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Pipeline Embolization Device for intracranial aneurysms presenting with mass effect:a large Chinese cohort

Stroke & Vascular Neurology 2024年第1期9卷 50-58页

作者： Yang Zhao Junlin Lu Hongqi Zhang Tianxiao LI Donglei Song Sheng Guan Aisha Maimaitili Yunyan Wang Wenfeng Feng Yang Wang Jieqing Wan Guohua Mao Huaizhang Shi Xinjian Yang Jianmin Liu Yuanli Zhao department of neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina department of neurosurgery Peking University International HospitalBeijingChina department of neurosurgery West China HospitalSichuan UniversityChengduSichuanChina department of neurosurgery Xuanwu HospitalCapital Medical UniversityBeijingChina department of Interventional Neuroradiology Zhengzhou University People's HospitalZhengzhouHenanChina department of neurosurgery Shanghai Donglei Brain HospitalShanghaiChina department of Interventional Neuroradiology The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina department of neurosurgery The First Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiangChina department of neurosurgery Qilu Hospital of Shandong University QingdaoJinanShandongChina department of neurosurgery Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina department of neurosurgery The First Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina department of neurosurgery Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina department of neurosurgery The Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina department of neurosurgery The First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina department of neurosurgery Changhai HospitalNaval Medical UniversityShanghaiChina

Background Unruptured intracranial aneurysm treatment aims to reduce the risk of aneurysm rupture and bleeding,relieves symptoms and improve the quality of life for patients.This study aimed to assess the safety and efficacy of Pipeline Embolization Device(PED,Covidien/Medtronic,Irvine,CA)treatment for intracranial aneurysms presenting with mass effect in real-world settings.Methods We selected patients from the PED in China Post-Market Multi-Center Registry Study with mass effect presentation.The study endpoints included postoperative mass effect deterioration and mass effect relief at follow-up(3–36 months).We conducted multivariate analysis to identify factors associated with mass effect relief.Subgroup analyses by aneurysm location,size and form were also performed.Results This study included 218 patients with a mean age of 54.3±11.8 years and a female predominance of 74.0%(162/218).The postoperative mass effect deterioration rate was 9.6%(21/218).During a median follow-up period of 8.4 months,the mass effect relief rate was 71.6%(156/218).Notably,immediate aneurysm occlusion following treatment was significantly associated with mass effect relief(OR 0.392,95%CI,0.170 to 0.907,p=0.029).Subgroup analysis demonstrated that adjunctive coiling contributed to mass effect relief in cavernous aneurysms,while dense embolism impeded symptom relief in aneurysms<10mm and saccular aneurysms.Conclusions Our data confirmed the efficacy of PED in relieving mass effect.The findings of this study provide support for endovascular treatment to alleviate mass effect in unruptured intracranial aneurysms.Trial registration number NCT03831672.

关键词： aneurysm intracranial Irvine

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China stroke surveillance report 2021

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Military medical Research 2024年第3期11卷 374-399页

作者： Wen-Jun Tu Long-De Wang 无 department of neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China School of Public Health Peking UniversityBeijing 100191China Special Writing Group of China Stroke Surveillance Report

Since 2015,stroke has become the leading cause of death and disability in China,posing a significant threat to the health of its citizens as a major chronic non-communicable disease.According to the China Stroke High-risk Population Screening and Intervention Program,an estimated 17.8 million[95%confidence interval(CI)17.6–18.0million]adults in China had experienced a stroke in 2020,with 3.4 million(95%CI 3.3–3.5 million)experiencing their first-ever stroke and another 2.3 million(95%CI 2.2–2.4 million)dying as a result.Additionally,approximately 12.5%(95%CI 12.4%–12.5%)of stroke survivors were left disabled,as defined by a modified Rankin Scale score greater than 1,equating to 2.2 million(95%CI 2.1–2.2 million)stroke-related disabilities in 2020.As the population ages and the prevalence of risk factors like diabetes,hypertension,and hyperlipidemia continues to rise and remains poorly controlled,the burden of stroke in China is also increasing.A large national epidemiological survey initiated by the China Hypertension League in 2017 showed that the prevalence of hypertension was 24.7%;the awareness,treatment,and control rates in hypertensive patients were:60.1%,42.5%,and 25.4%,respectively.A nationally representative sample of the Chinese mainland population showed that the weighted prevalence of total diabetes diagnosed by the American Diabetes Association criteria was 12.8%,suggesting there are 120 million adults with diabetes in China,and the awareness,treatment,and control rates in diabetic patients were:43.3%,49.0%,and 49.4%,respectively.The“Sixth National Health Service Statistical Survey Report in 2018”showed that the proportion of the obese population in China was 37.4%,an increase of 7.2 points from 2013.Data from 1599 hospitals in the hospital Quality Monitoring System and Bigdata Observatory Platform for Stroke of China(BOSC)showed that a total of 3,418,432 stroke cases[mean age±standard error(SE)was(65.700±0.006)years,and 59.1%were male]were admitted during 2020.Of those,over 80.0%(81.9%)were ischemic

