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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.

Atrazine herbicide is known to disrupt the endocrine system and is potentially carcinogenic. Its continual application leads to high residue levels in soil, causing water pollution, which when consumed is associated with devastating health effects. This research reported the isolation and characterization of a new bacterial strains from active agricultural soil with the potential to biodegrade atrazine as a sole carbon source. An enrichment method was utilized to isolate the bacteria (A1, A2, B1, B2, C1 and C2) on mineral salt media (MSM) following serial dilution. Six isolates were screened for their tolerance to various concentrations of atrazine (500 to 1500 mg∙L‐1), and only isolate B1 tolerated up to 1500 mg∙L‐1 atrazine. The isolate was identified molecularly as Bacillus safensis strain BUK_BCH_BTE6 based on 16S rRNA gene sequencing and molecular phylogenetic analysis. Characterization of the isolate based on the effects of temperature, pH, substrate concentration, incubation time, inoculum size, and heavy metals revealed optimum growth and atrazine degradation at 35 °C, a pH of 7.5, 400 mg∙L‐1, at 48 h, and inoculum size of 600 µL, respectively. The growth of the isolate was inhibited by 2 ppm Hg, Cd, Cr, Pb, Ar, and Ni, while Fe, Cu, and Zn stimulated it. GC‐MS analysis revealed a degradation efficiency of 88.85% within 120 h, while metabolites such as desethyldeisopropylatrazine, deisopropylatrazine, N‐ethylammelide, and cyanuric acid were also detected. This isolate is a highly atrazine‐tolerant and efficient atrazine degrader that could be employed for bioremediation of atrazine‐polluted sites.

Lead is one of the most toxic heavy metals ever known by man today, which has zero biological role. It is known to cause anemia and affect the nervous and reproductive systems with irreversible effects. Its continual usage leads to its high accumulation polluting the soil and water bodies with devastating health effects. This research, aimed at isolation and characterization of indigenous lead tolerant bacteria from contaminated soil of Anka. Results of Atomic Absorption Spectrophotometry (AAS) showed high concentration of lead (738 mg/kg) of the affected sites above the EPA standard (400 mg/kg). Similarly, a mineral salt media was used to isolate the bacteria following serial dilution. An indigenous bacterial isolate (Ac) with potential to tolerate up to 3000 mg/L Pb(NO3)2 was isolated and molecularly identified based on 16s rRNA sequencing as Bacillus cereus strain BUK_BCH_BTE2 with the accession number MT160412. The isolate was further characterized for its optimum growth and tolerance conditions using one factor at a time (OFAT). Sucrose with an optimum concentration of 5 g/L was the best carbon source for the isolate. The isolate was found to utilize ammonium sulphate as the best nitrogen source at a concentration of 2.5 g/L, with an optimum pH and tempertaure of 7.0 and 37 °C respectively. A concentration of 1000 mg/L Pb(NO3)2 was found to be the optimum concentration for the isolate. The optimum incubation time and inoculum size were found to be 48 hrs and 100 μL respectively. The fact that the isolate could tolerate high Pb(NO3)2 concentration makes it suitable for future bioremediation work involving lead.

Bioremediation process is one of the most effective methods which facilitates the cleaning of contaminated sites and restores contaminated sites through the broad biodegradative capabilities evolved by microorganisms towards undesirable organic compounds. In this study, Alcaligenes sp. with potential to degrade and utilize used engine oil as its source of carbon and energy was isolated, identified and its growth parameters optimized for efficient and better breakdown of the pollutant. Alcaligenes sp. was isolated from a used engine oil contaminated soil in an old mechanic shop, after enrichment using a carbon free (Bush-Nell Haas) media which was supplemented with used engine oil. The bacterium was identified (morphologically, biochemically, and molecularly) and studied for its ability to extract carbon from used engine oil hence degrading used engine oil. Thereafter, the various growth parameters of the bacterium isolate were optimized. Data obtained showed optimum growth parameter of 2% (v/v) used engine oil (carbon source), pH 7, temperature 37 °C, inoculum size 2 ml and incubation time 240 hours. Also, measured ribosomal RNA (16S RNA) sequence and phylogenetic analysis revealed that the isolate is a very close relative of Alcaligenes species. The degradation potential of the isolate was assessed using gravimetric analysis, and a percentage degradation of 92.5% was discovered. Overall, the results of this study suggest that Alcaligenes sp. can effectively degrade used engine oil, hence, a potential remediation organism against engine oil contamination and spills on soils or water surface.

Chromium, a transition metal element widely distributed in the earth's crust, with the valence from −2 to +6, but exists mainly in the form of trivalent and hexavalent states. Hexavalent chromium Chromium (VI) is often found in soil and ground water due to its widespread industrial use such as tannery, electroplating, and steel industries. Chromium (VI) is toxic, mutagenic, carcinogenic, and teratogenic and much more toxic to many plants, animals, and bacteria inhabiting aquatic environments because it is motile, highly toxic, soluble in water and it is a strong oxidizing agent that causes severe damage to cell membranes while the trivalent chromium Cr (III) is the most stable form of chromium and relatively immobile in the aquatic system due to its lower solubility. This study therefore, aims at identifying a bacterium that can reduce Chromium (IV) to (III) using a pour plate technique on Luria Bertani medium amended with K2Cr2O7. Graphs and tables were used for the data analysis. The effects of incubation time, pH, temperature, inoculum size, and potassium dichromate (K2Cr2O7) concentration were then examined to characterize the bacterium based on one factor at a time. To assess Chromium (VI) reduction, a spectrophotometric study of the 1, 5-diphenyl carbazide test (DPC) at 370 nm was utilized. By using molecular phylogenetic analysis and partial 16s ribosomal RNA analysis, the isolate was found to be Acinetobacter sp. strain BUK_BCH_BTE 5. The findings demonstrated that tryptic soy broth (TSB), with an optimal K2Cr2O7 level of 200 mg/L, pH of 6.5, 35 °C temperature, inoculum size of 2%, as well as incubation time of 48 h, was the most successful approach for decreasing chromium (VI). Following Nickel (Ni), the isolate was found to withstand the highest doses of Lead (Pb), Mercury (Hg), Zink (Zn), Iron (Fe), Cadmium (Cd), Arsenic (As), and Cupper, in that order. A reduced culture's (supernatant) larvacidal bioassay showed a 30% decrease in toxicity in just 48 hours, indicating that the isolate is a promising candidate, and that the reduction method is less dangerous for decontaminating chromium-contaminated environments.

