Current Mouse Models of Intracranial Aneurysms: Analysis of Pharmacological Agents Used to Induce Aneurysms and Their Impact on Translational Research

Intracranial aneurysms (IAs) are rare vascular lesions that are more frequently found in women. The pathophysiology behind the formation and growth of IAs is complex. Hence, to date, no single pharmacological option exists to treat them. Animal models, especially mouse models, represent a valuable tool to explore such complex scientific questions. Genetic modification in a mouse model of IAs, including deletion or overexpression of a particular gene, provides an excellent means for examining basic mechanisms behind disease pathophysiology and developing novel pharmacological approaches. All existing animal models need some pharmacological treatments, surgical interventions, or both to develop IAs, which is different from the spontaneous and natural development of aneurysms under the influence of the classical risk factors. The benefit of such animal models is the development of IAs in a limited time. However, clinical translation of the results is often challenging because of the artificial course of IA development and growth. Here, we summarize the continuous improvement in mouse models of IAs. Moreover, we discuss the pros and cons of existing mouse models of IAs and highlight the main translational roadblocks and how to improve them to increase the success of translational IA research.

Subsequent pregnancy in women who have undergone bilateral uterine artery ligation during cesarean section: A case series

Bilateral uterine artery ligation (BUAL) serves as an effective surgical devascularization procedure in obstetric emergencies. However, concerns regarding the impact of uterine devascularization have evoked dispute. Here, the fetal growth index and obstetrical outcomes during the subsequent pregnancy of women who had undergone BUAL during cesarean section are reported. The case series of women who underwent BUAL during cesarean section and had another delivery later at the Xiamen Women and Children's Hospital between 2011 and 2020 is described. Pregnancies that did not continue beyond 20 weeks of gestation were excluded. Cases were identified from neonatal and obstetric databases and the clinical data of all cases were extracted. A total of 12 cases were identified retrospectively. Fetal biometric parameters of subsequent pregnancies in all cases including biparietal diameter, head circumference, abdominal circumference, and femur length are presented graphically across the different gestational ages and were all within the range of the 3rd-97th percentile. No maternal or neonatal morbidity was observed. BUAL did not appear to compromise a woman's subsequent obstetric outcomes. As a safe and simple surgical technique, it is safe to recommend BUAL in clinical practice.

Impact of the introduction of a low-cost uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage in India: A comparative before-and-after study

OBJECTIVE

To evaluate the impact of introducing a uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage (PPH), mainly due to uterine atony, in health facilities in India on the rates of PPH-related maternal death and invasive procedures for PPH control.

METHODS

We used a quasi-experimental, difference-in-difference (DID) design to compare changes in the rates of a composite outcome (PPH-related maternal death and/or artery ligation, uterine compression sutures, or hysterectomy) among women delivering in nine intervention facilities compared with those delivering in two control facilities, before and after the introduction of ESM-UBT.

RESULTS

The study sample included 214 123 deliveries (n = 78 509 before ESM-UBT introduction; n = 47 211 during ESM-UBT introduction; and n = 88 403 after ESM-UBT introduction). After introduction of ESM-UBT, there was a significant decline in the rate of the primary composite outcome in intervention facilities (21.0-11.4 per 10 000 deliveries; difference -9.6, 95% confidence interval -14.0 to -5.4). Change in the rate of the primary composite outcome was not significant in control facilities (11.7-17.2 per 10 000 deliveries; difference 5.4, 95% confidence interval -3.9 to 14.9). DID analyses showed there was a significant reduction in the rate of the primary composite outcome in intervention facilities relative to control facilities (adjusted DID estimate -15.0 per 10 000 points, 95% confidence interval -23.3 to -6.8; P = 0.005).

CONCLUSION

Introduction of the ESM-UBT in health facilities in India was associated with a significant reduction in PPH-related maternal death and/or invasive procedures for PPH control.

High Ligation of the Inferior Mesenteric Artery Induces Hypoperfusion of the Sigmoid Colon Stump During Anterior Resection

