Search Results (218)

Introduction: Given the impact of aneurysmal subarachnoid hemorrhage (aSAH) on patients’ health, preclinical research is substantial to understand its pathophysiology and improve treatment strategies, which necessitates reliable and comprehensive animal models. Traditionally, aSAH models utilize iliac or subclavian access for angiography, requiring invasive procedures that are associated with significant risks and animal burden. This pilot study explores a less invasive method of digital subtraction angiography (DSA) by using the auricular artery (AA) as an alternative access point. Our aim was to demonstrate the feasibility of this refined technique, with the intention of reducing procedural risks, providing shorter operation times with enhanced neurological recovery, and simplifying the process for both researchers and animals. Materials and Methods: In this study, six female New Zealand white rabbits (3.2–4.1 kg body weight) underwent experimental induction of aSAH via a subclavian-cisternal shunt. The initial steps of this procedure followed traditional techniques, consisting of subclavian access through microsurgical preparation, followed by DSA to analyze retrograde filling of the basilar artery (BA). To evaluate the alternative method, on day 3 after induction of aSAH, DSA was performed via the AA instead of the traditional subclavian or femoral access. A catheter was placed in the AA to allow retrograde filling of the BA. This approach aimed to simplify the procedure while maintaining comparable imaging quality. Results: All rabbits survived until the study endpoint. Postoperatively, two rabbits showed signs of hemisyndrome, which significantly improved by the time of follow-up. No additional morbidities were observed. Upon euthanasia and necropsy, all animals showed clear subarachnoid bleeding patterns. DSA via the AA produced strong contrasting of the BA comparable to the traditional method. Conclusions: This technical note presents an initial evaluation of AA access as a feasible and potentially advantageous method for DSA in a rabbit model of blood shunt subarachnoid hemorrhage. The method shows promise in reducing invasiveness and procedural complexity, but further studies are required to fully establish its efficacy and safety. Future research should focus on expanding the sample size, refining the anatomical understanding of the AA, and continuing to align with ethical considerations regarding animal welfare. Full article

Colonic ischemia (CI) is a serious and potentially fatal complication after major abdominal vascular surgery. This literature review explores the pathogenesis, risk factors, diagnostic methods, and preventive strategies associated with CI, emphasizing the differences between emergency and elective treatments. Early diagnosis through clinical signs and instrumental diagnostics, such as sigmoidoscopy and computed tomography, is crucial. Preventive measures, including preoperative evaluation and perioperative management, are emphasized to reduce the incidence of CI. The results of different studies suggest that endovascular aneurysm repair (EVAR), both emergency and elective, has lower risks of ischemic complications than open surgical repair (OSR), as well as better survival for patients. Further research and standardized clinical guidelines are needed to improve patient outcomes and minimize CI severity. Full article

Modeling and simulation of aneurysm formation, growth, and rupture plays an essential role in a wide spectrum of application scenarios, ranging from risk stratification to stability prediction, and from clinical decision-making to treatment innovation. Unfortunately, it remains a non-trivial task due to the difficulties imposed by the complex and under-researched pathophysiological mechanisms behind the different development stages of various aneurysms. In this paper, we present a novel computational method for aneurysm simulation using smoothed particle hydrodynamics (SPH). Firstly, we consider blood in a vessel as a kind of incompressible fluid and model its flow dynamics using the SPH method; and then, to simulate aneurysm growth and rupture, the relationship between the aneurysm development and the properties of fluid particles is established by solving the motion control equation. In view of the prevalence of aneurysms in bifurcation vessels, we further enhance the capability of the model by introducing a solution for bifurcation aneurysms simulation according to Murray’s law. In addition, a CUDA parallel computing scheme is also designed to speed up the simulation process. To evaluate the performance of the proposed method, we conduct extensive experiments with different physical parameters associated with morphological characteristics of an aneurysm. The experimental results demonstrate the effectiveness and efficiency of proposed method in modeling and simulating aneurysm formation, growth, and rupture. Full article

