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Navandhar PS, Gharde P, Shinde RK, Nagtode T. Moyamoya Disease: Advances in Diagnosis, Treatment, and Surgical Interventions. Cureus 2024; 16:e59826. [PMID: 38846195 PMCID: PMC11156423 DOI: 10.7759/cureus.59826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive narrowing of the brain's arteries, leading to an increased risk of stroke. The primary susceptibility gene, RNF213, has been identified in individuals of East Asian descent, contributing to ongoing research into potential therapeutic targets. The distinction between idiopathic MMD and secondary forms, such as Moyamoya syndrome (MMS), is discussed, focusing on associated conditions and risk factors. Surgical revascularization emerges as the mainstay of treatment, with direct, indirect, and combination bypass procedures explored. The review delves into advancements in imaging technology for diagnosis and treatment planning, emphasizing non-invasive magnetic resonance examination's role in identifying asymptomatic patients. Additionally, insights into anesthetic care and therapeutic approaches underscore the evolving understanding of this complex disease. The presented information aims to contribute to the ongoing dialogue surrounding MMD, providing a valuable resource for clinicians and researchers.
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Affiliation(s)
- Pratik S Navandhar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tushar Nagtode
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Chen J, Zheng H, Wu X, Niu X, Dai Y, Zhou Z, Ye F. Neuregulin 1 as a potential biomarker for disease progression in moyamoya disease: A case-control study in Chinese population. J Stroke Cerebrovasc Dis 2024; 33:107581. [PMID: 38224792 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107581] [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: 09/28/2023] [Revised: 01/07/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE Moyamoya disease (MMD) is a rare and progressive stenosis of cerebral arteries characterized by abnormally proliferative vasculopathy. Current studies have demonstrated that Neuregulin 1 (NRG1) plays a key role in angiogenesis-related disorders. Thus, the aim of our study is to investigate the serum NRG1 levels and their clinical correlations in MMD patients. METHODS In this study, thirty adult patients with MMD and age-gender matched healthy controls were enrolled from our hospital between July 2020 and April 2022. Peripheral blood samples were collected at baseline, and clinical data were obtained from the electronic medical record system. Serum NRG1 concentrations were measured by enzyme-linked immunosorbent assay. Sanger sequencing was applied to detect the RNF213 p.R4810K mutation. RESULTS The serum NRG1 levels were significantly higher in MMD patients compared to controls (14.48 ± 10.81 vs.7.54 ± 6.35mmol/L, p < 0.001). No statistical difference in baseline clinical characteristics was found between both groups. Correlation analyses showed that NRG1 levels were positively associated with Suzuki staging (r = 0.4137, p = 0.023) while not related to other clinical features (reduced cerebral blood flow, posterior cerebral artery involvement, bilateral or unilateral steno-occlusive changes). Furthermore, subgroup analysis revealed that MMD patients with the RNF213 p.R4810K mutation presented with significantly higher NRG1 levels than those without the mutation (9.60 ± 0.929 vs. 25.89 ± 4.338 mmol/L, p = 0.001). CONCLUSIONS Our study suggests that increased serum NRG1 levels may constitute a characteristic feature of MMD, indicating a potential positive correlation with disease progression and the presence of the RNF213 mutation. This positions NRG1 as a potentially crucial target for further studies aimed at comprehending the pathogenesis of MMD.
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Affiliation(s)
- Jie Chen
- Department of Neurology and Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hanyue Zheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxin Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingyang Niu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuanyuan Dai
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenhua Zhou
- Department of Neurology and Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
| | - Fei Ye
- Department of Neurology and Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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Wittenberg B, Ryan M, Hoffman J, Bernard T, Seinfeld J, Wilkinson C. Rapidly Progressive Contralateral Internal Carotid Artery Stenosis After COVID-19 Infection in a Down Syndrome Patient With Unilateral Moyamoya Arteriopathy. Cureus 2024; 16:e56575. [PMID: 38646238 PMCID: PMC11031128 DOI: 10.7759/cureus.56575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Moyamoya arteriopathy is a condition where chronic, progressive stenosis of large intracranial arteries, primarily of the anterior circulation, results in ischemia and the growth of small, abnormal collateral vessels. There is increasing evidence that infectious pathologies, such as COVID-19, may serve as a sort of trigger, or "second hit," for the development of moyamoya arteriopathy. In this article, we present the case of a 13-year-old female with Down syndrome and unilateral moyamoya arteriopathy who developed contralateral internal carotid artery (ICA) dissection and thrombus in the setting of a positive COVID-19 test and subsequently developed rapidly progressive contralateral ICA and bilateral anterior cerebral artery (ACA) moyamoya-like stenosis. The rapidly progressive contralateral ICA and bilateral ACA moyamoya-like stenosis are likely multifactorial in nature. The contralateral ICA may have had a predisposition for injury and stenosis due to the preexisting moyamoya arteriopathy, making stenosis more likely after COVID-19-induced vascular inflammation and injury as well as after a possible thrombectomy-associated injury. Based on this presentation, patients with moyamoya arteriopathy may be at risk for rapid progression of their moyamoya pathology when exposed to catalysts, including infection, such as COVID-19, and vascular injury, such as thrombectomy-induced injury. In these circumstances, high suspicion and close monitoring are essential for addressing ischemia related to the stenosis before permanent injury.