关键词： Stroke Epidemiological characteristics Treatment Prognosis China

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A model with multiple intracranial aneurysms: possible hemodynamic mechanisms of aneurysmal initiation, rupture and recurrence

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中华神经外科杂志(英文) 2024年第2期10卷 1-8页

作者： Li Wenqiang Wang Chao Wang Yanmin Zhao Yapeng Yang Xinjian Liu Xianzhi Liu Jian department of Interventional Neuroradiology and neurosurgery Beijing Neurosurgical Institute and Beijing Tiantan Hospital Beijing China department of neurosurgery The First Affiliated Hospital of Zhengzhou University Zhengzhou China

Background Hemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple aneurysms (initiation, growth, rupture, and recurrence) is helpful to avoids the confounders and further explore the possible hemodynamic mechanisms of aneurysm in different states.Methods We present a model with multiple aneurysms, and including the states of initiation, growth, rupture, and recurrence, discuss the proposed mechanisms, and describe computational fluid dynamic model that was used to evaluate the likely hemodynamic effect of different states of the aneurysms.Results The hemodynamic analysis suggests that high flow impingement and high WSS distribution at normal parent artery was found before aneurysmal initiation. The WSS distribution and flow velocity were decreased in the new sac after aneurysmal growth. Low WSS was the risk hemodynamic factor for aneurysmal rupture. High flow concentration region on the neck plane after coil embolization still marked in recanalized aneurysm.Conclusions Associations have been identified between high flow impingement and aneurysm recanalization, while low WSS is linked to the rupture of aneurysms. High flow concentration and high WSS distribution at normal artery associated with aneurysm initiation and growth, while after growth, the high-risk hemodynamics of aneurysm rupture was occurred, which is low WSS at aneurysm dome.

关键词： Multiple intracranial aneurysms Hemodynamic Aneurysm initiation and growth Rupture Recurrence

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Silencing of Jumonji domain-containing 1C inhibits the osteogenic differentiation of bone marrow mesenchymal stem cells via nuclear factor-κB signaling

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World Journal of Stem Cells 2024年第2期16卷 151-162页

作者： Jing-Yi Li Ting-Ting Wang Li Ma Yu Zhang Di Zhu department of medical Cosmetology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China department of General Gerontology The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052Henan ProvinceChina department of Plastic Surgery China-Japan Friendship HospitalBeijing 100029China Senior department of Hematology The Fifth Medical CentreGeneral Hospital of Chinese People’s Liberation ArmyBeijing 100071China department of Orthopaedic Surgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China

BACKGROUND Osteoporosis is a common metabolic bone disorder induced by an imbalance between osteoclastic activity and osteogenic activity.During osteoporosis,bone mesenchymal stem cells(BMSCs)exhibit an increased ability to differentiate into adipocytes and a decreased ability to differentiate into osteoblasts,resulting in bone loss.Jumonji domain-containing 1C(JMJD1C)has been demonstrated to suppress osteoclastogenesis.AIM To examine the effect of JMJD1C on the osteogenesis of BMSCs and the potential underlying mechanism.METHODS BMSCs were isolated from mouse bone marrow tissues.Oil Red O staining,Alizarin red staining,alkaline phosphatase staining and the expression of adipo-genic and osteogenic-associated genes were assessed to determine the differen-tiation of BMSCs.Bone marrow-derived macrophages(BMMs)were incubated with receptor activator of nuclear factor-kappaΒligand to induce osteoclast differentiation,and osteoclast differen-tiation was confirmed by tartrate-resistant acid phosphatase staining.Other related genes were measured via reverse transcription coupled to the quantitative polymerase chain reaction and western blotting.Enzyme-linked immunosorbent assays were used to measure the levels of inflammatory cytokines,including tumor necrosis factor alpha,interleukin-6 and interleukin-1 beta.RESULTS The osteogenic and adipogenic differentiation potential of BMSCs isolated from mouse bone marrow samples was evaluated.JMJD1C mRNA and protein expression was upregulated in BMSCs after osteoblast induction,while p-nuclear factor-κB(NF-κB)and inflammatory cytokines were not significantly altered.Knockdown of JMJD1C repressed osteogenic differentiation and enhanced NF-κB activation and inflammatory cytokine release in BMSCs.Moreover,JMJD1C expression decreased during BMM osteoclast differentiation.CONCLUSION The JMJD1C/NF-κB signaling pathway is potentially involved in BMSC osteogenic differentiation and may play vital roles in the pathogenesis of osteoporosis.

