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Background: True posterior communicating artery (PcomA) aneurysms are rare compared to those at the junction of the internal carotid artery (ICA) and PcomA. They account for a small subset of unruptured intracranial aneurysms, yet approximately 20 % present with ophthalmoplegia, significantly impairing quality of life. While direct third nerve compression was considered the primary cause of symptoms, evidence suggests that restricted blood flow can alleviate symptoms. Flow-diverter (FD) stents, while effective for complex aneurysms, are scarcely reported for symptomatic, unruptured true PcomA aneurysms. Methods: A retrospective study (March 2015–December 2023) included patients with unruptured, saccular true PcomA aneurysms presenting with ophthalmoplegia. Data on demographics, aneurysm characteristics, interventions, clinical outcomes, and occlusion were analyzed. Results: Endovascular treatment involved loose coiling with an FD in 9 patients (60 %) and FD alone in 6 patients (40 %). All procedures were successful, with no complications. Angiographic follow-up showed total occlusion in 13 out of 15 aneurysms (87 %). At six months, 60 % of patients had complete resolution of ophthalmoparesis, and 40 % showed partial improvement. By 12 months, 73.3 % had complete symptom resolution, and 26.7 % exhibited partial improvement. Conclusion: FD stents, used alone or with coiling, are promising for treating symptomatic, unruptured true PcomA aneurysms, showing high occlusion rates, safety, and symptom relief. Despite the study’s retrospective design and small cohort, findings highlight the potential of this approach, warranting larger multicenter studies.

IntroductionIn the past decade, flow diverters (FDs) have increasingly been used to treat cerebral aneurysms with unfavorable morphology in which other endovascular techniques fall short of being as effective. In-stent stenosis (ISS) is one of the most puzzling and frequent risks of flow diversion therapy observed on follow-ups. This complication, although mostly placid in its clinical course, can have dire consequences if patients become symptomatic. ISS is associated with many factors, none of which have been demonstrated to date to be solely responsible for the phenomenon.MethodsThis study was aimed at evaluating ISS incidence in patients in our clinic who were treated with flow-diverters for aneurysms, located on the supraclinoid segments of the internal carotid artery between September 2022 and May 2023. A retrospective analysis was conducted, which included 137 patients with a total of 142 aneurysms being treated. The main hypothesis was that oversizing of the implant might play a role in ISS development. The performed statistical analysis, aimed at finding a correlation between it and vessel lumen narrowing on the follow-ups. The effects of other known risk factors, such as sex, age, smoking, and hypertension, were also analyzed.ResultsStent oversizing with respect to the parent artery was positively correlated with subsequent ISS occurrence and severity. Older age was a protective factor against ISS. Patients who actively smoked had diminished risk of developing severe ISS.DiscussionStent oversizing can lead to ISS development, which might be more pronounced with larger implant-to-vessel sizing discrepancies. To achieve optimal results, the choice of implant diameter should consider all segments of the vessel in which it will be implanted. In cases of severe symptomatic ISS, continuation of dual anti-platelet therapy is a reasonable and effective option to address this complication.

Background. There are an increasing number of children and adolescents with reduced age-related rate of bone mass accumulation, low bone mineral density (BMD) and low-energy fractures. This problem is widely discussed in the scientific literature. Purpose of the study was to assess the BMD in children and adolescents with low-energy fractures of long bones and to investigate some biochemical parameters of bone metabolism. Materials and methods. Body mass index (BMI), bone densitometry, levels of vitamin D, calcium, phosphorus and alkaline phosphatase in blood serum of 230 children and adolescents with low-energy fractures of long bones, aged 6 to 17 years, who underwent treatment due to the fractures were studied. Results. Fractures occurred predominantly in 41.3 % of the humerus and 43 % of the forearm bones. 20 % of children and adolescents had abnormal BMI values. Low BMD values in 86 of 230 examinees were detected in the lumbar spine, of which only 66 (76.7 %) had BMD abnormalities in the hip. In assessing vitamin D status, 19.3 % of the girls and 9.2 % of the boys had normal vitamin D values. A decrease in calcium level and an increase in alkaline phosphatase in blood serum were found. In terms of BMD and vitamin D status, the dependence of boys was statistically significant in the elementary and high school groups, while in girls it was only in the elementary school group. A direct link between low BMD and vitamin D has been established. Conclusions. Low BMD, vitamin D, impaired calcium-phosphorus metabolism and obesity in children and adolescents may be considered predictors of fracture occurrence.

