Clipping Treatments Research Articles

Jejunal Dieulafoy's lesion - An exceptionally rare and challenging culprit of gastrointestinal bleeding.

A 78-year-old male presented to the emergency department with melena. He was hemodynamically stable but displayed a hemoglobin level of 5.8g/dL necessitating blood transfusion. Initial esophagogastroduodenoscopy and colonoscopy failed to identify a bleeding source, prompting a capsule endoscopy that revealed an active bleeding site in the jejunum. A single-balloon enteroscopy identified an aberrant vessel in the mid-jejunum protruding through a 3mm mucosal defect, devoid of surrounding inflammation, consistent with a Dieulafoy's lesion, in which two through-the-scope clips were applied. Despite this, ongoing melena and decreasing hemoglobin levels in the subsequent days led to a second single-balloon enteroscopy, which confirmed continued bleeding. Definitive hemostasis was achieved through diluted adrenaline injection, four additional through-the-scope clips, and polidocanol sclerotherapy. Jejunal Dieulafoy's lesion is extremely rare and presents notable diagnostic and therapeutic challenges. Ávila et al. recently reported a case where, despite capsule endoscopy identifying the bleeding site, single-balloon enteroscopy failed to confirm the diagnosis, leading to the use of motorized enteroscopy with argon and metallic clip treatment. Similarly, our experience highlights the diagnostic value of capsule endoscopy and the crucial role of device-assisted enteroscopy in a multimodal therapeutic approach, which was essential for achieving successful hemostasis.

Machine Learning-Based Prediction of Clinical Outcomes in Microsurgical Clipping Treatments of Cerebral Aneurysms.

Background: This study investigates the application of Machine Learning techniques to predict clinical outcomes in microsurgical clipping treatments of cerebral aneurysms, aiming to enhance healthcare processes through informed clinical decision making. Methods: Relying on a dataset of 344 patients' preoperative characteristics, various ML classifiers were trained to predict outcomes measured by the Glasgow Outcome Scale (GOS). The study's results were reported through the means of ROC-AUC scores for outcome prediction and the identification of key predictors using SHAP analysis. Results: The trained models achieved ROC-AUC scores of 0.72 ± 0.03 for specific GOS outcome prediction and 0.78 ± 0.02 for binary classification of outcomes. The SHAP explanation analysis identified intubation as the most impactful factor influencing treatment outcomes' predictions for the trained models. Conclusions: The study demonstrates the potential of ML for predicting surgical outcomes of ruptured cerebral aneurysm treatments. It acknowledged the need for high-quality datasets and external validation to enhance model accuracy and generalizability.

Decoupled responses of the stability of above‐ and belowground productivity to drought and clipping in an alpine meadow

Abstract Extreme drought and intensification of land use pose substantial threats to ecosystem stability. However, existing studies that assess ecosystem stability focus primarily on the stability of aboveground net primary productivity (ANPP), while the stability of belowground net primary productivity (BNPP) is often not considered. Here, we examined the response patterns and drivers of ANPP stability and BNPP stability in an alpine meadow to drought and clipping (simulating grazing and mowing) by the implementation of five levels of simulated precipitation (1/12, 1/4, 1/2, 3/4 and ambient precipitation) and clipping (unclipped vs. clipped) treatments over 7 years (2016–2022). The results showed that extreme drought decreased ANPP stability, while moderate drought increased BNPP stability and net primary productivity stability. The findings highlight the importance of jointly considering above‐ and belowground processes when evaluating ecosystem stability. Moreover, clipping did not have an impact on ANPP stability but reduced BNPP stability, and clipping differentially affected the stability of ANPP and BNPP in response to extreme drought. Furthermore, ANPP stability was largely determined by species temporal asynchrony rather than richness, whereas dominant species stability strongly contributed to the variation in BNPP stability of this alpine meadow faced with drought and clipping. Synthesis: In general, these results provide experimental evidence for the decoupling of the responses of above‐ and belowground productivity stability to extreme drought and clipping. Our findings indicate that aboveground responses should not be used as the sole indicator of the whole ecosystem consequences of extreme drought and disturbance factors such as grazing or mowing, emphasizing the need to evaluate ecosystem stability from a whole ecosystem perspective.

