Stent-Assisted Coiling versus Coiling in Treatment of Intracranial Aneurysm: A Systematic Review and Meta-Analysis

<div><p>Background and Purpose</p><p>Stent-assisted coiling was initially invented for wide-neck aneurysms, but is now used for smaller berry aneurysms. The aim of this study was to compare the safety and efficiency of stent-assisted coiling with conventional coiling in treatment of intracranial aneurysms.</p><p>Methods</p><p>A meta-analysis of studies that compared stent-assisted coiling with coiling only was conducted by searching English literatures via Pubmed, Medline and Cochrane Library databases without restricting the publication year. The primary outcomes in this study were immediate occlusion, progressive thrombosis rate, all-complication rate and angiographic recurrence. The secondary outcomes examined were packing density, mortality, permanent complication and thromboembolic complication rate.</p><p>Results</p><p>Ten retrospective cohort studies were included. There is currently only one unfinished randomized study. Although the stent-assisted coiling group tended to show a lower initial occlusion rate than that of the coiling-only group (57.6% versus 68.7%; OR, 0.66; 95% CI, 0.30–1.44; P = 0.30), it achieved a significantly higher progressive thrombosis rate during follow up compared to that of the coiling only group (37.5% versus 19.4%; OR, 2.75; 95% CI, 1.95–3.86; P<0.00001) and a significantly lower recurrence rate (16.2% versus 34.4%; OR, 0.35; 95% CI, 0.25–0.49; P<0.00001). With respect to safety concerns, the all-complication rate (17.6% versus 15.9%; OR, 1.12; 95% CI, 0.77–1.62; P = 0.56), mortality rate (9.1% versus 2.6%; OR, 2.31; 95% CI, 0.68–7.82; P = 0.18), permanent complication rate (5.6% versus 3.9%; OR, 1.52; 95% CI, 0.96–2.41; P = 0.08) and thromboembolic complication rate (4.2% versus 4.9%; OR, 0.99; 95% CI, 0.41–2.38; P = 0.97) did not show significant difference between the two groups.</p><p>Conclusions</p><p>Stent-assisted coiling has a lower recurrence rate than conventional coiling. Analysis of complication events did not show any significant difference between the two methods. Despite the findings reported herein, further validation by well-designed prospective studies is needed.</p></div

Forest plot of recurrence rate comparing stent-assisted coiling versus coiling only.

<p>Fixed-effect model was applied.</p

Forest plot of all-complication rate comparing stent-assisted coiling versus coiling only.

<p>Fixed-effect model was applied.</p

Risk of bias in the observational studies using Ottawa-Newcastle rules.

<p>Follow up period set as 1 year. Follow up rate set as 80%.</p

Flowchart of studies to final number of eligible studies.

<p>Flowchart of studies to final number of eligible studies.</p

Design and baseline characteristics of included trials.

<p>No., number; y, year; mm, millimeter; mo, month; NA, not available.</p>a<p>, the data were presented in a categorized manner.</p

<i>In Situ</i> Polymerization of Zwitterions on Therapeutic Proteins to Enable Their Effective Oral Delivery

Oral administration of protein drugs has always been challenging owing to various intestinal barriers. Herein, we developed an efficient oral protein delivery strategy by using in situ polymerization of zwitterions to encapsulate proteins, which were then loaded into enteric coated capsules for oral feeding. After oral administration of such capsules, the enteric coating would be degraded once the capsule enters the intestine, releasing polyzwitterion/protein nanocomplexes. With the help of polyzwitterion modification, such nanocomplexes were able to pass through the mucus and cellular barriers, likely by the proton-assisted amino acid transporter 1 (PAT1) pathway. Such a polyzwitterion-based protein encapsulation strategy could allow for effective oral delivery of different proteins, including bovine serum albumin (BSA), insulin, and antibodies. Using this strategy, the oral bioavailabilities of insulin and immunoglobin G (IgG) were measured to be as high as 16.9% and 12.5%, respectively. Notably, oral feeding of polyzwitterion/insulin capsules could effectively lower the blood glucose level of diabetic animals (mice, rats, and pigs). Moreover, polyzwitterion/antiprogramed death-1 (αPD-1) capsules were able to induce efficient antitumor immune responses, showing significant tumor inhibition effects toward B16F10- and 4T1-tumor bearing mouse models after oral administration. No significant toxic effect was observed for such oral protein formulations in the treated animals. Our work presents a strategy for the efficient oral delivery of protein drugs, including those with large molecular weights (e.g., antibodies) that can hardly be orally delivered using existing technologies

