Intraoperative local hemodynamic quantitative analysis of direct revascularization in patients with moyamoya disease

Individualised evaluation based on pathophysiology for moyamoya vasculopathy: application in surgical revascularisation

BACKGROUND

Although bypass surgery is an effective treatment for moyamoya vasculopathy (MMV), the incidence of postoperative complications is still high. This study aims to introduce a novel evaluating system based on individualised pathophysiology of MMV, and to assess its clinical significance.

METHODS

This multicentre, prospective study enrolled adult patients with MMV from Huashan Hospital, Fudan University and National Center for Neurological Disorders, China between March 2021 and February 2022. Multimodal neuroimages containing structural and functional information were used to evaluate personalised disease severity and fused to localise the surgical field, avoid invalid regions and propose alternative recipient arteries. The recipient artery was further selected intraoperatively by assessing regional haemodynamic and electrophysiological information. The preanastomosis and postanastomosis data were compared with assist with the postoperative management. Patients who received such tailored revascularisations were included in the novel group and the others were included in the traditional group. The 30-day surgical outcomes and intermediate long-term follow-up were compared.

RESULTS

Totally 375 patients (145 patients in the novel group and 230 patients in the traditional group) were included. The overall complication rate was significantly lower in the novel group (p˂0.001). In detail, both the rates of postoperative infarction (p=0.009) and hyperperfusion syndrome (p=0.010) were significantly lower. The functional outcomes trended to be more favourable in the novel group, though not significantly (p=0.260). Notably, the proportion of good functional status was higher in the novel group (p=0.009). Interestingly, the preoperative statuses of perfusion and metabolism around the bypass area were significantly correlated with the occurrence of postoperative complications (P˂0.0001).

CONCLUSIONS

This novel evaluating system helps to identify appropriate surgical field and recipient arteries during bypass surgery for MMV to achieve better haemodynamic remodelling and pathophysiological improvement, which results in more favourable clinical outcomes.

A Risk Signature Consisting of Eight m6A Methylation Regulators Predicts the Prognosis of Glioma

Glioma progression seriously correlates to the epigenetic context. This study aims to identify glioma subtypes by clustering analysis of patients using the multi-omics data of N6-methyladenosine (m⁶A) methylation regulators and to construct a risk signature for investigating the role of m⁶A methylation regulators in the prognosis of glioma. Multi-omics data of glioma and normal control tissues were obtained through The Cancer Genome Atlas (TCGA) database. The clustering analysis of multi-omics data of patients was conducted using the R package iClusterPlus software. The risk model was constructed by univariate and multivariate Cox analysis, and the glioma expression data and related clinical data were obtained by Chinese Glioma Genome Atlas (CGGA) datasets to verify the risk model. By analyzing the glioma data in TCGA, we found that the risk signature could be constructed according to the eight genes with m⁶A methylation modification function, including ALKBH5, HNRNPA2B1, IGF2BP2, IGF2BP3, RBM15, WTAP, YTHDF1, and YTHDF2. Meanwhile, we found that IGF2BP2 and IGF2BP3 were highly expressed in glioma subtypes with high-risk scores and closely related to the prognosis of glioma patients. m⁶A methylation regulators, especially IGF2BP2 and IGF2BP3, play important roles in the malignant progression of glioma. The risk signature constructed by eight m⁶A methylation regulators can predict the prognosis of glioma. IGF2BP2 and IGF2BP3 may be the key regulatory factors of m⁶A methylation regulators involved in the occurrence and development of glioma, and can serve as molecular markers for the prognosis of glioma.

Combined dystonias: clinical and genetic updates

The genetic combined dystonias are a clinically and genetically heterogeneous group of neurologic disorders defined by the overlap of dystonia and other movement disorders such as parkinsonism or myoclonus. The number of genes associated with combined dystonia syndromes has been increasing due to the wider recognition of clinical features and broader use of genetic testing. Nevertheless, these diseases are still rare and represent only a small subgroup among all dystonias. Dopa-responsive dystonia (DYT/PARK-GCH1), rapid-onset dystonia-parkinsonism (DYT/PARK-ATP1A3), X-linked dystonia-parkinsonism (XDP, DYT/PARK-TAF1), and young-onset dystonia-parkinsonism (DYT/PARK-PRKRA) are monogenic combined dystonias accompanied by parkinsonian features. Meanwhile, MYC/DYT-SGCE and MYC/DYT-KCTD17 are characterized by dystonia in combination with myoclonus. In the past, common molecular pathways between these syndromes were the center of interest. Although the encoded proteins rather affect diverse cellular functions, recent neurophysiological evidence suggests similarities in the underlying mechanism in a subset. This review summarizes recent developments in the combined dystonias, focusing on clinico-genetic features and neurophysiologic findings. Disease-modifying therapies remain unavailable to date; an overview of symptomatic therapies for these disorders is also presented.