Clipping and coiling of intracranial aneurysms in the elderly patients: clinical features and treatment outcomes

ObjectiveIn recent years, more and more cases of intracranial aneurysms (IAs) have been found in elderly patients, and neurosurgical interventions have increased, but there is still no consensus on the best treatment strategy for elderly patients. In elderly patients, endovascular coiling (EC) is more popular than surgical clipping (SC) due to its advantages of less trauma and faster recovery. However, SC has made great progress in recent years, significantly improving the prognosis of elderly patients. Therefore, it is necessary to further explore the effects of different treatment modalities on clinical prognosis, hospital stay, and hospital cost of elderly IA patients, and select the most appropriate treatment modalities.MethodsThe authors retrospectively analyzed 767 patients with intracranial aneurysms admitted to the facility between August 2017 and December 2022. Prognostic risk factors and multivariate logistic regression were analyzed for elderly patients treated with EC or SC. The area under the receiver operating characteristic (ROC) curve was used to calculate the predictive power of each independent predictor between the treatment groups.ResultsOur study included 767 patients with aneurysms, of whom 348 (45.4%) were elderly, 176 (22.9%) underwent endovascular coiling, and 172 (22.4%) underwent microsurgical clipping. A comparison of elderly patients treated with EC and SC showed a higher prevalence of hypertension in the EC group (P = 0.011) and a higher Hunt–Hess score on admission in the SC group (P = 0.010). Patients in the EC group had shorter hospital stays but higher costs (P = 0.000 and P = 0.000, respectively). Patients treated with SC had a higher incidence of postoperative cerebral infarction and poor prognosis (P = 0.002 and P = 0.008, respectively). Through multi-factor logistic analysis, it was found that age (OR 1.209, 95% CI 1.047–1.397, P = 0.010), length of stay (LOS) (OR 1.160, 95 CI% 1.041–1.289, P = 0.007), and complications (OR 31.873, 95 CI% 11.677–320.701, P = 0.000) was an independent risk factor for poor prognosis in elderly patients with EC. In elderly patients treated with SC, age (OR 1.105, 95% CI 1.010–1.209, P = 0.029) was an independent risk factor for poor prognosis.ConclusionEC and SC interventions in elderly adults carry higher risks compared to non-older adults, and people should consider these risks and costs when making a decision between intervention and conservative treatment. In elderly patients who received EC or SC treatments, EC showed an advantage in improving outcomes in elderly patients although it increased the economic cost of the patient's hospitalization

Regenerative braking control strategy for pure electric vehicles based on fuzzy neural network

This study investigates the efficiency and safety of regenerative brake energy recuperation systems for electric vehicles. A three-input single-output fuzzy controller is developed to allocate hydraulic and electric braking forces, considering brake intensity, vehicle speed, and battery SOC's impact on regenerative braking performance. Fuzzy neural networks are utilized due to their effectiveness in solving complex, nonlinear, and fuzzy systems, along with their robustness to parameter changes and external disturbances. The fuzzy process of the controller is optimized using a self-tuning algorithm for designing membership function parameters, resulting in a fuzzy neural network controller. Moreover, electric and hydraulic braking forces are redistributed. Simulation using AVL Cruise software is conducted under NEDC and FTP-75 working conditions. The suggested brake energy recovery control approach using fuzzy neural networks successfully recovers braking energy, achieving energy recovery efficiencies of 14.52% and 39.61% under NEDC and FTP-75 conditions, respectively

TGF-β1-induced miR-503 controls cell growth and apoptosis by targeting PDCD4 in glioblastoma cells

Abstract Aberrant expression of microRNAs hae been shown to be closely associated with glioblastoma cell proliferation, apoptosis and drug resistance. However, mechanisms underlying the role of mcroRNAs in glioblastoma cell growth and apoptosis are not fully understood. In this study, we report that miR-503 is overexpressed in glioblastoma tissue compared with normal human brain tissue. Mechanistically, miR-503 can be induced by TGF-β1 at the transcriptional level by binding the smad2/3 binding elements in the promoter. Ectopic overexpression of miR-503 promotes cell growth and inhibits apoptosis by targeting PDCD4. In contrast, inhibition of miR-503 reduces cell growth. Furthermore, miR-503 inhibitor augments the growth inhibitory effect of temozolomide in glioblastoma cells. These results establish miR-503 as a promising molecular target for glioblastoma therapy