Treatment with a flow diverter-assisted coil embolization for ruptured blood blister-like aneurysms of the internal carotid artery: a technical note and analysis of single-center experience with pooled data

Treatment of blood blister-like aneurysms (BBAs) of the supraclinoid internal carotid artery (ICA) with flow diverters (FDs) has become widespread in recent years. However, ruptured blood blister-like aneurysm (BBA) of ICA treatment with flow diverter-assisted coil embolization (FDAC) remains controversial. Moreover, limited direct comparative studies have been conducted between the two treatment modalities, FDs and FDAC, for BBAs. The purpose of this study was to document our experience and evaluate the effectiveness and safety of FDAC. We conducted a retrospective analysis of clinical and radiological information from ten patients who experienced ruptured BBAs of the supraclinoid ICA at our center from January 2021 to February 2023. The technical details of FDAC for ruptured BBAs were described, and the technical steps were named "pipeline embolization device (PED)-Individualized shaping(microcatheter)-Semi deploying-Rivet(coils)-Massage(microwire)" as the PEISSERM technique. Clinical outcomes were assessed using the modified Rankin Scale (mRS), whereas radiological results were determined through angiography. A pooled analysis was implemented, incorporating data from literature sources that reported perioperative and long-term clinical and angiographic outcomes of ruptured BBAs treated with FD and FDAC strategies, along with our data. Data in our analysis pool were categorized into FD and FDAC strategy groups to explore the preferred treatment modalities for BBAs. The PEISSERM technique was utilized to treat ten patients, seven males, and three females, with an average age of 41.7 years. A single PED was deployed in conjunction with coils in all ten patients. All PEDs were documented to have good wall apposition. The immediate postoperative angiograms demonstrated Raymond grade I in ten aneurysms. Angiographic follow-up of nine patients at 4-25 months showed total occlusion of the aneurysms. At the most recent follow-up, the mRS scores of nine patients hinted at a good prognosis. Pooled analysis of 233 ICA-BBA cases of FD revealed a technical success rate of 91% [95% confidence interval (CI), 0.88 to 0.95], a rate of complete occlusion of 79% (95% CI, 0.73 to 0.84), a recurrence rate of 2% (95% CI, 0.00 to 0.04), a rebleed rate of 2% (95% CI, 0.00 to 0.04), and the perioperative stroke rate was 8% (95% CI, 0.04 to 0.11). The perioperative mortality was 4% (95% CI, 0.01 to 0.07). The long-term good clinical outcome rate was 85% (95% CI, 0.80 to 0.90). The mortality rate was 6% (95% CI, 0.03 to 0.09). Results from the subgroup analysis illustrated that the FDAC strategy for BBAs had a significantly higher immediate postoperative complete occlusion rate (P < 0.001), total occlusion rate (P = 0.016), and a good outcome rate (P = 0.041) compared with the FD strategy. The FDAC strategy can yield a higher rate of good outcomes than the FD strategy. The PEISSERM technique employed by the FDAC is a reliable and effective treatment approach as it can minimize the hemodynamic burden of BBA's fragile dome, thereby achieving an excellent occlusion rate. The PEISSERM technique in the FDAC strategy contributes to understanding the BBA's treatment and offers a potentially optimal treatment for BBA.

[Study on protective effects and mechanisms of total glucosides of Paeony on Graves disease in BALB/c mice]

