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BackgroundBlood blister-like aneurysms (BBAs) of the internal carotid artery are rare but high risk lesions that frequently re-rupture due to their fragile structure and dissecting pathology. Treatment is particularly challenging in ruptured cases, given the risks associated with dual antiplatelet therapy. Recent advancements in flow diverter stents (FDSs) with surface modifications, and the use of single antiplatelet therapy (SAPT), offer a potential alternative strategy.MethodsWe conducted a retrospective review of 17 patients with ruptured internal carotid artery BBAs treated with surface modified FDS under SAPT (ticagrelor or prasugrel) bridged periprocedurally with intravenous tirofiban. All procedures were performed within the acute phase of subarachnoid hemorrhage. Clinical, radiographic outcomes, and procedure related complications were evaluated.ResultsAmong 17 patients, 94.1% achieved complete angiographic occlusion, and 76.5% attained favorable clinical outcomes (modified Rankin Scale score ≤2). No aneurysm rebleeding or device related ischemic events occurred. A total of 11 patients underwent external ventricular drainage or ventriculoperitoneal shunting without discontinuing SAPT, and no hemorrhagic complications were observed. A literature review incorporating seven additional series identified a total of 42 FDS plus SAPT treated BBA cases, with similar safety and efficacy profiles.ConclusionsSurface modified FDS with SAPT and tirofiban bridging appears to be a promising treatment option for ruptured BBAs, offering high occlusion rates with minimal thromboembolic and hemorrhagic complications. Larger prospective studies are needed to validate these findings.

6-hydroxydopamine (6-OHDA) is used to induce oxidative damage in neuronal cells, which can serve as an experimental model of Parkinson’s disease (PD). Jujuboside A and B confer free radical scavenging effects but have never been examined for their neuroprotective effects, especially in PD; therefore, in this study, we aimed to investigate the feasibility of jujubosides as protectors of neurons against 6-OHDA and the underlying mechanisms. 6-OHDA-induced neurotoxicity in the human neuronal cell lines SH-SY5Y and SK-N-SH, was used to evaluate the protective effects of jujubosides. These findings indicated that jujuboside A and B were both capable of rescuing the 6-OHDA-induced loss of cell viability, activation of apoptosis, elevation of reactive oxygen species, and downregulation of the expression levels of superoxide dismutase, catalase, and glutathione peroxidase. In addition, jujuboside A and B can reverse a 6-OHDA-elevated Bax/Bcl-2 ratio, downregulate phosphorylated PI3K and AKT, and activate caspase-3, -7, and -9. These findings showed that jujubosides were capable of protecting both SH-SY5Y and SK-N-SH neuronal cells from 6-OHDA-induced toxicity via the rebalancing of the redox system, together with the resetting of the PI3K/AKT apoptotic signaling cascade. In conclusion, jujuboside may be a potential drug for PD prevention.

Arsenic trioxide (As O ), a potent toxin in traditional Chinese medicine, has been utilized as an anticancer agent in Chinese culture for over a millennium. Betulin, commonly extracted from the bark of birch trees, has been identified for its pharmacological properties, including antibacterial, anti-inflammatory, antitumor, and antiviral activities. The aim of this study was to determine the efficacy and underlying anticancer signaling cascade induced by As O and betulin in neuroblastoma cells. SK-N-SH cells were treated with As O with or without betulin. Cell viability and apoptotic signaling were assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, measurement of mitochondrial membrane potential (MMP) loss and reactive oxygen species (ROS), and quantitative western blotting analysis. Student's t-test in addition to one- or two-way analysis of variance was used to examine significant differences between comparison groups. The combined treatment of As O plus betulin was more effective than single treatments in suppressing cell viability and induction of apoptosis, which correlated well with elevated ROS levels. The apoptotic signaling cascade of As O plus betulin was revealed as ROS elevation and relative loss of MMP, leading to the cleavage of caspase-3 and -9. As O plus betulin treatment also reduced the expression of BCL2 apoptosis regulator, BH3-interacting domain death agonist, and BCL2-like-1. The novel combination of As O plus betulin has the potential to serve as a practical anti-neuroblastoma drug.

