Objective: Morbidity and mortality in patients experiencing the rupture of intracranial aneurysm ruptures are high. We conducted a systematic review and meta-analysis to investigate the role of stent-assisted coiling (SAC) for unruptured intracranial aneurysms (UIAs) with wide neck. Materials and Methods: The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled proportions with 95% confidence intervals (CIs) of ten outcomes of interest were calculated. Results: We finally reviewed 13 studies, including 976 patients. The technical success of the method was 98.43% (95% CI: 95.62–99.95). Early outcomes included total periprocedural obliteration with a rate of 50.20% (95% CI: 36.09–64.30) and periprocedural rupture with zero rate. During the follow-up period, ranging from 6 months to 2 years, the total postprocedural obliteration rate was 63.83% (95% CI: 45.80–80.18) and the overall late rupture rate was 0.41% (95% CI: 0.00–2.38). The pooled in-stent stenosis rate was calculated at 1.24% (95% CI: 0.02–3.63). We also estimated a pooled rate of 0.02% (95% CI: 0.00–0.51) and 4.33% (95% CI: 2.03–7.23) for total mortality and overall neurological complications, respectively. A pooled rate of 3.94% (95% CI: 1.48–7.33) was found for stroke. Finally, the recanalization rate was recorded at 7.07% (95% CI: 4.35–10.26). Conclusions: SAC of UIAs with wide neck seems to be a safe and acceptable alternative to surgical clipping. Although early results concerning total periprocedural obliteration may be modest, follow-up outcomes may be indicative of adequate occlusion of treated UIAs.
Timeliness in conventional real-time systems is addressed by employing well-known scheduling techniques that guarantee the execution of a number of tasks within certain deadlines. However, these classical scheduling techniques do not take into account basic features that characterize today's critical pervasive computing environments. In this paper, we revisit the issue of timeliness in the context of pervasive computing environments. We propose a middleware service that addresses the timely provisioning of services, while taking into account both the mobility of the entities that constitute pervasive computing environments and the existence of multiple alternative entities, providing semantically compatible services. Specifically, we model the overall behavior of mobile entities in terms of the entities' lifetime. The lifetime of an entity is the duration for which the entity is present and available to other entities. Given a new request coming from a mobile client and a number of semantically compatible mobile entities that can fulfill the request, one of them must be selected. The proposed service realizes three different policies that facilitate the selection. With respect to the first policy, the selection is realized solely on the basis of the client's and the server's lifetimes. The second policy additionally considers the load of each server towards selecting the one that guarantees to serve the new request within the lifetime of both the client and the server. The third policy further deals with periodic service requests.
Hydrocephalus is a common neurosurgical pathology that affects people of all ages and especially the pediatric population. It can be very often a life threatening condition that pediatric neurosurgeons must deal with. Therefore a number of CSF diversion techniques have been established. The gold standard treatment currently is the placement of a ventriculo-peritoneal shunt. Because of hydrocephalus being a lifelong condition, it is almost in daily practice dealing with cases of shunt failures for a number of reasons. Herewith we present a 4 year old child with multiple ventriculo-peritoneal shunt revision surgeries and ventriculo-atrial failure due to distal catheter malfunction that was treated with percutaneous placement of the peripheral catheter in the subclavian vein.
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