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We report a case of cerebral aneurysm rerupture 24 months after initial bleeding and complete occlusion using a WEB device. A middle-aged patient was transferred at our institution because of a recurrent aneurysmal bleeding. The patient was graded WFNS2 and unenhanced CT showed a modified Fisher grade 3 SAH. DSA showed an increased compaction and an evolutive "proximal recess" of the WEB device associated with a small unprotected part of the aneurysm wall and a bleb pointing towards the haemorrhage. Balloon- and stent-assisted coiling was performed, allowing to completely occlude the recurrence. The patient suffered no neurological deficit neither delayed complication and was discharged at day 16. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, national risk management scenarios took an unexpected course at different individual and collective scales. In France, in the field of occupational risk, long-established practices, rules, and categories have been disturbed and placed 'under stress'. The field of prevention of occupational risk, which has constituted a distinct field in health policies, with its own bodies, missions and approaches, was similarly disturbed. To describe and analyse these social phenomena, we propose using two complementary concepts: the British 'risk work' and the French 'prevention work' ['travail de prévention']. We show some of the empirical manifestations of risk work associated with prevention work and their effects on the boundaries instituted in the field of prevention at work. Our investigation used data from documentation and interviews in order to explore the experiences of two categories of professionals – physicians specialising in occupational health and home care aides – concerned with prevention during an acute phase of the pandemic. We point out that the question of protective means and equipment has been a central issue, in a context characterised by tensions between knowledge and available material resources. We also show that contradictions and points of tension between actors reveal the subjects under discussion and the more or less porous nature of the boundaries. Amid these processes, however, the principles underlying occupational health were reaffirmed, along with the need for a cooperation between workers and prevention professionals. [ABSTRACT FROM AUTHOR]

Introduction: Stent-assisted coiling has widened indications and improved stability of endovascular treatment of intracranial aneurysms. However, stent-assisted coiling is usually not used to treat acutely ruptured intracranial aneurysms to avoid antiplatelet therapy. The objective of this study is to evaluate a strategy of staged endovascular treatment of ruptured intracranial aneurysms including coiling at the acute phase with complementary stenting with or without coiling at the subacute phase. Material and methods: Between 2012 and 2017, we retrospectively identified, in our prospectively maintained database, all patients treated for a ruptured intracranial aneurysm based on this staged stenting strategy. Clinical charts and imaging follow-up were analyzed to assess the procedural safety and feasibility as well as clinical and anatomical outcome. Results: We identified 23 patients with 23 intracranial aneurysms including 15 (65.2%) women with a mean age of 50 years (range 24–69 years). No rebleeding occurred during the mean delay of 24.3 days between initial coiling and stenting. All procedures were successful and additional coiling was performed in 5/23 procedures (21.7%). Clinical status was unchanged in all patients. At follow-up, the modified Rankin scale was graded 0 in 19/23 (82.6%), 1 in 2/23 (8.7%), and 2 in 2/23 (8.7%) patients, respectively. The rate of complete occlusion rose from 30.4% before the stenting procedure to 52.2% immediately after and 72.7% at follow-up. Conclusion: This strategy of early staged stenting in selected patients is safe and improves immediate intracranial aneurysm occlusion and long-term stability in this population at high risk of intracranial aneurysm recurrence with coiling alone. [ABSTRACT FROM AUTHOR]

Purpose: Embolization of arteriovenous malformations (AVMs) before radiosurgery has been reported to negatively impact the obliteration rate. This study aims to assess treatment outcomes in a series of 190 patients treated by Gamma Knife radiosurgery (GKRS) for previously embolized AVMs. Methods: The institutional database of AVMs was retrospectively reviewed between January 2004 and March 2018. The clinical and radiological data of patients treated with GKRS for previously embolized AVMs were analyzed. Predicting factors of obliteration and hemorrhage following GKRS were assessed with univariate and multivariate regression analyses. Results: The mean AVM size was significantly reduced after embolization (p < 0.001). The obliteration rate was 78.4%. Multivariate analyses showed that a lower Spetzler-Martin grade (p = 0.035) and a higher marginal dose (p = 0.007) were associated with obliteration. Post-GKRS hemorrhages occurred in 14 patients (7.4%). A longer time between diagnosis and GKRS was the only factor associated with post-GKRS hemorrhages in multivariate analysis (p = 0.022). Complications related to the combined treatment were responsible for a new permanent neurological disability in 20 patients (10.5%), and a case of death (0.5%). Conclusions: This study shows that the embolization of AVMs does not have a negative impact on the obliteration rate after radiosurgery. Embolization reduces the AVM size to a treatable volume by GKRS. However, the combined treatment results in an increased complication rate related to the addition of the risks of each treatment modality. [ABSTRACT FROM AUTHOR]

