scholarly journals Update on flow diverters for the endovascular management of cerebral aneurysms

2017 ◽  
Vol 42 (6) ◽  
pp. E2 ◽  
Author(s):  
Gary Rajah ◽  
Sandra Narayanan ◽  
Leonardo Rangel-Castilla
Keyword(s):  
Treatment Effect ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Significant Treatment Effect ◽  
Endovascular Management ◽  
Significant Treatment ◽  
Future Directions ◽  
Pipeline Embolization Device ◽  
And Function ◽  
Flow Diverters

Flow diversion has become a well-accepted option for the treatment of cerebral aneurysms. Given the significant treatment effect of flow diverters, numerous options have emerged since the initial Pipeline embolization device studies. In this review, the authors describe the available flow diverters, both endoluminal and intrasaccular, addressing nuances of device design and function and presenting data on complications and outcomes, where available. They also discuss possible future directions of flow diversion.

Ultrasound for the evaluation of stenosis after flow diversion

2017 ◽  
Vol 10 (3) ◽  
pp. 297-300 ◽  
Author(s):  
Cameron M McDougall ◽  
Khurshid Khan ◽  
Maher Saqqur ◽  
Andrew Jack ◽  
Jeremy Rempel ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Transcranial Doppler Ultrasound ◽  
Flow Diversion ◽  
Clinical Implications ◽  
Optimal Method ◽  
Pipeline Embolization Device ◽  
New Strategy ◽  
Flow Diverters ◽  
Stent Stenosis

Background and purposeFlow diversion is a relatively new strategy used to treat complex cerebral aneurysms. The optimal method for radiographic follow-up of patients treated with flow diverters has not been established. The rate and clinical implications of in-stent stenosis for these devices is unclear. We evaluate the use of transcranial Doppler ultrasound (TCD) for follow-up of in-stent stenosis.Materials and methodsWe analyzed 28 patients treated with the Pipeline embolization device (PED) over the course of 42 months from January 2009 to June 2012. Standard conventional cerebral angiograms were performed in all patients. TCD studies were available in 23 patients.ResultsAngiographic and TCD results were compared and found to correlate well.ConclusionsTCD is a potentially useful adjunct for evaluating in-stent stenosis after flow diversion.

scholarly journals Intergenerational paternal effect of adult density in Drosophila melanogaster

2018 ◽  
Author(s):  
Purbasha Dasgupta ◽  
Saubhik Sarkar ◽  
Akankshya A. Das ◽  
Tanya Verma ◽  
Bodhisatta Nandy
Keyword(s):  
Drosophila Melanogaster ◽  
Treatment Effect ◽  
Egg Size ◽  
Competitive Ability ◽  
Differential Mortality ◽  
Adult Density ◽  
Significant Treatment Effect ◽  
Male Fitness ◽  
Fitness Components ◽  
Significant Treatment

AbstractNotwithstanding recent evidences, paternal environment is thought to be a potential but unlikely source of fitness variation that can affect trait evolution. Here we studied intergenerational effects of males’ exposure to varying adult density in Drosophila melanogaster laboratory populations.We held sires at normal (N), medium (M) and high (H) adult densities for two days before allowing them to mate with virgin females. This treatment did not introduce selection through differential mortality. Further, we randomly paired males and females and allowed a single round of mating between the sires and the dams. We then collected eggs from the dams and measured the egg size. Finally, we investigated the effect of the paternal treatment on juvenile and adult (male) fitness components.We found a significant treatment effect on juvenile competitive ability where the progeny sired by the H-males had higher competitive ability. Since we did not find the treatment to affect egg size, this effect is unlikely to be mediated through variation in female provisioning.Male fitness components were also found to have a significant treatment effect: M-sons had lower dry weight at eclosion, higher mating latency and lower competitive mating success.While being the first study to show both adaptive and non-adaptive effect of the paternal density in Drosophila, our results highlight the importance of considering paternal environment as important source of fitness variation.

