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Abstract The incidence of growth hormone deficiency (GHD) after subarachnoid hemorrhage (SAH) is significantly higher than that of other neuroendocrine disorders, but the mechanism is still elusive. We used mass spectrometry to identify differentially expressed proteins in cerebrospinal fluid samples from a well-characterized cohort of patients. A total of 683 proteins were identified, including 39 upregulated proteins in the GHD group. ADAM9 was most highly associated with GHD. In vivo, ADAM9 colocalized with M1 microglia markers, GH and cognitive ability of mice decreased significantly, and microglia secreted ADAM9 significantly. ADAM9 regulates pyroptosis of GHRH neurons by the Mad2L2-JNK-caspase-1 pathway. Sorafenib inhibits ADAM9 secretion by microglia and improves GH levels and the cognitive ability of mice. This study found that the crosstalk between GHRH neurons and neuroglial cells in the hypothalamic arcuate nucleus, i.e., microglia, is an essential factor in the formation of GHD in SAH. We propose that neutralization of ADAM9 production by microglia might be a potential therapy for GHD after SAH. Graphical abstract

IntroductionIn response to the current mainstream deep learning detection methods with a large number of learned parameters and the complexity of apple leaf disease scenarios, the paper proposes a lightweight method and names it LCGSC-YOLO. This method is based on the LCNet(A Lightweight CPU Convolutional Neural Network) and GSConv(Group Shuffle Convolution) module modified YOLO(You Only Look Once) framework.MethodsFirstly, the lightweight LCNet is utilized to reconstruct the backbone network, with the purpose of reducing the number of parameters and computations of the model. Secondly, the GSConv module and the VOVGSCSP (Slim-neck by GSConv) module are introduced in the neck network, which makes it possible to minimize the number of model parameters and computations while guaranteeing the fusion capability among the different feature layers. Finally, coordinate attention is embedded in the tail of the backbone and after each VOVGSCSP module to improve the problem of detection accuracy degradation issue caused by model lightweighting.ResultsThe experimental results show the LCGSC-YOLO can achieve an excellent detection performance with mean average precision of 95.5% and detection speed of 53 frames per second (FPS) on the mixed datasets of Plant Pathology 2021 (FGVC8) and AppleLeaf9.DiscussionThe number of parameters and Floating Point Operations (FLOPs) of the LCGSC-YOLO are much less thanother related comparative experimental algorithms.

Plant disease identification is a crucial issue in agriculture, and with the advancement of deep learning techniques, early and accurate identification of plant diseases has become increasingly critical. In recent years, the rise of vision transformers has attracted significant attention from researchers in various vision-based application areas. We designed a model with an encoder–decoder architecture to efficiently classify plant diseases using a transfer learning approach, which effectively recognizes a large number of plant diseases in multiple crops. The model was tested on the “PlantVillage”, “FGVC8”, and “EMBRAPA” datasets, which contain leaf information from crops such as apples, soybeans, tomatoes, and potatoes. These datasets cover diseases caused by fungi, including rust, spot, and scab, as well as viral diseases such as leaf curl. The model’s performance was rigorously evaluated on datasets, and the results demonstrated its high accuracy. The model achieved 99.9% accuracy on the “PlantVillage” dataset, 97.4% on the “EMBRAPA” dataset, and 91.5% on the “FGVC8” dataset, showcasing its competitiveness with other state-of-the-art models. This study provides a robust and reliable solution for plant disease classification and contributes to the advancement of precision agriculture.

IntroductionRecent studies have found that the sound-induced alleviation of visual attentional blink, a well-known phenomenon exemplifying the beneficial influence of multisensory integration on time-based attention, was larger when that sound was semantically congruent relative to incongruent with the second visual target (T2). Although such an audiovisual congruency effect has been attributed mainly to the semantic conflict carried by the incongruent sound restraining that sound from facilitating T2 processing, it is still unclear whether the integrated semantic information carried by the congruent sound benefits T2 processing.MethodsTo dissociate the congruence-induced benefit and incongruence-induced reduction in the alleviation of visual attentional blink at the behavioral and neural levels, the present study combined behavioral measures and event-related potential (ERP) recordings in a visual attentional blink task wherein the T2-accompanying sound, when delivered, could be semantically neutral in addition to congruent or incongruent with respect to T2.ResultsThe behavioral data clearly showed that compared to the neutral sound, the congruent sound improved T2 discrimination during the blink to a higher degree while the incongruent sound improved it to a lesser degree. The T2-locked ERP data revealed that the early occipital cross-modal N195 component (192–228 ms after T2 onset) was uniquely larger in the congruent-sound condition than in the neutral-sound and incongruent-sound conditions, whereas the late parietal cross-modal N440 component (400–500 ms) was prominent only in the incongruent-sound condition.DiscussionThese findings provide strong evidence that the modulating effect of audiovisual semantic congruency on the sound-induced alleviation of visual attentional blink contains not only a late incongruence-induced cost but also an early congruence-induced benefit, thereby demonstrating for the first time an unequivocal congruent-sound-induced benefit in alleviating the limitation of time-based visual attention.