Background and Objectives: Visceral arterial pseudoaneurysms (VAPAs) are rare vascular lesions characterized by the disruption of partial disruption of the arterial wall, most commonly involving the intima and media. They have an estimated incidence of 0.1–0.2%, with the splenic artery most commonly affected. Their management poses unique challenges due to the high risk of rupture. Timely recognition is crucial, as unmanaged pseudoaneurysms have a mortality rate of 90%. This narrative review aims to synthesize current knowledge regarding the epidemiology, etiology, clinical presentation, diagnostic methods, and management strategies for VAPAs. Materials and Methods: A literature search was performed across Pubmed for articles reporting on VAPAs, including case reports, review articles, and cohort studies, with inclusion of manuscripts that were up to (date). VAPAs are grouped by embryological origin—foregut, midgut, and hindgut. Results: Chronic pancreatitis is a primary cause of VAPAs, with the splenic artery being involved in 60–65% of cases. Other causes include acute pancreatitis, as well as iatrogenic trauma from surgeries, trauma, infections, drug use, and vascular diseases. VAPAs often present as abdominal pain upon rupture, with symptoms like nausea, vomiting, and gastrointestinal hemorrhage. Unruptured pseudoaneurysms may manifest as pulsatile masses or bruits but are frequently asymptomatic and discovered incidentally. Diagnosis relies on both non-invasive imaging techniques, such as CT angiography and Doppler ultrasound, and invasive methods like digital subtraction angiography, which remains the gold standard for detailed evaluation and treatment. A range of management options exists that are tailored to individual cases based on the aneurysm’s characteristics and patient-specific factors. This encompasses both surgical and endovascular approaches, with a growing preference for minimally invasive techniques due to lower associated morbidity. Conclusions: VAPAs are a critical condition requiring prompt early recognition and intervention. This review highlights the need for ongoing research to improve diagnostic accuracy and refine treatment protocols, enhancing patient outcomes in this challenging domain of vascular surgery. Full article

Kawasaki disease (KD), first identified in 1967 by Dr. Tomisaku Kawasaki, is an acute, self-limited vasculitis and remains the leading cause of acquired heart disease in children worldwide, particularly affecting those under the age of five. Clinically, it presents with persistent fever, mucocutaneous inflammation, skin rashes, and lymphadenopathy, with a marked tendency to involve the coronary arteries, potentially leading to serious complications such as coronary artery aneurysms. Despite extensive research spanning more than five decades, the precise etiology of KD remains unclear. However, accumulating evidence supports the significant role of genetic predisposition, highlighting the contribution of inherited factors in modulating immune responses and influencing disease susceptibility and severity. Emerging evidence highlights genetic susceptibility as pivotal, with genome-wide studies identifying polymorphisms in immune-related genes, such as ITPKC, CASP3, BLK, CD40, and ORAI1, which modulate disease risk and coronary complications. Epigenetic mechanisms, including DNA methylation and non-coding RNAs, bridge the gap between genetic and environmental factors, regulating immune responses and endothelial activation. Furthermore, emerging insights into autophagy-related processes provide a deeper understanding of the molecular mechanisms underlying the disease. This review aims to explore the current knowledge on the genetic landscape of KD, examine how these findings contribute to our understanding of its pathophysiology, and investigate the potential for genetically targeted therapeutic strategies in the future. Full article

Aortic aneurysm is a vascular disease with a complex pathogenesis which is usually asymptomatic but can lead to high mortality with sudden rupture. This review comprehensively examines the molecular mechanisms of aortic aneurysms in the context of extracellular matrix destruction, smooth muscle cell apoptosis, chronic inflammation, oxidative stress, genetic mutations, and epigenetic regulations. In addition, the potential of molecular biomarkers in diagnosis and prognosis and targeted treatment strategies are evaluated. Animal models and translational findings form the basis for establishing a bridge between preclinical and clinical applications. This study aims to provide insight into the integration of molecular findings into clinical practice in light of the current literature and to guide future research. Full article

Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, underscoring the need for continuous innovation in diagnostics and treatment. Mock circulation loops (MCLs) systems have recently emerged as new research platforms capable of replicating the hemodynamics of the human cardiovascular system. This review explores the expanding applications of MCLs to cardiovascular diseases beyond their traditional role in testing ventricular assist devices and heart failure management. We focus on their versatility in simulating various cardiovascular conditions, particularly arterial diseases such as atherosclerosis, stenosis, and aneurysms. This review traces the evolution of MCLs and their integration with computational simulations and real-time data acquisition systems. MCLs provide detailed insights into hemodynamic responses under diverse conditions, enhancing the precision and safety of cardiovascular interventions. This comprehensive review emphasizes the critical role of MCLs in advancing cardiovascular research, refining clinical interventions, and improving patient outcomes. Full article