Flow Diversion for Intracranial Aneurysm Treatment: Trials Involving Flow Diverters and Long-Term Outcomes

Neurosurgery ◽  
2019 ◽  
Vol 86 (Supplement_1) ◽  
pp. S36-S45 ◽  
Author(s):  
Bree Chancellor ◽  
Eytan Raz ◽  
Maksim Shapiro ◽  
Omar Tanweer ◽  
Erez Nossek ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Long Term Outcomes ◽  
Complex Aneurysms ◽  
Aneurysm Treatment ◽  
Endovascular Methods ◽  
Cure Rates ◽  
Flow Diverters

Abstract Flow diverters (FDs) have changed the management of brain aneurysms; not only for complex aneurysms (giant, fusiform and blister) refractory to conventional therapies, but also for unruptured lesions previously managed by traditional surgical or coil-based endovascular methods. Since 2011 when the PipelineTM Embolization Device (Medtronic) was cleared by the Food and Drug Administration for adults with large or giant wide-neck intracranial aneurysms of the internal carotid artery proximal to the posterior communicating segment, the role of flow diversion for aneurysm treatment has expanded—supported by favorably low complication and high cure rates compared with alternative treatments. Here we review the key clinical trials and the long term outcomes that have demonstrated safety and efficacy of minimized porosity endoluminal devices in the treatment of cerebral aneurysms.

scholarly journals A randomized, placebo-controlled, phase 2 trial of laquinimod in primary progressive multiple sclerosis

Neurology ◽  
2020 ◽  
Vol 95 (8) ◽  
pp. e1027-e1040 ◽  
Author(s):  
Gavin Giovannoni ◽  
Volker Knappertz ◽  
Joshua R. Steinerman ◽  
Aaron P. Tansy ◽  
Thomas Li ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Primary Endpoint ◽  
Treatment Effect ◽  
Brain Volume ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Phase 2 ◽  
Significant Treatment Effect ◽  
Significant Treatment ◽  
Primary Progressive

ObjectiveTo evaluate efficacy, safety, and tolerability of laquinimod in patients with primary progressive multiple sclerosis (PPMS).MethodsIn the randomized, double-blind, placebo-controlled, phase 2 study, ARPEGGIO (A Randomized Placebo-controlled Trial Evaluating Laquinimod in PPMS, Gauging Gradations in MRI and Clinical Outcomes), eligible patients with PPMS were randomized 1:1:1 to receive once-daily oral laquinimod 0.6 mg or 1.5 mg or matching placebo. Percentage brain volume change (PBVC; primary endpoint) from baseline to week 48 was assessed by MRI. Secondary and exploratory endpoints included clinical and MRI measures. Efficacy endpoints were evaluated using a predefined, hierarchical statistical testing procedure. Safety was monitored throughout the study. The laquinimod 1.5 mg dose arm was discontinued on January 1, 2016, due to findings of cardiovascular events.ResultsA total of 374 patients were randomized to laquinimod 0.6 mg (n = 139) or 1.5 mg (n = 95) or placebo (n = 140). ARPEGGIO did not meet the primary endpoint of significant treatment effect with laquinimod 0.6 mg vs placebo on PBVC from baseline to week 48 (adjusted mean difference = 0.016%, p = 0.903). Laquinimod 0.6 mg reduced the number of new T2 brain lesions at week 48 (risk ratio 0.4; 95% confidence interval, 0.26–0.69; p = 0.001). Incidence of adverse events was higher among patients treated with laquinimod 0.6 mg (83%) vs laquinimod 1.5 mg (66%) and placebo (78%).ConclusionsLaquinimod 0.6 mg did not demonstrate a statistically significant effect on brain volume loss in PPMS at week 48.Clinicaltrials.gov identifierNCT02284568.Classification of evidenceThis study provides Class I evidence that, although well tolerated, laquinimod 0.6 mg did not demonstrate a significant treatment effect on PBVC in patients with PPMS.

Flow diverters for intracranial aneurysms

2015 ◽  
Vol 3 (3-4) ◽  
Author(s):  
Alice Venier ◽  
Beatrice Gardenghi ◽  
Giuseppe Lanzino ◽  
Stylianos K. Rammos
Keyword(s):  
Present Article ◽  
Intracranial Aneurysms ◽  
Flow Diversion ◽  
Parent Artery ◽  
Endovascular Management ◽  
Innovative Technologies ◽  
Unruptured Aneurysms ◽  
Flow Diverters

AbstractThe progressive establishment of endovascular management in treating intracranial aneurysms had lead to continuous technique advancements and development of innovative technologies. Flow diverters are “stent-like” devices currently used for complex unruptured aneurysms allowing endoluminal reconstruction of the parent artery and occlusion of the aneurysm sac. In the present article, we review the development of flow diversion devices through