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Affiliation(s)
- Blake Wittenberg
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Megan Ryan
- Neurosurgery, Rocky Vista University College of Osteopathic Medicine, Parker, USA
| | - Jessa Hoffman
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Timothy Bernard
- Neurology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Joshua Seinfeld
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Corbett Wilkinson
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
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Wang A, Li N, Zhang N, Liu J, Yang T, Li D, Li C, Li R, Jiang T, Xia C. Desmoglein-2 Affects Vascular Function in Moyamoya Disease by Interacting with MMP-9 and Influencing PI3K Signaling. Mol Neurobiol 2024:10.1007/s12035-024-04010-0. [PMID: 38326520 DOI: 10.1007/s12035-024-04010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
The pathogenesis and development of Moyamoya disease are still unclear. This study aimed to investigate the effect of desmoglein-2 (DSG2) on Moyamoya disease and determine the inhibitory effect of DSG2 in vascular remodeling in Moyamoya disease.RNA sequencing, immunohistochemistry (IHC), and western blotting were used to detect the expression of DSG2 in the superficial temporal artery (STA) tissues of Moyamoya disease. The association between DSG2 and endothelial cells' biological activities was investigated by cell counting kit-8 (CCK-8), migration assay, tube formation assay, flow cytometry with Annexin V-FITC/PI staining, and TUNEL apoptotic cell detection kit. Pathways affected by overexpression or knockdown of DSG2 were identified in endothelial cells.The expression of DSG2 in the STA tissues of Moyamoya disease was lower than that in normal controls. Overexpression of DSG2 inhibits the proliferation and migration but promotes apoptosis in endothelial cells, and low DSG2 levels result in impaired angiogenesis. In addition, there was an interaction between DSG2 and MMP-9, and DSG2 acted through the PI3K signaling in endothelial cells.Our results indicate that DSG2 affects PI3K signaling in vascular endothelial cells, and MMP-9 is involved in DSG2-mediated vascular changes in Moyamoya disease.
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Affiliation(s)
- Ajun Wang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui Province, China
- Department of Neurosurgery, Anhui Provincial Hospital, Affiliated to Anhui Medical University, Hefei, China
| | - Nan Li
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui Province, China
| | - Nan Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui Province, China
| | - Jian Liu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui Province, China
- Department of Neurosurgery, Anhui Provincial Hospital, Affiliated to Anhui Medical University, Hefei, China
| | - Tao Yang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui Province, China
| | - Dongxue Li
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui Province, China
| | - Changwen Li
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui Province, China
| | - Rui Li
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui Province, China
| | - Tongcui Jiang
- School of Basic Medical Sciences, Anhui Medical University, 81 Meishan Road, Hefei, Anhui Province, China.
| | - Chengyu Xia
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui Province, China.
- Department of Neurosurgery, Anhui Provincial Hospital, Affiliated to Anhui Medical University, Hefei, China.
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Chen X, Song C, Ma X, Tao J, Hu L, Xu Y, Yi Y, Yang X, Jiang L. High lipoprotein(a) concentration is associated with moyamoya disease. Lipids Health Dis 2024; 23:21. [PMID: 38254149 PMCID: PMC10802057 DOI: 10.1186/s12944-024-02015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Moyamoya disease (MMD) has attracted the attention of scholars because of its rarity and unknown etiology. METHODS Data for this study were sourced from the Second Affiliated Hospital of Nanchang University. Regression analyses were conducted to examine the association in Lipoprotein [Lp(a)] and MMD. R and IBM SPSS were conducted. RESULTS A cohort comprising 1012 MMD patients and 2024 controls was established through the propensity score matching method. Compared with controls, MMD patients showed higher median Lp(a) concentrations [18.5 (9.6-37.8) mg/dL vs. 14.9 (7.8-30.5) mg/dL, P < 0.001]. The odds ratios and 95% confidence intervals for Lp(a) were calculated in three models: unadjusted model, model 1 (adjusted for body mass index and systolic blood pressure), and model 2 (adjusted for model 1 plus triglyceride, C-reactive protein, homocysteine, and low-density lipoprotein cholesterol). Results were [1.613 (1.299-2.002), P < 0.001], [1.598 (1.286-1.986), P < 0.001], and [1.661 (1.330-2.074), P < 0.001], respectively. Furthermore, age, sex, or hypertension status had nothing to do with this relationship. CONCLUSIONS Positive relationship exists between Lp(a) and MMD.