Textile industry wastewater contains azo dye leftovers, which have a deleterious impact on most environmental systems. Because of safety and cost considerations, biological waste treatment is the best alternative. The goal of the study was to isolate and characterized fungus that could decolorize and use azo dye (Congo red) as a single carbon source. After serial dilution on mineral salt media, the fungus was isolated using the pour plating procedure. Based on gene sequencing of ITS1 and ITS2 ribosomal RNA region and molecular phylogenetic analysis the strain was identified as Aspergillus quadrilineatus with the accession number OK178927. Temperature, pH, substrate concentration, incubation period, inoculum size, and the influence of interacting heavy metals in Mineral Salt Medium were all investigated during the characterization process Congo red is used as the sole carbon source. This fungal isolate grew and decolorized Congo red best at 400 μɡ/ml substrate concentration, 30 °C temperature, 5.0 pH, an inoculum size of 200 μL, and a 72-h incubation time. The isolate was shown to withstand up to 6 ppm of Zink (Zn), Chromium (Cr), and Cupper (Cu), with Iron (Fe) and Arsenic (Ar) showing the most inhibition. Comparing Congo red's metabolites to a standard database of organic substances. LC/MS analyses of the intermediate compounds produced during Congo red decolorization revealed the formation of Isamine blue, p-bromo-N-(2-naphthyl)-benzenesulfonamide, 4-acetomido-N,N-dicyclohexyl-3-nitrobenzene, and azobenzene-2-sulfenyl bromide as metabolites in the fungal biodegradation of Congo red. The isolate might be a good candidate for bioremediation.

In recent years, the degradation of pollutants by microorganisms has emerged as a feasible and cost-effective strategy for restoring the quality of the environment. Anthracene is an integral part of many carcinogenic polyaromatic hydrocarbons (PAHs) and causes skin irritation. The aimed of the study is to investigate the anthracene-degrading ability bacteria and from environmental samples and characterized them using an enrichment technique. The bacterial strain was identified as Achromobacter xylosoxidans based on molecular identification achieved via 16SrRNA sequencing and phylogenetic analysis. The strain, designated as BUK_BTEG6 (accession number OM52853), was found to efficiently degrade anthracene as the sole carbon and energy source. A one factor at a time (OFAT) approach was utilized to determine the optimal growth factors that include substrate concentration, temperature, pH, and inoculum size. Results indicated that 400-600 mg/L was found as the optimal growth conditions as substrate concentration with temperature to be 35 °C, pH of 7.5 after 72 hours of incubation. Moreover, the GC-MS analysis of the culture medium confirmed the presence of degradation metabolites such as 9-10 anthraquinone, anthracene cis 1,2 dihydro diol, catechol, and cis-cis muconic acid. This isolate represents a potential candidate for use in environmental bioremediation strategies aimed at eliminating anthracene contamination from the environment.

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).)

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 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.)

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.)

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.)

Objective: The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device., Methods: The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use., Results: The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p = 0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use., Conclusions: This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.