Purpose: Wide-neck bifurcation aneurysms remain challenging for the neurointerventionist and/or neurosurgeon despite many recent advances. The pCONus (Phenox, Bochum, Germany) is an emerging device for endovascular neck protection, we report the first long-term results of this device. Methods: We performed a retrospective analysis of all consecutive intracranial wide-neck bifurcation aneurysms treated with the pCONus. Patients' characteristics were reviewed, procedural complications, angiographic (Roy-Raymond scale) and clinical outcomes were documented. Results: Between January 2016 and September 2019, 43 patients (74% female, median age 56 [49–66] years) with 43 wide-neck bifurcation aneurysms (mean width of 6.8 ± 2.1 mm, dome/neck ratio of 1.3 ± 0.2 and neck of 5.2 ± 1.3 mm) were included. A procedural angiographic complication was reported in five patients (12%), no patient presented a post-operative neurological deficit or long-term complication, mortality rate was 0%. At last follow-up (median of 46.5 months [38.3–51.7]), an adequate occlusion (complete and neck remnant) was observed in 37/43 patients (86%) and an aneurysm remnant in 6/43 (14%). Four patients (9%) needed retreatment. No in-stent stenosis or branch occlusion was depicted. Conclusion: pCONus device provides a safe and efficient alternative for endovascular wide-neck bifurcation aneurysms management, with long-term stability. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of the Tigertriever 13 (Rapid Medical, Yoqneam, Israel) stent retriever in acute ischemic stroke (AIS) patients with primary or secondary distal, medium vessel occlusions (DMVO). Methods: We performed a retrospective analysis of all consecutive AIS patients who underwent thrombectomy with the Tigertriever13 for DMVO. Patients' characteristics were reviewed, procedural complications, angiographic (modified thrombolysis in cerebral infarction score [mTICI]) and clinical (modified Rankin Scale [mRS]) outcomes were documented. Results: Between November 2019 and November 2020, 16 patients with 17 DMVO were included (40% female, median age 60 [50–65] years). The Tigertriever13 was used in 11/17 (65%, median NIHSS of 8 [6–15]) primary DMVO and in 6/17 (35%, median NIHSS of 20 [13–24]) cases of secondary DMVO after a proximal thrombectomy. The successful reperfusion rate (mTICI 2b, 2c, 3) was 94% (16/17) for the dedicated vessel. At day 1, CT imaging showed a subarachnoid hemorrhage in 29% of the cases and a parenchymal hematoma in 12%. At 3 months, 65% of the patients (11/17) had a favorable outcome (mRS 0–2). Conclusion: Mechanical thrombectomy using the Tigertriever13 appears to be safe and effective for DMVO. Clinical and anatomical results are in line with those of patients with proximal occlusions. [ABSTRACT FROM AUTHOR]

Purpose: Endovascular treatment of unruptured intracranial aneurysms with stent-assisted coiling or flow diverter stents requires a prophylactic antiplatelet premedication to avoid thrombo-embolic complications. Guidelines for optimal antiplatelet regimens are poorly defined. The aim of this study is to report our experience using a high dosage antiplatelet premedication regimen for patients with unruptured intracranial aneurysms undergoing endovascular treatment by stent-assisted coiling or flow diverter stents. Methods: From a retrospective analysis of a prospectively maintained database, we collected clinical and angiographic data of 400 procedures in 362 patients treated by stent-assisted coiling or flow diverter stents for 419 unruptured intracranial aneurysms. Descriptive and analytic statistics were performed to report morbidity, mortality, and complication rates and to demonstrate associations between variables and outcomes. Logistic multivariable regression was performed to rule out confounding factors between subgroups. Results: Thrombo-embolic complications occurred in 23/400 procedures (5.75%) and hemorrhagic complications in 19/400 procedures (4.75%). The majority of complications were minor and transient with overall procedure-related morbidity and mortality rates of 1.75% (n = 7/400) and 1.25% (n = 5/400) respectively. The co-existence of multiple cardiovascular risk factors among smoking, hypertension, dyslipidemia, and age > 65 years old was significantly associated with permanent procedure-related morbidity (p = 0.006) and thrombo-embolic complications occurrence (p = 0.034). Age alone was associated with higher permanent morbidity (p = 0.029) and was the only variable associated with higher hemorrhagic complication (p = 0.024). Conclusion: In this study, the use of a high dosage antiplatelet premedication was safe and effective for the treatment of unruptured intracranial aneurysms with stent-assisted coiling or flow diverter stents. Mortality and morbidity rates compare favorably with the current literature. The thrombo-embolic complications rate is low and most of them were clinically silent. However, the hemorrhagic complications rate was substantial and a significant proportion of them were associated with mortality. [ABSTRACT FROM AUTHOR]