Introduction: In the past decade, flow diverters (FDs) have increasingly been used to treat cerebral aneurysms with unfavorable morphology in which other endovascular techniques fall short of being as effective. In-stent stenosis (ISS) is one of the most puzzling and frequent risks of flow diversion therapy observed on follow-ups. This complication, although mostly placid in its clinical course, can have dire consequences if patients become symptomatic. ISS is associated with many factors, none of which have been demonstrated to date to be solely responsible for the phenomenon. Methods: This study was aimed at evaluating ISS incidence in patients in our clinic who were treated with flow-diverters for aneurysms, located on the supraclinoid segments of the internal carotid artery between September 2022 and May 2023. A retrospective analysis was conducted, which included 137 patients with a total of 142 aneurysms being treated. The main hypothesis was that oversizing of the implant might play a role in ISS development. The performed statistical analysis, aimed at finding a correlation between it and vessel lumen narrowing on the follow-ups. The effects of other known risk factors, such as sex, age, smoking, and hypertension, were also analyzed. Results: Stent oversizing with respect to the parent artery was positively correlated with subsequent ISS occurrence and severity. Older age was a protective factor against ISS. Patients who actively smoked had diminished risk of developing severe ISS. Discussion: Stent oversizing can lead to ISS development, which might be more pronounced with larger implant-to-vessel sizing discrepancies. To achieve optimal results, the choice of implant diameter should consider all segments of the vessel in which it will be implanted. In cases of severe symptomatic ISS, continuation of dual anti-platelet therapy is a reasonable and effective option to address this complication. [ABSTRACT FROM AUTHOR]

Abstract Background Many with an acute depressive disorder go on to develop chronic depression, despite ongoing care. There are few specifically designed interventions to treat chronic depression. DIALOG+, a technology-assisted intervention based on the principles of solution-focused therapy, may be beneficial. It has been shown to be effective as a treatment for patients with psychotic disorders, especially in regards to increasing quality of life. DIALOG+ was designed to be flexibly applied and not diagnosis-specific, aiming to structure communication and generate a personally-tailored care plan. This cluster randomised controlled trial (RCT) is part of a programme of research to adapt and test DIALOG+ for patients with chronic depression. Methods Patients will be eligible for the trial, if they have exhibited symptoms of depression or non-psychotic low mood for at least 2 years, have regular contact with a clinician and have a low subjective quality of life and moderate depressive symptoms. Clinicians, who routinely see eligible patients, will be recruited from a number of sites across NHS England. Clusters will have between 1 and 6 patients per clinician and will be randomised in a 1:1 ratio to either the intervention (DIALOG+) or active control group (treatment as usual + DIALOG scale). Clinicians in the intervention group are trained and asked to deliver the intervention regularly for 12 months. Active control participants receive treatment as usual and are asked to rate their satisfaction with areas of life and treatment on the DIALOG scale at the end of the clinical session. Approximately 112 clinician clusters will be recruited to reach a total patient sample size of 376. Clinical and social outcomes including costs are assessed at baseline and 3, 6 and 12 months post randomisation. The primary outcome will be subjective quality of life at 12 months. Discussion This definitive multi-site, cluster RCT aims to evaluate the clinical- and cost-effectiveness of DIALOG+ for people with chronic depression. If shown to be effective for this patient population it could be used to improve outcomes of mental health care on a larger scale, ensuring that patients with complex and co-morbid diagnoses can benefit. Trial registration ISRCTN11301686 . Registered on 13 Jun 2019.

The bryophyte genus Ulota has its main diversification area in Patagonia, with 18 currently accepted species, all of which are endemic to the area. Despite this richness, ongoing studies indicate the existence of hitherto unknown species in this territory. However, the strong resemblance between species often complicates the discrimination of new taxa, making the use of integrative taxonomy approaches compulsory. During surveys conducted in past decades, a morphotype of a Ulota , closely resembling Ulota macrodontia , was discovered coexisting with this species. Ulota macrodontia is characterized by unique peristomial features within the genus, and the variant morphotype shares these characteristics while displaying some distinct gametophytic and sporophytic features. Biometric analyses demonstrate that the differences are stable, and without intermediate states. The results obtained from the analyses of one nuclear and four plastid loci reveal a close relationship between both morphotypes, with the samples of U. macrodontia forming a well-supported monophyletic group. We propose to treat the new morphotype at species level (Ulota brachypoda sp. nov.), discussing why this is the most appropriate taxonomic rank, and we provide a detailed and illustrated description. Additionally, a distribution map of the two endemics is included. [ABSTRACT FROM AUTHOR]

Abstract Background Treating chronic depression represents a significant burden for the NHS, yet there is a lack of evidence-based interventions and research specifically focused on this condition. DIALOG+, a technology-assisted and resource-oriented intervention found effective for people with psychosis, may improve care for this service user group. The aim of this study was to explore the acceptability and relevance of DIALOG+ for the treatment of chronic depression in community-based settings. Methods A convenience sample of 16 mental health professionals and 29 service users with chronic depression tested the DIALOG+ intervention in routine community care appointments for 3 months across 3 different mental health NHS Trusts in England. Of these, 15 clinicians and 19 service users were individually interviewed about their experiences. Interview transcripts were analysed using thematic analysis by an analytic team which included a service user researcher. Results Analysis of the combined dataset identified five overarching themes: DIALOG+ Structure; Therapeutic Communication; Reflecting and Monitoring; Empowerment and Powerlessness; and The Impact of Technology. Overall, service users and clinicians were interested in the continued use of DIALOG+ as part of routine care. Conclusions DIALOG+ was viewed as acceptable by both service users with chronic depression and their clinicians who work in community care settings, albeit with some caveats. Clinician training required significant improvements to address the issues that were referenced, most notably around support with using technology.