关键词： Osteoporosis Mesenchymal stem cells Osteogenesis Jumonji domain-containing 1C Nuclear factor-κB

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Association of DNA methylation/demethylation with the functional outcome of stroke in a hyperinflammatory state

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Neural Regeneration Research 2024年第10期19卷 2229-2239页

作者： Yubo Wang Ling Zhang Tianjie Lyu Lu Cui Shunying Zhao Xuechun Wang Meng Wang Yongjun Wang Zixiao Li Vascular Neurology Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalCapital Medical UniversityBeijingChina National Center for Healthcare Quality Management in Neurological Diseases Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Chinese Institute for Brain Research BeijingChina Research Unit of Artificial Intelligence in Cerebrovascular Disease Chinese Academy of Medical SciencesBeijingChina beijing Engineering Research Center of Digital Healthcare for Neurological Diseases BeijingChina

Inflammation is closely related to stroke prognosis, and high inflammation status leads to poor functional outcome in stroke. DNA methylation is involved in the pathogenesis and prognosis of stroke. However, the effect of DNA methylation on stroke at high levels of inflammation is unclear. In this study, we constructed a hyperinflammatory cerebral ischemia mouse model and investigated the effect of hypomethylation and hypermethylation on the functional outcome. We constructed a mouse model of transient middle cerebral artery occlusion and treated the mice with lipopolysaccharide to induce a hyperinflammatory state. To investigate the effect of DNA methylation on stroke, we used small molecule inhibitors to restrain the function of key DNA methylation and demethylation enzymes. 2,3,5-Triphenyltetrazolium chloride staining, neurological function scores, neurobehavioral tests, enzyme-linked immunosorbent assay, quantitative reverse transcription PCR and western blot assay were used to evaluate the effects after stroke in mice. We assessed changes in the global methylation status by measuring DNA 5-mc and DNA 5-hmc levels in peripheral blood after the use of the inhibitor. In the group treated with the DNA methylation inhibitor, brain tissue 2,3,5-triphenyltetrazolium chloride staining showed an increase in infarct volume, which was accompanied by a decrease in neurological scores and worsening of neurobehavioral performance. The levels of inflammatory factors interleukin 6 and interleukin-1 beta in ischemic brain tissue and plasma were elevated, indicating increased inflammation. Related inflammatory pathway exploration showed significant overactivation of nuclear factor kappa B. These results suggested that inhibiting DNA methylation led to poor functional outcome in mice with high inflammation following stroke. Further, the effects were reversed by inhibition of DNA demethylation. Our findings suggest that DNA methylation regulates the inflammatory response in stroke and has an important role in the functional out

关键词： DNA demethylation DNA methylation DNMT3A functional outcome hyperinflammatory state interleukin neuroinflammation stroke TET2

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Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS): protocol of a prospective, multicentre, randomised, controlled trial

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Stroke & Vascular Neurology 2024年第1期9卷 66-74页

作者： Xuan Sun Ming Yang Dapeng Sun Guangge Peng Yiming Deng Xingquan Zhao Liping Liu Ning Ma Feng Gao Dapeng Mo Wengui Yu Yongjun Wang Yilong Wang Zhongrong Miao department of Interventional Neuroradiology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina department of Neurology Beijing Luhe HospitalCapital Medical UniversityBeijingChina department of Neurology Comprehensive Stroke&Cerebrovascular CenterUniversity of California IrvineIrvineCaliforniaUSA Chinese Institute for Brain Research BeijingChina National Center for Neurological Diseases BeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina beijing Laboratory of Oral Health Capital Medical UniversityBeijingChina

