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Environmental pollution by heavy metals and other toxic substances has increasingly become a global health concern. Lead is a hazardous environmental contaminant that is been released to the surface causing deleterious health effects to man. Various strategies have been employed such as excavation, precipitation, and vitrification to remove lead from polluted sites. However, bioremediation of heavy metal contaminated sites has served as a cost-effective and ecofriendly tool for detoxifying and restoration of ecological entities. In this study, we reported the isolation and optimization of two novel lead-resistant isolates from active goldmine contaminated site of Anka, Zamfara state Nigeria. Results of Atomic Absorption Spectroscopy (AAS) showed higher lead concentration from the sampled sites (p

Environmental contamination, primarily driven by human activities such as industrialization, urbanization, and agricultural practices, has led to the accumulation of heavy metals, particularly molybdenum, in urban soils. This contamination adversely affects plant growth, food security, and poses health risks. This study explores the bioreduction potential of Bacillus cereus strain BUK_BCH_BTE1 in transforming toxic hexavalent molybdate to molybdenum blue which is a less toxic state. The bacterium was isolated from agricultural soil in Nigeria and identified through 16S rRNA sequencing. Factors influencing molybdate reduction were optimized, including carbon and nitrogen sources, molybdate, and phosphate concentrations. Glucose was found to be the most effective carbon source, while ammonium sulfate was the preferred nitrogen source. Molybdate reduction was most efficient at a concentration of 20 mM, and a phosphate concentration of approximately 3.5 mM was optimal. These findings contribute to understanding molybdate bioreduction and its potential application in addressing heavy metal pollution in the environment. Bacillus cereus strain BUK_BCH_BTE1 shows promise as an effective agent for molybdate bioreduction, with implications for mitigating environmental and health hazards associated with molybdenum contamination.

Fungal processes for the treatment of dye contaminated wastewater have the advantage of being cost-effective, environmentally friendly, and producing less sludge. This research was therefore aimed at isolating and characterizing fungus capable of decolourizing and utilizing azo dye (dimethyl yellow) as a sole carbon source using one-factor-at-a-time. Pour plating method was used to isolate the fungus on mineral salt media (MSM) following serial dilution. The isolate was then morphologically and molecularly identified as Aspergillus quadrilineatus strain BUK_BCH_BTE1 with the accession number OK178927 based on ITS1 and ITS2 rRNA gene sequence and molecular phylogenetic analysis. Characterization was conducted by studying the effect of temperature, incubation time, substrate concentration, pH, inoculum size and effect of heavy metals. The decolourization and growth of dimethyl yellow by the isolated Aspergillus quadrilineatus was optimal at substrate concentration of 200 μɡ/mL, temperature of 30 °C, 100–200 μL inoculum size, pH 5.0, and 72-h incubation time. The isolate was found to tolerate up to 4 ppm of Hg, Cu and Zn, with maximum inhibition shown by Cr and Ar. LC/MS analyses of the intermediate compounds produced during decolourization of dimethyl yellow suggested that in the fungal biodegradation of dimethyl yellow detected the formation of dimethyl yellow, 2,6-dichloro-p-benzoquinone, 1,2,3,5-tetrafluoro-4-nitrobenzene, and 3,4-dinitrobenzoic acid as metabolites. The finding from this study suggested that the isolate is a suitable candidate in bioremediation of coloured effluents particularly containing these compounds.

Palm oil mill effluent (POME) has a high concentration of organic matter and total suspended solids. However, improper disposal of oil refining wastes containing oils, fats, and sludge can cause environmental damage and harm human health due to their toxic, carcinogenic, and polluting effects. This research was carried out to solve the harmful effects caused by the release of POME to the environment. The goal of this study was to isolate a naturally occurring bacterium that could degrade POME and use it as a single carbon source. Bacteria were isolated from POME-contaminated medium using an enrichment technique. Judging by 16S rRNA partial gene sequencing, morphological, biochemical, and molecular identification methods, the isolated bacteria was identified as a novel Bacillus sp. The effects of substrate concentration, inoculum size, pH, temperature, and incubation time on the bacterial growth were investigated using a ''one factor at a time'' (OFAT) approach. The optimal conditions for the bacterium's growth were found to be pH 7.5, 35 °C, 20 % v/v substrate concentration, 6 % v/v inoculum size, and 96 hours of incubation. The isolate is capable of reducing 84 % of COD and 91 % of BOD from a POME sample. The high degradation potential of POME by the isolate suggests it can be used as a good option for bioremediation of POME-polluted areas.