Objective: To investigate the protective effect and its immunoregulatory mechanism of Total Glucosides of Paeony (TGP) against Graves' Disease (GD) model on BALB/c mice. Methods: Fifty female (6 weeks old, weighing 16-18 g) BALB/c mice of specific pathogen free were divided into control group according to random number table method, model group, early low-dose TGP intervention group (250 mg·kg^-1·d^-1), early high-dose TGP intervention group (500 mg·kg^-1·d^-1), and late TGP intervention group, with 10 mice in each group. Except the control group, the other 4 groups were immunized 3 times (0, 3^rd, and 6^th week) with recombinant adenovirus expressing the thyroid stimulating hormone receptor (TSHR) A subunit to establish the GD model. The early low-dose and high-dose intervention group were given diets containing different doses of TGP throughout the whole process, and the late intervention group was given diets containing low doses of TGP from the 1^st week after the 2^nd immunization (week 4). The levels of thyrotropin receptor antibody (TRAb) and total thyroxine (TT4) were detected in the tail venous blood of mice at the 4^th week. At the 10^th week, the serum TRAb and TT4 levels and the ratio of regulatory T cells (Treg) in each group were detected, and the pathological changes of thyroid tissue were observed. Serum helper T cell 1(Th1) and Th2 cell-related factors interleukin-2 (IL-2), IL-4, IL-5, IL-10, IL-12p70, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ (IFN-γ) and tumor necrosis factors-α (TNF-α) were detected to investigate the protective effect of TGP on GD model in BALB/c mice and its mechanism. Results: At the 4^th week, The level of TT4 [(55.07±12.89) μg/L] in early high-dose intervention group was lower than that in model group [(74.33±8.63) μg/L] (all P<0.05). The level of TT4 in early low-dose intervention group and late intervention group and model group had no statistical significance (all P>0.05). TRAb level of mice between early low-dose, early high-dose, late intervention groups and model group was no significant difference (all P>0.05). At the 10^th week, TRAb [(90.00±26.89) U/L] and TT4[(32.66±8.11) μg/L] levels in the early high-dose intervention group were lower than those in the model group [(396.97±95.35) U/L, (73.70±16.33) μg/L] (all P<0.05). The TRAb and TT4 levels in the early low-dose intervention group and late intervention group were not significantly different from those in the model group (all P>0.05). The thyroid tissue of hyperthyroidism mice in the early high dose intervention group showed focal hypertrophic changes, while the thyroid tissue of other hyperthyroidism mice showed diffuse hypertrophic changes. The CD4⁺CD25⁺/CD4⁺Treg ratio in early high-dose intervention group was higher than that in model group at the 10^th week (4 weeks after three recombinant adenovirus immunization) (P<0.05). Compared with the model group at the 10^th week, the levels of IL-2, IL-12p70 and IFN-γ in the early high-dose intervention group were all decreased (all P<0.05), and the levels of IL-10 were increased (P<0.05). Conclusion: Early high-dose (500 mg·kg^-1·d^-1) TGP intervention group displays a protective effect against GD mice, the mechanism of which may be related to regulatory T cell function changes and Th1/Th2 cytokine balance restoration.

[Multiple pulmonary masses with diffuse cystic lesions]

A 50-year-old female patient, presenting with a past history of Reynaud's syndrome, xerostomia and xerophthalmia, was admitted to Fujian Provincial Hospital because of coughing for 10 days and left anterior chest pain for 1 day. Chest imaging showed multiple nodules and masses, and diffuse cystic lesions in both lungs. Based on the differential diagnosis of multiple pulmonary masses and diffuse cystic lesions respectively, autoantibodies, radionuclide dynamic imaging of the parotid, positron emission tomography-CT, CT-guided percutaneous transthoracic needle biopsy, and other examinations were performed. The diagnosis of diffuse large B-cell lymphoma stage ⅣA (lung, parotid gland) and Sjögren's syndrome was confirmed. By analyzing the imaging features and pathogenesis in detail, the diffuse cystic lesions of both lungs were considered to be related to lymphocytic interstitial pneumonia caused by Sjögren's syndrome. The pulmonary space-occupying lesions in the lungs were significantly absorbed after RCHOP regimen for lymphoma.

Microcatheter-guided compartment packing of acutely ruptured complex intracerebral aneurysms (ARCIAs): Preliminary experience and technical note

Objective

We present our initial experience using the microcatheter-guided compartment packing (MCP) technique for endovascular embolization of acutely ruptured complex intracerebral aneurysms (ARCIAs) and evaluate the safety, feasibility, and efficiency of this technique.