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: a multicenter randomized controlled trial (TOP Study).

First-line over-the-scope (OTS) clip treatment has shown higher efficacy than standard endoscopic therapy in acute nonvariceal upper gastrointestinal bleeding (NVUGIB) from different causes. We compared OTS clips with through-the-scope (TTS) clips as first-line mechanical treatment in the specific setting of peptic ulcer bleeding. We conducted an international, multicenter randomized controlled trial on consecutive patients with suspected NVUGIB. Patients with Forrest Ia-IIb gastroduodenal peptic ulcer were randomized 1:1 to OTS clip or TTS clip treatment. The primary outcome was the rate of 30-day rebleeding after successful initial hemostasis. Secondary outcomes included the rates of successful initial hemostasis and overall clinical success, defined as the composite of successful initial hemostasis and no evidence of 30-day rebleeding. 251 patients were screened and 112 patients were randomized to OTS (n = 61) or TTS (n = 51) clip treatment. The 30-day rebleeding rates were 1.6% (1/61) and 3.9% (2/51) in patients treated with OTS clips and TTS clips, respectively (Kaplan-Meier log-rank, P = 0.46). Successful initial hemostasis rates were 98.4% (60/61) in the OTS clip group and 78.4% (40/51) in the TTS clip group (P = 0.001). Overall clinical success rates were 96.7% (59/61) with OTS clips and 74.5% (38/51) with TTS clips (P = 0.001). Low rates of 30-day rebleeding were observed after first-line endoscopic treatment of acute peptic ulcer bleeding with either OTS or TTS clips. However, OTS clips showed higher efficacy than TTS clips in achieving successful initial hemostasis and overall clinical success.

Rare‐earth element phytoextraction efficiency in southern Chinese mines under different clipping intensities using a co‐cropping system (Dicranopteris pedata and Pinus massoniana)

AbstractOur understanding of how varying clipping intensities affect the efficiency of phytoextraction remains limited, particularly with co‐cropping systems. This study focuses on assessing the effects of different clipping intensities on phytoextraction efficiency within co‐cropping systems dominated by the key species Dicranopteris pedata and Pinus massoniana in rare‐earth mines of southern China. Our results confirmed the following. Firstly, the compensation index, dry aboveground biomass, and rare‐earth elements (REE) accumulation of clipped D. pedata per unit area were highest under 100% clipping (p < 0.05). Meanwhile, the bioabsorption coefficient, bioconcentration factor, and translocation factor of P. massoniana were less than 1. Secondly, the soil catalase, sucrase, and α‐diversity indices of bacteria and fungi separately indicated no significant variation between the clipping treatments and control. The REE content in tree rings increased, and the total REE contents in thicker tree rings were higher than those in the thinner tree rings of P. massoniana from 1997 to 2016. Additionally, the soil erosion intensity diminished significantly in the growth area of P. massoniana from 1995 to 2019. Thirdly, both D. pedata and P. massoniana, when subjected to 100% clipping, could effectively remove excess REEs from the 0–20 cm soil layer within 18.57–61.19 years. In contrast, P. massoniana alone achieved a removal rate of excess REEs in the 20–60 cm layer, within 923.16–1899.62 years. Thus, D. pedata with 100% clipping can phytoextract the maximum amount of REEs. It is noted that P. massoniana cannot be used for REEs phytoextraction or phytostabilization. Co‐cropping with 100% clipping would have a less negative impact on growth and REEs extraction, and the co‐cropping system can phytoextract excess REEs from the surface soil within decades. However, it is not efficient for the phytoextraction of excess REEs from deep soil layers.

Prognostic Factors for Anterior Cerebral Artery Aneurysms: A Single-Center Series.

