Application of the Pipeline Embolization Device for Giant Vertebrobasilar Dissecting Aneurysms in Pediatric Patients

Objective: To evaluate the feasibility and effectiveness of the pipeline embolization device (PED) for the treatment of pediatric giant vertebrobasilar dissecting aneurysms (VBDAs).Methods: We retrospectively reviewed our institutional clinical database and identified 2,706 patients who presented with a diagnosis of intracranial aneurysms from January 2016 to June 2018. Among this group, 153 patients were diagnosed with VBDAs, and 54 of these patients underwent PED therapy. The PED technique was used in four patients who were 18 years old or younger at the time of presentation (two males, two females; mean age 9.25 years; age range 8–11 years).Results: All four included pediatric patients were managed with the PED. One patient (25%) was treated with the PED alone, while three (75%) were treated with the PED and coils. One patient died from brainstem infarction or compression of the brainstem, while follow-up of the other three patients revealed favorable outcomes. The mass effect was reduced in cases 1, 2, and 3 on follow-up MRI performed 6 months after the PED procedure.Conclusions: PEDs could be feasible in the treatment of pediatric giant VBDAs. However, the safety and efficacy of this method have not been clarified in this special pediatric population, and long-term follow-up is still necessary

Tracking transient boreal wetland inundation with Sentinel-1 SAR: Peace-Athabasca Delta, Alberta and Yukon Flats, Alaska

Accurate and frequent mapping of transient wetland inundation in the boreal region is critical for monitoring the ecological and societal functions of wetlands. Satellite Synthetic Aperture Radar (SAR) has long been used to map wetlands due to its sensitivity to surface inundation and ability to penetrate clouds, darkness, and certain vegetation canopies. Here, we track boreal wetland inundation by developing a two-step modified decision-tree algorithm implemented in Google Earth Engine using Sentinel-1 C-band SAR and Sentinel-2 Multispectral Instrument (MSI) time-series data as inputs. This approach incorporates temporal as well as spatial characteristics of SAR backscatter and is evaluated for the Peace-Athabasca Delta, Alberta (PAD), and Yukon Flats, Alaska (YF) from May 2017 to October 2019. Within these two boreal study areas, we map spatiotemporal patterns in wetland inundation classes of Open Water (OW), Floating Plants (FP), Emergent Plants (EP), and Flooded Vegetation (FV). Temporal variability, frequency, and maximum extents of transient wetland inundation are quantified. Retrieved inundation estimates are compared with in-situ field mapping obtained during the NASA Arctic-Boreal Vulnerability Experiment (ABoVE), and a multi-temporal Landsat-derived surface water map. Over the 2017–2019 study period, we find that fractional inundation area ranged from 18.0% to 19.0% in the PAD, and from 10.7% to 12.1% in the YF. Transient wetland inundation covered ~595 km2 of the PAD, comprising ~9.1% of its landscape, and ~102 km2 of the YF, comprising ~3.6%. The implications of these findings for wetland function monitoring, and estimating landscape-scale methane emissions are discussed, together with limitations and uncertainties of our approach. We conclude that time series of Sentinel-1 C-band SAR backscatter, screened with Sentinel-2 MSI optical imagery and validated by field measurements, offer a valuable tool for tracking transient boreal wetland inundation

China Intracranial Aneurysm Project (CIAP): protocol for a registry study on a multidimensional prediction model for rupture risk of unruptured intracranial aneurysms

Abstract Background Ruptured aneurysms, the commonest cause of nontraumatic subarachnoid hemorrhage, can be catastrophic; the mortality and morbidity of affected patients being very high. Some risk factors, such as smoking, hypertension and female sex have been identified, whereas others, such as hemodynamics, imaging, and genomics, remain unclear. Currently, no accurate model that includes all factors for predicting such rupture is available. We plan to use data from a large cohort of Chinese individuals to set up a multidimensional model for predicting risk of rupture of unruptured intracranial aneurysms (UIAs). Methods The China Intracranial Aneurysm Project-2 (CIAP-2) will comprise screening of a cohort of 500 patients with UIA (From CIAP-1) and focus on hemodynamic factors, high resolution magnetic resonance imaging (HRMRI) findings, genetic factors, and biomarkers. Possible risk factors for rupture of UIA, including genetic factors, biomarkers, HRMRI, and hemodynamic factors, will be analyzed. The first project of the China Intracranial Aneurysm Project (CIAP-1; chaired by the Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China) will prospectively collect a cohort of 5000 patients with UIA from 20 centers in China, and collect baseline information for each patient. Multidimensional data will be acquired in follow-up assessments. Statistically significant clinical features in the UIA cohort will also be analyzed and integrated into the model for predicting risk of UIA rupture. After the model has been set up, the resultant evidence-based prediction will provide a preliminary theoretical basis for treating aneurysms at high risk of rupture. Discussion This study will explore the risk of rupture of aneurysms and develop a scientific multidimensional model for predicting rupture of unruptured intracranial aneurysms. Clinical Trials registration A Study on a Multidimensional Prediction Model for Rupture Risk of Unruptured Intracranial Aneurysms (CIAP-2), NCT03133624. Registered: 16 April 2017. https://clinicaltrials.gov/ct2/show/NCT0313362