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Chen C, Tang F, Zhu M, Wang C, Zhou H, Zhang C, Feng Y. Role of inflammatory mediators in intracranial aneurysms: A review. Clin Neurol Neurosurg 2024; 242:108329. [PMID: 38781806 DOI: 10.1016/j.clineuro.2024.108329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
The formation, growth, and rupture of intracranial aneurysms (IAs) involve hemodynamics, blood pressure, external stimuli, and a series of hormonal changes. In addition, inflammatory response causes the release of a series of inflammatory mediators, such as IL, TNF-α, MCP-1, and MMPs, which directly or indirectly promote the development process of IA. However, the specific role of these inflammatory mediators in the pathophysiological process of IA remains unclear. Recently, several anti-inflammatory, lipid-lowering, hormone-regulating drugs have been found to have a potentially protective effect on reducing IA formation and rupture in the population. These therapeutic mechanisms have not been fully elucidated, but we can look for potential therapeutic targets that may interfere with the formation and breakdown of IA by studying the relevant inflammatory response and the mechanism of IA formation and rupture involved in inflammatory mediators.
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Affiliation(s)
- Cheng Chen
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Fengjiao Tang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Meng Zhu
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Chao Wang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Han Zhou
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Chonghui Zhang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Yugong Feng
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China.
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2
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Ali M, van Etten ES, Akoudad S, Schaafsma JD, Visser MC, Ali M, Cordonnier C, Sandset EC, Klijn CJM, Ruigrok YM, Wermer MJH. Haemorrhagic stroke and brain vascular malformations in women: risk factors and clinical features. Lancet Neurol 2024; 23:625-635. [PMID: 38760100 DOI: 10.1016/s1474-4422(24)00122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/18/2024] [Accepted: 03/14/2024] [Indexed: 05/19/2024]
Abstract
Haemorrhagic stroke is a severe condition with poor prognosis. Biological sex influences the risk factors, presentations, treatment, and patient outcomes of intracerebral haemorrhage, aneurysmal subarachnoid haemorrhage, and vascular malformations. Women are usually older at onset of intracerebral haemorrhage compared with men but have an increased risk of aneurysmal subarachnoid haemorrhage as they age. Female-specific factors such as pregnancy, eclampsia or pre-eclampsia, postmenopausal status, and hormone therapy influence a woman's long-term risk of haemorrhagic stroke. The presence of intracranial aneurysms, arteriovenous malformations, or cavernous malformations poses unique clinical dilemmas during pregnancy and delivery. In the absence of evidence-based guidelines for managing the low yet uncertain risk of haemorrhagic stroke during pregnancy and delivery in women with vascular malformations, multidisciplinary teams should carefully assess the risks and benefits of delivery methods for these patients. Health-care providers should recognise and address the challenges that women might have to confront when recovering from haemorrhagic stroke.
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Affiliation(s)
- Mariam Ali
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.
| | - Ellis S van Etten
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Saloua Akoudad
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
| | - Joanna D Schaafsma
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marieke C Visser
- Department of Neurology, Amsterdam University Medical Centre, Location AMC, Amsterdam, Netherlands
| | - Mahsoem Ali
- Department of Surgery, Amsterdam University Medical Centre, Location VUmc, Amsterdam, Netherlands
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, UMR-S1172, Lille Neuroscience and Cognition, Lille, France
| | - Else Charlotte Sandset
- Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway; The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marieke J H Wermer
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
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3
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Asikainen A, Korja M, Kaprio J, Rautalin I. Sex Differences in Case Fatality of Aneurysmal Subarachnoid Hemorrhage: A Systematic Review. Neuroepidemiology 2024:1-14. [PMID: 38599189 DOI: 10.1159/000538562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (SAH) is more common in women than in men, contrary to most cardiovascular diseases. However, it is unclear whether the case fatality rate (CFR) of SAH also differs by sex. Thus, we performed a systematic review to address the relationship between sex and SAH CFRs. METHODS We conducted a systematic literature search in PubMed, Scopus, and Cochrane library databases. We focused on population-based studies that included both nonhospitalized and hospitalized SAHs and had either reported 1-month (28-31 day) SAH CFRs separately for men and women or calculated risk estimates for SAH CFR by sex. For quality classification, we used the Cochrane Collaboration Handbook and Critical Appraisal Skills Program guidelines. We pooled the study cohorts and calculated relative risk ratios (RRs) with 95% confidence intervals (CIs) for SAH death between women and men using a random-effects meta-analysis model. RESULTS The literature search yielded 5,592 initial publications, of which 33 study cohorts were included in the final review. Of the 33 study cohorts, only three reported significant sex differences, although the findings were contradictory. In the pooled analysis of all 53,141 SAH cases (60.3% women) from 26 countries, the 1-month CFR did not differ (RR = 0.99 [95% CI: 0.93-1.05]) between women (35.5%) and men (35.0%). According to our risk-of-bias evaluation, all 33 study cohorts were categorized as low quality. The most important sources of bias risks were related to the absence of proper confounding control (all 33 study cohorts), insufficient sample size (27 of 33 study cohorts), and poor/unclear diagnostic accuracy (27 of 33 study cohorts). CONCLUSION Contrary to SAH incidence rates, the SAH CFRs do not seem to differ between men and women. However, since none of the studies were specifically designed to examine the sex differences in SAH CFRs, future studies on the topic are warranted.