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Affiliation(s)
- Xinyue Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, 330006, China
| | - Chenxin Song
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, 330006, China
| | - Xianrun Ma
- School of Basic Medical Sciences, Nanchang University, Jiangxi, Nanchang, 330006, China
| | - Junjie Tao
- The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, 330006, China
| | - Lijuan Hu
- Department of Nursing, Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yuan Xu
- Department of Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yingping Yi
- Department of Medical Big Data Center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xinlei Yang
- Biobank center, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Long Jiang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Wang Q, Yao Q, Yuan S, Shen Y, Feng Y, Liu L, Zhu Y, Zhao Y, Cui J, Qin J, Tian J, Zhao R, Liu L, Zhou Y, Liu X. Recurrent Cerebral Infarction Due to Moyamoya Disease Complicated With Systemic Lupus Erythematosus: A Case Report and Literature Review. Neurologist 2024; 29:4-13. [PMID: 37582681 DOI: 10.1097/nrl.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
INTRODUCTION We report a rare case of moyamoya disease caused by an RNF213 mutation, complicated with systemic lupus erythematosus. CASE REPORT A 32-year-old woman experienced 4 cerebral ischemia stroke events within 6 months. The main symptom was left limb weakness with blurred vision in the right eye. Results of digital subtraction angiography conducted at another hospital were consistent with moyamoya disease. On genetic testing, we found that the patient carried 2 mutations in the moyamoya disease-related gene RNF213 (p.R4810K, p.T1727M). On the basis of the laboratory immunologic indicators, such as positive antibodies and abnormal immunoglobulin levels and imaging examinations, the patient was finally diagnosed as moyamoya disease complicated with systemic lupus erythematosus. She was treated with aspirin, butylphthalide, urinary kallidinogenase, and sodium methylprednisolone. CONCLUSIONS This was a 32-year-old young patient diagnosed with moyamoya disease carrying RNF213 gene mutation and accompanied by lupus with cerebral ischemic event as the first occurrence. The patient's condition was complex; therefore, comprehensive analysis and in-depth consideration were needed to avoid a missed diagnosis and misdiagnosis. When the primary disease cannot be identified, genetic testing can help to clarify the diagnosis of moyamoya disease.
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Affiliation(s)
- Qisong Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Yajima H, Miyawaki S, Sayama S, Kumasawa K, Ikemura M, Imai H, Hongo H, Hirano Y, Ishigami D, Torazawa S, Kiyofuji S, Koizumi S, Saito N. Hypertensive disorders of pregnancy in moyamoya disease: A single institution experience. J Stroke Cerebrovasc Dis 2023; 32:107377. [PMID: 37742384 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107377] [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: 05/23/2023] [Revised: 08/21/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE The characteristics of pregnancy and delivery in patients with moyamoya disease (MMD) remain unclear. We retrospectively investigated perinatal outcomes in patients with MMD to evaluate the risks associated to this condition. MATERIALS AND METHODS Clinical data of women with MMD who delivered at the University of Tokyo Hospital between 2000 and 2021 were collected. Maternal characteristics including genetic data, obstetric complications, method of delivery and anesthesia, neonatal outcomes, neurological events during pregnancy, delivery, and postpartum course, were reviewed. RESULTS Thirteen pregnancies with MMD were identified. The median maternal age was 30 years. The initial clinical symptoms were identified as transient ischemic attack, infarction, and headache. Eight patients had a history of bypass surgery. The median gestational age at delivery was 37 weeks. DNA samples were collected from five patients, responsible for six pregnancies. Of these six cases, five had the RNF213 c.14429G > A (p.Arg4810Lys) heterozygous variant. Of the 13 pregnancies, seven had hypertensive disorder of pregnancy (HDP). Additionally, three of five pregnancy cases with RNF213 p.Arg4810Lys heterozygous variant presented with HDP. Nine patients underwent cesarean section, and four delivered vaginally with epidural anesthesia. One case of ischemic stroke was confirmed during the postpartum period. Regarding newborns, neither Apgar scores lower than 7 nor neonatal intensive care unit admissions were reported. CONCLUSIONS This study suggests that the frequency of HDP is higher in patients with MMD compared to those with normal pregnancies. Strict blood pressure control should be performed in patients with MMD during pregnancy and postpartum period.
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Affiliation(s)
- Hirohisa Yajima
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan.