Although proton magnetic resonance spectroscopy (1H-MRS) is a common method for the evaluation of intracranial meningiomas, controversy exists regarding which parameter of 1H-MRS best predicts the histopathological grade of an intracranial meningioma. In this study, we evaluated the results of pre-operative 1H-MRS to identify predictive factors for high-grade intracranial meningioma. Thirteen patients with World Health Organization (WHO) grade II-III meningioma (confirmed by pathology) were defined as high-grade; twenty-two patients with WHO grade I meningioma were defined as low-grade. All patients were evaluated by 1H-MRS before surgery. The relationships between the ratios of metabolites (N-acetylaspartate [NAA], creatine [Cr], and choline [Cho]) and the diagnosis of high-grade meningioma were analyzed. According to Mann-Whitney U test analysis, the Cho/NAA ratio in cases of high-grade meningioma was significantly higher than in cases of low-grade meningioma (6.34 ± 7.90 vs. 1.58 ± 0.77, p<0.05); however, there were no differences in age, Cho/Cr, or NAA/Cr. According to conditional inference tree analysis, the optimal cut-off point for the Cho/NAA ration between high-grade and low-grade meningioma was 2.409 (sensitivity = 61.54%; specificity = 86.36%). This analysis of pre-operative 1H-MRS metabolite ratio demonstrated that the Cho/NAA ratio may provide a simple and practical predictive value for high-grade intracranial meningiomas, and may aid neurosurgeons in efforts to design an appropriate surgical plan and treatment strategy before surgery.

Canonical burr-hole craniostomy (BHC) with drainage is the primary treatment for chronic subdural hematomas. However, complicated situations such as organized clots or compartmentation may result in recurrent chronic subdural hematoma (CSDH). Herein, we introduce a novel technique by applying an endoscope for tearing the inner membrane and septum, in addition to evacuating the hematoma in the subdural space where in-line visualization is not possible. Two hundred and twenty-nine cases of CSDH were enrolled in this study. Of these, 13 patients were treated endoscopically. The 0-degree and 30-degree, 2.7 mm endoscope was applied after a BHC. The arachnoid knife for microsurgery was used to tear the inner membrane to open the compartments. Non-endoscope-assisted operated (non-Endo group) and endoscope-assisted membranectomy patients (Endo group) demonstrated no differences in sex, age, body mass index, trauma, other diseases, or use of anticoagulation agents. Although the surgery time spent for the Endo patients was longer (128.53±49.56 min) than that for the non-Endo group (65.18±32.89 min), no recurrence was found among the Endo group, whereas a higher rate was observed in the non-Endo group. Novel endoscope-assisted membranectomy is a powerful technique capable of reducing recurrence and improving surgical outcomes.

BackgroundEndoscopic transorbital approach is a novel development of minimally invasive skull base surgery. Recently, anatomical studies have started to discuss the expanded utilization of endoscopic transorbital route for intracranial intradural lesions. The goal of this cadaveric study is to assess the feasibility of endoscopic transorbital transtentorial approach for exposure of middle incisural space.MethodsAnatomical dissections were performed in four human cadaveric heads (8 sides) using 0- and 30-degree endoscopes. A stepwise description of endoscopic transorbital transtentorial approach to middle incisural space and related anatomy was provided.ResultsOrbital manipulation following superior eyelid crease incision with lateral canthotomy and cantholysis established space for bone drilling. Extradural stage consisted of extensive drilling of orbital roof of frontal bone, lessor, and greater wings of sphenoid bone. Intradural stage was composed of dissection of sphenoidal compartment of Sylvian fissure, lateral mobilization of mesial temporal lobe, and penetration of tentorium. A cross-shaped incision of tentorium provided direct visualization of crural cistern with anterolateral aspect of cerebral peduncle and upper pons. Interpeduncular cistern, prepontine cistern, and anterior portions of ambient and cerebellopontine cisterns were exposed by 30-degree endoscope.ConclusionThe endoscopic transorbital transtentorial approach can be used as a minimally invasive surgery for exposure of middle incisural space. Extensive drilling of sphenoid wing and lateral mobilization of mesial temporal lobe are the main determinants of successful dissection. Further studies are needed to confirm the clinical feasibility of this novel approach.

Background: Percutaneous vertebroplasty (PVP) is often performed under monitored anesthesia care (MAC) using a combination of propofol and remifentanil. However, the effects of different remifentanil effect-site concentrations (Ce) combined with propofol on perioperative outcomes in this procedure have not been reported. Methods: In this prospective, randomized controlled study, 80 patients scheduled for single-level PVP under MAC were enrolled. Participants were randomly assigned to receive propofol (Ce: 2.0 mcg/mL) combined with either a low (1.0 ng/mL; Group 1) or high (2.0 ng/mL; Group 2) remifentanil Ce. The primary outcome was the incidence of intraoperative patient movement; secondary outcomes included hemodynamic stability, perioperative adverse events, anesthetic consumption, frequency of dose adjustments, postoperative recovery, and anesthesia satisfaction. Results: Group 2 exhibited significantly fewer episodes of patient movement during the procedure and better intraoperative hemodynamic stability. Additionally, fewer upward adjustments in remifentanil infusion were observed in Group 2. Although the total propofol consumption was similar between the groups, Group 2 required a significantly lower propofol Ce to achieve adequate sedation. Surgeon satisfaction with anesthesia was also significantly higher in Group 2. Conclusions: Using a higher remifentanil Ce (2.0 ng/mL) in combination with propofol during PVP under MAC reduces patient movement and improves intraoperative hemodynamic stability without increasing adverse events. This regimen may thereby enhance procedural efficiency and surgeon satisfaction during vertebral interventions.

