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Abstract Background Patient satisfaction is a powerful predictor of an individual's mental health, according to previous research. However, there has not been a thorough study on the relationship between depression and overall medical service satisfaction (OMSS) in middle-aged and older adults. Moreover, little is known about how different Internet-using patterns affect this relationship. Methods We selected 4,523 participants from the China Family Panel Studies (CFPS) 2020 dataset who were aged 45 and older. The relationship between OMSS and depression was examined using logistic regression analysis, distinct Internet-using patterns were investigated using latent class analysis, and the moderating effects of these patterns were examined using SPSS PROCESS macro analysis. Results The results showed OMSS was negatively related to depression in middle-aged and older adults (β = -0.181, p

This study analyzed the factors influencing childcare preference and the relationship between childcare preference and childcare service demand scale, using data collected from a questionnaire survey of 3,921 parents of infants and toddlers in Chongqing, China. The results indicate that parents with higher incomes, higher education levels, older ages, multiple infants, and dual-career living in urban areas have a stronger preference for childcare. In the shared or grandparent care model, the childcare preference is not obvious. Parents of infants tend to choose childcare institutions that provide reception services, early education, and convenience services. Higher quality environmental facilities tend to reduce the preference of parents for childcare.

Abnormal origins of the vertebral artery with supra-aortic vessel variants are exceedingly uncommon. Herein, we present two cases of the vertebral artery originating from the right common carotid artery associated with the right subclavian artery arising separately as the initial branch of the aortic arch, followed by the right common carotid artery. We reviewed the embryology of the anomalous origins of the vertebral and subclavian arteries. These variants can significantly affect surgical planning and cause severe clinical symptoms.

BackgroundBlood blister aneurysm (BBA) is a complex and rare aneurysm that presents significant treatment challenges. The application of pipeline embolization device (PED)-assisted coiling in the treatment of ruptured BBA remains controversial. This study aimed to report on our experience and assess the safety and efficacy of this strategy.MethodsBetween February 2019 and February 2021, 12 patients with ruptured BBAs underwent PED-assisted coil embolization. We collected detailed data about each patient, including demographic information, aneurysmal data, technical details, antiplatelet strategy, operation-related complications, and follow-up outcomes.ResultsA total of 12 BBA patients were treated with single PED-assisted coil embolization. One patient experienced intraoperative rupture that was controlled by rapid coiling without clinical consequences. All the patients demonstrated complete occlusion on postoperative angiography. A total of three patients had postoperative complications: left hemiparesis, Broca's aphasia, and right hemiplegia due to vasospasm, and transient hemiparesis. Follow-up angiography revealed that all BBAs were completely occluded, except one with neck residue. All patients had favorable outcomes at discharge and the most recent clinical follow-up (mRS score ≤ 2).ConclusionEndovascular treatment of BBAs of the internal carotid artery using PED-assisted coil embolization is a safe and effective strategy. This has contributed to the understanding of BBA therapy and provides a potentially optimal treatment option for this intractable lesion.

Intracranial xanthoma is a rare benign intracranial tumor. It often occurs in patients with hyperlipidemia. Intracranial xanthomas grow slowly, and clinical symptoms only appear when the mass compresses the surrounding tissues, so early diagnosis of the disease is difficult.

BackgroundIt is hard to distinguish cerebral aneurysms from overlapping vessels in 2D digital subtraction angiography (DSA) images due to these images’ lack of spatial information. ObjectiveThe aims of this study were to (1) construct a deep learning diagnostic system to improve the ability to detect posterior communicating artery aneurysms on 2D DSA images and (2) validate the efficiency of the deep learning diagnostic system in 2D DSA aneurysm detection. MethodsWe proposed a 2-stage detection system. First, we established the region localization stage to automatically locate specific detection regions of raw 2D DSA sequences. Second, in the intracranial aneurysm detection stage, we constructed a bi-input+RetinaNet+convolutional long short-term memory (C-LSTM) framework to compare its performance for aneurysm detection with that of 3 existing frameworks. Each of the frameworks had a 5-fold cross-validation scheme. The receiver operating characteristic curve, the area under the curve (AUC) value, mean average precision, sensitivity, specificity, and accuracy were used to assess the abilities of different frameworks. ResultsA total of 255 patients with posterior communicating artery aneurysms and 20 patients without aneurysms were included in this study. The best AUC values of the RetinaNet, RetinaNet+C-LSTM, bi-input+RetinaNet, and bi-input+RetinaNet+C-LSTM frameworks were 0.95, 0.96, 0.92, and 0.97, respectively. The mean sensitivities of the RetinaNet, RetinaNet+C-LSTM, bi-input+RetinaNet, and bi-input+RetinaNet+C-LSTM frameworks and human experts were 89% (range 67.02%-98.43%), 88% (range 65.76%-98.06%), 87% (range 64.53%-97.66%), 89% (range 67.02%-98.43%), and 90% (range 68.30%-98.77%), respectively. The mean specificities of the RetinaNet, RetinaNet+C-LSTM, bi-input+RetinaNet, and bi-input+RetinaNet+C-LSTM frameworks and human experts were 80% (range 56.34%-94.27%), 89% (range 67.02%-98.43%), 86% (range 63.31%-97.24%), 93% (range 72.30%-99.56%), and 90% (range 68.30%-98.77%), respectively. The mean accuracies of the RetinaNet, RetinaNet+C-LSTM, bi-input+RetinaNet, and bi-input+RetinaNet+C-LSTM frameworks and human experts were 84.50% (range 69.57%-93.97%), 88.50% (range 74.44%-96.39%), 86.50% (range 71.97%-95.22%), 91% (range 77.63%-97.72%), and 90% (range 76.34%-97.21%), respectively. ConclusionsAccording to our results, more spatial and temporal information can help improve the performance of the frameworks. Therefore, the bi-input+RetinaNet+C-LSTM framework had the best performance when compared to that of the other frameworks. Our study demonstrates that our system can assist physicians in detecting intracranial aneurysms on 2D DSA images.