Methods

This retrospective, single-center study included 28 patients who underwent coil embolization using the MCP technique for ARCIAs at our institution between January 2021 and January 2022. The MCP technique was the placement of microcatheters in different compartments within the aneurysm to deploy the coils simultaneously or sequentially. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. The clinical outcomes were evaluated with modified Rankin Scale (mRS) scores.

Results

Of the 28 patients successfully treated with the MCP technique, 24 (85.7%) aneurysms were considered as complete occlusions (Raymond I) based on the immediate postembolization angiogram results. Complications occurred in 2/28 treatments, including guidewire perforation with subarachnoid hemorrhage and cerebral vasospasm-related cerebral infarction. An angiography follow-up demonstrated complete occlusion in 25/28 aneurysms. Twenty-six (92.9%) patients had favorable 90-day outcomes (mRS 0-2) after the endovascular coil embolization.

Conclusion

The MCP technique is simple, safe, and effective, achieving good packing density and initial occlusion rate when used to treat ARCIAs.

A Novel Titanium Cranioplasty Technique of Marking the Coronal and Squamosoparietal Sutures in Three-Dimensional Titanium Mesh as Anatomical Positioning Markers to Increase the Surgical Accuracy and Reduce Postoperative Complications

Objective: The objective of this research is to modify the titanium cranioplasty (Ti-CP) technique to increase the surgical accuracy and preliminarily verify the effectiveness and safety of this improvement.

Methods: We developed a novel technique of marking the coronal and squamosoparietal sutures in three-dimensional (3D) titanium mesh as anatomical positioning markers and designed a prospective trial in patients with a unilateral frontotemporoparietal skull defect. Patients were randomly divided into two groups by the presence or absence of the anatomical positioning markers, and the therapeutic effects of these two groups were compared.

Results: Forty-four patients were included in this study, including 28 (64%) males and 16 (36%) females. The mean age was 44.8 ± 15.2 years (range, 13–75 years). Overall postoperative complication rate of the intervention group (18%) was significantly (P = 0.03) lower than the control group (50%). Surgical accuracy of the intervention group (97.8%) was significantly (P < 0.001) higher than the control group (94%). Visual analog scale for cosmesis (VASC) of the intervention group (8.4) was significantly (P < 0.001) higher than the control group (7). The overall postoperative complication rate was 34%. Multivariate analyses showed that surgical accuracy <95.8% (OR = 19.20, 95% CI = 3.17–116.45, P = 0.001) was significantly associated with overall postoperative complications. Independent predictor of overall postoperative complications was surgical accuracy (OR = 0.57, 95% CI = 0.40–0.82, P = 0.002).

Conclusions: This novel technique for repairing frontotemporoparietal skull defects increases surgical accuracy, improves cosmetic prognosis, and reduces postoperative complications. Therefore, it is a safe and effective improvement for Ti-CP.

[Clinical diagnosis and treatment of 27 cases of metanephric adenoma]

The clinical features, imaging features, treatment methods and pathological features of 27 patients with metanephric adenoma were analyzed. It was found that the clinical features and imaging features of metanephric adenoma were difficult to differentiate from renal malignantology. Pathology can be clearly diagnosed and some can be combined with malignant components. Nephron sparing surgery is the first choice, and the prognosis is good, but still need regular follow-up.

[A prospective multi-center clinical investigation of HIV-negative pulmonary cryptococcosis in China]