Background: Several pharmacological pathways have revealed statin to have a positive role in patients with for intracranial aneurysms. However, prior studies regarding the association between statin use and patients’ outcomes after pipeline embolization device (PED) treatment were not completely supportive. Objectives: To investigate whether statin medication following PED treatment would improve the outcomes of intracranial aneurysm patients in a real-world setting. Design: A retrospective multicenter cohort study. Methods: Patients were selected from the PLUS registry study conducted from November 2014 to October 2019 across 14 centers in China. The population was divided into two groups: those who received statin medication after the PED treatment and those who did not receive statin medication after PED treatment. Study outcomes included angiographic evaluation of aneurysm occlusion, parent arteries stenosis, ischemic and hemorrhage complications, all-cause mortality, neurologic mortality, and functional outcome. Results: 1087 patients with 1168 intracranial aneurysms were eligible; 232 patients were in the statin user group and the other 855 were in the non-statin user group. For the statin user group versus the non-statin user group, no significant difference was found for the primary outcomes of complete occlusion of aneurysm (82.4% versus 84.2%; p = 0.697). Of the secondary outcomes, none had a significant difference including stenosis of parent arteries ≥ 50% (1.4% versus 2.3%; p = 0.739), total subarachnoid hemorrhage (0.9% versus 2.5%; p = 0.215), all-cause mortality (0.0% versus 1.9%; p = 0.204), neurologic mortality (0.0% versus 1.6%; p = 0.280), excellent (95.5% versus 97.2%; p = 0.877), and favorable (98.9% versus 98.4%; p = 0.933) functional outcomes. The total ischemic complication rate (9.0% versus 7.1%; p = 0.401) was higher but not significant in the statin user group. The propensity score-matched cohort showed similar results. Results of binary multivariable logistic regression analysis and propensity score-matched analysis both showed that statin usage was not independently associated with an increased rate of complete occlusion or any other secondary outcomes. Subgroup analysis found the same result in patients who did not use statin before the procedure. Conclusion: Among patients with intracranial aneurysms, statin use after the PED treatment was not significantly associated with better angiographic and clinical outcomes. Well-designed studies are needed to further confirm this finding.

Abstract Background Laparoscopy is widely used in pancreatic surgeries nowadays. The efficient and correct judgment of the location of the anatomical structures is crucial for a safe laparoscopic pancreatic surgery. The technologies of 3-dimensional(3D) virtual model and image fusion are widely used for preoperative planning and intraoperative navigation in the medical field, but not in laparoscopic pancreatic surgery up to now. We aimed to develop an intraoperative navigation system with an accurate multi-modality fusion of 3D virtual model and laparoscopic real-time images for laparoscopic pancreatic surgery. Methods The software for the navigation system was developed ad hoc. The preclinical study included tests with the laparoscopic simulator and pilot cases. The 3D virtual models were built using preoperative Computed Tomography (CT) Digital Imaging and Communications in Medicine (DICOM) data. Manual and automatic real-time image fusions were tested. The practicality of the navigation system was evaluated by the operators using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) method. Results The 3D virtual models were successfully built using the navigation system. The 3D model was correctly fused with the real-time laparoscopic images both manually and automatically optical orientation in the preclinical tests. The statistical comparative tests showed no statistically significant differences between the scores of the rigid model and those of the phantom model(P > 0.05). There was statistically significant difference between the total scores of automatic fusion function and those of manual fusion function (P = 0.026). In pilot cases, the 3D model was correctly fused with the real-time laparoscopic images manually. The Intraoperative navigation system was easy to use. The automatic fusion function brought more convenience to the user. Conclusions The intraoperative navigation system applied in laparoscopic pancreatic surgery clearly and correctly showed the covered anatomical structures. It has the potentiality of helping achieve a more safe and efficient laparoscopic pancreatic surgery.