The aim of the present study is to summarize the characteristics of anterior cerebral artery aneurysms and to explore the prognostic factors of microsurgical clipping treatment for anterior cerebral artery aneurysms. A total of 90 anterior cerebral artery aneurysms (ACAAs) are reviewed from January 2000 to July 2019. Patients are categorized into good outcome group and poor outcome group according to Glasgow outcome scale scores. Multiple factors, including clinical characteristics and aneurysms' characteristics, are evaluated to identify the independent risk factors associated with prognosis of ACAAs. This analysis reveals that in the ACAAs database the number of SAH (P=0.01), high H-H grade (P<0.001) and high Fisher grade (P<0.001) are correlated with prognosis of ACAAs. Finally, age (P=0.007, odds ratio=1.124, 95% CI: 1.033-1.223) and Hunt-Hess (grade III-V, P=0.022, odds ratio =59.77, 95% CI: 1.794-1991.298) are found to be independent risk factors for prognosis. The age and high Hunt-Hess grade seem to be important factors affecting the prognosis of ACAAs.

Effects of Clipping Intensity on the Physiology of Dicranopteris pedata and Its Interroot Soil in the Rare-Earth-Mining Area in Southern China

Clipping is crucial during phytoremediation. However, research into the effects of clipping intensity on the physiology of Dicranopteris pedata (D. pedata) and its interroot soil in the rare-earth-mining area in southern China is lacking. A clipping experiment was conducted to verify the phytoremediation effect of D. pedata. The physiology of D. pedata, such as biomass, antioxidant enzymes, chlorophyll, and rare-earth elements (REEs), were determined after clipping. And the microbial community diversity and soil enzyme activities in the interroot soil of D. pedata were investigated. The phytoremediation efficiency was determined at the end of the experiment. The results showed that the compensatory growth effect of D. pedata was stronger with increasing clipping intensity. There was no significant difference in the α diversity of interroot soil microorganisms of D. pedata at different clipping intensities, but β diversity analysis showed that the clipping treatment group deviated from the control group. Only urease activity decreased among the interroot soil enzymes in D. pedata after clipping, while the soil catalase and sucrase were less responsive to clipping. The REEs accumulated by D. pedata were dominated by light REEs in the aboveground part of the plant, while the amounts of light and heavy rare-earth elements accumulated in the underground part of the plant were similar. The phytoextraction of REEs gradually increased with increasing clipping intensity. It was concluded that 100% clipping once a year is the most appropriate when considering D. pedata’s phytoremediation potential and soil system. The time it takes for 100% clipping of D. pedata to reduce the soil TREEs (total rare-earth elements), LREEs (light rare-earth elements), and HREEs (heavy rare-earth elements) to below-average soil REE concentration in China was estimated to be 25.54 years, 19.56 years, and 65.43 years, respectively, which was significantly lower than that for other clipping intensities and the control group. It is concluded that clipping D. pedata is an effective way to promote phytoextraction efficiency in the southern rare-earth-mining areas. The soil can still support the resumption of D. pedata growth after high-intensity clipping.

Variations of Middle Cerebral Artery Hemodynamics Due to Aneurysm Clipping Surgery

Abstract Cerebral aneurysms are potentially life-threatening cerebrovascular conditions where a weakened blood vessel in the brain bulges or protrudes over time. The most common way to treat aneurysms is surgical clipping, an approach where blood flow to the aneurysm is blocked by a permanently placed clip on the artery. However, not all aneurysms are identical; thus, there has been a need for patient-specific treatment options, where each aneurysm is treated based on its individual characteristics. Computational fluid dynamics (CFD) modeling can offer insights to predict how different treatment procedures will affect cerebral hemodynamics. In that regard, the goal of this pilot study was to investigate the flow characteristics and hemodynamic parameters in cerebral arteries before and after neurosurgical clipping. For this purpose, two patient-specific cerebral artery geometries with at least one aneurysm at the middle cerebral artery bifurcation were selected from an online dataset. A companion postclipping model was created for each geometry by removing the aneurysm from the original geometry. Tetrahedral mesh elements were then generated and CFD simulations were conducted to compare the blood velocity profile, secondary flow, flow streamline, and wall shear stress in the computational models with and without aneurysm. Results showed that the clipping treatment led to changes in the velocity profiles, secondary flow structures, and wall shear stress in the middle cerebral artery. In conclusion, our results suggest that CFD modeling can assist in predicting hemodynamic parameters prior to treatment, thus facilitating more tailored planning for each patient’s treatment.