Background The superiority of balloon angioplasty plus aggressive medical management(AMM)to AMM alone for symptomatic intracranial artery stenosis(sICAS)on efficacy and safety profiles still lacks evidence from randomised controlled trials(RCTs).Aim To demonstrate the design of an RCT on balloon angioplasty plus AMM for sICAS.Design Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis(BASIS)trial is a multicentre,prospective,randomised,open-label,blinded end-point trial to investigate whether balloon angioplasty plus AMM could improve clinical outcome compared with AMM alone in patients with sICAS.Patients eligible in BASIS were 35–80 years old,with a recent transient ischaemic attack within the past 90 days or ischaemic stroke between 14 days and 90 days prior to enrolment due to severe atherosclerotic stenosis(70%–99%)of a major intracranial artery.The eligible patients were randomly assigned to receive balloon angioplasty plus AMM or AMM alone at a 1:1 ratio.Both groups will receive identical AMM,including standard dual antiplatelet therapy for 90 days followed by long-term single antiplatelet therapy,intensive risk factor management and life-style modification.All participants will be followed up for 3years.Study outcomes Stroke or death in the next 30 days after enrolment or after balloon angioplasty procedure of the qualifying lesion during follow-up,or any ischaemic stroke or revascularisation from the qualifying artery after 30 days but before 12 months of enrolment,is the primary outcome.Discussion BASIS trail is the first RCT to compare the efficacy and safety of balloon angioplasty plus AMM to AMM alone in sICAS patients,which may provide an alternative perspective for treating sICAS.Trial registration number NCT03703635;https://www.***.gov.

关键词： balloon prospective centre

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The clinical,radiological,and surgical characteristics of anterior perforated substance glioma:a retrospective study

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Chinese Neurosurgical Journal 2024年第1期10卷 28-34页

作者： Zhiliang Wang Lianwang Li Zheng Wang Xuzhu Chen Zhong Zhang department of neurosurgery Beijing Tiantan HospitalCapital Medical UniversityNo.119 South 4th Ring West RoadBeijing 100070People’s Republic of China department of Molecular Neuropathology Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina department of Radiology Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina department of Radiology Beijing Tiantan HospitalCapital Medical UniversityNo.119 South 4th Ring West RoadBeijing 100070People’s Republic of China

Background To explore the clinical,radiological,and surgical characteristics of anterior perforated substance(APS)gliomas.Methods Twenty patients with APS glioma who were treated with surgery between March 2019 and January 2022 from tiantan hospital were retrospectively reviewed.The clinical,histological and radiological data were collected.Results Twenty patients,including 7 males(55%)and 13 females(45%),with a mean age at diagnosis of 37.9 years(range,28-53 years)underwent operative intervention for APS.Headaches and dizziness were the most common preoperative symptoms in the majority patients(14,70%).Based on radiological features of MRI,the APS was classified into two subtypes,type A and type B.Seven patients(40%)in type A indicated a clear tumor margin,while 13 patients(60%)in type B showed an ill-defined margin.The surgical approach including frontal,temporal,and coronal frontal incisions for type A and type B tumors,respectively.Three patients in type A received total resection,while one patient in type B were total resected.Pathologically,12 cases(60%,12/20)were diagnosed as astrocytoma and 8 cases(20%,8/20)were oligodendroglioma.Meanwhile,17 cases(85%,17/20)had MGMT promotor methylation.Conclusion In this study,we performed the first systematic research of patients with APS glioma.Most of patients with APS presented headaches and dizziness symptoms.The APS glioma was further divided into two major radiological subtypes with relevant different surgical approaches.The APS glioma in type A were more likely to receive total resection.

关键词： Anterior perforated substance Glioma Magnetic resonance imaging Operation

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Distinct clinical profiles and mutation landscapes of gliomas originating from the neocortex,mesocortex,and cerebellum

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Genes & Diseases 2024年第1期11卷 53-56页

作者： Ye Cheng Lei Zhang Xiaolong Wu Hiroaki Wakimoto Haoming Geng Yukui Wei Geng Xu Xinru Xiao Jie Bai Yaming Wang Zeliang Hu Leiming Wang Qingtang Lian department of neurosurgery Xuanwu HospitalCapital Medical UniversityBeijing 100053China Brain Tumor Research Center Massachusetts General HospitalDepartment of NeurosurgeryHarvard Medical SchoolBostonMA02134USA department of Pathology Xuanwu HospitalCapital Medical UniversityBeijing 100053China

Gliomas originating from anatomically and developmentally distinct brain regions have different clinical outcomes.However,the molecular landscape underlying this difference remains largelyunknown.We analyzed key molecular mutations via sequencing and correlated them with clinical characteristics in 180 adult patients with gliomas originating from the neocortex,mesocortex,and cerebellum.Cases of cerebellar origin had significantly longer survival than those of supratentorial origin,consistent with higher rates of mutation in key genes associated with supratentorial gliomas.