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masako Ikemura
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideaki Imai
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan; Department of Neurosurgery, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Shinjuku-ku, Tokyo, Japan
| | - Hiroki Hongo
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan
| | - Yudai Hirano
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan
| | - Daiichiro Ishigami
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan
| | - Seiei Torazawa
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan
| | - Satoshi Kiyofuji
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan
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Singh R, Bauman MMJ, Seas A, Harrison DJ, Pennington Z, Brown NJ, Gendreau J, Rahmani R, Ellens N, Catapano J, Lawton MT. Association of moyamoya vasculopathy with autoimmune disease: a systematic review and pooled analysis. Neurosurg Rev 2023; 46:220. [PMID: 37658996 DOI: 10.1007/s10143-023-02123-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Despite more than six decades of extensive research, the etiology of moyamoya disease (MMD) remains unknown. Inflammatory or autoimmune (AI) processes have been suggested to instigate or exacerbate the condition, but the data remains mixed. The objective of the present systematic review was to summarize the available literature investigating the association of MMD and AI conditions as a means of highlighting potential treatment strategies for this subset of moyamoya patients. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, Embase, Scopus, Web of Science, and Cochrane databases were queried to identify studies describing patients with concurrent diagnoses of MMD and AI disease. Data were extracted on patient demographics, clinical outcomes, and treatment. Stable or improved symptoms were considered favorable outcomes, while worsening symptoms and death were considered unfavorable. Quantitative pooled analysis was performed with individual patient-level data. Of 739 unique studies identified, 103 comprising 205 unique patients (80.2% female) were included in the pooled analysis. Most patients (75.8%) identified as Asian/Pacific Islanders, and the most commonly reported AI condition was Graves' disease (57.6%), with 55.9% of these patients presenting in a thyrotoxic state. Of the 148 patients who presented with stroke, 88.5% of cases (n = 131) were ischemic. Outcomes data was available in 152 cases. There were no significant baseline differences between patients treated with supportive therapy alone and those receiving targeted immunosuppressant therapy. Univariable logistic regression showed that surgery plus medical therapy was more likely than medical therapy alone to result in a favorable outcome. On subanalysis of operated patients, 94.1% of patients who underwent combined direct and indirect bypass reported favorable outcomes, relative to 76.2% of patients who underwent indirect bypass and 82% who underwent direct bypass (p < 0.05). On univariable analysis, the presence of multiple AI disorders was associated with worse outcomes relative to having a single AI disorder. Autoimmune diseases have been uncommonly reported in patients with MMD, but the presence of multiple AI comorbidities portends poorer prognosis. The addition of surgical intervention appears to improve outcomes and for patients deemed surgical candidates, combined direct and indirect bypass appears to offer better outcomes that direct or indirect bypass alone.
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Affiliation(s)
- Rohin Singh
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA.
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Megan M J Bauman
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andreas Seas
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | | | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California-Irvine, Orange, CA, USA
| | - Julian Gendreau
- Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Redi Rahmani
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
- Barrow Neurological Institute, Phoenix, AZ, USA
| | - Nathaniel Ellens
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Oh WO, Park IT, Han J, Lee E, Lee A. Development of a mobile application based on the salutogenic model for self-management in adolescents with Moyamoya disease. J Pediatr Nurs 2023; 72:63-72. [PMID: 37086628 DOI: 10.1016/j.pedn.2023.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/19/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE Moyamoya disease (MMD) is a rare disease which has a high incidence of onset in adolescence. Disease self-management skills are imperative for adolescents with MMD. This study aimed to describe the systematic development, content, and usability of the Moyamoya Healthy Youth application (app), which was developed to enhance self-management skills for adolescents with MMD. DESIGN AND METHODS The theoretical grounding for the app was salutogenic model and the development process of the app was guided by the intervention mapping (IM) protocol. Results of each IM step were applied to the next step leading to the design of the app. Additionally, a pilot test was conducted to determine the usability of the app. RESULTS Following the salutogenic model, we identified the stressors, behaviors, and resources regarding managing symptoms of MMD by interviewing adolescents with MMD, their parents, and healthcare providers. Based on the findings of the interviews, we determined the program outcomes and performance objectives to improve the self-management of MMD in adolescents. The app was developed by translating the theoretical methods to achieve the performance objectives into practical strategies for delivering the program. A pilot test with eight participants showed satisfaction with the app in terms of its usefulness and ease of use. CONCLUSION We delineated the development process of the Moyamoya Healthy Youth. Additionally, we presented the positive outcomes regarding the usability of the app. PRACTICE IMPLICATIONS The Moyamoya Healthy Youth app could benefit adolescents with MMD, by improving their self-management skills which are crucial for their health.
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Affiliation(s)
- Won-Oak Oh
- Korea University, College of Nursing, Seoul, Republic of Korea.
| | - Il Tae Park
- Woosong University, College of Health and Welfare, Daejeon, Republic of Korea
| | - Jihee Han
- Korea University, College of Nursing, Seoul, Republic of Korea
| | - Eunji Lee
- Korea University, College of Nursing, Seoul, Republic of Korea.
| | - Anna Lee
- Yonsei University, College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea.