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Affiliation(s)
- Aleksanteri Asikainen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
| | - Ilari Rautalin
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- The National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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4
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Zhang X, Huangfu Z, Wang S. Review of mendelian randomization studies on age at natural menopause. Front Endocrinol (Lausanne) 2023; 14:1234324. [PMID: 37766689 PMCID: PMC10520463 DOI: 10.3389/fendo.2023.1234324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Menopause marks the end of the reproductive phase of life. Based on epidemiological studies, abnormal age at natural menopause (ANM) is thought to contribute to a number of adverse outcomes, such as osteoporosis, cardiovascular disease, and cancer. However, the causality of these associations remains unclear. A powerful epidemiological method known as Mendelian randomization (MR) can be used to clarify the causality between ANM and other diseases or traits. The present review describes MR studies that included ANM as an exposure, outcome and mediator. The findings of MR analyses on ANM have revealed that higher body mass index, poor educational level, early age at menarche, early age at first live birth, early age at first sexual intercourse, and autoimmune thyroid disease appear to be involved in early ANM etiology. The etiology of late ANM appears to be influenced by higher free thyroxine 4 and methylene tetrahydrofolate reductase gene mutations. Furthermore, early ANM has been found to be causally associated with an increased risk of osteoporosis, fracture, type 2 diabetes mellitus, glycosylated hemoglobin, and the homeostasis model of insulin resistance level. In addition, late ANM has been found to be causally associated with an increased systolic blood pressure, higher risk of breast cancer, endometrial cancer, endometrioid ovarian carcinoma, lung cancer, longevity, airflow obstruction, and lower risk of Parkinson's disease. ANM is also a mediator for breast cancer caused by birth weight and childhood body size. However, due to the different instrumental variables used, some results of studies are inconsistent. Future studies with more valid genetic variants are needed for traits with discrepancies between MRs or between MR and other types of epidemiological studies.
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Affiliation(s)
- Xiao Zhang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao Huangfu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shaowei Wang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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5
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Ortiz AFH, Suriano ES, Eltawil Y, Sekhon M, Gebran A, Garland M, Cuenca NTR, Cadavid T, Almarie B. Prevalence and risk factors of unruptured intracranial aneurysms in ischemic stroke patients - A global meta-analysis. Surg Neurol Int 2023; 14:222. [PMID: 37404522 PMCID: PMC10316137 DOI: 10.25259/sni_190_2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
Background Unruptured intracranial aneurysms (UIAs) have an estimated global prevalence of 2.8% in the adult population; however, UIA was identified among more than 10% of ischemic stroke patients. Many epidemiological studies and reviews have pointed to the presence of UIA among patients with ischemic stroke; yet, the extent of this association is not fully known. We performed a systematic review and meta-analysis to determine the prevalence of UIA in patients admitted to hospitals with ischemic stroke and transient ischemic attack (TIA) at both global and continental levels and evaluate factors associated with UIA in this population. Methods We identified, in five databases, all studies describing UIA in ischemic stroke and TIA patients between January 1, 2000, and December 20, 2021. Included studies were of observational and experimental design. Results Our search yielded 3581 articles of which 23 were included, with a total of 25,420 patients. The pooled prevalence of UIA was 5% (95% confidence interval [CI] = 4-6%) with stratified results showing 6% (95% CI = 4-9%), 6% (95% CI = 5-7%), and 4% (95% CI = 2-5%) in North America, Asia, and Europe, respectively. Significant risk factors were large vessel occlusion (odds ratios [OR] = 1.22, 95% CI = 1.01-1.47) and hypertension (OR = 1.45, 95% CI = 1.24-1.69), while protective factors were male sex (OR = 0.60, 95% CI = 0.53-0.68) and diabetes (OR = 0.82, 95% CI = 0.72-0.95). Conclusion The prevalence of UIA is notably higher in ischemic stroke patients than the general population. Physicians should be aware of common risk factors in stroke and aneurysm formation for appropriate prevention.
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Affiliation(s)
| | | | - Yasmin Eltawil
- Department of Medicine, San Francisco School of Medicine, San Francisco, California, United States
| | - Manraj Sekhon
- Department of Medicine, University of California, Riverside School of Medicine, Riverside, California, United States
| | - Anthony Gebran
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Mateo Garland
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, United States
| | | | - Tatiana Cadavid
- Department of Nuclear Medicine, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Bassel Almarie
- Department of Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
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6
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Carcel C, Caso V, Aguiar de Sousa D, Sandset EC. Sex differences in neurovascular disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:69-99. [PMID: 36038210 DOI: 10.1016/bs.irn.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurovascular disorders is a heterogenous group of diseases, including one of the most time critical disorders in emergency medicine; stroke. Sex differences are extensively described in neurovascular disorders, ranging from differences in symptom presentation, risk factors, treatment and outcomes. For example, women with stroke, more often present with generalized weakness, reduced consciousness and headache than men. Furthermore, there are differences in risk factors, outcomes and in the effect of secondary prevention. Women have a higher risk of cerebral venous thrombosis and developing cerebral aneurysms. In general, women have been underrepresented in trials on neurovascular disorders. This chapter provides an extensive overview of sex differences in stroke in general and in the differences specially seen in ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage and in cerebral venous thrombosis.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia Hospital University of Perugia, Perugia, Italy
| | - Diana Aguiar de Sousa
- Stroke Center, Lisbon Central University Hospital, Lisbon, Portugal; CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway; The Norwegian Air Ambulance Foundation, Oslo, Norway.
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7
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Lai PMR, Jimenez M, Du R, Rexrode K. Association of Reproductive Life Span and Age at Menopause With the Risk of Aneurysmal Subarachnoid Hemorrhage. Neurology 2022; 98:e2005-e2012. [PMID: 35351793 PMCID: PMC9162048 DOI: 10.1212/wnl.0000000000200222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Subarachnoid hemorrhage from cerebral aneurysm remains a devastating disease with high mortality and morbidity. Cerebral aneurysm and its rupture are more prevalent in postmenopausal women and have been postulated to be hormonally influenced. The goal of this study was to investigate the associations of female-specific factors, including reproductive life span, age at menarche, and age at menopause, with the incidence of aneurysmal subarachnoid hemorrhage (aSAH) in women. METHODS Participants in the Nurses' Health Study were followed up from 1980 or the time of reaching menopause until 2018. Only women with natural menopause or surgical menopause due to bilateral oophorectomy were included. Reproductive life span was defined by subtracting the age at menarche from the age at menopause. Multivariable-stratified proportional hazards models were used to study reproductive life span, age at menarche, and age at menopause with the incidence of aSAH. Multivariable models were adjusted for age, race, smoking, hysterectomy, hypertension, hyperlipidemia, body mass index, hormone therapy use, oral contraceptive use, and parity. RESULTS A total of 97,398 postmenopausal women with reproductive life span data were included; 138 participants developed aSAH, which was confirmed on medical record review by a physician. A shorter reproductive life span (≤35 years) was associated with a 2-fold higher incidence of aSAH after multivariable adjustment (hazard ratio [HR] 2.0 [95% CI 1.4-2.8]). Early age at menopause (age <45 years) was similarly associated with a higher risk of aSAH (HR 2.1 [95% CI 1.4-3.1]), but age at menarche was not. Use of oral contraceptives and postmenopausal hormone therapy was not associated with the incidence of aSAH. DISCUSSION An earlier age at menopause and a shorter reproductive life span duration (≤35 years) were associated with a higher risk of incident aSAH in women. No associations were noted for age at menarche, parity, oral contraceptive use, or postmenopausal therapy use.