BackgroundThe primary goal of conventional endovascular and microvascular approaches is the clinical and radiological resolution of the symptomatic aneurysm-induced mass effect. This study assessed the volume changes and mass effect reduction due to sac shrinkage after treatment with flow diverter stents (FD) for unruptured cerebral aneurysms.MethodsWe analyzed retrospectively 36 symptomatic aneurysms that were larger or equal to 25 mm in diameter in patients treated at our center from January 2016 to April 2022. Radiological and clinical outcomes were analyzed, including aneurysmal volume changes and resolution of aneurysm-related symptoms.ResultsAt 6 months, 25 aneurysms decreased in size, 2 remained unchanged, and 9 aneurysms demonstrated a post-treatment dimensional increase. At 12 months, 30 aneurysms showed a progressive radiological volume reduction. Either no change or negligible shrinkage was observed in the remaining six aneurysms. At 24 months, 32 aneurysms showed aneurysmal shrinkage by a mean 47% volume loss with respect to baseline. At the last follow-up, all 13 patients who had presented with third cranial nerve palsy showed improvements. Complete reversal of the pretreatment edematous changes was confirmed in all cases. The overall post-treatment complication rate was 8.3%, as 3 patients experienced non-fatal delayed rupture of their aneurysm. There was no mortality in this study.ConclusionFlow diversion could effectively induce progressive aneurysmal shrinkage and resolution of the mass effect associated with giant symptomatic cerebral aneurysms.

Thought to be benign anatomical variants, cerebral infundibular dilatations (ID) are most commonly encountered at the junction of the internal carotid artery (ICA) and the posterior communicating artery (PcomA). The true nature of this entity remains controversial, as some literature reports suggest they should be considered preaneurysmal lesions and a potential source of devastating subarachnoid hemorrhage. This report describes cases of presumably ruptured IDs and their therapeutic endovascular management. We retrospectively reviewed and analyzed patients with isolated subarachnoid hemorrhage (SAH) where the only potential cause was ruptured cerebral IDs, treated or not, between January 2012 and June 2021. Morphological and radiological features, treatment and procedural considerations, clinical and angiographic outcomes were also reviewed. Natural history of the ID is poorly understood, and its relation to SAH remains controversial. Ruptured cerebral IDs can be the suspected cause of bleeding if no other vascular lesion is present during multimodal examinations. Endovascular flow diversion stenting is safe and effective for the proper treatment of ruptured IDs. Pending further validations with longitudinal data are needed to legitimate the natural course of these mysterious lesions.

Introduction: Cerebral arterio-venous malformations (AVMs) are an enigmatic pathological entity in both their etiopathogenesis and natural history. Sporadic vascular malformations need to be differentiated from familial and genetic conditions, linked with similar or resembling radiological features. Brain vascular syndromes have a wide variety of presenting symptoms, not always linked with the observation of typical arterio-venous malformations. Purpose: In our review paper, we summarized the basic features of some of the more common brain vascular syndromes, including vascular malformations, hypervascular tumors and steno-occlusive conditions, which may present either clinically or radiologically in a similar manner to one another. We aim to increase the vigilance of treating physicians in such cases, as to adequately diagnose and manage patients presenting with said syndromes. Even though some of them are similar, differences in their progression and treatment options are of great importance in the long term. Methods: We conducted a literature review and summarized our findings in the paper, regarding brain vascular syndromes. We included some of the most common radiological findings, as to better differentiate between each pathological entity. Conclusions: Cerebral vascular syndromes are a highly heterogenic group of pathologies, which need to be properly diagnosed in order to choose a correct form of treatment. Due to the difference in the natural history of each syndrome, both conservative and invasive medical approaches may be chosen as a course of action. Involvement of other systems and organs also needs to be taken into account. A wide differential diagnosis and familial screening are a key point in patient management. [ABSTRACT FROM AUTHOR]

Introduction: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic condition, which is diagnosed based on strict criteria. The main symptoms include recurrent epistaxis episodes, multiple mucocutaneus telangiectasia, the presence of organ arteriovenous malformations (AVMs) and a family history of the disease. Up to 98% of patients present with epistaxis episodes, some of which could potentially be life threatening. Different approaches have been used in historical perspective to gain control over the site of bleeding, with hemodynamically unstable patients requiring urgent medical supportive care. Endovascular therapy is a still relatively unexplored treatment option for such cases. Purpose: To establish the safety and efficacy of endovascular embolization as a treatment option of malignant refractory epistaxis in patients with HHT. Materials and methods: We present a case series of endovascular embolizations of the maxillary artery and/or its branches, supplying bleeding lesions in patients, refractory to other conventional means of treatment. Between the period of February 2022 and March 2024, nine patients with HHT underwent such an endovascular procedure. Results: Satisfactory results were achieved in all cases, with no added neurological complications being observed. Only one of the patients had a recurrence of the condition and required an additional embolization procedure. Conclusion: Endovascular embolization of the maxillary artery and its branches for malignant recurrent epistaxis in patients with HHT is a safe and effective way to control the site of bleeding. [ABSTRACT FROM AUTHOR]