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Luther E, McCarthy D, Hect J, Burks J, Lu VM, Govindarajan V, Ramsay IA, King H, Silva MA, Abdelsalam A, Yavagal D, Peterson E, Starke RM, Morcos J. Transradial Access Failures During Neuroangiography for Patients With Moyamoya. Neurosurgery 2023; 93:366-372. [PMID: 36847520 PMCID: PMC10586839 DOI: 10.1227/neu.0000000000002421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/27/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Despite studies continuing to demonstrate the utility of transradial access (TRA) in neuroangiography, minimal data exist regarding predictors of TRA failure. Furthermore, although many patients with moyamoya disease/syndrome will require life-long angiographic evaluation, even less has been reported on the usage of TRA in this population. OBJECTIVE To perform a matched analysis at our high-volume moyamoya center to determine predictors of TRA failure in these patients. METHODS A total of 636 patients undergoing TRA for neuroangiography were identified from 2018 to 2020. Demographic and angiographic characteristics including radial artery spasm (RAS), radial anomalies, and access site conversion were compared between patients with moyamoya and the rest of the cohort. A 4:1 matched analysis, based on age and sex, was also performed to eliminate confounding variables. RESULTS Patients with moyamoya were younger (40 vs 57 years, P < .0001), had smaller radial diameters (1.9 vs 2.6 mm, P < .0001), more commonly had a high brachial bifurcation (25.9% vs 8.5%, P = .008), more frequently experienced clinically significant RAS (40% vs 8.4%, P < .0001), and more often required access site conversion (26.7% vs 7.8%, P = .002). Increasing age was associated with less TRA failures in patients with moyamoya (odds ratio = 0.918) but more failures in the rest of the cohort (odds ratio = 1.034). In the matched analysis, patients with moyamoya continued to experience more radial anomalies, RAS, and access site conversions. CONCLUSION Patients with moyamoya, when controlling for age and sex, have higher rates of TRA failure during neuroangiography. Increasing age in Moyamoya is inversely correlated with TRA failures suggesting that younger patients with moyamoya are at higher risk of extracranial arteriopathy.
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Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David McCarthy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jasmine Hect
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joshua Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor M. Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vaidya Govindarajan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ian A. Ramsay
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hunter King
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael A. Silva
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ahmed Abdelsalam
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dileep Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eric Peterson
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert M. Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jacques Morcos
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Liu T, Qin M, Xiong X, Li T, Feng L, Lai X, Gao Y. Benefits and risks of antiplatelet therapy for moyamoya disease: a systematic review and meta-analysis. Front Neurol 2023; 14:1132339. [PMID: 37409015 PMCID: PMC10318533 DOI: 10.3389/fneur.2023.1132339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Background Moyamoya disease (MMD) is a leading cause of stroke in children and young adults, whereas no specific drugs are available. Antiplatelet therapy (APT) has been considered a promising treatment option, but its effectiveness remains controversial. Therefore, we aimed to comprehensively evaluate the benefits and risks of APT for MMD. Methods We systematically searched PubMed, Embase, and Cochrane Library electronic databases from their inception to 30 June 2022 and conducted a systematic review. All-cause mortality was taken as the primary outcome. Results Nine studies that enrolled 16,186 patients with MMD were included. The results from a single study showed that APT was associated with lower mortality [hazard ratio (HR) = 0.60; 95% confidence interval (CI) (0.50-0.71); p < 0.01] and improved bypass patency after surgical revascularization [HR = 1.57; 95% CI (1.106-2.235); p < 0.05]. The results of the meta-analysis showed that APT reduced the risk of hemorrhagic stroke [HR = 0.47; 95% CI (0.24-0.94); p < 0.05] but neither reduced the risk of ischemic stroke [HR = 0.80; 95% CI (0.33-1.94); p = 0.63] nor increased the proportion of independent patients [RR = 1.02; 95% CI (0.97-1.06); p = 0.47]. Conclusion Current evidence showed that APT was associated with a reduced risk of hemorrhagic stroke in MMD patients but did not reduce the risk of ischemic stroke or increase the proportion of independent patients. There was insufficient evidence about the benefit of APT on survival and postoperative bypass patency after surgical revascularization. However, the results should be interpreted cautiously because of the limited number of studies. Systematic review registration https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Tingting Liu
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Mingzhen Qin
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Xuejiao Xiong
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Tingting Li
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Luda Feng
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xinxing Lai
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Chinese Medicine Key Research Room of Brain Disorders Syndrome and Treatment of the National Administration of Traditional Chinese Medicine, Beijing, China
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12
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Reed LK, Soto JM, Benardete EA. Early Surgery for Moyamoya Is Not Associated with Worse Outcomes: Analysis of a North American Adult Cohort. World Neurosurg 2023; 174:e53-e61. [PMID: 36871651 DOI: 10.1016/j.wneu.2023.02.115] [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: 12/26/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Patients with symptomatic moyamoya disease (MMD) or moyamoya syndrome (MMS) are at high risk of recurrent stroke. Surgical revascularization with either direct or indirect superficial temporal artery to middle cerebral artery bypass is a well-accepted treatment. However, the optimal timing and surgical technique for adult patients with MMD or MMS remain unknown. METHODS We performed a retrospective medical record review of patients who had undergone superficial temporal artery to middle cerebral artery bypass for MMD or MMS from January 1, 2017, to January 1, 2022. The data collected included demographics, comorbidities, complications, as well as angiographic, and clinical outcomes. Early surgery was defined as surgery performed ≤2 weeks of the last stroke and delayed surgery as surgery performed >2 weeks after the last stroke. In the statistical analysis, we compared early versus delayed surgery and direct versus indirect bypass. RESULTS Nineteen patients had undergone bypass surgery on 24 hemispheres. Of the 24 cases, 10 were early and 14 were delayed. In addition, 17 were direct, and 7 were indirect. No statistically significant difference was found in total complications between the early (3 of 10; 30%) and delayed (3 of 14; 21%; P = 0.67) groups. Five complications occurred in the direct group (5 of 17; 29%) and one in the indirect group (1 of 7; 14%; P = 0.63). No mortalities related to surgery occurred. Angiographic follow-up showed more extensive revascularization after early direct bypass than after delayed indirect bypass. CONCLUSIONS In our population of North American adults who had undergone surgical revascularization for MMD or MMS, early surgery within 2 weeks of the last stroke did not differ from delayed surgery in terms of complications or clinical outcomes. Early direct bypass showed more revascularization on angiography than did delayed indirect surgery.