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Affiliation(s)
- Pui Man Rosalind Lai
- From the Department of Neurosurgery (P.M.R., R.D.), and Department of Medicine (M.J., K.R.), Division of Women's Health, Brigham and Women's Hospital; and Department of Medicine (P.M.R., M.J., R.D., K.R.), Harvard Medical School, Boston, MA
| | - Monik Jimenez
- From the Department of Neurosurgery (P.M.R., R.D.), and Department of Medicine (M.J., K.R.), Division of Women's Health, Brigham and Women's Hospital; and Department of Medicine (P.M.R., M.J., R.D., K.R.), Harvard Medical School, Boston, MA
| | - Rose Du
- From the Department of Neurosurgery (P.M.R., R.D.), and Department of Medicine (M.J., K.R.), Division of Women's Health, Brigham and Women's Hospital; and Department of Medicine (P.M.R., M.J., R.D., K.R.), Harvard Medical School, Boston, MA
| | - Kathryn Rexrode
- From the Department of Neurosurgery (P.M.R., R.D.), and Department of Medicine (M.J., K.R.), Division of Women's Health, Brigham and Women's Hospital; and Department of Medicine (P.M.R., M.J., R.D., K.R.), Harvard Medical School, Boston, MA
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8
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Su SX, Wang XT, Li XF, Duan CZ, Bi YM, Zhang X. Nonlinear Association of Glycosylated Hemoglobin With Single Intracranial Aneurysm Rupture in Patients With Diabetes Mellitus: A Cross-Sectional Study. Front Neurol 2022; 13:854008. [PMID: 35418940 PMCID: PMC8995878 DOI: 10.3389/fneur.2022.854008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background The published literature linking diabetes mellitus (DM) to intracranial aneurysm (IA) ruptured has been controversial and limited by methodology. Thus, this study was performed to examine whether hyperglycemia control status is independently associated with single IA rupture in patients with DM. Methods We conducted a cross-sectional study on two Chinese hospitals between January 2010 and November 2017. Medical records of 223 patients with single IA and DM were reviewed and analyzed. We used glycosylated hemoglobin (GHB) as the independent variable of interest, and the outcome variable was ruptured status of IA. Covariates included data on demographics, morphological parameters, lifestyle habits, clinical features, and comorbidities. Results Multivariable adjusted binary logistic regression and sensitivity analyses indicated that GHB was not associated with IA rupture (odds ratio OR, = 1.07, 95% CI 0.84-1.35). A nonlinear association between GHB and IA rupture was observed, whose inflection points were 5.5 and 8.9. The OR values (95% confidence intervals) were 0.38 (0.16-0.9) at the range of 1.88-5.5% of GHB, 1.6 (1.03, 2.5) at the range of 5.5-8.9%, and 0.56 (0.06-5.34) at the range of 8.9-10.1, respectively. Conclusion The independent correlation between GHB and risk of IA rupture presented is nonlinear. The good glycemic control in single IA patients with DM can reduce the risk of IA rupture, and vice versa.
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Affiliation(s)
- Shi-Xing Su
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xue-Tao Wang
- Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Xi-Feng Li
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chuan-Zhi Duan
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yi-Ming Bi
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Interventional Treatment, Southern Medical University, Guangzhou, China
| | - Xin Zhang
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Neurosurgery Institute, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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9
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Fréneau M, Baron-Menguy C, Vion AC, Loirand G. Why Are Women Predisposed to Intracranial Aneurysm? Front Cardiovasc Med 2022; 9:815668. [PMID: 35224050 PMCID: PMC8866977 DOI: 10.3389/fcvm.2022.815668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/11/2022] [Indexed: 12/21/2022] Open
Abstract
Intracranial aneurysm (IA) is a frequent and generally asymptomatic cerebrovascular abnormality characterized as a localized dilation and wall thinning of intracranial arteries that preferentially arises at the arterial bifurcations of the circle of Willis. The devastating complication of IA is its rupture, which results in subarachnoid hemorrhage that can lead to severe disability and death. IA affects about 3% of the general population with an average age for detection of rupture around 50 years. IAs, whether ruptured or unruptured, are more common in women than in men by about 60% overall, and more especially after the menopause where the risk is double-compared to men. Although these data support a protective role of estrogen, differences in the location and number of IAs observed in women and men under the age of 50 suggest that other underlying mechanisms participate to the greater IA prevalence in women. The aim of this review is to provide a comprehensive overview of the current data from both clinical and basic research and a synthesis of the proposed mechanisms that may explain why women are more prone to develop IA.
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10
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Lefèvre S, Audrézet MP, Halimi JM, Longuet H, Bridoux F, Ecotière L, Augusto JF, Duveau A, Renaudineau E, Vigneau C, Frouget T, Charasse C, Gueguen L, Perrichot R, Couvrat G, Seret G. Diagnosis and Risk Factors for Intracranial Aneurysms in Autosomal Polycystic Kidney Disease: A cross-sectional study from the Genkyst Cohort. Nephrol Dial Transplant 2022; 37:2223-2233. [PMID: 35108395 DOI: 10.1093/ndt/gfac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is associated with an increased risk for developing intracranial aneurysms (IAs). We aimed to evaluate the frequency of diagnosis of IAs in the cross-sectional, population-based, Genkyst cohort, to describe ADPKD-associated IAs and to analyze the risk factors associated with the occurrence of IAs in ADPKD patients. METHODS Cross-sectional study performed in 26 nephrology centers from the Western part of France. All patients underwent genetic testing for PKD1/PKD2 and other cystogenes. RESULTS Among the 2449 Genkyst participants, 114 (4.65%) had a previous diagnosis of ruptured or unruptured IAs at inclusion, and ∼47% of them had a positive familial history for IAs. Most aneurysms were small and saccular and located in the anterior circulation; 26.3% of the patients had multiple IAs. The cumulative probabilities of a previous diagnosis of IAs were 3.9, 6.2 and 8.1% at 50, 60 and 70 y, respectively. While this risk appeared to be similar in male and female individuals <50 y, after that age, the risk continued to increase more markedly in female patients, reaching 10.8% vs 5.4% at 70 y. The diagnosis rate of IAs was more than twofold higher in PKD1 compared to PKD2 with no influence of PKD1 mutation type or location. In multivariate analysis, female sex, hypertension <35 y, smoking and PKD1 genotype were associated with an increased risk for diagnosis of IAs. CONCLUSIONS This study presents epidemiological data reflecting real-life clinical practice. The increased risk for IAs in postmenopausal women suggests a possible protective role of estrogen.