ObjectiveCombined bypass is commonly used in adult Moyamoya disease (MMD) for revascularization purposes. The blood flow from the external carotid artery system supplied by the superficial temporal artery (STA), middle meningeal artery (MMA), and deep temporal artery (DTA) can restore the impaired hemodynamics of the ischemic brain. In this study we attempted to evaluate the hemodynamic changes of the STA graft and predict the angiogenesis outcomes in MMD patients after combined bypass surgery by using quantitative ultrasonography.MethodsWe retrospectively studied Moyamoya patients who were treated by combined bypass between September 2017 and June 2021 in our hospital. We quantitatively measured the STA with ultrasound and recorded the blood flow, diameter, pulsatility index (PI) and resistance index (RI) to assess graft development preoperatively and at 1 day, 7 days, 3 months, and 6 months after surgery. All patients received both pre- and post- operative angiography evaluation. Patients were divided into either well- or poorly-angiogenesis groups according to the transdural collateral formation status on angiography at 6 months after surgery (W group or P group). Patients with matshushima grade A or B were divided into W group. Patients with matshushima grade C were divided into P group, indicating a poor angiogenesis development.ResultsA total of 52 patients with 54 operated hemispheres were enrolled, including 25 men and 27 women with an average age of 39 ± 14.3 years. Compared to preoperative values, the average blood flow of an STA graft at day 1 postoperation increased from 16.06 ± 12.47 to 117.47± 73.77 (mL/min), diameter increased from 1.14 ± 0.33 to 1.81 ± 0.30 (mm), PI dropped from 1.77 ± 0.42 to 0.76 ± 0.37, and RI dropped from 1.77 ± 0.42 to 0.50 ± 0.12. According to the Matsushima grade at 6 months after surgery, 30 hemispheres qualified as W group and 24 hemispheres as P group. Statistically significant differences were found between the two groups in diameter (p = 0.010) as well as flow (p = 0.017) at 3 months post-surgery. Flow also remained significantly different at 6 months after surgery (p = 0.014). Based on GEE logistic regression evaluation, the patients with higher levels of flow post-operation were more likely to have poorly-compensated collateral. ROC analysis showed that increased flow of ≥69.5 ml/min (p = 0.003; AUC = 0.74) or a 604% (p = 0.012; AUC = 0.70) increase at 3 months post-surgery compared with the pre-operative value is the cut-off point which had the highest Youden's index for predicting P group. Furthermore, a diameter at 3 months post-surgery that is ≥0.75 mm (p = 0.008; AUC = 0.71) or 52% (p =0.021; AUC = 0.68) wider than pre-operation also indicates a high risk of poor indirect collateral formation.ConclusionsThe hemodynamic of the STA graft changed significantly after combined bypass surgery. An increased flow of more than 69.5 ml/min at 3 months was a good predictive factor for poor neoangiogenesis in MMD patients treated with combined bypass surgery.

BackgroundMicroglia have been identified for a century. In this period, their ontogeny and functions have come to light thanks to the tireless efforts of scientists. However, numerous documents are being produced, making it challenging for scholars, especially those new to the field, to understand them thoroughly. Therefore, having a reliable method for quickly grasping a field is crucial.MethodsWe searched and downloaded articles from the Web of Science Core Collection with “microglia” or “microglial” in the title from 2002 to 2021. Eventually, 12,813 articles were located and, using CiteSpace and VOSviewer, the fundamental data, knowledge domains, hot spots, and emerging trends, as well as the influential literature in the field of microglia research, were analyzed.ResultsFollowing 2011, microglia publications grew significantly. The two prominent journals are Glia and J Neuroinflamm. The United States and Germany dominated the microglia study. The primary research institutions are Harvard Univ and Univ Freiburg, and the leading authors are Prinz Marco and Kettenmann Helmut. The knowledge domains of microglia include eight directions, namely neuroinflammation, lipopolysaccharide, aging, neuropathic pain, macrophages, Alzheimer’s disease, retina, and apoptosis. Microglial phenotype is the focus of research; while RNA-seq, exosome, and glycolysis are emerging topics, a microglial-specific marker is still a hard stone. We also identified 19 influential articles that contributed to the study of microglial origin (Mildner A 2007; Ginhoux F 2010), identity (Butovsky O 2014), homeostasis (Cardona AE 2006; Elmore MRP 2014); microglial function such as surveillance (Nimmerjahn A 2005), movement (Davalos D 2005; Haynes SE 2006), phagocytosis (Simard AR 2006), and synapse pruning (Wake H 2009; Paolicelli RC 2011; Schafer DP 2012; Parkhurst CN 2013); and microglial state/phenotype associated with disease (Keren-Shaul H 2017), as well as 5 review articles represented by Kettenmann H 2011.ConclusionUsing bibliometrics, we have investigated the fundamental data, knowledge structure, and dynamic evolution of microglia research over the previous 20 years. We hope this study can provide some inspiration and a reference for researchers studying microglia in neuroscience.

The treatment of complex cerebrovascular diseases (CCVDs) at the skull base, such as complex intracranial aneurysms, carotid-cavernous sinus fistulas, and intracranial artery traumatic injuries, is a difficult clinical problem despite advances in endovascular and surgical therapies. Covered stents or stent graft insertion is a new concept for endovascular treatment that focuses on arterial wall defect reconstruction, differing from endovascular lesion embolization or flow diverter therapies. In recent years, covered stents specifically designed for cerebrovascular treatment have been applied in the clinical setting, allowing thousands of patients with CCVDs to undergo intraluminal reconstruction treatment and achieving positive results, even in the era of flow diverters. Since there is no unified reference standard for the application of covered stents for treating CCVDs, it is necessary to further standardize and guide the clinical application of this technique. Thus, we organized authoritative experts in the field of neurointervention in China to write an expert consensus, which aims to summarize the results of covered stent insertion in the treatment of CCVDs and propose suitable standards for its application in the clinical setting. Based on the contents of this consensus, clinicians can use individualized intraluminal reconstruction treatment techniques for patients with CCVDs.