Retracted: Clinical Treatment and Nursing Intervention Study of Clipping Treatment of Cerebral Aneurysm under the Health Model of Data Analysis.

[This retracts the article DOI: 10.1155/2022/8178963.].

Simulated mechanical control of Nitellopsis obtusa under mesocosm conditions

AbstractManagement efforts to control starry stonewort [Nitellopsis obtusa (Desvaux in Loiseleur) J. Groves] have been limited to stressing the thalli and have not been able to directly target the reproductive bulbils. Smaller-scale efforts such as the use of hand pulling can be employed, but hand pulling is not realistic for larger infestations. This research was conducted to test the effects of clipping stress on N. obtusa to provide a baseline for the effect of stress on the production of bulbils and the regrowth of thalli. Mesocosms were set up under greenhouse conditions to test the effects on N. obtusa of simulated mechanical harvesting once, twice, and four times per growing season. Different seasonal timing and frequency of clipping treatments will remove different amounts of thalli biomass. The four-clipping treatment always reduced thalli biomass in this study at both 16 and 52 wk after treatment (WAT) compared with the nontreated reference, but there was no difference among clipping treatments at 52 WAT. At 16 WAT, one clipping reduced bulbil density by 44% (Trial 1) to 50% (Trial 2), two clippings reduced bulbil density by 28% (Trial 2) to 52% (Trial 1), and four clippings reduced bulbil density by 22% (Trial 2) to 88% (Trial 1). At 52 WAT, bulbil densities were 69% and 93% lower than those of the nontreated reference Trials 2 and 1, respectively. Results from this study indicate that clipping may be effective for N. obtusa control and could impact bulbil production.

Clipping Height and Frequency Effects on Japanese Brome Seed Production and Viability

Japanese brome (Bromus japonicus Thunb.) is an invasive annual grass that is common in the Great Plains. Grazing or clipping in the spring has been shown to decrease Japanese brome biomass, but the effect on seed viability is not as clearly understood. We tested two clipping height and two clipping frequency combinations against nonclipped controls to determine effects on productivity and seeds of Japanese brome in greenhouse conditions. Pots containing two Japanese brome plants each were the experimental unit, with six per treatment, and the experiment was repeated a second yr. Plants were clipped to a 75-mm or 150-mm stubble height on a 7-d or 14-d interval starting at the boot stage, or no clipping occurred. Brome biomass was reduced 35% by clipping to 150 mm and 54% with clipping to 75 mm. No biomass differences were detected between clipping frequencies at either clipping height. Cumulative seed production was reduced at least 54% by clipping and reductions increased with shorter clipping and greater clipping frequency. At the end of the experiment, clipped plants had 7−310 seeds per pot, compared with a mean of 2 585 seeds per pot for nonclipped. Mean seed weight for all clipped treatments was 73% less than that of nonclipped plants. Only 15 seeds germinated from the 150-mm treatment clipped every 14 d. Plants clipped at 75 mm, regardless of frequency, and plants clipped to 150 mm weekly did not produce any viable seeds. Defoliation, across clipped heights and frequencies, drastically reduced the number and viability of Japanese brome seed. Targeted defoliation by mowing or grazing can contribute to Japanese brome control through seed limitation.