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Affiliation(s)
- Siriane Lefèvre
- Service de Néphrologie, Hémodialyse et Transplantation rénale, CHRU Brest, Brest 29609, France.,Univ Brest, Inserm, UMR 1078, GGB, Brest, France
| | - Marie-Pierre Audrézet
- Univ Brest, Inserm, UMR 1078, GGB, Brest, France.,Service de génétique moléculaire, CHRU Brest, Brest, France
| | - Jean-Michel Halimi
- Service de Néphrologie-HTA, dialyses, transplantation rénale, Centre Hospitalier Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
| | - Hélène Longuet
- Service de Néphrologie-HTA, dialyses, transplantation rénale, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Frank Bridoux
- Service de Néphrologie, Hémodialyse et Transplantation rénale Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Laure Ecotière
- Service de Néphrologie, Hémodialyse et Transplantation rénale Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jean-François Augusto
- Service de Néphrologie, Hémodialyse et Transplantation rénale Centre Hospitalier Universitaire de Angers, Angers, France
| | - Agnès Duveau
- Service de Néphrologie, Hémodialyse et Transplantation rénale Centre Hospitalier Universitaire de Angers, Angers, France
| | - Eric Renaudineau
- Service de Néphrologie, Centre hospitalier Broussais, Saint-Malo, France
| | - Cécile Vigneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | | | - Christophe Charasse
- Service de Néphrologie, Centre Hospitalier Yves Le Foll, Saint Brieuc, France
| | - Lorraine Gueguen
- Service de Néphrologie, Centre Hospitalier de Cornouaille, Quimper, France
| | - Régine Perrichot
- Service de Néphrologie, Centre Hospitalier de Bretagne Atlantique, Vannes, France
| | - Grégoire Couvrat
- Service de Néphrologie, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
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11
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Fuentes AM, Stone McGuire L, Amin-Hanjani S. Sex Differences in Cerebral Aneurysms and Subarachnoid Hemorrhage. Stroke 2022; 53:624-633. [PMID: 34983239 DOI: 10.1161/strokeaha.121.037147] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sex differences in cerebral aneurysm occurrence and characteristics have been well described. Although sex differences in outcomes following ischemic stroke have been identified, the effect of sex on outcomes following hemorrhagic stroke, and in particular, aneurysm treatment has been less studied. We describe the current state of knowledge regarding the impact of sex on treatment and outcomes of cerebral aneurysms. Although prior studies suggest that aneurysm prevalence and progression may be related to sex, we did not find clear evidence that outcomes following subarachnoid hemorrhage vary based on sex. Last, we identify areas for future research that could enhance understanding of the role sex plays in this context.
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Wang J, Wei L, Lu H, Zhu Y. Roles of inflammation in the natural history of intracranial saccular aneurysms. J Neurol Sci 2020; 424:117294. [PMID: 33799211 DOI: 10.1016/j.jns.2020.117294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022]
Abstract
Aneurysmal subarachnoid hemorrhage is caused by intracranial aneurysm (IA) rupture and results in high rates of mortality and morbidity. Factors contributing to IA generation, growth and rupture can involve genetics, injury, hemodynamics, environmental factors, and inflammation, in which inflammatory factors are believed to play central roles in the whole natural history. Inflammatory reactions that contribute to IA development may involve synthesis of many functional proteins and expression of genes induced by changes of blood flow, external stimuli such as smoking, internal balance such as hormonal status changes, and blood pressure. Meanwhile, inflammatory reactions itself can evoke inflammatory cytokines release and aggregation such as MMPs, MCP-1, TNF-α and ZO-1, directly or indirectly promoting aneurysm growth and rupture. However, the details of these inflammatory reactions and their action on inflammatory chemokines are still unknown. Moreover, some agents with the function of anti-inflammation, lipid-lowering, antihypertension or inflammatory factor inhibition may have the potential benefit to reduce the risk of aneurysm development or rupture in a group of population despite the underlying mechanism remains unclear. Consequently, we reviewed the potential inflammatory responses and their mechanisms contributing to aneurysm development and rupture and sought intervention targets that may prevent IA rupture or generation.
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Affiliation(s)
- Jienan Wang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China
| | - Liming Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China
| | - Haitao Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China.
| | - Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China.