Background: The Woven EndoBridge (WEB) device is a novel intrasaccular flow disruptor tailored for bifurcation aneurysms. We aim to describe the degree of aneurysm occlusion at the latest follow-up, and the rate of complications of aneurysms treated with the WEB device stratified according to rupture status., Methods: Our data were taken from the WorldWideWeb Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups: ruptured and unruptured. We compared clinical and radiologic outcomes of both groups. Propensity score matching (PSM) was done to match according to age, gender, bifurcation, location, prior treatment, neck, height, dome width, daughter sac, incorporated branch, pretreatment antiplatelets, and last imaging follow-up., Results: The study included 676 patients with 691 intracranial aneurysms (529 unruptured and 162 ruptured) treated with the WEB device. The PSM analysis had 55 pairs. In both the unmatched (85.8% vs 84.3%, p=0.692) and matched (94.4% vs 83.3%, p=0.066) cohorts there was no significant difference in the adequate occlusion rate at the last follow-up. Likewise, there were no significant differences in both ischemic and hemorrhagic complications between the two groups. There was no documented aneurysm rebleeding after WEB device implantation., Conclusion: There was no significant difference in both the radiologic outcomes and complications between unruptured and ruptured aneurysms. Our findings support the feasibility of treatment of ruptured aneurysms with the WEB device., Competing Interests: Competing interests: JDBD: Honoraria from Medtronic. Travel grant from Microvention. MD: No relevant relationships NA: No relevant relationships RWR: Grants from National Institutes of Health, Heitman foundation, Society of vascular and interventional neurology; Advisory board participation for Rapid medical; Site PI for Microvention and Penumbra JEV: No relevant relationships AG : No relevant relationships SVL: No relevant relationships LR: No relevant relationships AAB: No relevant relationships ES: No relevant relationships KP: No relevant relationships KEL: No relevant relationships GS : No relevant relationships MAM: No relevant relationships IL: No relevant relationships PMR: No relevant relationships JAV: Fees from MicroVention for proctoring cases for new physician users of the Woven EndoBridge device; Medtronic travel expense VŽ: Participation on the data safety monitoring board or advisory board for KBC Sestre Milosrdnice, Zagreb / OB Nova Gradiška MUH: No relevant relationships CR: No relevant relationships HR: No relevant relationships VMT: No relevant relationships SM: No relevant relationships SG: No relevant relationships PH: No relevant relationships NA: No relevant relationships JDR: No relevant relationships YR: No relevant relationships CMS: No relevant relationships OG: No relevant relationships MP: No relevant relationships ALK: No relevant relationships CM: No relevant relationships SE: No relevant relationships RMS: Supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and the National Institutes of Health (R01NS111119-01A1, UL1TR002736, and KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. AH: Consulting or speaker fees from Medtronic, MicroVention, Stryker, Penumbra, Cerenovus, Genentech, GE Healthcare, Scientia, Balt, Viz.ai, Insera Therapeutics, Proximie, NeuroVasc, NovaSignal, Vesalio, and Galaxy Therapeutics. AS: No relevant relationships AN: No relevant relationships JJ: Consulting and speaker fees from Cerenovus MP: No relevant relationships JS: No relevant relationships CPF: No relevant relationships MBB: No relevant relationships MM: Grants from Balt, Medtronic, MicroVention, and Stryker. MMS: No relevant relationships JB: No relevant relationships BTJ: No relevant relationships RAD: No relevant relationships TH: No relevant relationships RT: Medtronic Stocks CU: No relevant relationships BL : No relevant relationships PP: No relevant relationships ASP: Grants from NIH, Microvention, Cerenovus, Medtronic and Stryker; Consulting fees from Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical; stock options from InNeuroCo, Agile, Perfuze, Galaxy and NTI GP: No relevant relationships CJG: Grants to institution from Medtronic and Penumbra; consulting fees from Stryker and MicroVention. HA: Proctoring fees from MicroVention. Grants to institution from the National Institutes of Health; consulting fees from Amnis Therapeutics, Apellis Pharmaceuticals, Boston Scientific, Canon Medical Systems, Cardinal Health 200, Cerebrotech Medical Systems, Cerenovus, Cerevatech Medical, Cordis, Corindus, EndoStream Medical, Imperative Care, Integra, IRRAS, Medtronic, MicroVention, Minnetronix Neuro, Penumbra, Q’Apel Medical, Rapid Medical, Serenity Medical, Silk Road Medical, StimMed, Stryker Neurovascular, Three Rivers Medical, VasSol, Viz.ai, and W.L. Gore & Associates; payment for participation on the steering committees for the Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE, and SWIFT DIRECT Trials; MicroVention FRED Trial and CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI Neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial; stock or stock options in Adona Medical, Amnis Therapeutics, Bend IT Technologies, BlinkTBI, Buffalo Technology Partners, Cardinal Consultants, Cerebrotech Medical Systems, Cerevatech Medical, Cognition Medical, CVAID, E8, EndoStream Medical, Imperative Care, Instylla, International Medical Distribution Partners, Launch NY, NeuroRadial Technologies, Neurotechnology Investors, Neurovascular Diagnostics, Perflow Medical, Q’Apel Medical, QAS.ai, Radical Catheter Technologies, Rebound Therapeutics (purchased in 2019 by Integra Lifesciences), Rist Neurovascular (purchased in 2020 by Medtronic), Sense Diagnostics, Serenity Medical, Silk Road Medical, Songbird Therapy, Spinnaker Medical, StimMed, Synchron, Three Rivers Medical, Truvic Medical, Tulavi Therapeutics, Vastrax, VICIS, and Viseon AFD: Consulting fees from Cerenovus, Penumbra, Medtronic, Stryker, Oculus, and Koswire. No relevant relationships RD: No relevant relationships PK: No relevant relationships. VK: No relevant relationships. PL: No relevant relationships SB: No relevant relationships CJS: Participation on the data safety monitoring board or advisory board for Zoll Circulation JK: No relevant relationships PJ: No relevant relationships ST: No relevant relationships FC: No relevant relationships NL: Honoraria for lectures from Cerenovus, Stryker, and CrossMed. MAA: Funding to institution from MicroVention for WEBIT trial; proctoring fees from MicroVention. HHC: No relevant relationships CC: Consulting fees from MicroVention, Stryker, Medtronic, MIVI, and Cerenovus. ABP: Grant to institution from Medtronic; consulting fees from MicroVention, Medtronic, and Q’Apel; workstation for research from Siemens AAD: No relevant relationships, (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Several studies have shown promising outcomes of the Woven EndoBridge (WEB) device for the treatment of wide-necked intracranial bifurcation aneurysms. This is a multicenter study attempts to explore the changes in trends and treatment outcomes over time for WEB embolization of intracranial aneurysms. The WorldWideWEB consortium is a retrospective multicenter collaboration of data from international centers spanning from January 2011 and June 2021, with no limitations on aneurysm location or rupture status. Both bifurcation and sidewall aneurysms were included. These patients were stratified based on treatment year into five treatment intervals: 2011-2015 (N = 66), 2016-2017 (N = 77), 2018 (N = 66), 2019 (N = 300), and 2020-2021 (N = 173). Patient characteristics and angiographic and clinical outcomes were compared between these time intervals. This study comprised 671 patients (median age 61.4 years; 71.2% female) with 682 intracranial aneurysms. Over time, we observed an increasing tendency to treat patients presenting with ruptured aneurysms and aneurysms with smaller neck, diameter, and dome widths. Furthermore, we observed a trend towards more off-label use of the WEB for sidewall aneurysms and increased adoption of transradial access for WEB deployment. Moreover, the proportion of patients with adequate WEB occlusion immediately and at last follow-up was significantly higher in more recent year cohorts, as well as lower rates of compaction and retreatment. Mortality and complications did not differ over time. This learning curve study suggests improved experience using the WEB for the treatment of intracranial aneurysms and has yielded higher rates of adequate occlusion over time., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The Woven EndoBridge (WEB) device has Food and Drug Administration approval for treatment of wide-necked intracranial bifurcation aneurysms. The WEB device has been shown to result in adequate occlusion in bifurcation aneurysms overall, but its usefulness in the individual bifurcation locations has been evaluated separately only in few case series, which were limited by small sample sizes., Objective: To compare angiographic and clinical outcomes after treatment of bifurcation aneurysms at various locations, including anterior communicating artery (AComA), anterior cerebral artery (ACA) bifurcation distal to AComA, basilar tip, internal carotid artery (ICA) bifurcation, and middle cerebral artery (MCA) bifurcation aneurysms using the WEB device., Methods: A retrospective cohort analysis was conducted at 22 academic institutions worldwide to compare treatment outcomes of patients with intracranial bifurcation aneurysms using the WEB device. Data include patient and aneurysm characteristics, procedural details, angiographic and functional outcomes, and complications., Results: A total of 572 aneurysms were included. MCA (36%), AComA (35.7%), and basilar tip (18.9%) aneurysms were most common. The rate of adequate aneurysm occlusion was significantly higher for basilar tip (91.6%) and ICA bifurcation (96.7%) aneurysms and lower for ACA bifurcation (71.4%) and AComA (80.6%) aneurysms (p=0.04)., Conclusion: To our knowledge, this is the most extensive study to date that compares the treatment of different intracranial bifurcation aneurysms using the WEB device. Basilar tip and ICA bifurcation aneurysms showed significantly higher rates of aneurysm occlusion than other locations., Competing Interests: Competing interests: The following authors serve on the editorial board of JNIS, JDBD, AG, AFD, FCA, and PK., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: First-pass efficacy (FPE) has been established as an important predictor of favorable functional outcomes after endovascular thrombectomy (ET) in anterior circulation strokes. In this retrospective cohort study, we investigate predictors and clinical outcomes of FPE in posterior circulation strokes (pcAIS). Methods: The Stroke Thrombectomy and Aneurysm Registry database was used to identify pcAIS patients who achieved FPE. Their baseline characteristics and outcomes were compared with the non-FPE group. The primary outcome was a 90-day modified Rankin Scale (mRS) of 0-3. Univariate (UVA) and multivariate (MVA) analyses were done to evaluate predictors of FPE. Safety outcomes included distal emboli, vessel rupture, symptomatic intracranial hemorrhage, and mortality. Results: Of 359 patients, 179 (50%) achieved FPE. Clot burden, occlusion site, and ET technique-related variables were similar between the two groups except for shorter procedure time with FPE. The primary outcome was significantly better with FPE (56.4% vs. 32.8%, p  < 0.001). Complications were similar except for a higher rate of distal emboli in non-FPE group (11.1% vs. 3.2%, p  = 0.032). Atrial fibrillation (Afib) had increased odds (aOR: 2.06, 95% CI; 1.24, 3.4, p  = 0.005) and prior ischemic stroke had decreased odds (aOR: 0.524, 95% CI; 0.28, 0.97, p  = 0.04) of FPE. Afib was the only independent predictor of FPE on MVA (1.94, 95% CI; 1.1, 3.43, p  = 0.022). Conclusions: Higher rate of FPE in Afib-related pcAIS could possibly be explained by the differences in clot composition and degree of in-situ atherosclerotic disease burden. Future studies are warranted to explore the relationship of clot composition with ET outcomes.