Good clinical outcome predictors have been emphasized in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) with large vessel occlusion. MT for distal, medium vessel occlusions (DMVO) is still debated. We sought to assess the factors associated with clinical outcome after MT for DMVO. We retrospectively analyzed the data of consecutive patients who underwent MT for a primary DMVO in 1 large academic center and aimed to identify the baseline clinical, imaging, and MT factors associated with good clinical outcome (defined as modified Rankin scale score of 0–2) at 3 months. Between January 2018 and January 2021, 61 patients underwent a MT for an AIS with a primary DMVO. Overall, good clinical outcome was achieved in 56% (34 of 61) of our patients. In multivariate analysis, an older age (odds ratio [OR] 0.89 [95% confidence interval 0.83–0.96], P = 0.003), longer puncture to recanalization time (OR 0.97 [0.93–0.99], P = 0.033), and higher baseline core volume (OR 0.84 [0.75–0.94], P = 0.003) decreased the probability of good clinical outcomes, while a final complete (or near-) recanalization (modified Thrombolysis In Cerebral Infarction [mTICI] score 2c–3) increased the probability of good outcome (OR 14.19 [1.99–101.4], P = 0.008). An older age, a longer puncture to recanalization time, and a higher baseline core volume decreased the probability of good clinical outcomes, while successful recanalization (mTICI 2c–3) was associated with better outcomes after MT for DMVO. [ABSTRACT FROM AUTHOR]

Paratuberculosis (PTB) is a disease caused by Mycobacterium avium subspecies paratuberculosis (MAP), which affects a broad range of hosts, including domestic and wild animals. PTB is a chronic granulomatous enteritis and lymphadenitis that compromises animal welfare and causes economic losses. The objective of this study was to evaluate the effect of a commercial heat-inactivated MAP vaccine on lesions and immunopathology developed in the target tissues of goats naturally infected with MAP. Lesions compatible with PTB in the intestine and regional lymph nodes (LNs), as well as local immune response to MAP, were evaluated and compared in Gudair®-vaccinated (n = 14) and unvaccinated (n = 11) goats from a MAP-infected farm. The percentage of animals with multifocal granulomatous lesions in the jejunal (p = 0.05) and ileocecal (p = 0.02) LNs was higher in unvaccinated animals, while a lesion score reduction of 50% was found in the LNs of vaccinated animals. Unvaccinated animals showed increased numbers and wider distribution of macrophages (MΦs, CD68 +) in histiocytic infiltrate (p = 0.0003), associated with increased numbers of mycobacteria. Increased inducible nitric oxide synthase (iNOS) expression was also reported in these animals, while M2 MΦs (CD163 +) were scarce in both groups. Vaccinated animals showed an increase in CD3 + lymphocytes, although differences in interferon gamma (IFNγ) were negligible. These results support the hypothesis that heat-inactivated MAP vaccination could reduce the severity of PTB lesions and mycobacterial load in target tissues in vaccinated adult goats. • Approach to the immunopathology associated with MAP-vaccination in goats. • Heat-inactivated MAP vaccination reduces the number and severity of the granulomas. • More intense MAP histiocytic infiltrate in non-vaccinated goats. • More lymphoplasmacytic intestinal infiltrate and IFNγ expression in vaccinated goats. [ABSTRACT FROM AUTHOR]

One promising candidate for the first detection of nuclear excitation in plasma is the 463-keV, 20.26-min-lifetime isomeric state in 84Rb, which can be excited via a 3.5-keV transition to a higher lying state. According to our preliminary calculations, under specific plasma conditions, nuclear excitation by electron transition (NEET) may be its strongest excitation process. Evaluating a reliable NEET rate requires, in particular, a thorough examination of all atomic transitions contributing to the rate under plasma conditions. We report the results of a detailed evaluation of the NEET rate based on multiconfiguration Dirac Fock (MCDF) atomic calculations, in a rubidium plasma at local thermodynamic equilibrium with a temperature of 400 eV and a density of 10-2 g/cm³ and based on a more precise energy measurement of the nuclear transition involved in the excitation. [ABSTRACT FROM AUTHOR]

Photoactivation yield measurements on 115In have been performed at the ELSA facility with Bremsstrahlung photon beams over a range of endpoint energies between 4.5 and 18 MeV. The measured photoexcitation yields of the 115Inm metastable state are compared with calculated yields using cross sections obtained with different models of the photon strength function. It is shown that additional photon strength with respect to the general Lorentzian model is needed at 8.1 MeV for the calculated yields to reproduce the data. The origin of this extra strength is unclear, because it is compatible with additional strength predicted in both E1 and M1 photon strength distributions by quasiparticle random-phase approximation calculations using the Gogny D1S force. [ABSTRACT FROM AUTHOR]