Chlorpyrifos, being a frequently used organophosphate pesticide poses a significant threat to human health due to its prolonged presence in soil, plants, and water, this has raised concern. Consequently, researchers have shifted their attention towards finding methods to mitigate its toxicity or eliminate it from the environment. This has highlighted the importance of bioremediation. This study was aimed at analyzing and characterizing the metabolites of chlorpyrifos degradation by Bacillus sp. strain UPMB10 isolated from polluted environment using Gas Chromatography-Mass Spectrometry. The bacteria were successfully isolated utilizing the enrichment technique in mineral salt media, followed by screening to obtain the best isolate. Identification of the isolate was done at morphological, biochemical, and molecular levels, with a focus on the 16S rRNA gene. Phylogenetic analysis revealed the close relationship between the bacterium and Bacillus sp. strain UPMB10. Optimization (One Factor at A Time) was done to determine best growth conditions of the isolate. The optimal growth conditions obtained include, incubation time of 48 hours, a substrate concentration of 4 g/L, a pH of 7.0, a temperature of 37 °C, and an inoculum size of 2 % (v/v), these quantitative data revealed valuable insights into the factors affecting efficient degradation of pesticide. Gas Chromatography-Mass Spectrometry analysis demonstrated that the bacterium achieved a remarkable degradation efficiency of 99 % after 48 hours of incubation. Notably, Mesitylene and Dimethylmalonic acid were obtained as some of the metabolites of chlorpyrifos degradation. This result provides insight into the transformation of products generated during degradation process. The study finding revealed that Bacillus sp. strain UPMB10 exhibits a remarkable capacity for chlorpyrifos degradation, making it a promising candidate for bioremediation of insecticides and acaricides.

λ-cyhalothrin (LC), a frequently used synthetic pyrethroid insecticide, poses a substantial risk to human health and the environment due to its prolonged presence in plants, soil, and water. This study aimed to identify and characterize bacteria with the ability to degrade and utilize λ-cyhalothrin as their sole carbon and energy source. The bacteria were isolated by employing an enrichment technique on mineral salt media through a series of dilution steps. Strain isolated underwent identification through morphological, biochemical, and molecular analyses, specifically employing 16S rRNA and phylogenetic analysis, which disclosed its classification as Bacillus sp. With the accession number OR133746. Physio-cultural conditions, including temperature, initial substrate concentration, pH, incubation time and inoculum size affecting the strain's activity were investigated in MSM using a one-variable-at-a-time approach. The optimal conditions for bacterial growth and λ-cyhalothrin degradation was found to be a substrate concentration of 6 g/L, a temperature of 30 °C, a pH of 6.5, and an incubation time of 96 hours. The results of Gravimetric analysis revealed that the selected isolate exhibited notable degradation rates of 75.4 % and 100 % after 72 hours and 96 hours of incubation, respectively. These findings highlight the exceptional efficiency of the strain in degrading λ-cyhalothrin. Consequently, this strain emerges as a promising candidate for tackling pollution attributed to λ-cyhalothrin through bioremediation processes.