Objective: To investigate the current status of the diagnosis and treatment of pulmonary cryptococcosis in respiratory medicine and improve the understanding of the clinical characteristics of HIV-negative pulmonary cryptococcosis in China. Methods: A prospective multi-center open cohort study was designed to screen for pulmonary cryptococcosis in the general wards and intensive care units of the Department of Respiratory Diseases in 22 hospitals. The HIV-negative patients with positive cryptococcal etiological diagnosis based on smear culture, antigen detection and histopathology were enrolled in the study. The clinical data of enrolled patients were collected and analyzed. Results: A total of 457 cases of pulmonary cryptococcosis were enrolled, among which 3.28% (15/457) were disseminated infections. The case fatality rate was 0.88% (4/457). The majority of the cases were diagnosed by histopathological examinations (74.40%, 340/457) and cryptococcus antigen detection (37.64%, 172/457). Patients with pulmonary cryptococcosis accounted for 2.04‰ (457/223 748) of the total hospitalized patients in the Department of Respiratory Diseases during the same period, and the ratio was the highest in south and east China. Meanwhile, 70.24% (321/457) of the patients had no underlying diseases, while 87.75% (401/457) were found to have immunocompetent status. Cough and expectoration were the most common clinical symptoms in patients with pulmonary cryptococcosis. However, 25.16% (115/457) of the patients had no clinical symptom or physical signs. In terms of imaging features on pulmonary CT, multiple pulmonary lesions were more common than isolated lesions, and there were more subpleural lesions than perihilar or medial lesions. Morphologically, most of the lesions were middle-sized nodules (1-5 cm) or small-sized nodules (3 mm to 1 cm). The sensitivity of serum cryptococcus antigen test was 71.99% (203/282). Moreover, antigen-positive patients differed from antigen-negative patients in terms of basic immune status, clinical symptoms, imaging features and infection types. Meanwhile, immunocompromised patients differed from immunocompetent patients in terms of clinical symptoms, physical signs, infection-related inflammation indicator levels, imaging features, serum cryptococcus antigen positive rate and prognosis. Conclusions: The majority of cases of HIV-negative pulmonary cryptococcosis in China had no underlying disease or immunocompromised status, and the overrall prognosis was favorable. However, early diagnosis of HIV-negative pulmonary cryptococcosis remains challenging due to the complicated manifestations of the disease.

[Effects of different time of cryoablation on the proliferation of airway traumatic granuloma and its mechanism in rabbits]

Objective: To investigate the effect of different cryoablation time on tracheal traumatic granulation formation and its mechanism. Methods: A total of 32 rabbits were randomly assigned into four groups (A-D). Group A underwent tracheotomy alone. Group B, C and D received intra-tracheal brush rubbing to establish airway granulation model. Group C and D underwent 30 s and 2-minute cryoablation respectively. Tracheal specimens of all groups were collected to examine pathological changes using HE staining. Levels of transforming growth factor beta 1 (TGF-β(1)) and CD34 in tracheal granulation were evaluated using immunohistochemistry (IHC) and real-time quantitative reverse transcription polymerase chain reaction (RT-qCR). Results: Tracheal lumens of group A were smooth without granulation. While the growth of granulation and luminal stenosis were most severe in Group B, followed by Group D and C. Submucosa thickness of Group B was largest as compared with other groups (0.20±0.07, 0.77±0.28, 0.44±0.13 and 0.55±0.18 mm for Group A to D, respectively. P<0.05). And the submucosa layer of Group C was thinner than Group D (P<0.05). The expression and transcription levels of TGF-β(1) of trachea were highest in Group B as detected by IHC and RT-qPCR (P<0.05), followed by Group D and C (IHC: 0.48±0.01 vs 0.43±0.01, P<0.05; RT-qPCR: 12.61±2.14 vs 2.38±0.10, P<0.05). Both protein and mRNA levels of CD34 were highest in Group B as detected by IHC and RT-qPCR (P<0.05). Tracheal mRNA levels of CD34 were more abundant in Group D than Group C (4.92±0.90 vs 2.09±0.10, P<0.05), while no significant difference was found between groups regarding protein levels measured by IHC. Conclusions: Cryoablation could alleviate the hyperplasia of tracheal traumatic granulation, possibly due to the inhibition of TGF-β(1) and CD34 expression. The effect of 30 s cryoablation for tracheal traumatic granulation is better.