In today’s world, agricultural products are becoming increasingly scarce globally due to a variety of factors, and the early and accurate automatic identification of plant diseases can help ensure the stability and sustainability of agricultural production, improve the quality and safety of agricultural products, and help promote agricultural modernization and sustainable development. For this purpose, a lightweight deep isotropic convolutional neural network model, FoldNet, is designed for plant disease identification in this study. The model improves the architecture of residual neural networks by first folding the chain of the same blocks and then connecting these blocks with jump connections of different distances. Such a design allows the neural network to explore a larger receptive domain, enhancing its multiscale representation capability, increasing the direct propagation of information throughout the network, and improving the performance of the neural network. The FoldNet model achieved a recognition accuracy of 99.84% on the laboratory dataset PlantVillage using only 685k parameters and a recognition accuracy of 90.49% on the realistic scene dataset FGVC8 using only 516k parameters, which is competitive with other state-of-the-art models. In addition, as far as we know, our model is the first model that has fewer than 1M parameters while achieving state-of-the-art accuracy in plant disease identification. This proposal facilitates precision agriculture applications on mobile, low-end terminals.

Post-translational modifications of tubulins regulate microtubule properties and neural development. Here, the authors report that one such post-translational modification, α-TubK40me3, is required for neuronal polarization and migration by promoting microtubule formation.

BackgroundThe Pipeline for Uncoilable or Failed Aneurysms (PUFS) trial primarily demonstrated the safety and efficacy of the implantation of multiple pipeline embolization devices (multi-PEDs) for large/giant intracranial aneurysms. However, no study has focused on when, why, or how to apply multi-PEDs.ObjectiveThe purpose of this study was to investigate the indications and strategies of using multi-PEDs for complex intracranial aneurysms.MethodsPatients who had been treated with two or more PEDs were included in the post-market multicenter registry study from 2014 to 2019, across 14 centers in China. Indications, strategies, perioperative safety, and clinical outcomes were retrospectively analyzed. The modified Rankin scale (mRS) score was used to evaluate clinical outcomes comprehensively, and the O’Kelly–Marotta (OKM) grading scale was used to evaluate aneurysm healing results.ResultsA total of 55 intracranial aneurysms were treated with multi-PEDs. There were 20 fusiform aneurysms with a large range, 25 large/giant saccular aneurysms, six aneurysms with failed treatment, and four aneurysms with greatly varied diameters of the parent artery. The strategies included telescope techniques in 40 patients and overlap techniques in 15 patients. In total, 120 stents were deployed in 55 patients. The operation styles included 25 patients (55.6%) with two PEDs, 21 patients (38.2%) with two PEDs combined with coiling, four patients (7.3%) with three PEDs, four patients (7.3%) with three PEDs combined with coiling, and one patient (1.8%) with four PEDs. Angiography revealed OKM D in two, OKM C in seven, and OKM A and B in 46 cases after surgery. During the perioperative period, eight patients developed neurological dysfunction, three of whom died. A total of thirty-four patients were followed up with digital subtraction angiography for 2–45 (8.2 ± 8.0) months. Angiography revealed OKM D in 26, OKM C in five, and OKM B in three. At the last follow-up, the mRS score was 0–1 in 52 patients.ConclusionThe treatment of anterior circulation aneurysms with multi-PEDs is safe and effective. The implantation of multi-PEDs could be considered for large-scale fusiform aneurysms, large/giant saccular aneurysms with a jet-sign, salvage of failed PED treatments, and in cases where the diameter of the parent artery varies greatly.

Objective: To compare the antiplatelet effect and major adverse cerebrovascular events of Pipeline for intracranial aneurysms using glycoprotein IIb/IIIa antagonists (GPI) eptifibatide and tirofiban. Methods: Retrospective analysis of relevant data of patients using GPIs combined with oral antiplatelet therapy in Nanfang Hospital of Southern Medical University from December 2017 to December 2019. The study was approved by the ethics Committee of Nanfang Hospital of Southern Medical University. According to the random use of GPIs drugs, they were assigned to the eptifibatide group and tirofiban group. Basic data, platelet inhibition rates at baseline, 24h and 72h after administration, short-term major adverse cerebrovascular events, and bleeding complications were compared between the two groups. Results: A total of 47 patients were included in this study, including 24 patients in eptifibatide group and 23 patients in tirofiban group. There was no significant difference in average age (53.75 vs. 53.91 years) and body mass index (BMI) (24.39 vs. 22.73 ​kg/m2) between eptifibatide group and tirofiban group. There was no significant difference in coagulation factor function (R), fibrinogen function (K), fibrinolysis function (EPL), comprehensive coagulation index (Cl), arachidonic acid pathway inhibition rate (AA%) and adenosine diphosphate inhibition rate (ADP%). However, the baseline level of residual platelet function MA (ADP) in eptifibatide group was significantly higher than that in tirofiban group (50.79 vs. 35.29 ​mm, P ​= ​0.0026). There was a statistical difference in the platelet aggregation function MA (65.38 vs. 62.54 ​mm, p ​= ​0.0442), the rate of spontaneous hemorrhagic stroke (4.3% vs. 0%) and the rate of asymptomatic minor bleeding (26.08% vs. 4.1%) in the two groups (P ​