Introduction: Understanding outcomes after Vein of Galen malformation (VOGM) embolization has been limited by small sample size in reported series and predominantly single center studies. To address these limitations, we perform an individual-participant meta-analysis (IPMA) to identify risk factors associated with all-cause mortality and clinical outcome after VOGM endovascular embolization., Methods: We performed a systematic review and IPMA of VOGM endovascular outcomes according to PRISMA guidelines. Individual patient characteristics including demographic, intra/post-operative adverse events, treatment efficacy (partial or complete occlusion), and clinical outcome were collected. Mixed-effects logistic regression with random effects modeling and Bonferroni correction was used ( p  ≤ 0.003 threshold for statistical significance). The primary and secondary outcomes were all-cause mortality and poor clinical outcome (moderate/severe developmental delay or permanent disabling injury), respectively. Data are expressed as (mean ± standard deviation (SD)) or (odds ratio (OR), 95% confidence interval (CI), I 2 , p -value)., Results: Thirty-five studies totaling 307 participants quantifying outcomes after endovascular embolization for VOGM were included. Follow up time was 42 (±57) months. Our analysis contained 42% neonates (<1 month) at first embolization, 45% infants (1 month ≤2 years), and 13% children (>2 years). Complete occlusion was reported in 48% of participants. Overall all-cause mortality was 16%. Overall, good clinical outcome was achieved in 68% of participants. First embolization as a neonate [OR = 6.93; 95% CI (1.99-24.08); I 2  < 0.01; p  < 0.001] and incomplete embolization [OR = 10.87; 95% CI (1.86-63.55); I 2  < 0.01; p  < 0.001] were associated with mortality. First embolization as a neonate [OR = 3.24; 95% CI (1.47-7.15); I 2  < 0.01; p  < 0.001], incomplete embolization [OR = 5.26; 95% CI (2.06-13.43); I 2  < 0.01; p  < 0.001], and heart failure at presentation [OR = 3.10; 95% CI (1.03-9.33); I 2  < 0.01; p  = 0.002] were associated with poor clinical outcomes. Sex, angioarchitecture of lesion, embolization approach (transvenous vs. transarterial), and single or multistage embolization were not associated with mortality or clinical outcome., Conclusions: We identify incomplete VOGM embolization independently associated with mortality and poor clinical outcome. While this study provides the highest level of evidence for VOGM embolization to date, prospective multicenter studies are needed to understand the optimal treatment strategies, outcomes, and natural history after VOGM embolization., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Savage, Hale, Parr, Hedaya, Saccomano, Tsemo, Hafeez, Tanweer, Kan, Solomon, Meila, Dirks, Blount, Johnston, Rocque, Rozzelle, Bhatia, Muthusami, Krings and Jones.)