[Expression of serum interleukin-13 and significance of gene polymorphism on the patients with bronchiectasis in acute exacerbation period]

Objective: To explore the expression of serum interleukin-13 (IL-13) and significance of its gene polymorphism on the patients with acute exacerbation of bronchiectasis in acute exacerbation period. Methods: Forty-three patients with bronchiectasis in acute exacerbation period admitted into the respiratory ward of Fujian Provincial Hospital from December, 2014 to March, 2016 were included as bronchiectasis group. Thirty-three healthy controls from normal people of health examination were included as control group during the corresponding period. A total of 5 ml fasting peripheral blood sample was extracted from each individual. The IL-13 levels were determined by enzyme-linked immunosorbent assay (ELISA). IL-13 gene polymorphisms in+ 1923 C/T site and+ 2044 site were genotyped in these two groups by using polymerase chain reaction (PCR) combined with gene sequencing methods. About 7 days after admission, thirty patients with improved condition among the 43 patients were included as bronchiectasis improvement group, all had the extraction of 3 ml peripheral blood for IL-13 detection determined by ELISA. The expression of serum IL-13 and gene polymorphisms between bronchiectasis group and control group were analyzed statistically. The changes of serum IL-13 between bronchiectasis group and bronchiectasis improvement group were also analyzed statistically. Results: The serum IL-13 level was lower in the bronchiectasis group in acute exacerbation period than that of the healthy controls [(31.1±26.3) vs (70.6±53.6) μg/L, P<0.05]. There was no significant difference of the genotype distribution in + 1923C/T site of IL-13 gene between the two groups (χ(2)=0.915, P>0.05). In the bronchiectasis group, the C and T allele frequencies at+ 1923 site of IL-13 gene were 79.1% and 20.9%, respectively, and its single nucleotide polymorphism (SNP) was in strong linkage disequilibrium with the SNP IL-13+ 2044G/A site (R(2)=0.835, P<0.001). There was no significant difference of the serum IL-13 between allele T_ groups and allele CC group, and also no significant difference between allele A_ groups and allele GG group (P>0.05). Conclusion: The IL-13 levels decreased specifically in the bronchiectasis group in acute exacerbation period, but IL-13+ 1923C/T and+ 2044G/A polymorphisms are not significantly related to the susceptibility of bronchiectasis.

Modulational instability of short-wavelength ion waves in strongly coupled dusty plasmas

Modulational instability of electrostatic short-wavelength ion waves in plasmas containing strongly coupled dusts with variable charge is considered. The evolution equations for the ion waves modulated by slow dust motion are obtained. The instability behavior differs considerably from that of plasmas with weakly coupled dust grains and depends strongly on the Coulomb coupling parameter as well as the dust-charge relaxation rate.

[Isokinetic concentric dynamometry of knee flexors and extensors in young male]

Objective. To investigate the effects of different moving speeds on isokinetic dynamometry of knee flexors and extensors, and to provide normative data for comparative purposes in strength evaluations. Method. Thirty healthy male were tested at 60, 180, and 240 deg/sec angular velocities using a REV9000 testing and rehabilitation system. Result. Both PT (peak torque) and PT/BW (peak torque/body weights) showed significant differences (P< 0.01, P< 0.05) between flexors and extensors, and declined significantly with increased speed (P< 0.001). Peak torque differences between dominant and nondominant knee (Di%) was 10%. TPT (time to peak torque) tended to decrease as moving speeds increased (P< 0.001). APT (angle of peak torque) were 50%-70% for quadriceps, and 32%-45% for hamstrings; H/Q (hamstrings peak torque/quadriceps peak torque) was 50%-60%; WF (work fatigue) was 65%. Conclusion. The results provided a reference for strength evaluations in space medicine and space physiology, especially under simulated weightlessness and microgravity.