ObjectiveThe purpose of this work was to summarize the real-world safety and efficacy of Pipeline Embolization Device (PED) therapy for small and medium-sized intracranial aneurysms in China.MethodsPatients from the PED in China post-market multi-center registry study (PLUS) with aneurysms smaller than 12 mm were selected. Radiographic outcomes were assessed using digital subtraction angiography. Clinical outcomes included functional outcomes (modified Rankin Scale, MRS) in the early postoperative period ( ≤ 30 days) and early postoperative complications associated with PED therapy.ResultsA total of 652 patients with a combined 754 aneurysms were included in this study (mean age of 53.9 ± 10.3 years, 68.7% women). Mean aneurysm diameter was 6.78 ± 2.67 mm. Of the 687 stents deployed, 99.7% (685/689) were successfully deployed. In this study, 64.7% (488/754) of aneurysms were treated with only the PED, whereas 35.3% (266/754) were subjected to PED-assisted therapy. Radiographic outcome at the last follow-up (median time: seven months) was available for 64.3% (485/754) of the aneurysms. 82.5% (400/485) of aneurysms demonstrated complete occlusion (Raymond Roy Grade I). 81.4% (395/485) of aneurysms were found to meet the study's primary effectiveness outcome. At the early postoperative period, the mRS score was determined to be 0–2 vs. 3-6 in 98.2% (640/652) vs. 1.8% (12/652) of the cases, respectively. The combined major morbidity and mortality rate was 3.2% (21/652).ConclusionIn the largest study of PED therapy for small and medium-sized intracranial aneurysms to date, pipeline-assisted coil embolization was chosen more often than multiple stent implantation for aneurysm treatment, demonstrating good results, high surgical success rates, high occlusion rates, and low morbidity and mortality.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03831672.

It has been reported that attending to stimuli in visual modality can spread to task-irrelevant but synchronously presented stimuli in auditory modality, a phenomenon termed the cross-modal spread of attention, which could be either stimulus-driven or representation-driven depending on whether the visual constituent of an audiovisual object is further selected based on the object representation. The stimulus-driven spread of attention occurs whenever a task-irrelevant sound synchronizes with an attended visual stimulus, regardless of the cross-modal semantic congruency. The present study recorded event-related potentials (ERPs) to investigate whether the stimulus-driven cross-modal spread of attention could be modulated by audio-visual emotional congruency in a visual oddball task where emotion (positive/negative) was task-irrelevant. The results first demonstrated a prominent stimulus-driven spread of attention regardless of audio-visual emotional congruency by showing that for all audiovisual pairs, the extracted ERPs to the auditory constituents of audiovisual stimuli within the time window of 200–300 ms were significantly larger than ERPs to the same auditory stimuli delivered alone. However, the amplitude of this stimulus-driven auditory Nd component during 200–300 ms was significantly larger for emotionally incongruent than congruent audiovisual stimuli when their visual constituents’ emotional valences were negative. Moreover, the Nd was sustained during 300–400 ms only for the incongruent audiovisual stimuli with emotionally negative visual constituents. These findings suggest that although the occurrence of the stimulus-driven cross-modal spread of attention is independent of audio-visual emotional congruency, its magnitude is nevertheless modulated even when emotion is task-irrelevant.

Background and purpose: Although grading scales for angiography outcomes following cerebral aneurysm treatment with flow diversion have been published, physicians have not widely adopted these scales in practice. The aim of this study is to propose and validate a novel Flow diversion Predictive Score (4F-FPS) grading scale based on previously established scales that is simple and reliable. Methods: We retrospectively analyzed consecutive patients who underwent endovascular treatment for cerebral aneurysms with flow diversion between January 2014 and September 2019. The included patients were randomly divided into the derivation and validation group in a 70/30 ratio, respectively. Aneurysms were classified as incomplete or complete occlusion based on final angiography outcomes. 4F-FPS was derived to predict aneurysm occlusion from multivariate logistic regression analyses in the derivation group and validated with previously published grading scales in the validation group. Results: Overall, 662 patients [mean age, 53.8 years; 72.5% (480/662) female] with 662 aneurysms treated with the Pipeline TM flow diverter were included [69.9% (463/662) derivation group, 30.1% (199/662) validation group]. The incidence of aneurysm occlusion was 82.7%. 4F-FPS demonstrated significant discrimination in 10-fold cross validation [mean receiver operating characteristic (ROC) area, 0.862 ± 0.055] and calibration (Cox & Snell R 2 , 0.251; Nagelkerke R 2 , 0.413) in the derivation group. The ROC area of 4F-FPS score in both the derivation and validation groups is the largest compared with previously published grading scales/scores ( p

