Objective:To investigate the efficacy and safety of off-label use of flow diverters (FDs) in aneurysms beyond the circle of Willis.Methods:Seventy-one patients with aneurysms beyond the circle of Willis treated with FDs from January 2016 to September 2023 at Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital of Southern Medical University), Department of Neurosurgery (Guangdong Provincial People's Hospital), Department of Neurosurgery (First Affiliated Hospital of Chongqing Medical University), and Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University) were selected. The clinical and imaging data of these patients were analyzed retrospectively, and the clinical characteristics, aneurysm characteristics, endovascular treatments, perioperative complications, and clinical and imaging follow-up results were summarized and analyzed.Results:Among the 71 patients, 22 (31.0%) had ischemic stroke history and 43 (60.6%) had hypertension history. A total of 76 aneurysms were found, including 5 aneurysms (6.6%) at the anterior communicating artery, 10 (13.2%) at the anterior cerebral artery, 53 (69.7%) at the middle cerebral artery, and 8 (10.5%) at the posterior cerebral artery. The median aneurysm size (Inter Quartile Range) was 5.65 (3.63, 10.12) mm, and mean diameter of the parent artery was (2.70±0.57) mm. A total of 80 FDs were used, including 38 (47.5%) Pipeline embolization devices and 42 (52.5%) Tubridge embolization devices; the implantation success rate was 98.8% (79/80). Seven patients (9.9%) had perioperative complications, of which 2 (2.8%) were permanent (1 patient with visual field defect and 1 patient with intracranial hemorrhage). Seventy-one patients had clinical follow-up for (19.73±11.90) months, of which 68 patients (95.8%) had good outcome (modified Rankin scale score of 0-2), 10 patients (14.1%) had ischemic complications, and one patient (1.4%) had hemorrhage complications. Sixty-seven aneurysms (88.2%) underwent angiographic follow-up for 7 (6-12) months, of which 44 aneurysms (65.7%) were completely occluded and 10 (14.9%) had in-stent stenosis.Conclusion:The results of this study preliminarily confirm that off-label use of FDs is relatively safe and effective in aneurysms beyond the circle of Willis.

Objective:To evaluate the efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms.Methods:One hundred and seventeen patients with wide-necked intracranial aneurysms treated with intrasaccular flow disruptor were collected from Department of Neurointervention (First Affiliated Hospital of Zhengzhou University), Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University), Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital, Southern Medical University), and Department of Neurosurgery (First Affiliated Hospital of Harbin Medical University) from August 2022 to March 2024. Raymond-Roy Occlusion Classification (RROC) was employed to evaluate aneurysm embolization immediately after procedure; cranial CT or MRI within 48 hours of embolization were performed to identify any new intracranial hemorrhage, subarachnoid hemorrhage, or new symptomatic cerebral infarction related to the intracranial aneurysms. Modified Rankin Scale (mRS) was used to assess the neurological function at discharge. Imaging follow-up and outpatient follow-up were performed at 6 months after embolization to evaluate the aneurysm occlusion degree and complications.Results:A total of 117 intrasaccular flow disruptors were implanted in 117 patients, with a technical success rate of 100%; 115 patients (98.3%) enjoyed successful one-time release of their disruptors, and 2 patients (1.7%) required retrieval and redirection of the disruptors before second successful attempt. Flow disruptor plus stent was performed in 13 patients (11.1%). Immediately after procedure, RROC grading I was noted in 3 patients, grading II in 51 patients and grading III in 63 patients. Cranial CT or MRI within 48 hours of embolization indicated no new intracranial hemorrhage, subarachnoid hemorrhage, or symptomatic cerebral infarction related to the intracranial aneurysms. All patients had mRS score of 0 at discharge. Eighty-three patients completed a 6-month follow-up (RROC grading I in 41 patients, grading II in 33 patients and grading III in 9 patients), without ischemic or hemorrhagic adverse events.Conclusion:The results of this study preliminarily suggest that intrasaccular flow disruptor is effective and safe in wide-necked intracranial aneurysms.