关键词： clinical cortex glioma

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Mice with type I interferon signaling deficiency are prone to epilepsy upon HSV-1 infection

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Virologica Sinica 2024年第2期39卷 251-263页

作者： Wei Yang Chong-Yang Tang Dong-Ying Fan Yi-Song Wang Pei-Gang Wang Jing An Guo-Ming Luan beijing Key Laboratory of Epilepsy Sanbo Brain HospitalCapital Medical UniversityBeijing100093China beijing Institute for Brain Disorders Capital Medical UniversityBeijing100093China department of neurosurgery Epilepsy CenterSanbo Brain HospitalCapital Medical UniversityBeijing100093China department of Microbiology School of Basic Medical SciencesCapital Medical UniversityBeijing100069China Chinese Institute for Brain Research Beijing102206China

Viral encephalitis continues to be a significant public health concern.In our previous study,we discovered a lower expression of antiviral factors,such as IFN-β,STING and IFI16,in the brain tissues of patients with Rasmussen's encephalitis(RE),a rare chronic neurological disorder often occurred in children,characterized by unihemispheric brain atrophy.Furthermore,a higher cumulative viral score of human herpes viruses(HHVs)was also found to have a significant positive correlation with the unihemispheric atrophy in RE.Type I IFNs(IFN-I)signaling is essential for innate anti-infection response by binding to IFN-α/βreceptor(IFNAR).In this study,we infected WT mice and IFNAR-deficient A6 mice with herpes simplex virus 1(HSV-1)via periocular injection to investigate the relationship between IFN-I signaling and HHVs-induced brain lesions.While all mice exhibited typical viral encephalitis lesions in their brains,HSV-induced epilepsy was only observed in A6 mice.The gene expression matrix,functional enrichment analysis and protein-protein interaction network revealed four gene models that were positively related with HSV-induced epilepsy.Additionally,ten key genes with the highest scores were identified.Taken together,these findings indicate that intact IFN-I signaling can effectively limit HHVs induced neural symptoms and brain lesions,thereby confirming the positive correlation between IFN-I signaling repression and brain atrophy in RE and other HHVs encephalitis.

关键词： IFN-I signaling Human herpes viruses(HHVs) Rasmussen's encephalitis(RE)

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Tirofiban combined with Aspirin in the Treatment of Acute Penetrating Artery Territory Infarction (STRATEGY): protocol for a multicentre, randomised controlled trial

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Stroke & Vascular Neurology 2024年第1期9卷 75-81,I0047-I0052页

作者： Xiaoling Liao Shuo Feng Yicong Wang Yuesong Pan Weiqi Chen Hui Qu Xingquan Zhao Liping Liu Yongjun Wang Yilong Wang department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases Beijing TiantanHospitalCapital Medical UniversityBeijingChina Chinese Institute for Brain Research BeijingChina National Center for Neurological Diseases BeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina beijing Laboratory of Oral Health Capital Medical UniversityBeijingChina

Background Perforating artery territorial infarction(PAI)caused by branch atheromatous disease(BAD)is prone to recurrence and early progression without an effective and well-documented antiplatelet treatment regimen.Tirofiban,an adjunctive antiplatelet agent,has shown great potential to treat acute ischaemic stroke.However,whether the combination of tirofiban and aspirin can improve the prognosis of PAI remains unclear.Aim To explore an effective and safe antiplatelet regimen for reducing the risk of recurrence and early neurological deterioration(END)in PAI caused by BAD by comparing the tirofiban and aspirin combination with placebo and aspirin combination.Methods Tirofiban combined with Aspirin in the Treatment of Acute Penetrating Artery Territory Infarction(STRATEGY)trial is an ongoing multicentre,randomised,placebo-controlled trial in China.Eligible patients shall be randomly assigned to receive standard aspirin with tirofiban or placebo on the first day and standard aspirin from days 2 to 90.The primary endpoint is a new stroke or END within 90 days.The primary safety endpoint is severe or moderate bleeding within 90 days.Discussion The STRATEGY trial will assess whether tirofiban combined with aspirin is effective and safe in preventing recurrence and END in patients with PAI.Trial registration number NCT05310968.

关键词： Aspirin regimen centre

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