Optimal clipping intensity for balancing soil erosion control and runoff production on revegetated slopes

Clipping management by reducing the above-ground parts of grassland has been gradually introduced to offset some of the additional issues caused by large-scale vegetation restoration, such as the formation of a dry soil layer, approaching the limits of watershed water resources, and reducing the sustainability of vegetation. Therefore, there is a scientific and practical need to evaluate the effectiveness of clipping management on runoff and erosion processes to ensure a balance between erosion control, surface water supply, and vegetation sustainability. In this study, simulated rainfall experiments with four levels of clipping intensities (no clipping, light clipping, heavy clipping, and clear clipping) were conducted to explore the mechanism of runoff and soil loss response under three rainfall intensities (i.e., 60, 90, and 120 mm·h−1) and three slope gradients (i.e., 18, 36, and 58 %) using structural equation modeling and variation partitioning. The results showed that the runoff depth increased by 42 %, 119 %, and 299 %, respectively, and the soil loss increased by 76 %, 80 %, and 470 %, respectively, in the light, heavy, and clear clipping treatments compared with the no clipping treatment, indicating that the increase in the percentage of runoff production and soil loss was not synchronized. According to the optimizing results of response surface method, the recommended vegetation cover after clipping was 23 % − 48 %, and the slope gradient of clipped vegetation should not exceed 36 %, which increased surface runoff while limiting soil erosion within an acceptable range. Runoff production and soil loss were primarily determined by rainfall intensity, followed by clipping intensity and slope gradient. Increasing rainfall intensity and slope gradient increased the effect of clipping on soil loss. Therefore, local rainfall and topography need to be considered in the application of clipping management. This study provides valuable insights into the use of clipping treatment as a sustainable management strategy for mitigating soil erosion and conserving surface water resources, and has important implications for developing restoration plans to promote sustainability in semi-arid ecosystems.

Soil saline-alkali heterogeneity is an important factor driving the spatial expansion of clonal plant in grassland

Soil salinity is well known heterogeneous and various within natural soil environment. In Songnen grassland of Northeast China, grazing aggravates the saline-alkali heterogeneity in soil habitat, which led to dominant clonal plant species forming a variety of adaptive strategies. However, based on the previous studies of morphological plasticity and clonal integration in clonal plants, there was a lack of mechanism research on the spatial expansion strategy of clonal plants population subjected to clipping in saline-alkali heterogeneity soil patches. To address this knowledge gap, we carried out an experiment by applying different clipping intensities (0%, 35%, 70% of the above-ground biomass removed) to explore the spatial expansion strategy and morphological plasticity of Leymus chinensis and their belowground rhizomes in different heterogeneous saline-alkali patches. We found that, clipping significantly decreased the plant average height and above-ground biomass in homogeneous patches, especially heavy clipping had a significant adverse impact on plant belowground (rhizome, fine root) biomass and leaf area. However, there was no significant difference in the biomass, average height, and leaf area among the clipping treatments in low saline-alkali heterogeneous patches. In addition, the number of leaves, daughter plants and rhizome internode buds were significantly affected by saline-alkali heterogeneity alone, and low saline-alkali heterogeneity had a positive effect on these parameters. Biomass accumulation and rhizome expansion were gradually inhibited by the increasing of clipping intensity in a homogeneous environment, but the inhibitory effect of clipping was not significant in saline-alkali patches soil. We concluded that L. chinensis can respond to grazing or mowing disturbance by increasing tiller and daughter-plant numbers in a saline-alkali heterogeneous environment. The saline-alkali patches promoted clonal plant population spatial expansion more than grazing or mowing disturbance did. This study emphasizes saline-alkali heterogeneity distribution patterns in grassland soil environment were the primary and important driving factor promoting the spatial expansion of L. chinensis.