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Affiliation(s)
- Laura K Reed
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA
| | - Jose M Soto
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA
| | - Ethan A Benardete
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA.
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13
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Irsyad MA, Fitra F, Sanjaya FA, Suroto NS, Al Fauzi A. Cerebellar cavernoma excision with a preserved venous anomaly: A case report in girl 28-year-old. Int J Surg Case Rep 2023; 107:108332. [PMID: 37269764 DOI: 10.1016/j.ijscr.2023.108332] [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: 02/28/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Cavernous malformations are congenital or acquired vascular abnormalities. They are uncommon entities with an incidence of 0.5 % of the general population and usually are unnoticed until a hemorrhagic event occurs. Cerebellar cavernomas (CCMs) account for 1.2 to 11.8 % of all intracranial cases and 9.3 to 52.9 % of all infratentorial cases. Cavernomas can be concurrently seen with developmental venous anomalies (DVAs) in 20 % (range 20 %-40 %) of cases, in which case they are known as mixed vascular malformations. PRESENTATION OF CASE We report a case of a healthy young adult who presented with acute onset of headache, with characteristics of chronic headache that gets progressively worse. The patient complains of frequent dizziness when sitting and standing for a long time. Complaints have been felt for two years and have worsened for the past two weeks. Additional complaints are dizziness and nausea with intermittent episodes of vomiting for four days. Magnetic resonance imaging (MRI) revealed an underlying cavernoma that had bled and a coexisting DVA. The patient was discharged home with no deficits. Outpatient follow-up two months later showed no symptoms or neurologic deficits. CLINICAL DISCUSSION Cavernous malformations are congenital or acquired vascular anomalies that occur in approximately 0.5 % of the general population. Our patient likely had dizziness due to localization of the bleeding of the cavernoma on the left side of the cerebellum. In our patient, brain imaging revealed numerous abnormal blood vessels radiating from the cerebellar lesion, a highly suggestive of DVAs associated with cavernoma. CONCLUSION A cavernous malformation is an uncommon entity that might coexist with deep venous anomalies, making management more challenging.
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Affiliation(s)
- Muhammad Ari Irsyad
- Universitas Sumatera Utara Hospital, Medan, Indonesia; Department of Neurosurgery, H. Adam Malik General Hospital, Medan, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Fitra Fitra
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Firman Adi Sanjaya
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Blambangan Hospital, Banyuwangi, Indonesia
| | - Nur Setiawan Suroto
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Asra Al Fauzi
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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14
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Yadav R, Pokhriyal SC, Yadav V, Idries I, Berekashvili K, Panigrahi K, Wasifuddin M. The Role of Dual Antiplatelet Therapy (DAPT) vs Surgery in a Case of Moyamoya Disease: A Case Report and Review of the Literature. Cureus 2023; 15:e39694. [PMID: 37398791 PMCID: PMC10308803 DOI: 10.7759/cureus.39694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by non-atherosclerotic and non-inflammatory progressive narrowing of the intracranial part of the carotid artery and its proximal branches. The disease process is commonly associated with the development of weak, dilated collateral blood vessels at the base of the brain. This gives it a classic smoky appearance on cerebral angiograms and hence the name "Moyamoya" which means "puff of smoke" in Japanese. When a patient has similar vasculopathy in the setting of another disease then it is known as Moyamoya syndrome (MMS). The associated diseases are sickle cell anemia, neurofibromatosis, long-standing diabetes, uncontrolled hypertension, or chemotherapy. Despite being known as a disease of the East Asian population, the disease is no longer exclusive to Asians, as evidenced by the rising incidence among non-Asian groups such as Caucasians, Hispanics, and African Americans. Patients can remain asymptomatic or present with ischemic or hemorrhagic stroke, headache, seizures, or recurrent transient ischemic attacks. Conventional cerebral angiography is considered the gold standard for diagnosing MMD. Treatment may be supportive, medical, or surgical. We present the case of a 42-year-old African American woman with several comorbidities who presented with sudden onset of ischemic stroke and upon further workup was found to have MMD. Equally important is to identify the most effective therapeutic approaches based on individual patients to achieve better clinical outcomes. Our case report highlights the importance of surgery in symptomatic MMD with a lack of supporting evidence indicating the benefits of dual antiplatelet therapy (DAPT).