In the agricultural sector, a class of chemical compounds known as chlorinated phenol and phenoxyacetic acid are employed as herbicides, wood preservatives, and pesticides. Certain groups of chlorinated phenoxyacetic acid are used as herbicides for agricultural and domestic application. They are listed as priority pollutants by the United States Environmental Protection Agency (USEPA). Thus, this study focuses on bacterial isolation for 2,4-dichlorophenoxyacetic acid herbicide degradation been a toxic contaminant that hinders the quality of the soil over time, availability of certain soil microbes, non-targeted plants and poses health risk even to humans such as Hodking's lymphoma, respiratory infections e.t.c. These therefore, make it necessary to search for scientific way of dealing with this chemical from our environments. Incubation time, substrate concentration, pH, temperature, and inoculum size in mineral salt medium were all the parameters tested during the study, while 2,4-dichlorophenoxyacetic acid (2,4-D) herbicide was used as the alternative source of carbon. Following systemic dilution of sample on mineral salt medium, three bacterial isolates (D1, D2, and D3), were isolated and subjected to lots of screening. D2 was proven to be the best. During molecular identification that involves polymerase chain reaction, gel electrophoresis, sequence alignment and phylogentic analysis, the isolated bacteria was found to be Achromobacter xylosoxidans. The bacterial isolate grew and degraded 2,4-dichlorophenoxyacetic acid herbicide at optimum conditions of 96 h incubation time, 0.72g L−1 substrate concentration, 7.5 pH, 40 °C temperature, and 400 μg/L inoculum size. High Performance Liquid Chromatography (HPLC) analysis of the residual 2,4-dichlorophenoxyacetic acid herbicide and the standard solution probe of the isolate was able to degrade up to 95.38 % of the substrate indicating great potentiality in bioremediation of herbicide polluted environments thereby, reducing if not all eliminating these toxic contaminants from our surroundings.

Herbal remedies are alternative option for the treatment, management, and prevention of different disease conditions such as malaria in most African communities due to their easy access and economic advantages. Heavy metals contaminations from the plant ingredients, processing or anthropogenic activities may render the herbal harmful for human consumption. Therefore, risk assessment of contaminating metals and antioxidant activities were determined in Agbo, a popular anti-malarial herbs mixture sold in Kano. The samples were collected from different locations across Kano State and labelled as A, B, C. The concentrations of some human cancer-causing (Cadmium Cd; Lead Pb and Chromium Cr) and some non-cancer-causing metals such as Copper Cu; Nickel, Ni in the sample were evaluated. The antioxidant properties were also evaluated using various assays, which include 2,2-diphenyl-2-picrylhydrazyl (DPPH), hydrogen peroxide (H2O2) scavenging actions, Metal Chelating, phosphomolybdate test and Reducing power properties of Agbo. Some phytochemicals (Phenolic acids, flavonoids, tannins, saponins and alkaloids) were found to be present. The values predicting the probability of human developing risk of cancer ailment after the ceaseless consumption of the herbal mixtures was found higher than a standard threshold limit (>10−4) established by USEPA. While the non-cancer predicted risk index projected the Cr, Pb and Cd (from sample B) as the leading metal pollutants of the herbal mixtures posing a risk index of more than one (>1), while Ni and Pb (from sample A and C) showed a relative safe quotient. The determined IC50 value for reducing power showed the herbal mixtures exhibiting almost same antioxidant activities with sample C having the highest (IC50 6.32 μg/mL), followed by sample B (IC50 6.36 μg/mL) and sample A (IC50 6.39 μg/mL). This suggests that excess consumption of this mixtures may be generally beneficial health-wise but unsafe due to the heavy metals which could expose the consumers to probable cancer risks and other biological process distraction.