Background: Anastomotic leakage (AL) after colorectal surgery is associated with insufficient vascular perfusion of the anastomotic ends. This study aimed to evaluate the effect of high vs. low ligation of the ileocolic artery and inferior mesenteric artery, respectively, on the vascular perfusion of the bowel stumps during ileocecal resection (ICR) and anterior rectal resection (AR). Methods: We retrospectively evaluated patients who underwent ICR or AR between 2016 and 2020. Real-time indocyanine green fluorescence angiography was performed to measure the fluorescence time (FT) as a marker of the blood flow in the proximal and distal stumps before anastomosis. Results: Thirty-four patients with lower right-sided colon cancer underwent laparoscopic ICR. Forty-one patients with rectosigmoid colon or rectal cancer underwent robotic high AR (HAR) (n = 8), robotic low AR (LAR) (n = 6), laparoscopic HAR (n = 8), or laparoscopic LAR (n = 19). The FT was similar in the ileal and ascending colon stumps (p = 1.000) and did not differ significantly between high vs. low ligation of the ileocolic artery (p = 0.934). The FT was similar in the sigmoid colon and rectal stumps (p = 0.642), but high inferior mesenteric artery ligation significantly prolonged FT in the sigmoid colon during AR compared with low ligation (p = 0.004), indicating that the high ligation approach caused significant hypoperfusion compared with low ligation. The AL rate was similar after low vs. high ligation. Conclusions: Low vascular perfusion of the bowel stumps may not be an absolute risk factor for AL. High inferior mesenteric artery ligation could induce sigmoid colon stump hypoperfusion during anterior rectal resection.

Surgical management of a delayed post-traumatic saccular aneurysm of the radial artery

Post-traumatic aneurysm of the radial artery is a rare and often misdiagnosed vascular lesion of the wrist. Radial artery ligation can lead to excellent results if Allen test confirmed that ulnar artery is the dominant feeding artery to the hand.

Temporary Ligation of the Bilateral Uterine Arteries During Laparoscopy Combined with Hysteroscopy in the Treatment of Caesarean Scar Pregnancy: Experience at a Chinese Teaching Hospital

Purpose

This study aimed to investigate the clinical efficacy of temporary ligation of the bilateral uterine arteries during laparoscopy combined with hysteroscopy in the treatment of caesarean scar pregnancy (CSP).

Patients and Methods

This study was a retrospective analysis of 83 patients who had initially undergone laparoscopy combined with hysteroscopy for CSP between 2012 and 2018 at Xiamen Women and Children’s Hospital. Patients were assigned to the ligation group or the no ligation group according to whether they underwent temporary ligation of the bilateral uterine arteries. Factors extracted from the database included general preoperative information, surgical indicators (intraoperative blood loss, operation time, and blood transfusion), postoperative recovery indicators (β-hCG on day 3 after surgery, time to β-hCG normalization), and postoperative complications (decrease in menstrual bleeding, alteration in the menstrual cycle) and were compared between the two groups.

Results

The intraoperative blood loss of patients in the ligation group was significantly less than that of patients in the no ligation group (P=0.027), especially in patients with higher serum β-hCG level (P=0.030). No significant differences in the operation time, blood transfusion, decline ratio of hCG on day 3 after surgery, reduction in haemoglobin and haematocrit value, decrease in menstrual bleeding, or alteration in the menstrual cycle were observed between the two groups (P>0.05).

Conclusion

For CSP patients, temporary ligation of the bilateral uterine arteries during laparoscopy combined with hysteroscopy achieved better clinical outcomes than laparoscopy combined with hysteroscopy without ligation with respect to intraoperative blood loss. This approach offers effective and safe surgical management for CSP in clinical practice.

Clinical outcomes of Doppler-guided haemorrhoidal artery ligation: a meta-analysis

BACKGROUND AND OBJECTIVES

Numerous clinical studies have evaluated the potential benefits of DGHL for symptomatic hemorrhoids, particularly with regard to the perioperative parameters. However, the exact value of Doppler-assisted localization of vessels in hemorrhoid operations is still not clear. The aim of this study is to systematically analyze the randomized controlled trials on the effectiveness of DGHL and HL without Doppler guidance or other procedures for HD by using the principles of meta-analysis.

MATERIALS AND METHODS

Relevant RCTs which assessed DGHL as the primary procedure and reported clinical outcomes as primary end-points were selected from Pubmed database, Embase database and the Cochrane library. Mean difference (MD) was used to represent effect-quantity for continuous variable results, while Odds ratio (RR) was used to represent effect-quantity for discontinuous variable results. Statistical analysis was performed by RevMan 5.0 and STATA 12.0 software.

RESULTS

Five RCTs with a total of 388 patients were analyzed systematically. The main results showed that DGHL and HL without Doppler guidance or other procedures are equally effective in terms of treatment success rate (RR = 0.89, 95% CI 0.73-1.09, P = 0.27), operation time (MD = 11.41, 95% CI -9.26-32.09, P = 0.28), postoperative complications (RR = 0.89, 95% CI 0.62-1.28, P = 0.53), postoperative pain (MD = -1.01, 95% CI -2.27-0.26, P = 0.12) and incidence of HD recurrence (RR = 1.07, 95% CI 0.83-1.39, P = 0.60).

CONCLUSION

Our findings suggest that DGHL may not have evident superiority for the management of HD in terms treatment success rate, operation time, postoperative complications, postoperative pain and incidence of HD recurrence. However, further large scale randomized and multicentre studies are needed to confirm these findings.