Objective: This work aims to present our experience of patients with complex cerebral aneurysm treated with a hybrid approach: superficial temporal artery–middle cerebral artery (STA–MCA) bypass in combination with endovascular exclusion of the aneurysm.Method: Patients with aneurysms deemed unclippable and uncoilable were included. All patients were treated with a hybrid approach. After STA–MCA bypass, the parent artery was temporarily occluded. If the intraoperative motor evoked potential (MEP) and somatosensory evoked potential (SEP) waveforms remain normal and last for 30 min, the aneurysm and te parent artery will be embolized permanently with detachable balloons or coils.Results: A total of 20 patients with 22 aneurysms were included in this study. There were 13 women and 7 men, with an average age of 42.5 years. Intraoperative angiography showed the good patency of all the STA grafts, and neither SEP nor MEP abnormalities were detected. After the parent artery and the aneurysm were occluded, the intraoperative angiography showed an immediately successful exclusion of the aneurysm in 20 aneurysms and immediate contrast stasis in two. All patients recovered uneventfully without ischemic or hemorrhagic complication. Angiography at 6-month follow-up showed the total obliteration in 20 aneurysms. Two aneurysms showed residuals and were recoiled. All STA grafts showed a good patency, and the mean graft flow was 124.2 ml/min.Conclusion: STA–MCA bypass in combination with endovascular exclusion is an appropriate option for patients with complex cerebral aneurysms that are not amenable to direct surgical clipping or endovascular embolization.

Background and Purpose: The Pipeline Embolization Device (PED, Covidien/Medtronic) is widely used to treat intracranial aneurysms. This PED in China post-market multi-center registry study (PLUS) investigated safety and effectiveness of the PED for intracranial aneurysms in the Chinese population. Methods: This was a panoramic, consecutive, real-world cohort registry study. Patients treated with PED with or without coils between November 2014 and October 2019 at 14 centers in China were included, and those treated by parent vessel occlusion or other stents were excluded. Study outcomes included angiographic evaluation of aneurysm occlusion, complications, in-stent stenosis, and predictors of aneurysm occlusion. A central committee reviewed all imaging and endpoint events. Results: In total, 1171 patients with 1322 intracranial aneurysms were included. The total occlusion rate was 81.4% (787/967) at mean follow-up of 8.96 ± 7.50 months, with 77.1% (380/493) occlusion in the PED alone and 85.9% (407/474) in the PED plus coiling group. On multi-variate analysis, female sex, hyperlipidemia, vertebral aneurysms, PED plus coiling, and blood flow detained to venous phase were significant predictors of aneurysm occlusion. In posterior circulation cohort, there was no variable associated with aneurysm occlusion. In-stent stenosis predictors included current smoking and cerebral sclerosis/stenosis. Conclusion: In the largest series on PED of multi-center date of China, data suggest that treatment with the flow-diverting PED in intracranial aneurysms was efficacious. The treatment of PED combined coiling and blood flow detained to venous phase after PED implant were associated with aneurysmal occlusion. The occlusion rate of vertebral aneurysms was higher than other location aneurysms. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT03831672.

BackgroundMoyamoya disease (MMD) is an important cause of stroke in children and young adults in Asia. To date, diagnosis remains challenging due to varying clinical manifestations and unknown pathogenesis. The study aims to identify cerebrospinal fluid (CSF) exosomal microRNAs (exomiRs) that can serve as a novel diagnostic biomarker for diagnosis and assess its clinical applications.MethodsCSF samples were taken from 31 MMD patients and 31 healthy controls. Initial screening of miRNA expression was performed on samples pooled from MMD patients and controls using microarray and validated using quantitative reverse transcription polymerase chain reaction (qRT-PCR). The diagnostic accuracy of the potential exosomal miRNAs was evaluated using receiver operating characteristic curve analyses in an independent patient cohort. The potential pathways regulated by the miRNAs was also determined using bioinformatics analysis.ResultsThe microarray results demonstrated that six exomiRs were dysregulated in the MMD patients compared to the controls. Using qRT-PCR, we validated four of the miRNAs (miR-3679-5p, miR-6165, miR-6760-5p, and miR-574-5p) as a biomarker for MMD diagnosis. The four exomiRs showed enhanced sensitivity (75%) and specificity (93.75%) in terms of differentiating MMD patients from healthy subjects [area under the curve (AUC) = 0.9453]. Pathway enrichment analysis for potential targets of six exomiRs identified proteins involved in cell adhesion and junction formation in the brain.ConclusionsWe identified a novel and highly sensitive exomiRs signature for MMD detection and explored its potential targets using bioinformatics analysis.

Cognitive flexibility reflects the ability to switch quickly between tasks or stimulus sets, which is an important feature of human intelligence. Researchers have confirmed that this ability is related to the learners’ academic achievement, cognitive ability, and creativity development. The number-letter switching task is an effective tool for measuring cognitive flexibility. Previous studies have found that high flexibility individuals perform better in rule-based tasks such as the Iowa Gambling Task. It is not clear whether highly flexible learners have learning advantages when the rule tasks involve probabilistic cues. Using an inter-individual differences approach, we examined whether cognitive flexibility, as assessed by the number-letter task, is associated with the learning process of a probabilistic rule task. The results showed that the high flexibility group reached a higher level of rule acquisition, and the accuracy during the post-learning stage was significantly higher than the low flexibility group. These findings demonstrate that cognitive flexibility is associated with the performance after the rule acquisition during the probabilistic rule task. Future research should explore the internal process of learning differences between high and low flexibility learners by using other technologies across multiple modes.