Mechanisms of fire‐maintained plant species diversity in species‐rich wet pine savannas

AbstractTemperate savannas and grasslands maintained by frequent, low‐intensity disturbances such as fire contain among the most species‐rich plant communities in the world. Precisely how these disturbances maintain such high fine‐scale diversity is poorly understood. This study examined the effects of the frequency of simulated fire (clipping combined with litter removal) and the relative importance of recruitment and survival on species diversity and trait and species composition at each of two pine savannas in southeastern Mississippi (USA) that had not been recently burned. Ten 2 × 2 m plots at each site were clipped/cleared annually from 2014 to 2019 and again in spring 2021 (annual frequency). The other 10 clipping plots were not clipped from 2018 to 2020 (reduced frequency). Vegetation in small subplots in annual frequency and reduced frequency plots was compared in August 2021 to test the effects of a short period without clipping on diversity and composition. To test the relative importance of recruitment and survival on diversity and composition, four 0.25 × 0.25 m quarter plots were established within each of 10 annual frequency plots per site following a clipping treatment in fall 2019 and assigned a 2 × 2 factorial arrangement of transplantation of sods from long‐unburned areas and herbicide application. Reducing the frequency of clipping reduced plant diversity and altered composition at both sites. A comparison of diversity and trait composition responses to transplant and herbicide treatments revealed how recruitment and survival combined to affect species diversity. Partial or complete recovery of diversity following clipping and litter removal at both sites was driven by rapid increases in short‐lived, resilient species that show fire‐stimulated emergence from a seed bank and the persistence of long‐lived species capable of surviving the prolonged period without fire or clipping. Species with reduced resilience and persistence were more likely to be lost in the reduced frequency treatment. Results are consistent with a model of short‐term coexistence of maximum species diversity maintained by the most frequent fire regime fuels will permit.

Clinical Treatment and Nursing Intervention Study of Clipping Treatment of Cerebral Aneurysm under the Health Model of Data Analysis.

Middle cerebral artery aneurysm is a common type of intracranial aneurysm in neurosurgery, accounting for about 20% of intracranial aneurysms, and is the third most common site of intracranial aneurysms. The surgical success rate and postoperative recovery ability of today's treatment plans are not satisfactory. Therefore, this paper designs a health model based on data analysis to clinically apply clipping surgery for cerebral aneurysm. This paper studies data analytics health models in the context of big data analytics. The model combines the characteristics of cerebral aneurysms for targeted analysis, and then through the understanding of the clipping treatment of cerebral aneurysms, this paper combines the deep learning in the neural network to train the treatment plan under the data analysis health model. Finally, this paper designs a therapeutic plan for clipping treatment of cerebral aneurysm based on a data analysis health model. To verify its data analysis ability, this paper designs experiments on unbalanced data sets and experiments to improve the execution efficiency of the algorithm. After analyzing the results obtained from the experiment, this paper will apply them to the clinic. The final experiment showed that the surgical success rate of the clipping treatment for cerebral aneurysm based on the data analysis health model was increased by 21.84% compared with the traditional clipping treatment for cerebral aneurysm.

The Sutureless Excimer Laser Anastomosis Clip Pilot Study: a feasibility and safety study

BackgroundThe excimer laser-assisted non-occlusive anastomosis (ELANA) bypass technique may have the advantage of its non-occlusive design in the treatment of last-resort cases where endovascular treatment or direct clipping is considered to be unsafe. However, the technique remains technically challenging. Therefore, a sutureless ELANA Clip device (SEcl) was developed to simplify the technique avoiding tedious anastomosis stitching in depth.The present study investigates the clinical feasibility and safety of the SEcl technique.MethodsThree patients with complex and large aneurysms in the anterior circulation were selected after multidisciplinary consensus that the aneurysms were too complex for endovascular or direct clipping treatment options. Bypass surgery was considered as a last-resort treatment option, and after preoperative evaluation and informed consent, SEcl bypass surgery was performed. Applicability, technical aspects and patient outcomes are assessed.ResultsAll aneurysms were excluded from the circulation. The creation of the intracranial anastomosis was easier and faster. No device-related serious adverse events were encountered, and all outcomes were favorable (one patient stable Modified Rankin Scale, two patients improved).ConclusionThe SEcl anastomosis technique is feasible and, considering the severity of the disease, relatively safe. It can be considered a treatment option in very difficult-to treat last-resort aneurysm cases. From this study, further developments in minimizing clip size and application in cardiac surgery are initiated.