Objective:To explore the efficacy and safety of embolization of anterior cranial fossa dural arteriovenous fistula (ACF-DAVF) via different arterial approaches, and provide evidence for individualized treatment of ACF-DAVF. Methods:A retrospective study was performed; 25 patients with ACF-DAVF admitted to Department of Cerebrovascular Surgery, Neurosurgery Center, Zhujiang Hospital, Southern Medical University from January 2020 to December 2023 were enrolled. Vascular approaches, including the anterior cerebral artery ( n=7), facial artery ( n=3), middle meningeal artery ( n=8), ophthalmic artery ( n=6), and vein ( n=1), were selected based on angioarchitectural features and microcatheter accessibility. Fistula and proximal draining vein occlusions were confirmed by immediate post-embolization digital subtraction angiography (DSA), and perioperative complications were recorded. At a 6-month follow-up, prognoses were assessed by modified Rankin Scale (mRS), and DSA or MRA was performed to detect the recurrence of ACF-DAVF. Results:Six patients had complete embolization and 2 patients had near-total embolization of the fistula and proximal draining vein immediately after embolization via middle meningeal artery approach; 4 patients achieved complete embolization and 2 patients achieved near-total embolization via ophthalmic artery approach; 6 patients achieved complete embolization and one patient achieved near-total embolization via anterior cerebral artery approach; 3 patients achieved complete embolization via facial artery approach; one patient achieved complete embolization via venous approach. No perioperative intracranial hemorrhage or central retinal artery occlusion was noted. Follow-up for 6 months was performed in 25 patients: mRS score was 0 in 19 patients, 1 in 2 patients, and 2 in 4 patients; DSA in 19 patients and MRA in 6 patients indicated no ACF-DAVF recurrence. Conclusion:Based on the angioarchitectural features and microcatheter accessibility, individualized selection of vascular approaches for ACF-DAVF embolization can achieve better efficacy and safety.

Flow diverter (FD) devices have gradually become the mainstream approach for interventional treatment of intracranial aneurysms. In-stent stenosis (ISS) is a common complication after FD implantation, which can lead to ischemic events and affect the prognosis of patients. Current studies have shown that ISS occurrence is closely related to hemodynamic changes. From the perspective of hemodynamics, this article reviews the research progress of mechanisms, evaluation methods and treatments of ISS after FD implantation, in order to provide reference for clinical practice.

Objective:To investigate the safety and efficacy of Pipeline embolization device (PED) Shield in intracranial unruptured saccular aneurysms.Methods:This is a retrospective cohort study; 124 patients with intracranial unruptured saccular aneurysms treated with PED Shield at Department of Cerebrovascular Surgery, Neurosurgery Center, Zhujiang Hospital, Southern Medical University from July 2023 to October 2024 were enrolled. Intraoperative device-related complications and occurrence of hemorrhagic and ischemic complications within 30 days of the procedure were recorded. The clinical results and imaging results (degrees of stent patency and aneurysm occlusion rate) 6 months after follow-up were statistically analyzed. Modified Rankin scale (mRS) score>2 was defined as poor prognosis in clinical follow-up, and grade D according to O'Kelly Marotta (OKM) classification was considered as complete aneurysm occlusion in imaging follow-up.Results:Eighty-seven females and 37 males, aged (56.44±12.17) years (ranging from 27 to 80 years) were enrolled, with a maximum aneurysm diameter of 5.12 (3.73, 7.24) mm. Among the 124 patients, incidence of intraoperative instrument-related complications was 6.5% (8/124); and within 30 days of the procedure, incidence of ischemic complications was 4.8% (6/124) and that of hemorrhagic complications was 1.6% (2/124). Eighty-four patients had a 6-month clinical follow-up, with 1 patient (1.2%) having poor prognosis. Eighty-four patients (67.7%) completed a 6-month imaging follow-up: complete occlusion rate of aneurysms was 82.1% (69/84), incidence of in-stent stenosis (stenosis degree ≥25%) was 4.8% (4/84), and no symptomatic in-stent stenosis was found.Conclusion:Result of this study shows that PED Shield may be an effective and safe clinical option for intracranial unruptured saccular aneurysms.

