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Background: This study evaluates the effectiveness of Therapeutic Hypothermia (TH) in treating poor-grade aneurysmal subarachnoid hemorrhage (SAH), focusing on functional outcomes, mortality, and complications such as vasospasm, delayed cerebral ischemia (DCI), and hydrocephalus., Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search was conducted across multiple databases, including Medline, Embase, and Cochrane Central, up to November 2023. Nine studies involving 368 patients were selected based on eligibility criteria focusing on TH in poor-grade SAH patients. Data extraction, bias assessment, and evidence certainty were systematically performed., Results: The primary analysis of unfavorable outcomes in 271 participants showed no significant difference between the TH and standard care groups (risk ratio [RR], 0.87). However, a significant reduction in vasospasm was observed in the TH group (RR, 0.63) among 174 participants. No significant differences were found in DCI, hydrocephalus, and mortality rates in the respective participant groups., Conclusions: TH did not significantly improve primary unfavorable outcomes in poor-grade SAH patients. However, the reduction in vasospasm rates indicates potential specific benefits. The absence of significant findings in other secondary outcomes and mortality highlights the need for further research to better understand TH's role in treating this patient population.

Objective: To evaluate whether an occlusion pathomechanism can be accurately determined by common preprocedural findings through a machine learning-based prediction model (ML-PM)., Methods: A total of 476 patients with acute stroke who underwent endovascular treatment were retrospectively included to derive an ML-PM. For external validation, 152 patients from another tertiary stroke center were additionally included. An ML algorithm was trained to classify an occlusion pathomechanism into embolic or intracranial atherosclerosis . Various common preprocedural findings were entered into the model. Model performance was evaluated based on accuracy and area under the receiver operating characteristic curve (AUC). For practical utility, a decision flowchart was devised from an ML-PM with a few key preprocedural findings. Accuracy of the decision flowchart was validated internally and externally., Results: An ML-PM could determine an occlusion pathomechanism with an accuracy of 96.9% (AUC=0.95). In the model, CT angiography-determined occlusion type, atrial fibrillation, hyperdense artery sign, and occlusion location were top-ranked contributors. With these four findings only, an ML-PM had an accuracy of 93.8% (AUC=0.92). With a decision flowchart, an occlusion pathomechanism could be determined with an accuracy of 91.2% for the study cohort and 94.7% for the external validation cohort. The decision flowchart was more accurate than single preprocedural findings for determining an occlusion pathomechanism., Conclusions: An ML-PM could accurately determine an occlusion pathomechanism with common preprocedural findings. A decision flowchart consisting of the four most influential findings was clinically applicable and superior to single common preprocedural findings for determining an occlusion pathomechanism., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Studies have suggested that the dietary intake of antioxidant vitamins, such as vitamin C and vitamin E, has a potential role in inhibiting gastric carcinogenesis. The present study investigated the effect of antioxidant vitamins on the incidence of gastric intestinal metaplasia (GIM)., Methods: This study included 67,657 Koreans free of GIM who periodically underwent health check-ups. Dietary intake was assessed by a semiquantitative food frequency questionnaire based on the Korean National Health and Nutrition Examination Survey. Participants were categorized into 4 groups by quartiles of dietary vitamin C and vitamin E intake. The Cox proportional hazard assumption was used to determine the multivariable hazard ratio (HR) and 95% confidence interval (95% CI) for GIM., Results: The third and fourth quartiles of vitamin C intake had a lower risk of GIM than the first quartile (multivariable-adjusted HR, 0.95; 95% CI, 0.88 to 1.03 in the second quartile, HR, 0.88; 95% CI, 0.81 to 0.97 in the third quartile, and HR, 0.85; 95% CI, 0.76 to 0.95 in the fourth quartile). Vitamin E intake greater than the second quartile level was significantly associated with a lower risk of GIM than the first quartile (multivariable-adjusted HR, 0.90; 95% CI, 0.82 to 0.97 in the second quartile, HR, 0.90; 95% CI, 0.82 to 0.99 in the third quartile, and HR, 0.83; 95% CI, 0.74 to 0.94 in the fourth quartile). This association was observed only in the subgroup analysis for men., Conclusions: Higher dietary intake of vitamin C and vitamin E was associated with a lower risk of GIM.