Group-Assertive Training in Treatment of Expression of Inappropriate Anger

1974 ◽  
Vol 34 (3) ◽  
pp. 791-798 ◽  
Author(s):  
David C. Rimm ◽  
George A. Hill ◽  
Nancy N. Brown ◽  
James E. Stuart
Keyword(s):  
Treatment Effect ◽  
Effective Means ◽  
Training Group ◽  
Role Playing ◽  
External Control ◽  
Objective Measures ◽  
Significant Treatment Effect ◽  
Significant Treatment ◽  
History Of ◽  
Assertive Training

Male volunteers reporting a history of expressing anger in an inappropriate or antisocial manner were assigned to an assertive training group or to a placebo group. Assertive training, conducted over a total of 8 hr., consisted primarily of behavior rehearsal, i.e., role-playing anger-inducing situations. On objective measures of assertion and comfort, 7 Ss in the assertive condition showed significantly greater improvement than the 6 controls. Subjective measures of discomfort and anger showed significantly greater improvement for assertive Ss than for the controls, although a significant treatment effect was not observed for self-rated confidence. Results for a global assertive inventory, while in the predicted direction, were not significant. A measure relating to internal versus external control did not yield a treatment effect. Thus, consistent with previous findings, the effects of assertive training were highly situation-specific. These results support the value of group-assertive training. They also suggest that assertive training may provide an effective means for dealing with anger which typically leads to anti-social aggression.

Fluctuations in fuel moisture across restoration treatments in semi-arid ponderosa pine forests of northern Arizona, USA

2007 ◽  
Vol 16 (1) ◽  
pp. 119 ◽  
Author(s):  
Shawn Michael Faiella ◽  
John Duff Bailey
Keyword(s):  
Moisture Content ◽  
Treatment Effect ◽  
Ponderosa Pine ◽  
Pine Forests ◽  
Fuel Moisture ◽  
Significant Treatment Effect ◽  
Significant Treatment ◽  
Ponderosa Pine Forests ◽  
Northern Arizona ◽  
Semi Arid

Fuel moisture is an important variable in estimating fire behaviour and wildfire hazard. We measured three replicates each of thin-and-burn, burn-only, and control treatments in semi-arid ponderosa pine forests of northern Arizona, USA to quantify temporal changes and treatment effects on live foliar and dead fuel moisture content. Overstorey structure and canopy bulk density were reduced 40–75% in the thin-and-burn treatment v. the burn-only and control treatments. Fluctuations in foliar moisture content varied temporally and across study areas. In 2003, a significant treatment effect was found for two study sites for 1-year-old foliage, but no significant treatment effect was found for new foliage. In 2004, a significant treatment effect was found across all three study sites for both 1-year-old and new foliage. However, no clear pattern existed regarding a specific treatment and its effect on moisture content of old or new foliage. No conclusive evidence was found for a significant treatment effect on the moisture content of fuel particles in the size classes of 0–6, 6–25, and 25–100-mm diameter. Proposals regarding amplified fire behaviour as a consequence of reduced fuel moisture contents in treated v. untreated forest stands in semi-arid ponderosa pine forests of northern Arizona therefore appear to be unwarranted.

Aneurysms with persistent patency after treatment with the Pipeline Embolization Device

2016 ◽  
Vol 126 (6) ◽  
pp. 1894-1898 ◽  
Author(s):  
Peter Kan ◽  
Visish M. Srinivasan ◽  
Nnenna Mbabuike ◽  
Rabih G. Tawk ◽  
Vin Shen Ban ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Pipeline Embolization Device ◽  
Cerebellar Artery ◽  
Middle Cerebral Artery Aneurysms ◽  
Flow Diverters

The Pipeline Embolization Device (PED) was approved for the treatment of intracranial aneurysms from the petrous to the superior hypophyseal segment of the internal carotid artery. However, since its approval, its use for treatment of intracranial aneurysms in other locations and non-sidewall aneurysms has grown tremendously. The authors report on a cohort of 15 patients with 16 cerebral aneurysms that incorporated an end vessel with no significant distal collaterals, which were treated with the PED. The cohort includes 7 posterior communicating artery aneurysms, 5 ophthalmic artery aneurysms, 1 superior cerebellar artery aneurysm, 1 anterior inferior cerebellar artery aneurysm, and 2 middle cerebral artery aneurysms. None of the aneurysms achieved significant occlusion at the last follow-up evaluation (mean 24 months). Based on these observations, the authors do not recommend the use of flow diverters for the treatment of this subset of cerebral aneurysms.

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