Introduction: The Woven EndoBridge (WEB) device is emerging as a novel therapy for intracranial aneurysms, but its use for off-label indications requires further study. Using machine learning, we aimed to develop predictive models for complete occlusion after off-label WEB treatment and to identify factors associated with occlusion outcomes., Methods: This multicenter, retrospective study included 162 patients who underwent off-label WEB treatment for intracranial aneurysms. Baseline, morphological, and procedural variables were utilized to develop machine-learning models predicting complete occlusion. Model interpretation was performed to determine significant predictors. Ordinal regression was also performed with occlusion status as an ordinal outcome from better (Raymond Roy Occlusion Classification [RROC] grade 1) to worse (RROC grade 3) status. Odds ratios (OR) with 95 % confidence intervals (CI) were reported., Results: The best performing model achieved an AUROC of 0.8 for predicting complete occlusion. Larger neck diameter and daughter sac were significant independent predictors of incomplete occlusion. On multivariable ordinal regression, higher RROC grades (OR 1.86, 95 % CI 1.25-2.82), larger neck diameter (OR 1.69, 95 % CI 1.09-2.65), and presence of daughter sacs (OR 2.26, 95 % CI 0.99-5.15) were associated with worse aneurysm occlusion after WEB treatment, independent of other factors., Conclusion: This study found that larger neck diameter and daughter sacs were associated with worse occlusion after WEB therapy for aneurysms. The machine learning approach identified anatomical factors related to occlusion outcomes that may help guide patient selection and monitoring with this technology. Further validation is needed., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke., Methods: In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (±10 days) post-stroke, assessed by the Wilcoxon rank test (α=0·05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960., Findings: Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6-14]), and 91 patients received best medical treatment (6 years [3-12]; p<0·0001). The median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score on admission was 14 (IQR 10-19) in the endovascular thrombectomy group and 9 (5-13) in the best medical treatment group (p<0·0001). Both treatment groups had a median pre-stroke mRS score of 0 (IQR 0-0) at baseline. The change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·020). One (1%) patient developed a symptomatic intracranial haemorrhage (this patient was in the endovascular thrombectomy group). Six (5%) patients in the endovascular thrombectomy group and four (5%) patients in the best medical treatment group had died by day 90 (p=0·89). After propensity score matching for age, sex, and PedNIHSS score at hospital admission (n=79 from each group), the change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·029). Regarding the primary outcome for patients with suspected focal cerebral arteriopathy, endovascular thrombectomy (n=18) and best medical treatment (n=33) showed no difference in 90-day median mRS scores (2 [IQR 1-3] vs 2 [1-4]; p=0·074)., Interpretation: Clinical centres tended to select children with more severe strokes (higher PedNIHSS score) for endovascular thrombectomy. Nevertheless, endovascular thrombectomy was associated with improved functional outcomes in paediatric patients with large-vessel or medium-vessel occlusions compared with best medical treatment. Future studies need to investigate whether the positive effect of endovascular thrombectomy is confined to older and more severely affected children., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors' objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment., Methods: The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size., Results: The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters., Conclusions: This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.

Objectives: To standardize optic nerve sheath diameter (ONSD) point-of-care ultrasonography (POCUS) and improve its research and clinical utility by developing the ONSD POCUS Quality Criteria Checklist (ONSD POCUS QCC)., Design: Three rounds of modified Delphi consensus process and three rounds of asynchronous discussions., Setting: Online surveys and anonymous asynchronous discussion., Subjects: Expert panelists were identified according to their expertise in ONSD research, publication records, education, and clinical use. A total of 52 panelists participated in the Delphi process., Interventions: None., Measurements and Main Results: Three Delphi rounds and three asynchronous discussion rounds generated consensus on quality criteria (QC). This started with 29 QC in addition to other QC proposed by expert panelists. The QC items were categorized into probe selection, safety, body position, imaging, measurement, and research considerations. At the conclusion of the study, 28 QC reached consensus to include in the final ONSD POCUS QCC. These QC were then reorganized, edited, and consolidated into 23 QC that were reviewed and approved by the panelists., Conclusions: ONSD POCUS QCC standardizes ONSD ultrasound imaging and measurement based on international consensus. This can establish ONSD ultrasound in clinical research and improve its utility in clinical practice., Competing Interests: Dr. Sarwal’s institution received a loan device from Butterfly and Image Monitoring (Viasonix); she received funding from Stimdia. Dr. Hakimi received funding from the American Academy of Neurology and the American Society of Neuroimaging; he disclosed that he is President-Elect American Society of Neuroimaging. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Background: Endovascular treatment with the woven endobridge (WEB) device has been widely utilized for managing intracranial aneurysms. However, predicting the probability of achieving adequate occlusion (Raymond-Roy classification 1 or 2) remains challenging., Objective: Our study sought to develop and validate a predictive calculator for adequate occlusion using the WEB device via data from a large multi-institutional retrospective cohort., Methods: We used data from the WorldWide WEB Consortium, encompassing 356 patients from 30 centers across North America, South America, and Europe. Bivariate and multivariate regression analyses were performed on a variety of demographic and clinical factors, from which predictive factors were selected. Calibration and validation were conducted, with variance inflation factor (VIF) parameters checked for collinearity., Results: A total of 356 patients were included: 124 (34.8%) were male, 108 (30.3%) were elderly (≥65 years), and 118 (33.1%) were current smokers. Mean maximum aneurysm diameter was 7.09 mm (SD 2.71), with 112 (31.5%) having a daughter sac. In the multivariate regression, increasing aneurysm neck size (OR 0.706 [95% CI: 0.535-0.929], p  = 0.13) and partial aneurysm thrombosis (OR 0.135 [95% CI: 0.024-0.681], p  = 0.016) were found to be the only statistically significant variables associated with poorer likelihood of achieving occlusion. The predictive calculator shows a c -statistic of 0.744. Hosmer-Lemeshow goodness-of-fit test indicated a satisfactory model fit with a p -value of 0.431. The calculator is available at: https://neurodx.shinyapps.io/WEBDEVICE/., Conclusion: The predictive calculator offers a substantial contribution to the clinical toolkit for estimating the likelihood of adequate intracranial aneurysm occlusion by WEB device embolization., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The Woven EndoBridge (WEB) device is primarily used for treating wide-neck intracranial bifurcation aneurysms under 10 mm. Limited data exists on its efficacy for large aneurysms. We aim to assess angiographic and clinical outcomes of the WEB device in treating large versus small aneurysms. We conducted a retrospective review of the WorldWide WEB Consortium database, from 2011 to 2022, across 30 academic institutions globally. Propensity score matching (PSM) was employed to compare small and large aneurysms on baseline characteristics. A total of 898 patients were included. There was no significant difference observed in clinical presentations, smoking status, pretreatment mRS, presence of multiple aneurysms, bifurcation location, or prior treatment between the two groups. After PSM, 302 matched pairs showed significantly lower last follow-up adequate occlusion rates (81% vs 90%, p = 0.006) and higher retreatment rates (12% vs 3.6%, p < 0.001) in the large aneurysm group. These findings may inform treatment decisions and patient counseling. Future studies are needed to further explore this area., (© 2024. The Author(s).)