The comparison of neuronavigation combined with CT three-dimensional angiography vs. CT angiography in the guidance of clipping treatment in distal intracranial aneurysm surgery: a retrospective clinical study.

BackgroundDistal intracranial aneurysms are often located deep in the lateral or longitudinal fissure pool or brain parenchyma, lacking a fixed anatomical location. Precise intraoperative localization of distal intracranial aneurysms is a problem that plagues neurosurgeons. Studies have shown that neuronavigation and Computed Tomography (CT) three-dimensional angiography can significantly improve the accuracy of intracranial aneurysm surgery. However, their values in the distal intracranial aneurysm surgery remain unknown. The objective of this study was to explore the application value of neuronavigation combined with CT three-dimensional angiography in distal intracranial aneurysm surgery.Methods112 patients admitted to our hospital for intracranial distal aneurysm surgery were retrospectively collected and divided into an observation group (n=51) and a control group (n=61) according to the surgical method received by the patients. The observation group underwent clipping treatment based on neuronavigation combined with CT three-dimensional angiography, and the control group received clipping treatment under the guidance of CT angiography. Both groups were observed for the accuracy of localization and approach design, duration of surgery, intraoperative bleeding volume, Glasgow Outcome Scale (GOS), National Institute of Health Stroke Scale (NIHSS), length of hospital stay, and complications.ResultsCompared with the control group, the localization accuracy of patients in the observation group was significantly increased (94.12% vs. 78.69%, P=0.020), and the accuracy of approach design was markedly improved (90.20% vs. 72.13%, P=0.017). Furthermore, the length of hospital stay in the observation group was notably reduced compared with the control group (8.12±2.12 vs. 8.99±1.87 d, P=0.023). There was no statistical difference in the NIHSS scores between the two groups before treatment and at 3 days after treatment (P>0.05). However, compared with the control group, the NIHSS score was significantly reduced in the observation group at 28 days after surgery (4.10±2.48 vs. 6.30±3.20, P=0.000). There were no statistically significant postoperative complications in either group (P>0.05).ConclusionsNeuronavigation combined with CT three-dimensional angiography can enhance the accuracy of localization and approach design in intracranial distal aneurysm surgery, improve patient nerve function, and is worth promoting.

Trends and Outcomes of Endovascular Embolization and Surgical Clipping for Ruptured Intracranial Aneurysms: A Propensity-Matched Study of 1332 Patients in the United States

To describe recent trends in treatment and outcomes of endovascular coil embolization and microsurgical clipping treatment strategies for ruptured intracranial aneurysms. Using International Classification of Diseases, Tenth Revision, codes, 1332 propensity-matched patients >18 years old who underwent coiling or clipping were identified. Patient demographics, baseline characteristics, comorbidities, and clinical outcomes were evaluated within 1 year postoperatively. Pooled and individual studies of the International Classification of Diseases codes investigated differences in clinical outcomes owing to aneurysm location. Outcomes were mortality, intensive care, surgical complications, hydrocephalus, and vasospasm. After propensity matching for baseline characteristics and comorbidities, 666 patients were included in the coiling and clipping cohorts. There was no significant difference in 1-year mortality between cohorts. However, incidence of intensive care, surgical/medical complications, and vasospasm was significantly lower in the pooled coiling cohort (P= 0.02, P= 0.03, and P= 0.014) compared with the clipping cohort within 1 year postoperatively. Additionally, individual International Classification of Diseases code analysis revealed that coiling of anterior communicating artery aneurysms was associated with significantly fewer surgical/medical complications and hydrocephalus (P= 0.0008 and P= 0.015) and coiling of posterior communicating artery aneurysms was associated with substantially less vasospasm treatment (P= 0.034) compared with the respective clipping cohorts. Analysis revealed no difference in 1-year mortality between coiling and clipping. Clinical outcomes, including intensive care, surgical complications, and vasospasm, favored coiling regardless of aneurysm location. Patients with coiling of anterior communicating artery aneurysms had significantly less hydrocephalus and patients with coiling of posterior communicating artery aneurysms had substantially less vasospasm treatment within 1 year compared with the clipping cohort.