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13
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Desai M, Wali AR, Birk HS, Santiago-Dieppa DR, Khalessi AA. Role of pregnancy and female sex steroids on aneurysm formation, growth, and rupture: a systematic review of the literature. Neurosurg Focus 2020; 47:E8. [PMID: 31261131 DOI: 10.3171/2019.4.focus19228] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Women have been shown to have a higher risk of cerebral aneurysm formation, growth, and rupture than men. The authors present a review of the recently published neurosurgical literature that studies the role of pregnancy and female sex steroids, to provide a conceptual framework with which to understand the various risk factors associated with cerebral aneurysms in women at different stages in their lives. METHODS The PubMed database was searched for "("intracranial" OR "cerebral") AND "aneurysm" AND ("pregnancy" OR "estrogen" OR "progesterone")" between January 1980 and February 2019. A total of 392 articles were initially identified, and after applying inclusion and exclusion criteria, 20 papers were selected for review and analysis. These papers were then divided into two categories: 1) epidemiological studies about the formation, growth, rupture, and management of cerebral aneurysms in pregnancy; and 2) investigations on female sex steroids and cerebral aneurysms (animal studies and epidemiological studies). RESULTS The 20 articles presented in this study include 7 epidemiological articles on pregnancy and cerebral aneurysms, 3 articles reporting case series of cerebral aneurysms treated by endovascular therapies in pregnancy, 3 epidemiological articles reporting the relationship between female sex steroids and cerebral aneurysms through retrospective case-control studies, and 7 experimental studies using animal and/or cell models to understand the relationship between female sex steroids and cerebral aneurysms. The studies in this review report similar risk of aneurysm rupture in pregnant women compared to the general population. Most ruptured aneurysms in pregnancy occur during the 3rd trimester, and most pregnant women who present with cerebral aneurysm have caesarean section deliveries. Endovascular treatment of cerebral aneurysms in pregnancy is shown to provide a new and safe form of therapy for these cases. Epidemiological studies of postmenopausal women show that estrogen hormone therapy and later age at menopause are associated with a lower risk of cerebral aneurysm than in matched controls. Experimental studies in animal models corroborate this epidemiological finding; estrogen deficiency causes endothelial dysfunction and inflammation, which may predispose to the formation and rupture of cerebral aneurysms, while exogenous estrogen treatment in this population may lower this risk. CONCLUSIONS The aim of this work is to equip the neurosurgical and obstetrical/gynecological readership with the tools to better understand, critique, and apply findings from research on sex differences in cerebral aneurysms.
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Affiliation(s)
| | - Arvin R Wali
- 2Department of Neurological Surgery, University of California, San Diego, California
| | - Harjus S Birk
- 2Department of Neurological Surgery, University of California, San Diego, California
| | | | - Alexander A Khalessi
- 2Department of Neurological Surgery, University of California, San Diego, California
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The Bilateral Ovariectomy in a Female Animal Exacerbates the Pathogenesis of an Intracranial Aneurysm. Brain Sci 2020; 10:brainsci10060335. [PMID: 32486339 PMCID: PMC7349062 DOI: 10.3390/brainsci10060335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/23/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022] Open
Abstract
Considering the poor outcome of subarachnoid hemorrhage (SAH) due to the rupture of intracranial aneurysms (IA), mechanisms underlying the pathogenesis of IAs, especially the rupture of lesions, should be clarified. In the present study, a rat model of IAs in which induced lesions spontaneously ruptured resulting in SAH was used. In this model, the combination of the female sex and the bilateral ovariectomy increased the incidence of SAH, similar to epidemiological evidence in human cases. Importantly, unruptured IA lesions induced in female animals with bilateral ovariectomy were histopathologically similar to ruptured ones in the presence of vasa vasorum and the accumulation of abundant inflammatory cells, suggesting the exacerbation of the disease. The post-stenotic dilatation of the carotid artery was disturbed by the bilateral ovariectomy in female rats, which was restored by hormone replacement therapy. The in vivo study thus suggested the protective effect of estrogen from the ovary on endothelial cells loaded by wall shear stress. β-estradiol or dihydrotestosterone also suppressed the lipopolysaccharide-induced expression of pro-inflammatory genes in cultured macrophages and neutrophils. The results of the present study have thus provided new insights about the process regulating the progression of the disease.
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Ramesh SS, Christopher R, Indira Devi B, Bhat DI. The vascular protective role of oestradiol: a focus on postmenopausal oestradiol deficiency and aneurysmal subarachnoid haemorrhage. Biol Rev Camb Philos Soc 2019; 94:1897-1917. [DOI: 10.1111/brv.12541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Shruthi S. Ramesh
- Department of NeurochemistryNational Institute of Mental Health and Neuro Sciences Bengaluru‐560029 Karnataka India
| | - Rita Christopher
- Department of NeurochemistryNational Institute of Mental Health and Neuro Sciences Bengaluru‐560029 Karnataka India
| | - Bhagavatula Indira Devi
- Department of NeurosurgeryNational Institute of Mental Health and Neuro Sciences Bengaluru‐560029 Karnataka India
| | - Dhananjaya I. Bhat
- Department of NeurosurgeryNational Institute of Mental Health and Neuro Sciences Bengaluru‐560029 Karnataka India
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16
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Lai PMR, Du R. Differentially Expressed Genes Associated with the Estrogen Receptor Pathway in Cerebral Aneurysms. World Neurosurg 2019; 126:e557-e563. [DOI: 10.1016/j.wneu.2019.02.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/08/2019] [Accepted: 02/09/2019] [Indexed: 01/23/2023]
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17
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Cho BH, Kim JH, Suh SH, Baik SJ, Lee HS, Kim J, Lee KY. Characteristics of Intracranial Aneurysms According to Levels of Coronary Artery Calcium. Stroke 2019; 50:1403-1408. [PMID: 31084330 DOI: 10.1161/strokeaha.119.024726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background and Purpose- Several vascular risk factors are known to be associated with the occurrence of intracranial aneurysms (IAs). Coronary artery calcium (CAC), which reflects the atherosclerotic burden of the coronary arteries, is a known predictor of cardiovascular events and stroke. We investigated the relationship between IA and CAC. Methods- We retrospectively enrolled Korean subjects at a single university hospital who had both brain magnetic resonance angiography and cardiac computed tomography as part of health examinations from January 2010 to July 2017. Subjects were categorized into 4 groups according to CAC score as assessed by cardiac computed tomography: zero (0), low (1-99), intermediate (100-399), or high (≥400). Then, the prevalence of IA in each CAC score group was assessed. We also performed subgroup analysis by age, sex, and location of IA. Results- A total of 4934 subjects (mean age, 54.1±9.8 years; %women, 42.2%) were included for analysis. IAs were detected in 258 subjects (5.23%). The prevalence of IA significantly increased as the CAC score increased (4.8%, 5.4%, 6.4%, and 11.1%, respectively; P for trend, 0.004). In subjects over the age of 50 years, this correlation was more prominent in women than in men (7.1% versus 3.7%, 8.8% versus 4.4%, 8.6% versus 6.3%, and 21.1% versus 10.0%, respectively). Subgroup analysis for the aneurysm location showed that nonbifurcation aneurysm was associated with a high CAC score but bifurcation aneurysm was not. Multivariate logistic regression showed high CAC score was an independent risk factor for the presence of IA compared with zero CAC score (adjusted odds ratio, 2.16; 95% CI, 1.18-3.95). Conclusions- A high CAC score was associated with the presence of IA. This relationship was more prominent in females and nonbifurcation aneurysms.