Background and Purpose: The optic nerve is surrounded by the extension of meningeal coverings of the brain. When the pressure in the cerebrospinal fluid increases, it causes a distention of the optic nerve sheath diameter (ONSD), which allows the use of this measurement by ultrasonography (US) as a noninvasive surrogate of elevated intracranial pressure. However, ONSD measurements in the literature have exhibited significant heterogeneity, suggesting a need for consensus on ONSD image acquisition and measurement. We aim to establish a consensus for an ONSD US Quality Criteria Checklist (ONSD US QCC)., Methods: A scoping systematic review of published ultrasound ONSD imaging and measurement criteria was performed to guide the development of a preliminary ONSD US QCC that will undergo a modified Delphi study to reach expert consensus on ONSD quality criteria. The protocol of this modified Delphi study is presented in this manuscript., Results: A total of 357 ultrasound studies were included in the review. Quality criteria were evaluated under five categories: probe selection, safety, positioning, image acquisition, and measurement., Conclusions: This review and Delphi protocol aim to establish ONSD US QCC. A broad consensus from this process may reduce the variability of ONSD measurements in future studies, which would ultimately translate into improved ONSD clinical applications. This protocol was reviewed and endorsed by the German Society of Ultrasound in Medicine., (© 2022 American Society of Neuroimaging.)

Background The Woven EndoBridge (WEB) device was explicitly designed for wide-neck intracranial bifurcation aneurysms. Small-scale reports have evaluated the off-label use of WEB devices for the treatment of sidewall aneurysms, with promising outcomes. Purpose To compare the angiographic and clinical outcomes of the WEB device for the treatment of sidewall aneurysms compared with the treatment of bifurcation aneurysms. Materials and Methods A retrospective review of the WorldWideWEB Consortium, a synthesis of retrospective databases spanning from January 2011 to June 2021 at 22 academic institutions in North America, South America, and Europe, was performed to identify patients with intracranial aneurysms treated with the WEB device. Characteristics and outcomes were compared between bifurcation and sidewall aneurysms. Propensity score matching (PSM) was used to match by age, pretreatment ordinal modified Rankin Scale score, ruptured aneurysms, location of aneurysm, multiple aneurysms, prior treatment, neck, height, dome width, daughter sac, and incorporated branch. Results A total of 683 intracranial aneurysms were treated using the WEB device in 671 patients (median age, 61 years [IQR, 53-68 years]; male-to-female ratio, 1:2.5). Of those, 572 were bifurcation aneurysms and 111 were sidewall aneurysms. PSM was performed, resulting in 91 bifurcation and sidewall aneurysms pairs. No significant difference was observed in occlusion status at last follow-up, deployment success, or complication rates between the two groups. Conclusion No significantly different outcomes were observed following the off-label use of the Woven EndoBridge, or WEB, device for treatment of sidewall aneurysms compared with bifurcation aneurysms. The correct characterization of the sidewall aneurysm location, neck angle, and size is crucial for successful treatment and lower retreatment rate. © RSNA, 2022 See also the editorial by Hetts in this issue.

Introduction/aims: It is unknown if patients with neuromuscular diseases prefer in-person or virtual telemedicine visits. We studied patient opinions and preference on virtual versus in-person visits, and the factors influencing such preferences., Methods: Telephone surveys, consisting of 11 questions, of patients from 10 neuromuscular centers were completed., Results: Five hundred and twenty surveys were completed. Twenty-six percent of respondents preferred virtual visits, while 50% preferred in-person visits. Sixty-four percent reported physical interaction as "very important." For receiving a new diagnosis, 55% preferred in-person vs 35% reporting no preference. Forty percent were concerned about a lack of physical examination vs 20% who were concerned about evaluating vital signs. Eighty four percent reported virtual visits were sufficiently private. Sixty eight percent did not consider expenses a factor in their preference. Although 92% were comfortable with virtual communication technology, 55% preferred video communications, and 19% preferred phone calls. Visit preference was not significantly associated with gender, diagnosis, disease severity, or symptom management. Patients who were concerned about a lack of physical exam or assessment of vitals had significantly higher odds of selecting in-person visits than no preference., Discussion: Although neither technology, privacy, nor finance burdened patients in our study, more patients preferred in-person visits than virtual visits and 40% were concerned about a lack of physical examination. Interactions that occur with in-person encounters had high importance for patients, reflecting differences in the perception of the patient-physician relationship between virtual and in-person visits., (© 2022 The Authors. Muscle & Nerve published by Wiley Periodicals LLC.)