Abstract Background An intracranial aneurysm is a cerebrovascular disorder that can result in various diseases. Clinically, diagnosis of an intracranial aneurysm utilizes digital subtraction angiography (DSA) modality as gold standard. The existing automatic computer-aided diagnosis (CAD) research studies with DSA modality were based on classical digital image processing (DIP) methods. However, the classical feature extraction methods were badly hampered by complex vascular distribution, and the sliding window methods were time-consuming during searching and feature extraction. Therefore, developing an accurate and efficient CAD method to detect intracranial aneurysms on DSA images is a meaningful task. Methods In this study, we proposed a two-stage convolutional neural network (CNN) architecture to automatically detect intracranial aneurysms on 2D-DSA images. In region localization stage (RLS), our detection system can locate a specific region to reduce the interference of the other regions. Then, in aneurysm detection stage (ADS), the detector could combine the information of frontal and lateral angiographic view to identify intracranial aneurysms, with a false-positive suppression algorithm. Results Our study was experimented on posterior communicating artery (PCoA) region of internal carotid artery (ICA). The data set contained 241 subjects for model training, and 40 prospectively collected subjects for testing. Compared with the classical DIP method which had an accuracy of 62.5% and an area under curve (AUC) of 0.69, the proposed architecture could achieve accuracy of 93.5% and the AUC of 0.942. In addition, the detection time cost of our method was about 0.569 s, which was one hundred times faster than the classical DIP method of 62.546 s. Conclusion The results illustrated that our proposed two-stage CNN-based architecture was more accurate and faster compared with the existing research studies of classical DIP methods. Overall, our study is a demonstration that it is feasible to assist physicians to detect intracranial aneurysm on DSA images using CNN.

Objective: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality rates. Although research on BBAs is well documented in different populations, the study of BBAs in the Tibetan population is extremely rare. This study aimed to evaluate the characteristics of BBAs and analyze the treatment modalities and long-term outcomes in the Tibetan population in comparison with the Han population. Methods: The characteristics of patients with BBAs of the ICA from January 2009 to January 2021 at our institution were reviewed. The features of aneurysms, treatment modalities, complications, and follow-up outcomes were retrospectively analyzed. Results: A total of 130 patients (41 Tibetan and 89 Han patients) with BBAs of the ICA who underwent treatment were enrolled. Compared with the Han group, the Tibetan group significantly demonstrated a high ratio of BBAs among ICAs (8.6%, 41/477 vs. 1.6%, 89/5563; p<0.05), a high ratio of vasospasm (34.1%, 14/41 vs. 6.7%, 6/89; p=0.001), a high risk of ischemic events (43.9%, 18/41 vs. 22.5%, 20/89; p<0.05), and a low ratio of good outcomes (modified Rankin scale, 0-2) at the 1-year follow-up (51.2%, 21/41 vs. 74.2%, 66/89; p<0.05). The multivariate regression model showed that ischemic events significantly contributed to the prediction of outcomes at 1 year. Further analysis revealed that microsurgery and vasospasm were associated with ischemic events. Conclusion: In comparison with Han patients, the Tibetan population had a high ratio of BBA occurrence, a high incidence of ischemic events, and a high ratio of poor outcomes. The endovascular approach showed more benefits in BBA patients. [ABSTRACT FROM AUTHOR]