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Affiliation(s)
- Ruchi Yadav
- Hematology and Oncology, Brookdale University Hospital Medical Center, New York, USA
| | | | - Vivek Yadav
- Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York, USA
| | - Iyad Idries
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | | | | | - Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
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15
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Lu M, Zhang H, Liu D, Hao F, Zhang L, Peng P, Yuan F, Liu S, Sheng F, Liu Y, Zhao X, He Y, Han C, Cai J. Vessel wall enhancement as a predictor of arterial stenosis progression and poor outcomes in moyamoya disease. Eur Radiol 2023; 33:2489-2499. [PMID: 36334103 DOI: 10.1007/s00330-022-09223-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/03/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aimed to determine the association between vessel wall enhancement and progression of arterial stenosis and clinical outcomes in patients with moyamoya (MMD) using high-resolution magnetic resonance (HRMR) vessel wall imaging. METHODS Consecutive participants diagnosed with MMD were prospectively recruited and underwent HRMR at baseline and during follow-up, which had an interval period of ≥ 6 months and were clinically followed up for ≤ 24 months to record the occurrence of ischemic stroke. The relationship between vessel wall enhancement and arterial stenosis progression and stroke occurrence was evaluated. RESULTS HRMR vessel wall imaging was used to identify 309 stenotic lesions at the internal carotid artery (ICA) in 170 participants (mean age: 37.7 ± 11.3 years old, male: 44.1%). The baseline presence (adjusted odds ratio [aOR] = 3.57, 95% CI = 1.97-6.44, p < 0.001) and progression (aOR = 2.96, 95% CI = 1.29-6.80, p = 0.010) of vessel wall enhancement and middle cerebral artery (MCA) involvement (aOR = 4.98, 95% CI = 1.50-16.52, p = 0.009) were significantly associated with rapid progression of arterial stenosis. Furthermore, vessel wall enhancement (adjusted HR = 3.59, 95% CI = 1.33-9.70, p = 0.011) and rapid progression of arterial stenosis (adjusted HR = 4.52, 95% CI = 1.48-13.81, p = 0.008) were correlated with future stroke occurrence. CONCLUSION The baseline presence of vessel wall enhancement was associated with rapid progression of arterial stenosis and increased risk for stroke in MMD patients. Our findings suggest that vessel wall enhancement may serve as a predictor of disease progression and poor outcomes in MMD. KEY POINTS • The baseline presence of vessel wall enhancement was significantly associated with the rapid progression of arterial stenosis. • The baseline presence of vessel wall enhancement and rapid progression of arterial stenosis were both correlated with increased risk for future occurrence of stroke. • Our findings suggest that vessel wall enhancement may serve as a predictor of rapid progression of arterial stenosis and poor outcomes in MMD patients.
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Affiliation(s)
- Mingming Lu
- Institute of Geriatrics, State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, the Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.,Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Hongtao Zhang
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Dongqing Liu
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Fangbin Hao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lichen Zhang
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Peng Peng
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Fei Yuan
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Shitong Liu
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Fugeng Sheng
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yuan Liu
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Yao He
- Institute of Geriatrics, State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, the Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Jianming Cai
- Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
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16
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Association between White Matter Hyperintensities Burden and Cognitive Function in Adult Asymptomatic Moyamoya Disease. J Clin Med 2023; 12:jcm12031143. [PMID: 36769790 PMCID: PMC9917657 DOI: 10.3390/jcm12031143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/31/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
Background and Purpose: White matter hyperintensities (WMH) caused by chronic cerebral hypoperfusion are common in Moyamoya disease (MMD) patients, but WMH burden with comprehensive cognition in adult asymptomatic MMD remains unknown. This study tried to investigate the association between the WMH burden and cognitive function in adult asymptomatic MMD. Methods: Sixty-four adult asymptomatic MMD patients without surgical revascularization were enrolled in this study and underwent a 3T MRI scan and complete cognitive tests from 2021 to 2022. WMH volume was extracted with brain anatomical analysis using the diffeomorphic deformation (BAAD) toolbox, which works on SPM 12 software. Multivariable linear regression analysis was performed to assess the association between WMH burden and cognitive function in asymptomatic MMD. Results: Firstly, our data showed that lower education levels and higher WMH burden were strongly related to global cognitive impairment after adjusting for other variables. Secondly, WMH severity was significantly associated with several domains of neurocognitive function, including memory, semantic memory, and executive function. Finally, when stratified by sex, the female participants with WMH severity had lower cognitive performance in all areas than male participants. Conclusions: These results suggest that WMH burden was highly correlated with global cognition, memory, semantic memory, and executive function in asymptomatic MMD. Especially in female participants, the relationship became more evident.