Background and Aims. Computed tomography portal venography (CTPV) shows potential in detecting varices that need treatment and their drainage pathways. However, its agreement with endoscopy requires further study. We investigated the feasibility of CTPV as an alternative tool to endoscopy in screening gastroesophageal varices (GEVs) and developed a CTPV-based model to provide a less invasive assessment of endotherapy for cirrhotic patients with GEVs. Methods. The study included 33 cirrhotic patients with a recent history of variceal hemorrhage. The presence, grade, and classification of GEVs on endoscopy and CTPV were compared (kappa test). Twenty-four patients were treated endoscopically, including 12 for esophageal varices (EVs), 8 for gastric varices (GVs), and 4 for GEVs. Treatment efficacies were assessed with the newly developed CTPV-based method at 1 week and 1 month after treatment. Efficiency evaluated by CTPV and endoscopy was compared by Fisher’s exact test to determine whether CTPV is efficient in the assessment of endotherapy efficacy. Results. For the screening and grading/classification of EVs and GVs, substantial agreement (EV kappa: 0.63 and 0.68; GV kappa: 0.62 and 0.75, respectively) was noted between endoscopy and CTPV. The therapeutic efficacy of EVs was higher when assessed by CTPV than when evaluated by endoscopy (37.50% vs. 12.50% at 1 week postoperation, P=0.22; 62.50% vs. 25.00% at 1 month postoperation, P=0.07), but without statistical significance. The same trend was also found in the assessment of therapeutic efficacy for GVs (25.00% vs. 16.67% at 1 week postoperation, P=1; 58.33% vs. 41.67% at 1 month postoperation, P=0.68). Conclusion. CTPV is comparable to endoscopy in the detection of GEVs and in the evaluation of endotherapy efficacy, which suggests that it could be a less invasive alternative for endoscopy in cirrhotic patients with GEVs needing treatment.

Objective: To investigate the safety and effectiveness of the Pipeline Flex embolization device (PFED) in the treatment of large and wide-necked aneurysms in the internal carotid artery (ICA).Methods: The clinical data of 78 cases of large and wide-necked aneurysms in the ICA treated with this Pipeline Flex embolization device in Shanghai Hospital of the Second Military Medical University and Southern Hospital of Southern Medical University from February 2017 to June 2018 were retrospectively analyzed.Results: A total of 66 cases were treated with a Pipeline Flex embolization device, 10 with a pipeline flex embolization device, and 2 with a double tubride stent (10 patients were treated with a pipeline stent-assisted coil embolization in; and 2 patients were treated with two pipeline stents). The patients were followed up for 3 to 18 months (average, 9.25 months). Among them, 63 cases had complete occlusion of the neck of the aneurysm (Raymondl Class I; MRS score 0; 80.8%). Aneurysms recurred in 12 cases (Raymondl Class II; MRS score 1; 15.4%). Delayed ischemic complications were observed in 1 case (MRS score >2; 0.13%). There was 1 case of poor release of stent and 1 case of stent stenosis (0.13%).Conclusion: The treatment of large, wide-necked aneurysms in the ICA with PFED has a high total occlusion rate and good prognosis was better than coil embolization, but the placement of PFED still has some neurological complications. Keywords: Pipeline Flex embolization device, vascular reconstruction device, large, wide-necked aneurysms, neurological complications, curative effect

Abstract When two identical visual discs move toward each other on a two-dimensional visual display, they can be perceived as either “streaming through” or “bouncing off” each other after their coincidence. Previous studies have observed a strong bias toward the streaming percept. Additionally, the incidence of the bouncing percept in this ambiguous display could be increased by various factors, such as a brief sound at the moment of coincidence and a momentary pause of the two discs. The streaming/bouncing bistable motion phenomenon has been studied intensively since its discovery. However, little is known regarding the neural basis underling the perceptual ambiguity in the classic version of the streaming/bouncing motion display. The present study investigated the neural basis of the perception disambiguating underling the processing of the streaming/bouncing bistable motion display using event-related potential (ERP) recordings. Surprisingly, the amplitude of frontal central P2 (220–260 ms) that was elicited by the moving discs ~200 ms before the coincidence of the two discs was observed to be predictive of subsequent streaming or bouncing percept. A larger P2 amplitude was observed for streaming percept than the bouncing percept. These findings suggest that the streaming/bouncing bistable perception may have been disambiguated unconsciously ~200 ms before the coincidence of the two discs.