Background and Purpose: Despite the numerous studies evaluating the occlusion rates of aneurysms following WEB embolization, there are limited studies identifying predictors of occlusion. Our purpose was to identify predictors of aneurysm occlusion and the need for retreatment., Materials and Methods: This is a review of a prospectively maintained database across 30 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB who had available intraprocedural data and long-term follow-up., Results: We studied 763 patients with a mean age of 59.9 (SD, 11.7) years. Complete aneurysm occlusion was observed in 212/726 (29.2%) cases, and contrast stasis was observed in 485/537 (90.3%) of nonoccluded aneurysms. At the final follow-up, complete occlusion was achieved in 497/763 (65.1%) patients, and retreatment was required for 56/763 (7.3%) patients. On multivariable analysis, history of smoking, maximal aneurysm diameter, and the presence of an aneurysm wall branch were negative predictors of complete occlusion (OR, 0.5, 0.8, and 0.4, respectively). Maximal aneurysm diameter, the presence of an aneurysm wall branch, posterior circulation location, and male sex increase the chances of retreatment (OR, 1.2, 3.8, 3.0, and 2.3 respectively). Intraprocedural occlusion resulted in a 3-fold increase in the long-term occlusion rate and a 5-fold decrease in the retreatment rate ( P < .001), offering a specificity of 87% and a positive predictive value of 85% for long-term occlusion., Conclusions: Intraprocedural occlusion can be used to predict the chance of long-term aneurysm occlusion and the need for retreatment after embolization with a WEB device. Smoking, aneurysm size, and the presence of an aneurysm wall branch are associated with decreased chances of successful treatment., (© 2024 by American Journal of Neuroradiology.)