Background/Objectives: Denosumab has been considered effective for downstaging giant cell tumor of bone (GCTB), implying that it lowers the Campanacci grade rather than reducing tumor size. Preoperative tumor shrinkage holds therapeutic value by decreasing surgical complications. While previous studies have observed lesion shrinkage in some patients, no study has identified the types of patients likely to show treatment response. Thus, we sought to identify the clinical factors associated with post-denosumab GCTB size reduction. Methods: The data for 45 GCTB patients (29 females [64%], 16 males [36%], median age 32 years [range: 17–65]) who received denosumab were analyzed. Lesions were in the extremities (n = 25, 56%) or spinopelvic region (n = 20, 44%). Ten (22%) were recurrent. Lesion size reduction was assessed using two criteria: a ≥5% and a ≥5 mm decrease in the longest diameter. Univariate analyses were conducted for all variables, and those found to be significant were subjected to multivariate analyses. In addition, multicollinearity was evaluated. Subgroup analyses were performed based on lesion location and recurrence status. Results: Campanacci grade III predicted proportional shrinkage (≥5%) in all patients (OR 4.819, 95% CI 1.121–20.714) and in extremity (OR 11.171, 95% CI 1.023–122.014) and primary lesions (OR 5.781, 95% CI 1.181–28.297), and aneurysmal bone cyst (ABC)-like change was associated with absolute shrinkage (≥5 mm) in all patients (OR 8.734, 95% CI 1.159–65.845) and primary lesions (OR 11.936, 95% CI 1.074–132.69). The longest tumor diameter of ≥7 cm predicted absolute shrinkage in all patients (OR 12.380, 95% CI 1.038–147.694) and for spinopelvic lesions (OR 20, 95% CI 1.676–238.63). Conclusions: ABC-like change, Campanacci grade III, and the longest tumor diameter might predict post-denosumab GCTB shrinkage in all patients, though shrinkage varies with lesion location and recurrence status. These factors could help clinicians tailor treatment strategies in different settings. Further research is needed to explore how clinical factors pharmacologically influence denosumab-induced GCTB shrinkage. Full article

Background/Objectives: We sought to determine if glibenclamide, a sulfonylurea receptor 1-transient receptor potential melastatin 4 (SUR1-TRPM4) channel blocker, reduces cerebral edema and improves neurological functioning in aneurysmal subarachnoid hemorrhage (aSAH). Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted in PubMed, Cochrane Library, Web of Science, and SCOPUS for studies evaluating glibenclamide in aSAH patients. Primary outcomes included scores on the modified Rankin Scale (mRS) at discharge and the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) at ten days post-intervention. Secondary outcomes included adverse events, and safety and efficacy endpoints. Random-effects models were employed for meta-analyses. Results: Three studies utilizing oral glibenclamide (n = 245) met inclusion criteria. Oral glibenclamide demonstrated no significant improvements in mRS scores [MD −0.19 with 95% CI (−2.05, 1.66)] at discharge, [MD 0.06, (−0.60, 0.71)] at 3 months, and [MD 0.4, (−0.67, 0.87)] at 6 months; functional independence [risk ratio (RR) 1.05, (0.81, 1.36)]; independent ambulation [RR 1.07, (0.77, 1.48)]; mortality [RR 0.79, (0.42, 1.50)]; or delayed cerebral ischemia [RR 0.58, (0.31, 1.09]). Hypoglycemia risk was significantly higher in the glibenclamide group [RR 3.92, (1.14, 13.49)]. Conclusions: Oral glibenclamide offers a novel approach to addressing cerebral edema in aSAH but shows limited clinical efficacy in improving functional and neurological outcomes in subtherapeutic doses. Its safety profile is acceptable, though hypoglycemia risk necessitates careful monitoring. Further research is required to optimize dosing, timing of intervention, and patient selection to enhance therapeutic outcomes. By contrast, intravenous administration of therapeutic doses of glibenclamide offers a promising avenue for future studies in the management of aSAH by taking advantage of the favorable pharmacokinetics of this route of administration. Full article

Aneurysmal subarachnoid hemorrhage (aSAH) has high morbidity and mortality in part due to vasospasm and delayed cerebral ischemia (DCI). This retrospective, single-center, case–control study evaluates the accuracy of an attention test, counting backwards from twenty to one (TTO), for detecting vasospasm and DCI in patients admitted to the ICU with aSAH over one year. The odds of symptomatic vasospasm and hospital outcomes were compared between the inattention and control groups. A subgroup analysis included accuracy tests comparing TTO to radiographic vasospasm. Of 44 subjects, 24 had inattention during their ICU course. Compared to controls, the inattention group had increased odds of vasospasm (OR 72 [7.6–677.7], p = 0.001), with significantly longer ICU (5.9 days) and hospital (6.6 days) lengths of stay, and higher odds of discharge to other healthcare facilities (OR 11.4 [2.8 to 46.8], p < 0.001). Errors on TTO testing had a specificity and sensitivity of 78%, and a positive predictive value (PPV) of 91%, for radiographic vasospasm, primarily in the anterior circulation. This study provides support for future prospective research to help elucidate the utility of TTO testing for monitoring and treatment of patients with aSAH. Full article