Introduction: In our study, we aimed to investigate the association between a traumatic brain injury (TBI) and subsequent erectile dysfunction (ED). This is a population-based study using the claims dataset from The National Health Insurance Research Database. Methods: We included 72,642 patients with TBI aged over 20 years, retrospectively, selected from the longitudinal health insurance database during 2000–2010, according to the ICD-9-CM. The control group consisted of 217,872 patients without TBI that were randomly chosen from the database at a ratio of 1:3, with age- and index year matched. Cox proportional hazards analysis was used to estimate the association between the TBI and subsequent ED. Results: After a 10-year follow-up, the incidence rate of ED was higher in the TBI patients when compared with the non-TBI control group (24.66 and 19.07 per 100,000, respectively). Patients with TBI had a higher risk of developing ED than the non-TBI cohort after the adjustment of the confounding factors, such as age, comorbidity, residence of urbanization and locations, seasons, level of care, and insured premiums (adjusted hazard ratio (HR) = 2.569, 95% CI [1.890, 3.492], p < .001). Conclusion: This is the first study using a comprehensive nationwide database to analyze the association of ED and TBI in the Asian population. After adjusted the confounding factors, patients with TBI have a significantly higher risk of developing ED, especially organic ED, than the general population. This finding might remind clinicians that it’s crucial in early identification and treatment of ED in post-TBI patients.

General anesthesia comprises 3 essential components-hypnosis, analgesia, and immobility. Among these, maintaining an appropriate hypnotic state, or anesthetic depth, is crucial for patient safety. Excessively deep anesthesia may lead to hemodynamic instability and postoperative cognitive dysfunction, whereas inadequate anesthesia increases the risk of intraoperative awareness. Electroencephalography (EEG)-based monitoring has therefore become a cornerstone for evaluating anesthetic depth. However, processed electroencephalography (pEEG) indices remain vulnerable to various sources of interference, including electromyographic activity, interindividual variability, and anesthetic drug effects, which can yield inaccurate numerical outputs. With recent advances in machine learning, particularly unsupervised learning, data-driven methods that classify signals according to inherent patterns offer new possibilities for anesthetic depth analysis. This study aimed to establish a methodology for automatically identifying anesthesia depth using an unsupervised, machine learning-based clustering approach applied to pEEG data. Standard frontal EEG data from participants undergoing elective lumbar spine surgery were retrospectively analyzed, yielding more than 16,000 data points. The signals were filtered with a fourth-order Butterworth bandpass filter and transformed using the fast Fourier transform to estimate power spectral density. Normalized band power ratios for delta, high-theta, alpha, and beta frequencies were extracted as input features. Fuzzy C-Means (FCM) clustering (c=3, m=2) was applied to categorize anesthetic depth into slight, proper, and deep clusters. FCM clustering successfully identified 3 physiologically interpretable clusters consistent with EEG dynamics during progressive anesthesia. As anesthesia deepened, frontal alpha oscillations became more prominent within a delta-dominant background, while beta activity decreased with loss of consciousness. The fuzzy membership values quantified transitional states and captured the continuum of anesthetic depth. Visualization confirmed strong correspondence among cluster transitions, Patient State Index trends, and spectral density patterns. This study demonstrates the feasibility of using unsupervised machine learning to enhance anesthetic depth assessment. By applying FCM clustering to pEEG data, this approach improves the understanding of anesthesia depth and integrates effectively with existing monitoring modalities. The proposed FCM-based method complements current EEG indices and may assist anesthesia practitioners and even nonanesthesia professionals in assessing anesthetic depth to enhance patient safety.

Purpose – The purpose of this paper is to evaluate the mechanical properties of photopolymer/CB (carbon black) nanocomposite when applied in a visible-light rapid prototyping (RP) machine. Design/methodology/approach – The mechanical properties of the samples such as hardness and tensile strength along with thermal stability were analyzed. The curing time behavior of the photopolymer/CB nanocomposites was tested by using a rigid-body pendulum rheometer. The shrinkage property and dimensional stability were also analyzed using the technique according to ASTM D2566 and ASTM D1204, respectively. Findings – The results showed that the prototype fabricated from pristine photopolymer tended to exhibit poor mechanical properties and low thermal stability. However, after adding the photopolymer with various concentrations of nano-CB and dispersant in appropriate composition, the photopolymer/CB nanocomposite prototype not only reduced its curing time but also enhanced its mechanical properties, thermal stability and dimensional stability. Practical implications – The presented results can be used in a visible-light RP machine. Originality/value – The mechanical and thermal properties of photopolymer are improved with nano-CB additives for a RP system.