Objective To analyze the risk factors for postoperative subdural effusion(SE)in patients with severe traumatic brain in-jury(sTBI)and create a column chart to predict the occurrence of postoperative SE in patients.Methods A retrospective analysis was conducted on the data of 223 patients with sTBI admitted to The People's Hospital of Danyang from March 2020 to December 2023.They were divided into SE group and non-SE group based on with or without postoperative SE.24 items of data collected from the SE group and non-SE group were compared,and multivariate Logistic regression were applied to analyze and screen for risk factors of postoperative SE occurrence.The determined predictive variables were introduced into R software to construct a column chart model,and the area under the receiver operator characteristic curve(ROC)curve(area under the curve,AUC)and correction curve were applied to test the predic-tive performance of the model.Results The incidence of postoperative SE in sTBI patients was 27.80％(62/223).There were statisti-cally obvious differences between the SE group and the non-SE group in terms of Glasgow coma scale(GCS)scores at admission,hema-toma volume,proportion of basilar cistern compression,proportion of subarachnoid hemorrhage(SAH),midline displacement distance,dehydrating agent application time ≥7days,and postoperative intracranial infection rate(P＜0.05).The risk factors for postoperative SE in patients with sTBI mainly included admission GCS score of 3-5 points,hematoma volume＞40ml,basal pool compression,SAH,midline displacement distance≥10mm,and application time of dehydrating agent ≥7days.Internal validation showed that the AUC was 0.840(95％CI:0.784-0.896),and the goodness of fit Hosmer-Lemeshow test showed x2=6.860,P=0.552,with better curve fit-ting.Conclusion A column chart based on GCS score at admission,hematoma volume,whether the basal pool,whether SAH,midline displacement distance and time of dehydrating agent application has a good predictive effect on postoperative SE occurrence in sTBI patients.

Objective:To understand the characteristics of faculty in high-level public health schools in China, and analyze the differences in age, area and school level.Methods:Based on the internet information, the faculty information of 18 high-level public health schools was collected for a descriptive analysis on faculty characteristics.Results:There were 1 642 faculty members in the schools of public health in China, in whom 51.8% were women, 92.8% had doctorate, 32.4% had postdoctoral experience and 56.8% were former students staying to teach. The average age of the faculty members was (45.6±9.8) years. Meanwhile the top three study subjects were epidemiology and health statistics (31.0%), occupational health and environmental sanitation (16.5%), and health toxicology (16.3%). In the faculty members aged >40 years, 90.2% had doctorate, 62.6% were former students staying to teach, and 24.7% had no educational background of public health. The proportions of faculty members aged ≤40 years in the three groups mentioned above were 98.2%, 45.8% and 39.1% respectively. In terms of study subject, big data study were mainly conducted in the schools with top subject ranking and the schools in developed areas.Conclusions:The public health faculty was characterized by cross education background and high capability. The study subjects and sub-disciplines varied with schools and areas.

OBJECTIVE To observe the dynamic change trends of vancomycin resistance rates of Enterococcus fae-calis and Enterococcus faecium in medical institutions of Shanghai and nationwide based on the data from China Antimicrobial Resistance Surveillance System(CARSS)between 2014 and 2023 so as to provide bases for optimi-zing the prevention and control strategies for drug-resistant organisms.METHODS The data regarding to the van-comycin resistance rates of E.faecalis and E.faecium in Shanghai and nationwide were extracted from CARSS.The annual percentage change(APC),average annual percentage change(AAPC)and its 95％confi-dence interval(CI)were calculated by Joinpoint regression model(version 5.4.0).The differences in the changing trends and its statistical significance were analyzed.RESULTS The drug resistance rate of E.faecalis showed a re-markable and continuous decline in Shanghai(AAPC=-85.301％,P＜0.001),the isolation rate of the spe-cies maintained zero after 2019.The drug resistance rate nationwide showed a moderate decreasing amplitude(AAPC=-16.237％,P＜0.001),and there was no significant difference in the changing trend after 2019(P=0.628).The drug resistance rate of E.faecium showed a continuous decline trend in Shanghai(AAPC=-27.838％,P＜0.001),while the drug resistance rate nationwide firstly declined and then rose:with the decline from 2014 to 2020(APC=-18.476％,P＜0.001),the quick rebound from 2020 to 2023(APC=43.976％,P=0.005),and there was no significant difference in the overall change(AAPC=-1.459％,P=0.638).The decreasing amplitudes of drug resistance rates of the two species of Enterococcus were greater in Shanghai than nationwide(all P＜0.001),and the rebounds of drug resistance rates did not emerge nationwide.CONCLUSIONS Shanghai has achieved remarkable effect on control of drug resistance of Enterococcus through the management of antibiotics and infection control measures.The drug resistance rate of E.faecium re-bounds nationwide in recent years,indicating that the prevention and control should be strengthened in grass-roots medical institutions.It is suggested that Shanghai experience should be promoted,and the impact of transmis-sion mechanisms of drug resistance genes and COVID-19 epidemic on the use of antibiotics should be focused on.