Objective: Transradial access (TRA) is commonly utilized in neurointerventional procedures. This study compared the technical and clinical outcomes of the use of TRA versus those of transfemoral access (TFA) for intracranial aneurysm embolization with the Woven EndoBridge (WEB) device., Methods: This is a secondary analysis of the Worldwide WEB Consortium, which comprises multicenter data related to adult patients with intracranial aneurysms who were managed with the WEB device. These aneurysms were categorized into two groups: those who were treated with TRA or TFA. Patient and aneurysm characteristics and technical and clinical outcomes were compared between groups. Propensity score matching (PSM) was used to match groups according to the following baseline characteristics: age, sex, subarachnoid hemorrhage, aneurysm location, bifurcation aneurysm, aneurysm with incorporated branch, neck width, aspect ratio, dome width, and elapsed time since the last follow-up imaging evaluation., Results: This study included 682 intracranial aneurysms (median [interquartile range] age 61.3 [53.0-68.0] years), of which 561 were treated with TFA and 121 with TRA. PSM resulted in 65 matched pairs. After PSM, both groups had similar characteristics, angiographic and functional outcomes, and rates of retreatment, thromboembolic and hemorrhagic complications, and death. TFA was associated with longer procedure length (median 96.5 minutes vs 72.0 minutes, p = 0.006) and fluoroscopy time (28.2 minutes vs 24.8 minutes, p = 0.037) as compared with TRA. On the other hand, deployment issues were more common in those treated with TRA, but none resulted in permanent complications., Conclusions: TRA has comparable outcomes, with shorter procedure and fluoroscopy time, to TFA for aneurysm embolization with the WEB device.

Background: Open surgery has traditionally been preferred for the management of bifurcation middle cerebral artery (MCA) aneurysms. Flow diverting stents present a novel endovascular strategy for aneurysm treatment., Objective: To add to the limited literature describing the outcomes and complications in the use of flow diverters for the treatment of these complex aneurysms., Methods: This is a multicenter retrospective review of MCA bifurcation aneurysms undergoing flow diversion. We assessed post-treatment radiological outcomes and both thromboembolic and hemorrhagic complications., Results: We reviewed the outcomes of 54 aneurysms treated with flow diversion. Four (7.4%) of the aneurysms had a history of rupture (3 remote and 1 acute). Fourteen (25.9%) of the aneurysms already underwent either open surgery or coiling prior to flow diversion. A total of 36 out of the 45 aneurysms (80%) with available follow-up data had adequate aneurysm occlusion with a median follow-up time of 12 mo. There were no hemorrhagic complications but 16.7% (9/54) had thromboembolic complications., Conclusion: Flow diverting stents may be a viable option for the endovascular treatment of complex bifurcation MCA aneurysms. However, compared to published series on the open surgical treatment of this subset of aneurysms, flow diversion has inferior outcomes and are associated with a higher rate of complications., (© Congress of Neurological Surgeons 2021.)

Present article reads three dimensional flow analysis of incompressible viscous hybrid nanofluid in a rotating frame. Ethylene glycol is used as a base liquid while nanoparticles are of copper and silver. Fluid is bounded between two parallel surfaces in which the lower surface stretches linearly. Fluid is conducting hence uniform magnetic field is applied. Effects of non-linear thermal radiation, Joule heating and viscous dissipation are entertained. Interesting quantities namely surface drag force and Nusselt number are discussed. Rate of entropy generation is examined. Bvp4c numerical scheme is used for the solution of transformed O.D.Es. Results regarding various flow parameters are obtained via bvp4c technique in MATLAB Software version 2019, and displayed through different plots. Our obtained results presents that velocity field decreases with respect to higher values of magnetic parameter, Reynolds number and rotation parameter. It is also observed that the temperature field boots subject to radiation parameter. Results are compared with Ishak et al. (Nonlinear Anal R World Appl 10:2909-2913, 2009) and found very good agreement with them. This agreement shows that the results are 99.99% match with each other., (© 2021. The Author(s).)

Introduction: Botulinum neurotoxin (BoNT) is one of the most potent and extensively studied neurotoxins with clinical applications across several different medical specialties. This review article explores the latest evidence for therapeutic applications of BoNT in patients receiving critical management in an intensive care unit (ICU)., Areas Covered: The authors did a literature search in PubMed, Google Scholar, and Texas Medical Center Library database for studies describing the use of BoNT in a critical care setting. They extracted information on study design, patient selection, methodology, and results of relevant studies. Based on initial identification of 85 studies and after conducting screening, the authors identified 61 studies to be included in this review. In an ICU setting, BoNT has been used for several neurological and non-neurological indications. However, the supporting evidence is mostly limited to small observational studies., Expert Opinion: The use of BoNT in this setting is largely underutilized due to paucity of well-designed clinical trials and financial barriers. Further research is needed to provide evidence for the safety and efficacy of BoNT and to optimize the dosing and injection techniques for various conditions encountered in this setting.

Background: A new clinical syndrome has been recognized following the COVID-19 vaccine, termed thrombosis with thrombocytopenia syndrome (TTS). The following systematic review focuses on extrapolating thrombotic risk factors, clinical manifestations, and outcomes of patients diagnosed with TTS following the COVID-19 vaccine., Methods: We utilized the World Health Organization's criteria for a confirmed and probable case of TTS following COVID-19 vaccination and conducted a systematic review and posthoc analysis using the PRISMA 2020 statement. Data analysis was conducted using SPSS V25 for factors associated with mortality, including age, gender, anti-PF4/heparin antibodies, platelet nadir, D-dimer peak, time to event diagnosis, arterial or venous thrombi., Results: Of the 175 studies identified, a total of 25 studies with 69 patients were included in this systematic review and post hoc analysis. Platelet nadir ( P  < .001), arterial or venous thrombi ( χ 2 = 41.911, P  = .05), and chronic medical conditions ( χ 2 = 25.507, P  = .041) were statistically associated with death. The ROC curve analysis yielded D-dimer (AUC = .646) and platelet nadir (AUC = .604) as excellent models for death prediction., Conclusion: Adenoviral COVID-19 vaccines have been shown to trigger TTS, however, reports of patients having received mRNA COVID-19 vaccines are also present. Healthcare providers are recommended to maintain a high degree of suspicion among individuals who have received the COVID-19 vaccine within the last 4 weeks.