The side-effect effect (SEE) is the observation that people’s intuition about whether an action was intentional depends on whether the outcome is good or bad. The asymmetric response, however, does not represent all subjects’ judgments (Nichols and Ulatowski, 2007). It remains unexplored on subjective factors that can mediate the size of SEE. Thus, the current study investigated whether an individual related factor, specifically, whether adults’ intensity of caring about an outcome of someone’s actions influences their judgments about whether that person intended the outcome. We hypothesized that participants’ judgments about fictional agents’ responsibility for their action’s side-effects would depend on how much they care about the domain of the side-effect. In two experiments, the intensity of caring affected participants’ ascription of intention to an agent’s negative unintended side-effect. The stronger ascription of intentionality to negative than positive side-effects (i.e., the SEE; Knobe, 2003) was found only in domains in which participants reported higher levels of caring. Also, the intensity of caring increased intentionality attributions reliably for negative side-effects but not for positive side-effects. These results suggest that caring about a domain mediates an asymmetrical ascription of intentionality to negative more than positive side-effects.

Previous studies have discovered a fascinating phenomenon known as choice blindness—individuals fail to detect mismatches between the face they choose and the face replaced by the experimenter. Although previous studies have reported a couple of factors that can modulate the magnitude of choice blindness, the potential effect of facial expression on choice blindness has not yet been explored. Using faces with sad and neutral expressions (Experiment 1) and faces with happy and neutral expressions (Experiment 2) in the classic choice blindness paradigm, the present study investigated the effects of facial expressions on choice blindness. The results showed that the detection rate was significantly lower on sad faces than neutral faces, whereas no significant difference was observed between happy faces and neutral faces. The exploratory analysis of verbal reports found that participants who reported less facial features for sad (as compared to neutral) expressions also tended to show a lower detection rate of sad (as compared to neutral) faces. These findings indicated that sad facial expressions increased choice blindness, which might have resulted from inhibition of further processing of the detailed facial features by the less attractive sad expressions (as compared to neutral expressions).

Displacement of distal ventriculo-atrial (VA) shunt is not uncommon. However, misplacement of the distal catheter of VA shunt in the internal jugular vein is a possibility, especially when conducted without intraoperative monitoring. We describe a patient in whom a VA shunt was performed due to failure of ventriculo-peritoneal shunt and the distal catheter of the shunt was found to be misplaced in the left internal jugular vein. Endovascular intervention via femoral vein was used to retrieve the distal catheter.

Background Unruptured intracranial aneurysm treatment aims to reduce the risk of aneurysm rupture and bleeding, relieves symptoms and improve the quality of life for patients. This study aimed to assess the safety and efficacy of Pipeline Embolization Device (PED, Covidien/Medtronic, Irvine, CA) treatment for intracranial aneurysms presenting with mass effect in real-world settings.Methods We selected patients from the PED in China Post-Market Multi-Center Registry Study with mass effect presentation. The study endpoints included postoperative mass effect deterioration and mass effect relief at follow-up (3–36 months). We conducted multivariate analysis to identify factors associated with mass effect relief. Subgroup analyses by aneurysm location, size and form were also performed.Results This study included 218 patients with a mean age of 54.3±11.8 years and a female predominance of 74.0% (162/218). The postoperative mass effect deterioration rate was 9.6% (21/218). During a median follow-up period of 8.4 months, the mass effect relief rate was 71.6% (156/218). Notably, immediate aneurysm occlusion following treatment was significantly associated with mass effect relief (OR 0.392, 95% CI, 0.170 to 0.907, p=0.029). Subgroup analysis demonstrated that adjunctive coiling contributed to mass effect relief in cavernous aneurysms, while dense embolism impeded symptom relief in aneurysms

Background: Intracranial aneurysms pose a significant health issue, affecting 3-5% of the adult population. The pipeline embolization device (PED) has emerged as a promising treatment for these lesions. This study aimed to investigate the impact of operator experience on complication and poor outcome rates, as well as the learning curve for PED. Methods: A total of 217 patients were consecutively enroled from four eligible centres and divided into three groups based on the number of procedures performed: group 1 (first 10 procedures), group 2 (11-20 procedures), and group 3(> 20 procedures). Major complications include operation-related ischaemic or haemorrhagic events and mass effect deterioration. Poor outcome was defined as a modified Rankin Scale score greater than 2 at discharge. Cumulative summation (CUSUM) analysis was generated to assess the learning curve according to major complications and poor outcome. Results: The study found that major complications and poor outcomes occurred in 5.1% and 2.3% of cases, respectively. The rate of major complications decreased from 10.0% in group 1 to 2.9% in group 3 (P =0.053), while the rate of poor outcomes decreased from 7.5% in group 1 to 0.7% in group 3 (P =0.015). Multivariable regression analysis adjusted for covariates showed that operator experience was associated with a lower rate of poor outcomes (P= 0.034). CUSUM analysis demonstrated that the learning curve for avoiding major complications and poor outcomes required 27 (mean =13) and 40 (mean = 20) cases, respectively. Conclusions: These findings suggest that PED treatment requires a learning curve of 40 cases to achieve reproducibility regarding complications and functional results. Additionally, major complications and poor outcomes significantly decreases after the first 20 procedures. CUSUM analysis can serve as a useful tool for monitoring and assessing surgical performance. [ABSTRACT FROM AUTHOR]