight (LBW) babies account for nearly 80% of neonatal deaths globally. In Ethiopia, only 5% of them are weighed at birth. This study analyzes the prevalence and key proximate determinants of reported infant size, and its validity to use as a proxy indicator for low birth weight inthe Ethiopian context.

Methods

In-depth analysis of the Ethiopian Demographic and Health Survey dataset was conducted using representative data collected from all regions in the country. Considering reported fetal size at birth as an outcome variable, key predicting variables from socio-demographic, household, child and obstetric characteristics were employed for analyses. Chi-square test and multivariate logistic regression model were used to determine predictors at p value < 0.05.

Results

An average of 29.1% of Ethiopian babies were reported “small” at birth in 2011. various variables from socio-demographic, household, child and maternal reproductive characteristics were identified as key predictors. Women who develop anemia and not attending antenatal care during pregnancy had 15% and 41% more risk of giving birth to the reported “small size” babies than their counterparts (AoR = 1.15, and 1.41, 95% CI (1.02, 1.64 and 1.06, 1.88) respectively. Maternal age at delivery, maternal literacy level, paternal educational status and presence of radio or television in the household and other factors were also other key predictors identified.

Conclusion

The prevalence of small size babies in Ethiopia is high but comparable to regional estimates of LBW. It is recommend that improving maternal nutritional and socio-economic status is a timely intervention to tackle the problem.

Design of a 3T preamplifier which stability is insensitive to coil loading

In MRI (magnetic resonance imaging), preamplifiers are needed to amplify signals obtained from MRI receiver coils. Under various loading conditions of the corresponding receiver coils, preamplifiers see different source impedance at their input and may become unstable. Therefore preamplifiers which stability is not sensitive to coil loading are desirable. In this article, a coil-loading-insensitive preamplifier for MRI is presented, derived from an unstable preamplifier. Different approaches to improve stability were used during this derivation. Since a very low noise factor is essential for MRI preamplifiers, noise contributions from passive components in the MRI preamplifier have to be considered during the stabilization process. As a result, the initially unstable preamplifier became stable with regard to coil loading, while other MRI requirements, as the extremely low noise factor, were still fulfilled. The newly designed preamplifier was manufactured, characterized and tested in the MRI spectrometer. Compared to a commercially available preamplifier, the newly designed preamplifier has similar imaging performance but other advantages like smaller size and better stability. Furthermore, presented stabilization approaches can be generalized to stabilize other unstable low-noise amplifiers.

Management of early gastrointestinal neuroendocrine neoplasms

Neuroendocrine neoplasms (NENs) of the stomach, duodenum, appendix or rectum that are small (≤ 1 cm) and well differentiated can be considered “early” tumors, since they generally have a (very) good prognosis. In the new WHO classification of 2010, these neoplasms are called neuroendocrine tumors/ carcinoids (NETs), grade (G) 1 or 2, and distinguished from poorly differentiated neuroendocrine carcinomas (NECs), G3. NETs are increasing, with a rise in the age-adjusted incidence in the U.S.A. by about 700 % in the last 35 years. Improved early detection seems to be the main reason for these epidemiological changes. Both the better general availability of endoscopy, and imaging techniques, have led to a shift in the discovery of smaller-sized (≤ 10-20 mm) intestinal NETs/carcinoids and earlier tumor stages at diagnosis. Endoscopic screening is therefore effective in the early diagnosis, not only of colorectal adenocarcinomas, but also of NETs/carcinoids. Endoscopic removal, followed up with endoscopic surveillance is the treatment of choice in NETs/carcinoids of the stomach, duodenum and rectum that are ≤ 10 mm in size, have a low proliferative activity (G1), do not infiltrate the muscular layer and show no angioinvasion. In all the other intestinal NENs, optimal treatment generally needs surgery and/or medical therapy depending on type, biology and stage of the tumor, as well as the individual situation of the patient.