Sclerostin (SOST) is a specific osteocyte protein. During the differentiation and proliferation of osteoblasts and osteoclasts, the high expression of SOST can inhibit bone formation and contribute to osteoporosis and the bone metastasis of malignant tumors. Most of the research on SOST has focused on bone cells, but studies have found that SOST is not a specific product of bone cells but that it is also expressed by articular chondrocytes. SOST can regulate the progression of osteoarthritis in bone and cartilage, promote subchondral bone sclerosis, and inhibit cartilage degeneration. A review of the literature found that SOST can not only regulate bone metabolism, but it is also expressed in cardiovascular, kidney, liver, and other tissues, influencing the occurrence and development of diseases in these organs and tissues. Studies have found that diseases of extra-bone organs, such as atherosclerosis, aneurysm, chronic kidney disease, and cirrhosis, may be related to the expression of SOST. Simultaneously, long-term exercise can reduce SOST levels, especially in areas of high bone strain. Prolonged exercise induces bone adaptation to mechanical stress, resulting in diminished responsiveness of bone cells to exercise and a reduction in serum SOST levels. Short-term acute exercise can elevate serum SOST levels, but these results are often limited by age, gender, and energy status. In general, serum SOST rises immediately after short-term acute exercise, returning to baseline or even decreasing after exercise. Full article

Background: Aneurysm-related subarachnoid hemorrhage is a life-threatening form of stroke. While medical image acquisition for aneurysm screening is limited to high-risk patients, advances in artificial intelligence (AI)-based image analysis suggest that AI-driven routine screening of imaging studies acquired for other clinical reasons could be valuable. Methods: A representative cohort of 1761 routine cranial magnetic resonance imaging scans [cMRIs] (with time-of-flight angiographies) from patients without previously known intracranial aneurysms was established by combining 854 general radiology 1.5T and 907 neuroradiology 3.0T cMRIs. TOF-MRAs were analyzed with a commercial AI algorithm for aneurysm detection. Neuroradiology consultants re-assessed cMRIs with AI results, providing Likert-based confidence scores (0–3) and work-up recommendations for suspicious findings. Original cMRI reports from more than 90 radiologists and neuroradiologists were reviewed, and patients with new findings were contacted for consultations including follow-up imaging (cMRI / catheter angiography [DSA]). Statistical analysis was conducted based on descriptive statistics, common diagnostic metrics, and the number needed to screen (NNS), defined as the number of cMRIs that must be analyzed with AI to achieve specific clinical endpoints. Results: Initial cMRI reporting by radiologists/neuroradiologists demonstrated a high risk of incidental aneurysm non-reporting (94.4% / 86.4%). A finding-based analysis revealed high AI algorithm sensitivities (100% [3T] / 94.1% [1.5T] for certain aneurysms of any size, well above 90% for any suspicious findings > 2 mm), associated with AI alerts triggered in 22% of cMRIs with PPVs of 7.5–25.2% (depending on the inclusion of inconclusive findings). The NNS to prompt further imaging work-/follow-up was 22, while the NNS to detect an aneurysm with a possible therapeutic impact was 221. Reference readings and patient consultations suggest that routine AI-driven cMRI screening would lead to additional imaging for 4–5% of patients, with 0.45% to 0.74% found to have previously undetected aneurysms with possibly therapeutic implications. Conclusions: AI-based second-reader screening substantially reduces incidental aneurysm non-reporting but may disproportionally increase follow-/work-up imaging demands also for minor or inconclusive findings with associated patient concern. Future research should focus on (subgroup-specific) AI optimization and cost-effectiveness analyses. Full article