The Woven EndoBridge (WEB) device has been widely used to treat intracranial wide neck bifurcation aneurysms. Initial studies have demonstrated that approximately 90% of patients have same or improved long-term aneurysm occlusion after the initial 6-month follow up. The aim of this study is to assess the long-term follow-up in aneurysms that have achieved complete occlusion at 6 months. We also compared the predictive value of different imaging modalities used. This is an analysis of a prospectively maintained database across 13 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB device who achieved complete occlusion at first follow-up and had available long-term follow-up. A total of 95 patients with a mean age of 61.6 ± 11.9 years were studied. The mean neck diameter and height were 3.9 ± 1.3 mm and 6.0 ± 1.8 mm, respectively. The mean time to first and last follow-up was 5.4 ± 1.8 and 14.1 ± 12.9 months, respectively. Out of all the aneurysms that were completely occluded at 6 months, 84 (90.3%) showed complete occlusion at the final follow-up, and 11(11.5%) patients did not achieve complete occlusion. The positive predictive value (PPV) of complete occlusion at first follow was 88.4%. Importantly, this did not differ between digital subtraction angiography (DSA), magnetic resonance angiography (MRA), or computed tomography angiography (CTA). This study underlines the importance of repeat imaging in patients treated with the WEB device even if complete occlusion is achieved short term. Follow-up can be performed using DSA, MRA or CTA with no difference in positive predictive value., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: This study was conducted to investigate the impact of antiplatelet administration in the periprocedural period on the occurrence of thromboembolic complications (TECs) in patients undergoing treatment using the Woven EndoBridge (WEB) device for intracranial wide-necked bifurcation aneurysms. The primary objective was to assess whether the use of antiplatelets in the pre- and postprocedural phases reduces the likelihood of developing TECs, considering various covariates., Methods: A retrospective multicenter observational study was conducted within the WorldWideWEB Consortium and comprised 38 academic centers with endovascular treatment capabilities. Univariable and multivariable logistic regression analyses were performed to determine the association between antiplatelet use and TECs, adjusting for covariates. Missing predictor data were addressed using multiple imputation., Results: The study comprised two cohorts: one addressing general thromboembolic events and consisting of 1412 patients, among whom 103 experienced TECs, and another focusing on symptomatic thromboembolic events and comprising 1395 patients, of whom 50 experienced symptomatic TECs. Preprocedural antiplatelet use was associated with a reduced likelihood of overall TECs (OR 0.32, 95% CI 0.19-0.53, p < 0.001) and symptomatic TECs (OR 0.49, 95% CI 0.25-0.95, p = 0.036), whereas postprocedural antiplatelet use showed no significant association with TECs. The study also revealed additional predictors of TECs, including stent use (overall: OR 4.96, 95% CI 2.38-10.3, p < 0.001; symptomatic: OR 3.24, 95% CI 1.26-8.36, p = 0.015), WEB single-layer sphere (SLS) type (overall: OR 0.18, 95% CI 0.04-0.74, p = 0.017), and posterior circulation aneurysm location (symptomatic: OR 18.43, 95% CI 1.48-230, p = 0.024)., Conclusions: The findings of this study suggest that the preprocedural administration of antiplatelets is associated with a reduced likelihood of TECs in patients undergoing treatment with the WEB device for wide-necked bifurcation aneurysms. However, postprocedural antiplatelet use did not show a significant impact on TEC occurrence.

Introduction Extracorporeal membrane oxygenation (ECMO) is associated with a high rate of neurologic complications. Multimodal neurologic monitoring (MNM) has the potential for early detection and intervention. We examined the safety and feasibility of noninvasive MNM during ECMO. We hypothesized that survivors and non-survivors would have meaningful differences in transcranial Doppler (TCD) sonography and electroencephalographic (EEG) characteristics, which we aimed to identify. We also investigated adverse neurologic events and attempted to identify differences in EEG and TCD characteristics among patients based on the type of ECMO and the occurrence of these events. Material and methods We performed an observational study on all patients undergoing ECMO at Baylor St. Luke's Medical Center's critical care unit in Houston, Texas, United States, from January 2017 to February 2019. All patients underwent a noninvasive MNM protocol. Results NM was completed in 75% of patients; all patients received at least one component of the monitoring protocol. No adverse events were noted, showing the feasibility and safety of the protocol. The 60.4% of patients who did not survive tended to be older, had lower ejection fractions, and had lower median right middle cerebral artery (MCA) pulsatility and resistivity indexes. Patients undergoing venoarterial (VA)-ECMO had lower median left and right MCA velocities and lower right Lindegaard ratios than patients who underwent venovenous-ECMO. In VA-ECMO patients, EEG less often showed sleep architecture, while other findings were similar between groups. Adverse neurologic events occurred in 24.7% of patients, all undergoing VA-ECMO. Acute ischemic stroke occurred in 22% of patients, intraparenchymal hemorrhage in 4.9%, hypoxic-ischemic encephalopathy in 3.7%, subarachnoid hemorrhage in 2.5%, and subdural hematoma in 1.2%. Conclusion Our results suggest that MNM is safe and feasible for patients undergoing ECMO. Certain EEG and TCD findings could aid in the early detection of neurologic deterioration. MNM may not just be used in monitoring patients undergoing ECMO but also in prognostication and aiding clinical decision-making., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Siddiqui et al.)