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Affiliation(s)
- Bang-Hoon Cho
- From the Department of Neurology, Gangnam Severance Hospital (B.-H.C., J.H.K., J.K., K.-Y.L.), Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul (B.-H.C.)
| | - Ji Hwa Kim
- From the Department of Neurology, Gangnam Severance Hospital (B.-H.C., J.H.K., J.K., K.-Y.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital (S.H.S.), Yonsei University College of Medicine, Seoul, Korea
| | - Su Jung Baik
- Healthcare Research Team, Health Promotion Center, Gangnam Severance Hospital (S.J.B.), Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Jinkwon Kim
- From the Department of Neurology, Gangnam Severance Hospital (B.-H.C., J.H.K., J.K., K.-Y.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Yul Lee
- From the Department of Neurology, Gangnam Severance Hospital (B.-H.C., J.H.K., J.K., K.-Y.L.), Yonsei University College of Medicine, Seoul, Korea.,Severance Institute for Vascular and Metabolic Research (K.-Y.L.), Yonsei University College of Medicine, Seoul, Korea
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18
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Management of intracranial haemorrhage, unruptured aneurysms and arteriovenous malformations during and after pregnancy. Curr Opin Neurol 2019; 32:36-42. [DOI: 10.1097/wco.0000000000000643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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19
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Darkwah Oppong M, Iannaccone A, Gembruch O, Pierscianek D, Chihi M, Dammann P, Köninger A, Müller O, Forsting M, Sure U, Jabbarli R. Vasospasm-related complications after subarachnoid hemorrhage: the role of patients' age and sex. Acta Neurochir (Wien) 2018; 160:1393-1400. [PMID: 29704122 DOI: 10.1007/s00701-018-3549-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/11/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Outcome of aneurysmal subarachnoid hemorrhage (SAH) depends strongly on occurrence of symptomatic vasospasm (SV) leading to delayed cerebral ischemia (DCI). Various demographic, radiographic, and clinical predictors of SV have been reported so far, partially with conflicting results. The aim of this study was to analyze the role of patients' age and sex on SV/DCI risk, especially to identify age and sex-specific risk groups. METHODS All patients admitted with acute SAH during a 14-year-period ending in 2016 were eligible for this study. The study endpoints were the following: SV requiring spasmolysis, occurrence of DCI in follow-up computed tomography scans and unfavorable outcome at 6 months (modified Rankin scale > 2). RESULTS Nine hundred ninety-four patients were included in this study. The majority was female (666; 67%). SV, DCI, and unfavorable outcomes were observed in 21.5, 21.8, and 43.6% of the patients, respectively. Younger age (p < 0.001; OR = 1.03 per year decrease) and female sex (p = 0.025; OR = 1.510) were confirmed as independent predictors of SV. Regarding the sex differences, there were three age groups for SV/DCI risk ≤ 54, 55-74, and ≥ 75 years. Male patients showed earlier decrease in SV risk (at ≥ 55 vs. ≥ 75 years in females). Therefore, SAH females aged between 55 and 74 years were at the highest risk for DCI and unfavorable outcome, as compared to younger/older females (p = 0.001, OR = 1.77/p = 0.001, OR = 1.80). In contrast, their male counterparts did not show these risk alterations (p = 0.445/p = 0.822). CONCLUSION After acute SAH, female and male patients seem to show different age patterns for the risk of SV and DCI. Females aged between 55 and 74 years are at particular risk of vasospasm-related SAH complications, possibly due to onset of menopause. CLINICAL TRIAL REGISTRATION NUMBER DRKS, Unique identifier: DRKS00008749.
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Affiliation(s)
- Marvin Darkwah Oppong
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, 45147, Essen, Germany.
| | - Antonella Iannaccone
- Department of Gynecology and Obstetrics, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, 45147, Essen, Germany
| | - Daniela Pierscianek
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, 45147, Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, 45147, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, 45147, Essen, Germany
| | - Angela Köninger
- Department of Gynecology and Obstetrics, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Oliver Müller
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, 45147, Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, 45147, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, 45147, Essen, Germany
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20
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Gouda ZA, Khalifa MEA, Shalaby SM, Hussein S. Mechanistic effect of human umbilical cord blood derived mesenchymal stem cells on the submandibular salivary gland in ovariectomized rats. Biochem Cell Biol 2018; 96:57-67. [DOI: 10.1139/bcb-2017-0196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
We performed this study to understand the effect of human umbilical cord blood derived mesenchymal stem cells (hUCB-MSCs) on the submandibular gland after bilateral ovariectomy. For this, 21 adult female rats were distributed equally among 3 groups: the sham-operated group (SHAM); the ovariectomized group (OVX); and the OVX group that received repeated intravenous injections of the hUCB-MSCs (OVX + hUCB-MSCs). We used reverse transcription – PCR to analyze for the gene expression of AQPs 3, 4, 5, and BMP-6. The cellular localization and expression of human CD105, human CD34, proliferating nuclear antigen (PCNA), single-stranded DNA (ss-DNA), caspase 3, AQP1, and α smooth muscle actin (α-SMA) were determined immunohistochemically. In the OVX group, a significant decrease in the gene expression of AQP3, AQP4, and BMP6, as well as the acinar area % was detected, while area % of granular convoluted tubules (GCTs) showed a significant increase. A significant decrease in area % staining positively for AQP1 and α-SMA was noted. An obvious improvement in the structure of the submandibular gland was demonstrated in the group injected with hUCB-MSCs, as well as a significant increase in the gene expression of AQP3, AQP4, and BMP6. The acinar and GCT area %, as well as the different measured markers, were relatively normal. This demonstrates that E2-deficiency induces structural changes to the submandibular gland. Moreover, a definite amelioration of the structure and function of the submandibular gland was detected after the administration of hUCB-MSCs.