Objective:To investigate the relevant factors for rupture of basilar tip aneurysms.Methods:This is a retrospective cohort study. Patients who underwent cerebrovascular digital subtraction angiography at Department of Cerebrovascular Disease Surgery,Zhujiang Hospital of Southern Medical University from July 2008 to February 2023 and were confirmed to have basilar tip aneurysms were retrospectively analyzed. There were 45 males and 56 females, aged (57.5±10.2) years (range: 36 to 76 years); the maximum diameter of the basilar tip aneurysm ( M(IQR)) was 6.85 (5.79) mm (range: 1.28 to 27.48 mm). Finally, 101 basilar tip aneurysms were included, and divided into two groups based on whether the basilar tip aneurysm ruptured or not. There were 37 cases (36.6%) in the ruptured group and 64 cases (63.4%) in the unruptured group. Data were analyzed using independent t-test, Mann-Whitney U test, chi-square test, or Fisher′s exact test, as appropriate, and predictive factors for rupture of basilar tip aneurysms were explored by Logistic regression analysis. Variance inflation factors was used for analysis of collinearity. Results:The univariate results showed statistically significant differences between the ruptured and unruptured groups in terms of aneurysm neck width, basilar artery diameter, mean diameter of the parental artery, the ratio of neck width to parent artery diameter, aneurysm width and maximum diameter of the aneurysm (all P<0.05). In multivariate analysis, basilar artery diameter ( OR=0.347, 95% CI:0.176 to 0.687, P=0.002), and NRP ( OR=0.366, 95% CI:0.192 to 0.696, P=0.002) were predictive factors for rupture of aneurysms occurring at the basilar tip. There was no multiple covariance between NRP and basilar artery diameter in the analysis of covariance (VIF=1). Conclusion:Smaller basilar artery diameter and smaller NRP are relevant factors for rupture of basilar tip aneurysms.

Although cancer immunotherapy has made great strides in the clinic, it is still hindered by the tumor immunosuppressive microenvironment (TIME). The stimulator of interferon genes (STING) pathway which can modulate TIME effectively has emerged as a promising therapeutic recently. However, the delivery of most STING agonists, specifically cyclic dinucleotides (CDNs), is performed intratumorally due to their insufficient pharmacological properties, such as weak permeability across cell membranes and vulnerability to nuclease degradation. To expand the clinical applicability of CDNs, a novel pH-sensitive polycationic polymer-modified lipid nanoparticle (LNP-B) system was developed for intravenous delivery of CDNs. LNP-B significantly extended the circulation of CDNs and enhanced the accumulation of CDNs within the tumor, spleen, and tumor-draining lymph nodes compared with free CDNs thereby triggering the STING pathway of dendritic cells and repolarizing pro-tumor macrophages. These events subsequently gave rise to potent anti-tumor immune reactions and substantial inhibition of tumors in CT26 colon cancer-bearing mouse models. In addition, due to the acid-sensitive property of the polycationic polymer, the delivery system of LNP-B was more biocompatible and safer compared with lipid nanoparticles formulated with an indissociable cationic DOTAP (LNP-D). These findings suggest that LNP-B has great potential in the intravenous delivery of CDNs for tumor immunotherapy.