Predictive Factors of Cerebral Aneurysm Rerupture After Clipping.

BackgroundWe aimed to estimate the risk of rerupture after first-time aneurysmal clipping surgery, explore the possible related factors, and assess long-term physical functionality. We hypothesized that the modified Rankin scale (mRS) could serve as an effective substitute for Hunter and Hess scale.MethodsThis retrospective study included 171 patients with cerebral aneurysmal rupture who had completed aneurysmal clipping treatment and collected their demographic data and medical records. The outcome assessments include neuroimaging records, Hunter and Hess scale, and the mRS scale during hospitalization and follow-up after discharge. The mean length of follow-up was 4.28 years.ResultsAfter aneurysmal clipping treatment, 83 patients (48.5%) had subsequently ruptured aneurysms. The scores of the reruptured group on the Hunt and Hess scale and mRS were significantly higher than those of the non-reruptured group. Multiple Cox proportional-hazards regression also showed that postoperative mRS >2, smoking, and two or more aneurysms were potentially important risk factors leading to aneurysm rupture again [the corresponding hazard ratios (HRs) were 5.209, 2.109, and 2.775, respectively] in patients. In addition, the location of an aneurysm on the anterior cerebral artery (ACA) or the posterior communicating (Pcom) artery had a higher risk of rerupture (the corresponding HRs were 1.996 and 2.934, respectively).ConclusionsNearly half of the collected participants experienced the rerupture episode, who had undergone the second-time clipping surgery. Smoking and multiple aneurysms are potential risk factors for aneurysmal rerupture. Most aneurysms are located along the ICA, but aneurysms located at the ACA or Pcom site are most likely to rerupture. As compared with the Hunter and Hess scale, the mRS scale does not have inferior predicting power in following patients' long-term functionalities.

Endoscopic direct clipping versus indirect clipping for colonic diverticular bleeding: A large multicenter cohort study.

BackgroundDirect and indirect clipping treatments are used worldwide to treat colonic diverticular bleeding (CDB), but their effectiveness has not been examined in multicenter studies with more than 100 cases.ObjectiveWe sought to determine the short‐ and long‐term effectiveness of direct versus indirect clipping for CDB in a nationwide cohort.MethodsWe studied 1041 patients with CDB who underwent direct clipping (n = 360) or indirect clipping (n = 681) at 49 hospitals across Japan (CODE BLUE‐J Study).ResultsMultivariate analysis adjusted for age, sex, and important confounding factors revealed that, compared with indirect clipping, direct clipping was independently associated with reduced risk of early rebleeding (<30 days; adjusted odds ratio [AOR] 0.592, p = 0.002), late rebleeding (<1 year; AOR 0.707, p = 0.018), and blood transfusion requirement (AOR 0.741, p = 0.047). No significant difference in initial hemostasis rates was observed between the two groups. Propensity‐score matching to balance baseline characteristics also showed significant reductions in the early and late rebleeding rates with direct clipping. In subgroup analysis, direct clipping was associated with significantly lower rates of early and late rebleeding and blood transfusion need in cases of stigmata of recent hemorrhage with non‐active bleeding on colonoscopy, right‐sided diverticula, and early colonoscopy, but not with active bleeding on colonoscopy, left‐sided diverticula, or elective colonoscopy.ConclusionsOur large nationwide study highlights the use of direct clipping for CDB treatment whenever possible. Differences in bleeding pattern and colonic location can also be considered when deciding which clipping options to use.