Long-term preclinical study available extracranial brain activator (ECBA) system, ECBAv2, is proposed for the non-anesthetic canine models. The titanium-packaged module shows enhanced durability, even after a year of implantation in the scalp. In addition, the wearable helmet type base station provides a stable experimental environment without anesthesia. In this work, HFS stimulation is induced to six canine models for 30 minutes every day over 4 weeks (10Hz, 40Hz and no stimulation for each pair of subjects). Pre- and post-HFS stimulation PET-CT image shows remarkable increases of glucose metabolism in the temporal and parietal lobes. Moreover, both the 40-Hz and 10-Hz groups shows noticeable increase and the former group has more increments than the latter. Our results establish that HFS stimulation definitely worked as facilitating brain activity which may affect memory and sensory skills, respectively.

Objective: The current grading system for moyamoya disease (MMD) is focused on angiographic studies with limited clinical application. The authors aimed to determine relevant factors that may impact postoperative outcome and establish a scoring system to predict the functional outcome., Methods: Adult patients with MMD who underwent treatment between 1998 and 2016 were included. Factors such as age, sex, comorbidity, smoking, MMD family history, initial presentation, multimodal imaging modalities, and types of surgical revascularization were thoroughly reviewed. These factors were analyzed to determine possible risk factors related to unfavorable 6-month postoperative outcomes using the modified Rankin Scale (mRS) (unfavorable: mRS score ≥ 3). A scoring system was developed using these independent risk factors to predict the outcome and validated using prospectively collected data from multiple centers between 2017 and 2018., Results: Of 302 patients for whom applications were submitted, 260 patients (321 hemispheres) met the diagnostic criteria. In multivariate analysis, hyperlipidemia, smoking, cerebral infarction on preoperative CT or MRI, and moderately to severely reduced regional cerebrovascular reserve results from Diamox SPECT were significantly related to unfavorable outcome. The authors developed a scoring system and stratified patients into risk groups according to their scores: low-risk (score 0-3), intermediate-risk (score 4-6), and high-risk (score 7-9) groups. This model demonstrated both good discrimination and calibration using C-statistics and the Hosmer-Lemeshow goodness-of-fit test showing 0.812 (95% CI 0.743-0.881) (p = 0.568) for the development and 0.954 (95% CI 0.896-1) (p = 0.097) for the temporal and external validation cohort., Conclusions: The authors' scoring system is readily adoptable to predict the postoperative outcome for MMD. Their data revealed the importance of smoking and hyperlipidemia, which were the only modifiable factors included in the scoring system. The authors validated their scoring system both internally and externally and maintained good performance, highlighting the system's generalizability and reliability.

Aim: To suggest a geometric classification of paraclinoid aneurysms for microcatheter superselection., Material and Methods: Clinical data from 76 patients (80 paraclinoid aneurysms) who underwent endovascular treatments were retrospectively reviewed. Paraclinoid aneurysms were classified according to the six directions where the aneurysm neck lies and simplified into three groups as follows: superior, medial, and lateral groups. The medial group was further divided into proximal, mid, and distal subgroups according to the location of the aneurysm neck on lateral angiography. Furthermore, we assessed the superselection success rate with the first-selected pre-shaped microcatheter per group., Results: According to the aneurysm direction, the medial group showed relatively lower superselection success rates (66.1%) than the superior (81.8%) and lateral groups (85.7%). The S-shaped microcatheter was the most frequently used in the superior (69.2%) and lateral groups (62.5%). Acute-angled J- and C-shaped microcatheters (88.5%) were preferred for proximal aneurysms; and obtuse-angled 45°- and 90°-angled microcatheters (75%), for distal aneurysms. The mid-portion group showed the lowest success rate (45.8%) and more difficulties in pre-shaped microcatheter superselection., Conclusion: Medially directed mid-portion aneurysms were difficult to access using pre-shaped microcatheters; thus, tailored steam-shaping techniques may be considered. Superiorly and laterally directed aneurysms could be accessed using pre-S-shaped microcatheters. Acute-angled microcatheters may be considered for proximal aneurysms; and obtuse-angled microcatheters, for distal aneurysms.

A novel minimally invasive wirelessly powered medical device, a magnetic induction extra-cranial brain stimulation (MI-ECBS) system is implemented for treating neurological disorders, Alzheimer's disease (AD) and Epilepsy. The proposed system provides 2 different types of clinically significant stimulation waveforms for the therapy. For high frequency stimulation (HFS), we used 1mA, 10Hz, rectangular, charge balanced (0.5msec pulse width) pulses for 3sec with 21sec rest (total 600 pulses). Subsequently, under same configuration, a low frequency stimulation (LFS; 1Hz, 600 pulses) protocol was applied to canine-animal models. As a result, complementary neuro-modulation, facilitation and an inhibition are successfully demonstrated with an EEG power spectrum monitoring and the stimulation delivery efficacy is enhanced to 39.57x comparing to conventional transcutaneous direct current stimulation (tDCS).