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Affiliation(s)
- Zienab A. Gouda
- Histology and Cell Biology, Faculty of Medicine, Zagazig University, 44519, Zagazig, Egypt
| | - Mohamed E. Ali Khalifa
- Histology and Cell Biology, Faculty of Medicine, Zagazig University, 44519, Zagazig, Egypt
| | - Sally M. Shalaby
- Medical Biochemistry and Molecular Biology Departments, Faculty of Medicine, Zagazig University, 44519, Zagazig, Egypt
| | - Samia Hussein
- Medical Biochemistry and Molecular Biology Departments, Faculty of Medicine, Zagazig University, 44519, Zagazig, Egypt
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21
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Can A, Castro VM, Yu S, Dligach D, Finan S, Gainer VS, Shadick NA, Savova G, Murphy S, Cai T, Weiss ST, Du R. Antihyperglycemic Agents Are Inversely Associated With Intracranial Aneurysm Rupture. Stroke 2018; 49:34-39. [DOI: 10.1161/strokeaha.117.019249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/11/2017] [Accepted: 10/27/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Anil Can
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Victor M. Castro
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Sheng Yu
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Dmitriy Dligach
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Sean Finan
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Vivian S. Gainer
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Nancy A. Shadick
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Guergana Savova
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Shawn Murphy
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Tianxi Cai
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Scott T. Weiss
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
| | - Rose Du
- From the Department of Neurosurgery (A.C., R.D.), Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology, and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Research Information Systems and Computing, Partners Healthcare, Boston, MA (V.M.C., V.G., S.M.); Center for Statistical Science, Tsinghua University, Beijing, China (S.Y.); Computational Health Informatics Program, Boston
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22
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Wáng YXJ, He J, Zhang L, Li Y, Zhao L, Liu H, Yang L, Zeng XJ, Yang J, Peng GM, Ahuja A, Yang ZH. A higher aneurysmal subarachnoid hemorrhage incidence in women prior to menopause: a retrospective analysis of 4,895 cases from eight hospitals in China. Quant Imaging Med Surg 2016; 6:151-6. [PMID: 27190767 DOI: 10.21037/qims.2016.01.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) from a ruptured cerebral aneurysm is a devastating disease. Despite the risk factors, including hypertension, cigarette smoking and alcohol use, are more common in men, aneurysmal SAH belongs to a few diseases which the incidence is higher in women than in men. Sex hormones, especially estrogen, might be protective against this condition. Hormone replacement therapy (HRT) seems to be associated with a reduced risk for aneurysmal SAH. This study aims to know the prevalence of aneurysmal SAH of men and women at different ages. METHODS The age and gender information of 4,895 case of aneurysmal SAH (3,016 females, 1,879 males) were collected retrospectively from eight institutions in mainland China. The prevalence of aneurysmal SAH of men and women at different ages was analyzed. RESULTS The data showed women had a higher incidence of aneurysmal SAH than men starting at late thirties, and men might have a higher incidence of aneurysmal SAH than women only before 37-year-old. CONCLUSIONS Menopause may not be the only dominant factor causing higher incidence of aneurysmal SAH in women than in men.
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Affiliation(s)
- Yì Xiáng J Wáng
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jian He
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lihong Zhang
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yao Li
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lin Zhao
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Heng Liu
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lin Yang
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xian Jun Zeng
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jian Yang
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Guang Ming Peng
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Anil Ahuja
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zheng Han Yang
- 1 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Prince of Wales Hospital, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Neurology, 4 Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China ; 5 Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China ; 6 Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China ; 7 Department of Radiology, North Sichuan Medical College Hospital, Nanchong 637000, China ; 8 Department of Radiology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, China ; 9 Department of Radiology, The General Hospital of Guangzhou Military Command, Guangzhou 510010, China ; 10 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Relationship between Postmenopausal Estrogen Deficiency and Aneurysmal Subarachnoid Hemorrhage. Behav Neurol 2015; 2015:720141. [PMID: 26538819 PMCID: PMC4619901 DOI: 10.1155/2015/720141] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/09/2015] [Accepted: 08/02/2015] [Indexed: 11/18/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is one of the most severe forms of stroke, which results from the rupture of a cerebral aneurysm. SAH is the only type of stroke with a female predominance, suggesting that reproductive factors may play a significant role in the etiology. Estrogen has important effects on vascular physiology and pathophysiology of cerebral aneurysm and SAH and, thus, potential therapeutic implications. There have been growing bodies of epidemiological and experimental studies which support the hypothesis of a significant relationship between estrogen deficiency and cerebral aneurysm formation with subsequent SAH. This hypothesis is the focus of this review as well as possible pathology-based therapeutics with regard to aspects of molecular pathophysiology, especially related to women's health.
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Hamdan A, Barnes J, Mitchell P. Subarachnoid hemorrhage and the female sex: analysis of risk factors, aneurysm characteristics, and outcomes. J Neurosurg 2014; 121:1367-73. [PMID: 25216063 DOI: 10.3171/2014.7.jns132318] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH) is unclear. Sex may play a role in the outcome of patients with aSAH. METHODS The authors retrospectively identified 617 patients with aSAH (April 2005 to February 2010) and analyzed sex differences in risk factors (age, hypertension, smoking, alcohol consumption, and family history), admission-related factors (World Federation of Neurosurgical Societies grade and admission delay), aneurysm characteristics (site, side, location, and multiplicity), and outcomes (treatment modalities [coiling/clipping/both/conservative], complications [vasospasm and hydrocephalus], length of stay, and modified Rankin Scale score at 3 months). RESULTS The female patients with aSAH were older than the male patients (mean age 56.6 vs 51.9 years, respectively, p < 0.001), and more women than men were ≥ 55 years old (56.2% vs 40.4%, respectively, p < 0.001). Women exhibited higher rates of bilateral (6.8% vs 2.6%, respectively, p < 0.05), multiple (11.5% vs 5.2%, respectively, p < 0.05), and internal carotid artery (ICA) (36.9% vs 17.5%, respectively, p < 0.001) aneurysms and a lower rate of anterior cerebral artery aneurysms (26.3% vs 44.8%, respectively, p < 0.001) than the men, but no side differences were noted. There were no sex differences in risk factors, admission-related factors, or outcome measures. For both sexes, outcomes varied according to aneurysm location, with odds ratios for a poor outcome of 1.62 (95% CI 0.91-2.86, p = 0.1) for middle cerebral artery, 2.41 (95% CI 1.29-4.51, p = 0.01) for ICA, and 2.41 (95% CI 1.29-4.51, p = 0.006) for posterior circulation aneurysms compared with those for anterior cerebral artery aneurysms. The odds ratio for poor outcome (modified Rankin Scale score of 4-6) in women compared with men after adjusting for significant prognostic factors was 0.71 (95% CI 0.45-1.11, p > 0.05). CONCLUSIONS The overall outcomes after aSAH between women and men are similar.