PbMn(IV)TeO₆: A New Noncentrosymmetric Layered Honeycomb Magnetic Oxide

PbMnTeO₆, a new noncentrosymmetric layered magnetic oxide was synthesized and characterized. The crystal structure is hexagonal, with space group <i>P</i>6̅2<i>m</i> (No. 189), and consists of edge-sharing (Mn⁴⁺/Te⁶⁺)­O₆ trigonal prisms that form honeycomb-like two-dimensional layers with Pb²⁺ ions between the layers. The structural difference between PbMnTeO₆, with disordered/trigonal prisms of Mn⁴⁺/Te⁶⁺, versus the similar chiral SrGeTeO₆ (space group <i>P</i>312), with long-range order of Ge⁴⁺ and Te⁶⁺ in octahedral coordination, is attributed to a difference in the electronic effects of Ge⁴⁺ and Mn⁴⁺. Temperature-dependent second harmonic generation by PbMnTeO₆ confirmed the noncentrosymmetric character between 12 and 873 K. Magnetic measurements indicated antiferromagnetic order at <i>T</i>_N ≈ 20 K and a frustration parameter (|θ|/<i>T</i>_N) of ∼2.16

Structure and Magnetic Behavior of Layered Honeycomb Tellurates, BiM(III)TeO₆ (M = Cr, Mn, Fe)

New layered honeycomb tellurates, BiM­(III)­TeO₆ (M = Cr, Mn, Fe) were synthesized and characterized. BiM­(III)­TeO₆ (M = Cr, Fe) species crystallize in a trigonal space group, <i>P</i>3̅1<i>c</i> (No. 163), of edge-sharing M³⁺/Te⁶⁺O₆ octahedra, which form honeycomb-like double layers in the <i>ab</i> plane with Bi³⁺ cations located between the layers. Interestingly, the structure of BiMnTeO₆ is similar to those of the Cr/Fe analogues, but with monoclinic space group, <i>P</i>2₁/<i>c</i> (No. 14), attributed to the strong Jahn–Teller distortion of Mn³⁺ cations. The crystal structure of BiM­(III)­TeO₆ is a superstructure of PbSb₂O₆-related materials (ABB′O₆). The Cr³⁺ and Fe³⁺ cations are ordered 80% and 90%, respectively, while the Mn³⁺ ions are completely ordered on the B-site of the ABB′O₆ structure. BiCrTeO₆ shows a broad antiferromagnetic transition (AFM) at ∼17 K with a Weiss temperature (θ) of −59.85 K, while BiFeTeO₆ and BiMnTeO₆ show sharp AFM transitions at ∼11 K with θ of −27.56 K and at ∼9.5 K with θ of −17.57 K, respectively. These differences in the magnetic behavior are ascribed to the different concentration of magnetic nearest versus next-nearest neighbor interactions of magnetic cations due to the relative differences in the extent of M/Te ordering

A(II)GeTeO₆ (A = Mn, Cd, Pb): Non-Centrosymmetric Layered Tellurates with PbSb₂O₆‑Related Structure

A­(II)­GeTeO₆ (A = Mn, Cd, Pb), new non-centrosymmetric (NCS) honeycomb-layered tellurates, were synthesized and characterized. A­(II)­GeTeO₆ (A = Mn, Cd, Pb) crystallize in trigonal space group <i>P</i>312 (No. 149) of edge-sharing Ge⁴⁺O₆ and Te⁶⁺O₆ octahedra, which form honeycomb-like-layers in the <i>ab</i>-plane with A­(II) (A = Mn, Cd, Pb) cations located between the layers. Their crystal structures are PbSb₂O₆-related, and the ordering of Ge⁴⁺ and Te⁶⁺ in octahedral environment breaks the inversion symmetry of the parent PbSb₂O₆ structure. The size of A­(II) cation in six coordination is an important factor to stabilize PbSb₂O₆-based structure. Temperature-dependent optical second harmonic generation measurements on A­(II)­GeTeO₆ confirmed non-centrosymmetric character in the entire scanned temperature range (0 to 600 °C). The materials exhibit a powder SHG efficiency of ∼0.37 and ∼0.21 times of KH₂PO₄ for PbGeTeO₆ and CdGeTeO₆, respectively. Magnetic measurements of MnGeTeO₆ indicate anti-ferromagnetic order at <i>T</i>_N ≈ 9.4 K with Weiss temperature of −22.47 K