Diagnosis in stroke patients is based mainly on clinical and radiological findings; therefore, there is a need for serological markers that can orient the clinician. Copeptin is a new blood marker for diagnosis and prognosis in several neurological conditions, such as ischemic stroke, hemorrhagic stroke, aneurysmal subarachnoid hemorrhage, and multiple sclerosis. The aim of our study was to highlight the diagnostic value of copeptin in differentiating between stroke subtypes and stroke mimics. We performed a literature review by searching the PubMed and Scopus databases for papers with the following keywords: “stroke AND copeptin AND differential”. The PRISMA criteria were used. We identified 29 papers that met the criteria. We analyzed only original research articles, excluding reviews and only including those in English. Some studies did not find any significant differences between cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage, but one study demonstrated significant correlations. All studies agreed that copeptin levels can help in differentiating stroke patients from stroke-free patients. Copeptin levels were correlated with prognostic scales For stroke mimics, copeptin levels were extremely broad and for vestibular disorders; it was shown that a normal level of copeptin excludes stroke. Copeptin is a new blood marker that can help clinicians in the acute neurological field. It may help in diagnosing stroke, in differentiating between stroke subtypes and stroke mimics, and in evaluating the prognosis of these patients, but further studies are needed. Full article

Thrombospondin Type 1 Domain-Containing Protein 1 (THSD1) is a transmembrane protein increasingly recognized for its critical roles in vascular biology and disease pathogenesis. Initially identified as a marker of hematopoietic stem and endothelial cells during embryogenesis, THSD1 has since been implicated in a wide spectrum of physiological and pathological processes. This paper consolidates current knowledge on THSD1, with a focus on its roles in vascular integrity, perinatal disorders, and tumorigenesis. In vascular systems, THSD1 promotes focal adhesion assembly and suppresses autophagy-mediated adhesion turnover, thereby stabilizing endothelial attachment and maintaining barrier function. Genetic and functional studies support its protective role against intracranial aneurysms and hemorrhagic vascular disorders. THSD1 mutations have also been linked to perinatal disorders such as nonimmune hydrops fetalis and congenital vascular anomalies, suggesting a broader role in embryonic vascular patterning. Moreover, emerging evidence indicates that THSD1 acts as a tumor and metastasis suppressor, with potential anti-angiogenic properties, although its role in cancer remains to be fully defined. This paper not only consolidates existing knowledge but also identifies critical research gaps, providing a robust foundation for future investigations into the biology and clinical relevance of THSD1. Full article

Introduction: The transforming growth factor beta (TGF-β) signaling pathway plays a critical role in cellular processes, including maintaining vascular integrity and regulating vascular remodeling. Aneurysm rupture is associated with pathological changes in the arterial wall. Aims: We aimed to investigate the gene expression of transforming growth factors (TGFB1, TGFB2, TGFB3) in peripheral blood mononuclear cells (PBMCs) isolated from the blood of patients with unruptured intracranial aneurysms (UIAs) and ruptured intracranial aneurysms (RIAs), and from a control group. Additionally, we evaluated serum levels of TGF-β1, TGF-β2, and TGF-β3 and analyzed their associations with various risk factors, including sex, age, aneurysm size, number, shape, smoking, and hypertension. Materials and Methods: The study group consisted of patients diagnosed with intracranial aneurysms (IAs) who were eligible for embolization at the Department of Neurosurgery, Clinical Hospital of the Medical University of Bialystok. The control group consisted of healthy volunteers, recruited from the employees of the Clinical Hospital of the Medical University of Bialystok. Expression levels were assessed using quantitative real-time polymerase chain reaction techniques in PBMCs. Serum concentrations of TGF-β isoforms were evaluated using a multiplexed bead-based immunoassay. Results: Among 32 patients, 24 had unruptured intracranial aneurysms (UIAs), including 18 women and 6 men, while 8 presented with ruptured intracranial aneurysms (RIAs), evenly distributed between women and men (4 each). The mean age of the patients was 53 years (range: 24–71 years). The control group consisted of 20 healthy volunteers, 14 females and 6 males, with a mean age of 51 years (range: 24–71 years). The expression of TGFB1 was significantly higher in the IA versus C group, but TGFB3 expression was significantly higher in the RIA versus C group. The serum level of TGF-β1 and TGF-β3 was significantly higher in the RIA versus UIA group. Serum TGF-β1 levels were higher in men and individuals < 60 years of age. Positive correlations were observed between serum TGF-β1, TGF-β3 and aneurysm size, with significantly higher TGF-β3 levels in patients with giant aneurysms. Conclusions: Our study highlights the distinct roles of TGFB1 and TGFB3 in aneurysm pathophysiology, identifying TGFB1 as a molecular contributor to aneurysm formation and TGFB3 with rupture. Increased serum TGF-β1 and TGF-β3 concentrations could serve as promising noninvasive parameters for assessing the risk of aneurysm rupture. Further research with larger cohorts is needed to define cut-off values and validate the method, enabling the use of blood TGF-β levels as a tool for clinical decision-making. Full article