Dust acoustic waves in strongly coupled dissipative plasmas

The theory of dust acoustic waves is revisited in the frame of the generalized viscoelastic hydrodynamic theory for highly correlated dusts. Physical processes relevant to many experiments on dusts in plasmas, such as ionization and recombination, dust-charge variation, elastic electron and ion collisions with neutral and charged dust particles, as well as relaxation due to strong dust coupling, are taken into account. These processes can be on similar time scales and are thus important for the conservation of particles and momenta in a self-consistent description of the system. It is shown that the dispersion properties of the dust acoustic waves are determined by a sensitive balance of the effects of strong dust coupling and collisional relaxation. The predictions of the present theory applicable to typical parameters in laboratory strongly coupled dusty plasmas are given and compared with the experiment results. Some possible implications and discrepanies between theory and experiment are also discussed.

[Cardiovascular reactions to gravitational force in different directions]

OBJECTIVE

To observe the features of the cardiovascular reactions to gravitational forces along different axes of the body.

METHOD

Dogs were exposed to gravitational forces along axes of body on an animal centrifuge.

RESULT

It was found that when the direction of G force changed from +Gz to +Gx, the predominating effect on the cardiovascular system changed from the drop of eye level blood pressure to the increase of central venous pressure, and the reactions of the organism changed from a presson reflex of the arterial system to the inhibition of cardiac activities at higher G levels. The turning point was found to be at the back angle of 75 degrees with respect to the direction of the gravitational force.

CONCLUSION

These findings provide an important reference for choosing the optimal seat back angle in a manned space vehicle.

[Changes in QT interval of electrocardiogram under +Gz acceleration and its significance]

OBJECTIVE

To define whether QT interval could be used to predict the response of pilots to +Gz stress.

METHOD

37 pilots underwent +4 Gz acceleration on a human centrifuge. According to their responses to +Gz stress, subjects were divided into group A (good reaction group, n=18), group B (hyperfunction reaction group, n=14) and group C (inhibition reaction group, n=1). QT and RR interval were measured pre-, during and post-G. The data of 33 subjects (89.2%) whose QT interval could be measured were analyzed statistically.

RESULT

During +Gz, QT and RR interval were shortened and sensitivity of QT interval to RR interval was augmented significantly (vs. pre-G, P<0.001); group B had higher sensitivity of QT interval to RR interval during +Gz (P<0.001, as compared with group A); discrimination functions established by QT and RR interval during +Gz were efficient and their accurate judgement rate was 81.8%.

CONCLUSION

The changes in QT interval of ECG were related to autonomic nervous imbalance under +Gz; QT interval and RR interval could be used to predict the response of pilots to +Gz stress. These suggested that the parameters and method in this study might be used in G-LOC warning system.

Computer analysis system of blood oxygen saturation in an animal hypoxia model

An experimental animal hypoxia model has been developed. It consists of two sensors (an in vitro and in vivo model), an experimental device and a computer signal processing system. This method can easily be applied to determine and analyse blood oxygen saturation at various hypoxia levels. It can also be used to evaluate the accuracy of pulse oximetry over a wide range of oxyhemoglobin desaturation levels. The DC and AC components of recorded red and infra-red signals, the dual-wavelength ratio R12 and the reading of a pulse oximeter (SpO2) can be automatically calculated and displayed on a computer screen. Preliminary results of the animal hypoxia test indicate that the measurements made by the instrument correlate well with the oxygen saturation readings of the automatic blood gas analyser AVL945. The computer analysis system is suitable for repeated estimations in the animal model.

The study on the mechanism of G intolerance of rabbits after simulated weightlessness

The direct consequence of cardiovascular adaptation to weightlessness (WL) is the decrease of G tolerance. In studying the mechanism of G intolerance after WL, respiration, heart rate, electrocardiogram, temporal arterial flow, loss of vision were usually used as the indices for evaluation of G tolerance. However the changes of microcirculation and blood rheological indices were seldom observed. Considering that the changes of status of blood circulation after WL may be one of the important factors causing decrease of G tolerance, the purpose of this paper is to observe the changes of microcirculation, blood rheological and the structure and circulatory status of four organs in rabbits during -4Gx after exposure to simulated weightlessness (SWL), in order to understand the cause of G intolerance after WL.