Purpose: To study the prescribing pattern of antibiotics in outpatients and emergency departments in the Gulf region. To compare the appropriateness of prescriptions and antibiotics commonly prescribed for respiratory tract infection. Method: The search was limited to the years 2008-2020, and articles had to be in English. Articles were searched from various resources and evaluated using PRISMA. Forty-one articles were selected and screened, and in the end, 17 articles were included in the study. All articles were selected from the gulf region of six countries: UAE, Saudi Arabia, Qatar, Oman, Yemen, and Bahrain. Only primary literature were included. Inpatient and literature from other countries outside the gulf region were excluded. Result: Penicillins, cephalosporins, and macrolides are highly useful antibiotics for respiratory tract infections. Ceftriaxone IV is recommended in acute respiratory tract infection if therapy with penicillin fails. Most of the antibiotic prescriptions in Gulf countries are inappropriate. Inappropriate antibiotic prescribing in the gulf region varies from place to place and reaches a maximum of 80%. Antibiotics may be prescribed with the wrong dosage or frequency and inappropriate guidelines. Penicillins are prescribed at about 50-60%; the most common penicillins prescribed are amoxicillin and co-amoxiclave. Cephalosporins are prescribed at about 30%, and the most common are third-generation. Macrolides are prescribed at about 17-20%, and the most common macrolides are azithromycin and clarithromycin. Fluoroquinolones are prescribed at about 10-12%, of which levofloxacin and ciprofloxacin are more commonly prescribed with metronidazole at 10%. Conclusion: It is suggested that the antibiotic-prescribing pattern in outpatient and emergency departments in the Gulf region are highly inappropriate and need improvement through education, following guidelines, annual vaccination, and stewardship programs; the most prescribed antibiotic is amoxicillin/co-amoxiclave, and the most often encountered infection in outpatients is acute respiratory tract infection., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Mahmood, Gillani, Saeed, Hafeez and Gulam.)

Background: Endovascular thrombectomy is a promising treatment for acute ischemic stroke in children, but outcome and technical data in pediatric patients with large-vessel occlusions are lacking., Objective: To assess technical and clinical outcomes of thrombectomy in pediatric patients., Methods: We undertook a retrospective cohort study of pediatric patients who experienced acute ischemic stroke from April 2017 to April 2019 who had immediate, 30-, and 90-d follow-up. Patients were treated with endovascular thrombectomy at 5 US pediatric tertiary care facilities. We recorded initial and postprocedural modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b, initial and postprocedural Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score, and pediatric modified Rankin scale (mRS) score 0 to 2 at 90 d., Results: There were 23 thrombectomies in 21 patients (mean age 11.6 ± 4.9 yr, median 11.5, range 2.1-19; 52% female). A total of 19 (83%) thrombectomies resulted in mTICI grade ≥ 2b recanalization. The median PedNIHSS score was 13 on presentation (range 4-33) and 2 (range 0-26) at discharge (mean reduction 11.3 ± 6.1). A total of 14 (66%) patients had a mRS score of 0 to 2 at 30-d follow-up; 18/21 (86%) achieved that by 90 d. The median mRS was 1 (range 0-4) at 30 d and 1 (range 0-5) at 90 d. One patient required a blood transfusion after thrombectomy., Conclusion: In this large series of pediatric patients treated with endovascular thrombectomy, successful recanalization was accomplished via a variety of approaches with excellent clinical outcomes; further prospective longitudinal study is needed., (Copyright © 2020 by the Congress of Neurological Surgeons.)

Background: First-pass efficacy (FPE) is an established marker of technical and clinical efficacy among mechanical thrombectomy (MT) techniques. It is unclear what the optimal approach is in achieving FPE. We present a single-center experience comparing rates of FPE among 2 MT techniques and evaluate the potential predictors of FPE among other outcomes., Methods: A single-center retrospective analysis was carried out of patients with consecutive large-vessel occlusion strokes (LVOS) of anterior circulation from September 2015 to April 2019 who underwent MT and for whom data were available on the status of FPE. Four MT techniques were identified: ADAPT (a direct first-pass aspiration), SrADAPT (stent retriever with aspiration), SRBG (stent retriever with balloon guide catheter), and STRAP (stent retriever-aspiration and proximal flow arrest). The primary outcome was FPE and secondary outcomes included the rate of successful reperfusion., Results: Among 226 patients with LVOS of the anterior circulation who underwent MT, data were available for 164 on FPE for the 4 MT techniques. SRBG was the most prevalent technique. No significant difference was found in rates of FPE among the 4 MT techniques (P = 0.332). No independent predictors of FPE were identified on multivariable analysis. STRAP had the highest rate of successful reperfusion compared with the other techniques (P = 0.049) and was the only independent predictor of that outcome (P = 0.027)., Conclusions: Among patients with LVOS of the anterior circulation, the rate of FPE did not differ among the 4 MT techniques. There were no predictors of FPE among the studied variables. STRAP was the only predictor of successful reperfusion., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Study of nanofluids has been enormously increased for the last couple of years. Regardless of some irregularity in the revealed outcomes and lacking consistency, yet the mechanisms of heat transport have been emerged as highly efficient. In the continuation of nanomaterials research, the investigators and analyst have also attempted to utilize hybrid nanomaterial recently, which is designed by suspending unique nanomaterials (nanoparticles) either in mixture or composite structure. The theory of hybrid nanofluids can be further modified for heat transport and pressure drop attributes by trade-off between disadvantages and advantages of individual suspension, ascribed to great aspect ratio, better thermal system and synergistic impact of nanomaterials. Therefore, we have conducted a theoretical attempt on MHD entropy optimized viscous hybrid nanomaterial flow between two parallel plates. The boundaries of plates are fixed with velocity and thermal slip aspects. Chemical reaction with novel aspect of activation energy is accounted. Furthermore, thermal radiation, heat generation and Joule heating are examined., Method: The modeled system is numerically simulated through bvp4c technique., Results: Behaviors of pertinent variables on the velocity, skin friction, temperature, Nusselt number, entropy generation rate and concentration are presented and discussed through different graphs. Temperature field decays against higher values of Eckert number and thermal slip variable., Conclusions: It is noticed that velocity of material particles increase against larger estimations of rotation parameter. Temperature declines versus larger Prandtl and Eckert numbers. Concentration decays when an enhancement is occurred in the Lewis number. Magnitude of surface drag force upsurges for rising values of Prandtl number and radiation parameter. Furthermore, magnitude of Nusselt number enhances through larger Eckert number, magnetic number and Prandtl number., (Copyright © 2019. Published by Elsevier B.V.)