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Larrew T, Pryor W, Weinberg J, Webb S, Battenhouse H, Turk AS, Chaudry I, Spiotta A, Turner R. Aneurysmal subarachnoid hemorrhage: a statewide assessment of outcome based on risk factors, aneurysm characteristics, and geo-demography. J Neurointerv Surg 2014; 7:855-60. [DOI: 10.1136/neurintsurg-2014-011359] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/20/2014] [Indexed: 11/04/2022]
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Therapeutic implications of estrogen for cerebral vasospasm and delayed cerebral ischemia induced by aneurysmal subarachnoid hemorrhage. BIOMED RESEARCH INTERNATIONAL 2014; 2014:727428. [PMID: 24724095 PMCID: PMC3958795 DOI: 10.1155/2014/727428] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/21/2014] [Indexed: 12/18/2022]
Abstract
Cerebral vasospasm (CV) remains the leading cause of delayed morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). However, increasing evidence supports etiologies of delayed cerebral ischemia (DCI) other than CV. Estrogen, specifically 17 β -estradiol (E2), has potential therapeutic implications for ameliorating the delayed neurological deterioration which follows aneurysmal SAH. We review the causes of CV and DCI and examine the evidence for E2-mediated vasodilation and neuroprotection. E2 potentiates vasodilation by activating endothelial nitric oxide synthase (eNOS), preventing increased inducible NOS (iNOS) activity caused by SAH, and decreasing endothelin-1 production. E2 provides neuroprotection by increasing thioredoxin expression, decreasing c-Jun N-terminal kinase activity, increasing neuroglobin levels, preventing SAH-induced suppression of the Akt signaling pathway, and upregulating the expression of adenosine A2a receptor. The net effect of E2 modulation of these various effectors is the promotion of neuronal survival, inhibition of apoptosis, and decreased oxidative damage and inflammation. E2 is a potentially potent therapeutic tool for improving outcomes related to post-SAH CV and DCI. However, clinical evidence supporting its benefits remains lacking. Given the promising preclinical data available, further studies utilizing E2 for the treatment of patients with ruptured intracranial aneurysms appear warranted.
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Friedrich V, Bederson JB, Sehba FA. Gender influences the initial impact of subarachnoid hemorrhage: an experimental investigation. PLoS One 2013; 8:e80101. [PMID: 24250830 PMCID: PMC3826711 DOI: 10.1371/journal.pone.0080101] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 09/29/2013] [Indexed: 12/14/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) carries high early patient mortality. More women than men suffer from SAH and the average age of female SAH survivors is greater than that of male survivors; however, the overall mortality and neurological outcomes are not better in males despite their younger age. This pattern suggests the possibility of gender differences in the severity of initial impact and/or in subsequent pathophysiology. We explored gender differences in survival and pathophysiology following subarachnoid hemorrhage induced in age-matched male and female rats by endovascular puncture. Intracranial pressure (ICP), cerebral blood flow (CBF), blood pressure (BP) and cerebral perfusion pressure (CPP) were recorded at and after induction of SAH. Animals were sacrificed 3 hours after lesion and studied for subarachnoid hematoma size, vascular pathology (collagen and endothelium immunostaining), inflammation (platelet and neutrophil immunostaining), and cell death (TUNEL assay). In a second cohort, 24-hour survival was determined. Subarachnoid hematoma, post-hemorrhage ICP peak, BP elevation, reduction in CPP, intraluminal platelet aggregation and neutrophil accumulation, loss of vascular collagen, and neuronal and non-neuronal cell death were greater in male than in female rats. Hematoma size did not correlate with the number of apoptotic cells, platelet aggregates or neutrophil. The ICP peak correlated with hematoma size and with number of apoptotic cells but not with platelet aggregates and neutrophil number. This suggests that the intensity of ICP rise at SAH influences the severity of apoptosis but not of inflammation. Mortality was markedly greater in males than females. Our data demonstrate that in rats gender influences the initial impact of SAH causing greater bleed and early injury in males as compared to females.
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Affiliation(s)
- Victor Friedrich
- Department of Neuroscience, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Joshua B. Bederson
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Fatima A. Sehba
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, United States of America
- Department of Neuroscience, Mount Sinai School of Medicine, New York, New York, United States of America
- * E-mail:
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Lee Y, Min HK, Yoon SP. Anterior cerebral artery aneurysm associated with multiple intracranial aneurysms and abdominal aorta aneurysm. Anat Cell Biol 2013; 46:220-2. [PMID: 24179699 PMCID: PMC3811850 DOI: 10.5115/acb.2013.46.3.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 11/27/2022] Open
Abstract
We found multiple aneurysms in the intracranial arteries and abdominal aorta of an 87-year-old Korean female cadaver, whose cause of death was reported as "cholangiocarcinoma." An abdominal aortic aneurysm was observed in the infrarenal aorta, where the inferior mesenteric artery arose. The intracranial aneurysms were found in the A3 segment of the anterior cerebral artery and at the bifurcation of the middle cerebral artery. This case provides an example of the very rare association of peripheral intracranial aneurysms with an abdominal aortic aneurysm. Clinicians as well as anatomists should recognize the potential association between these two aneurysm types.
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Affiliation(s)
- Yunghwan Lee
- Medical Course, Jeju National University School of Medicine, Jeju, Korea
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Affiliation(s)
- Nohra Chalouhi
- From the Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (N.C.); Jefferson Hospital for Neuroscience, Philadelphia, PA (N.C.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); and Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City (D.H.)
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