Background: The Woven EndoBridge (WEB) devices have been used for treating wide neck bifurcation aneurysms (WNBAs) with several generational enhancements to improve clinical outcomes. The original device dual-layer (WEB DL) was replaced by a single-layer (WEB SL) device in 2013. This study aimed to compare the effectiveness and safety of these devices in managing intracranial aneurysms., Methods: A multicenter cohort study was conducted, and data from 1,289 patients with intracranial aneurysms treated with either the WEB SL or WEB DL devices were retrospectively analyzed. Propensity score matching was utilized to balance the baseline characteristics between the two groups. Outcomes assessed included immediate occlusion rate, complete occlusion at last follow-up, retreatment rate, device compaction, and aneurysmal rupture., Results: Before propensity score matching, patients treated with the WEB SL had a significantly higher rate of complete occlusion at the last follow-up and a lower rate of retreatment. After matching, there was no significant difference in immediate occlusion rate, retreatment rate, or device compaction between the WEB SL and DL groups. However, the SL group maintained a higher rate of complete occlusion at the final follow-up. Regression analysis showed that SL was associated with higher rates of complete occlusion (OR: 0.19; CI: 0.04 to 0.8, p = 0.029) and lower rates of retreatment (OR: 0.12; CI: 0 to 4.12, p = 0.23)., Conclusion: The WEB SL and DL devices demonstrated similar performances in immediate occlusion rates and retreatment requirements for intracranial aneurysms. The SL device showed a higher rate of complete occlusion at the final follow-up., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The Woven EndoBridge (WEB) device is frequently used for the treatment of intracranial aneurysms. Postoperative management, including the use of aspirin, varies among clinicians and institutions, but its impact on the outcomes of the WEB has not been thoroughly investigated., Methods: This was a retrospective, multicenter study involving 30 academic institutions in North America, South America, and Europe. Data from 1492 patients treated with the WEB device were included. Patients were categorized into two groups based on their postoperative use of aspirin (aspirin group: n=1124, non-aspirin group: n=368). Data points included patient demographics, aneurysm characteristics, procedural details, complications, and angiographic and functional outcomes. Propensity score matching (PSM) was applied to balance variables between the two groups., Results: Prior to PSM, the aspirin group exhibited significantly higher rates of modified Rankin scale (mRS) mRS 0-1 and mRS 0-2 (89.8% vs 73.4% and 94.1% vs 79.8%, p<0.001), lower rates of mortality (1.6% vs 8.6%, p<0.001), and higher major compaction rates (13.4% vs 7%, p<0.001). Post-PSM, the aspirin group showed significantly higher rates of retreatment (p=0.026) and major compaction (p=0.037) while maintaining its higher rates of good functional outcomes and lower mortality rates. In the multivariable regression, aspirin was associated with higher rates of mRS 0-1 (OR 2.166; 95% CI 1.16 to 4, p=0.016) and mRS 0-2 (OR 2.817; 95% CI 1.36 to 5.88, p=0.005) and lower rates of mortality (OR 0.228; 95% CI 0.06 to 0.83, p=0.025). However, it was associated with higher rates of retreatment (OR 2.471; 95% CI 1.11 to 5.51, p=0.027)., Conclusions: Aspirin use post-WEB treatment may lead to better functional outcomes and lower mortality but with higher retreatment rates. These insights are crucial for postoperative management after WEB procedures, but further studies are necessary for validation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)