Background: Chronic subdural hematoma is a very common neurosurgical condition. Although conventional surgical methods, such as burr hole irrigation, have been the mainstay of treatment, middle meningeal artery (MMA) embolization has emerged as a promising adjunctive or alternative treatment. The aim of this article was to present a meta-analysis and systematic review of this topic., Methods: A literature search using keywords "chronic subdural hematoma," "chronic subdural hemorrhage," "refractory subdural hematoma," "refractory subdural hemorrhage," and "middle meningeal artery embolization" was conducted through October 2018. Outcome variables of hematoma recurrence, surgical complications, and modified Rankin Scale score were analyzed and compared between MMA embolization and conventional surgery cohorts., Results: Three double-arm studies comparing embolization and conventional surgery groups and 6 single-arm case series were identified and analyzed. Hematoma recurrence rate was significantly lower in the embolization group compared with conventional treatment group (2.1% vs. 27.7%; odds ratio = 0.087; 95% confidence interval, 0.026-0.292; P < 0.001; I 2  = 0%); surgical complication rates were similar between groups (2.1% vs. 4.4%; odds ratio = 0.563; 95% confidence interval, 0.107-2.96; P = 0.497; I 2  = 27.5%). Number of patients with modified Rankin Scale score >2 in the embolization (12.5%) versus conventional treatment (9.1%) group showed no statistical difference (P = 0.689). A composite hematoma recurrence rate of 3.6% was found after summing the 6 case series. Composite recurrence and complication rates in the embolization cohorts of the double-arm studies and the case series were lower than literature values for conventional surgical treatments., Conclusions: MMA embolization is a promising treatment for chronic subdural hematoma. Future randomized clinical trials are needed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction Ocular involvement in leukemia may occur because of direct leukemic infiltration or because of secondary ophthalmic involvement as a result of abnormalities related to blood like anemia, thrombocytopenia, and leukocytosis. In some patients with leukemia, ophthalmic signs can precede the systemic features and can help in early diagnosis of systemic leukemia. Due to the scarcity of data on this topic from Pakistan, we conducted this study to determine the pattern of ocular involvement in patients with leukemia presenting in our settings. Methods This cross-sectional study was conducted in a tertiary care hospital of Pakistan over a period of one year. The study comprised of both newly diagnosed and follow-up patients of acute leukemia of age more than 15 years. Patients underwent detailed ophthalmic anterior and dilated posterior segment examination. Patient's demographic profile, type of leukemia, chemotherapy status, and hematologic findings were also documented. Results There were 97 leukemic patients in the study with 55 (56.7%) males and 42 (43.3%) females. Various ophthalmic manifestations were observed in 47 (48.45%) patients. Forty-two (43.3%) were diagnosed cases with acute lymphocytic leukemia (ALL) and 55 (56.7%) suffered from acute myelogenous leukemia (AML). Ophthalmic manifestations were present in 29 patients of AML (52.7%) and 18 patients of ALL (42.85%). Ocular involvement was significantly more common in newly diagnosed (n=32) as compared with follow-up patients (n=15) (p-value = 0.032). Posterior segment (n=48) was the most common site of ocular involvement (n=48, 49.5%) with retinal hemorrhages seen in 40 patients (41.2%) and papilloedema in seven cases (7.2%). Thirty-three (70.2%) out of 47 patients with ophthalmic manifestations were asymptomatic while 14 (29.8%) had ocular symptoms at the time of initial presentation. Conclusion Ophthalmic manifestations were present in about half of the patients with leukemia. Ocular involvement was more prevalent in newly diagnosed cases and in patients with AML., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To explore whether the ability to recognize specific odorant items is differentially affected in aging versus Alzheimer disease (AD); to refine olfactory identification deficit (OID) as a biomarker of prodromal and early AD., Design: Prospective multicenter cross-sectional study with a longitudinal arm., Setting: Outpatient memory diagnostic clinics in New York and Texas., Participants: Adults aged 65 and older with amnestic mild cognitive impairment (aMCI) and AD and healthy aging (HA) subjects in the comparison group., Measurements: Participants completed the University of Pennsylvania Smell Identification Test (UPSIT) and neuropsychological testing. AD-associated odorants (AD-10) were selected based on a model of ordinal logistic regression. Age-associated odorants (Age-10) were identified using a linear model., Results: For the 841 participants (234 HA, 192 aMCI, 415 AD), AD-10 was superior to Age-10 in separating HA and AD. AD-10 was associated with a more widespread cognitive deficit across multiple domains, in contrast to Age-10. The disease- and age-associated odorants clustered separately in age and AD. AD-10 predicted conversion from aMCI to AD., Conclusions: Nonoverlapping UPSIT items were identified that were individually associated with age and disease. Despite a modest predictive value of the AD-specific items for conversion to AD, the AD-specific items may be useful in enriching samples to better identify those at risk for AD. Further studies are needed with monomolecular and unilateral stimulation and orthogonal biomarker validation to further refine disease- and age-associated signals., (Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)