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17
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Circulating Inflammatory Cytokine Associated with Poor Prognosis in Moyamoya Disease: A Prospective Cohort Study. J Clin Med 2023; 12:jcm12030823. [PMID: 36769472 PMCID: PMC9917516 DOI: 10.3390/jcm12030823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Inflammation is a key factor in the development of moyamoya disease. However, the cytokine distribution in moyamoya disease and its impact on prognosis remain unclear. A total of 204 patients with moyamoya disease were enrolled in this study. The peripheral blood was analyzed for baseline data and cytokines, which included IL-6, IL-1β, IL-2R, IL-8, and TNF-α. Patients with the RNF213 mutation and those without the mutation were compared in terms of their differences in cytokines. A mRS score ≥2 was defined as a poor prognosis, and a mRS score <2 was described as a good prognosis, and differences in cytokines were compared between the two groups. Regression analysis was performed to identify markers affecting prognosis. TNF-α and IL-6 levels were higher in the group without the RNF213 mutation compared to the mutation group. Multivariate stepwise regression analysis indicated that the G3 subgroup of IL-6 and the G4 subgroup of TNF-α were the independent risk factors for adverse prognosis in adults with moyamoya disease (OR 3.678, 95% CI [1.491, 9.074], p = 0.005; OR 2.996, 95% CI [1.180, 7.610], p = 0.021). IL-6 and TNF-α were associated with poor prognosis in adult patients with moyamoya disease.
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18
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Clinical Efficacy of Superficial Temporal Artery-middle Cerebral Artery Bypass Grafting Surgery Combined With Temporal Muscle Patch on Patients With Moyamoya Disease. J Craniofac Surg 2023; 34:643-649. [PMID: 36731073 PMCID: PMC9944694 DOI: 10.1097/scs.0000000000008992] [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: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To analyze the clinical efficacy of superficial temporal artery-middle cerebral artery (STA-MCA) bypass grafting surgery combined with temporal muscle patch and STA-MCA bypass grafting surgery alone on patients with moyamoya disease. METHODS Totally 73 patients confirmed with moyamoya disease in our hospital between January 2019 and December 2021 were enrolled. Among them, 43 patients treated with STA-MCA bypass grafting surgery combined with temporal muscle patch were assigned to the experiment group, whereas 30 patients treated with STA-MCA bypass grafting surgery alone to the control group. The following items of the 2 groups were compared: clinical efficacy, total effective rate, and disease control rate 6 months after surgery, the changes of modified Rankin Scale (mRS) and Karnofsky performance scale (KPS) scores before and on the seventh day and 6 months after surgery, and changes of Glasgow coma scale scores before and 24 hours after surgery. In addition, the incidences of cerebral ischemia and cerebral hemorrhage within 1 year after surgery were counted. The cerebral perfusion-associated indexes including relative mean transit time (rMTT), relative time-to-peak, relative cerebral blood flow (rCBF), and relative cerebral blood volume (rCBV) on the seventh day and 6 months after surgery were compared between the 2 groups, and the predictive value of cerebral perfusion-associated indexes before surgery for clinical efficacy on patients was analyzed. RESULTS The Glasgow coma scale score after surgery ( P >0.05) was similar between the 2 groups, but the clinical efficacy and total effective rate of the 2 groups were notably different (both P <0.05). Compared with those before surgery, mRS scores of both groups declined, whereas KPS scores increased (both P <0.05) on the seventh day after surgery. In addition, compared with those before surgery and on the seventh day after surgery, mRS scores of both groups decreased 6 months after surgery, whereas KPS scores increased (both P <0.05). Both the groups showed decreased rMTT and rTPP, and increased rCBF and rCBV on the seventh day after surgery than those before surgery (all P <0.05). In addition, both the groups still showed decreased rMTT and rTPP, and increased rCBF and rCBV 6 months after surgery than those before surgery and on the seventh day after surgery (all P <0.05). Most notably, the experimental group displayed improved cerebral perfusion-associated indexes than the control group 6 months after surgery (all P <0.05). The relief group showed notably higher rCBF and rCBV levels than the nonrelief group (both P <0.05). According to ROC analysis, the areas under the curves of rCBF and rCBV in forecasting the clinical efficacy on patients were 0.842 and 0.823, respectively. CONCLUSION Superficial temporal artery-middle cerebral artery bypass grafting surgery combined with temporal muscle patch can deliver a higher total clinical curative rate for patients with moyamoya disease and can alleviate their coma.
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Li S, Han Y, Zhang Q, Tang D, Li J, Weng L. Comprehensive molecular analyses of an autoimmune-related gene predictive model and immune infiltrations using machine learning methods in moyamoya disease. Front Mol Biosci 2022; 9:991425. [PMID: 36605987 PMCID: PMC9808060 DOI: 10.3389/fmolb.2022.991425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Growing evidence suggests the links between moyamoya disease (MMD) and autoimmune diseases. However, the molecular mechanism from genetic perspective remains unclear. This study aims to clarify the potential roles of autoimmune-related genes (ARGs) in the pathogenesis of MMD. Methods: Two transcription profiles (GSE157628 and GSE141025) of MMD were downloaded from GEO databases. ARGs were obtained from the Gene and Autoimmune Disease Association Database (GAAD) and DisGeNET databases. Differentially expressed ARGs (DEARGs) were identified using "limma" R packages. GO, KEGG, GSVA, and GSEA analyses were conducted to elucidate the underlying molecular function. There machine learning methods (LASSO logistic regression, random forest (RF), support vector machine-recursive feature elimination (SVM-RFE)) were used to screen out important genes. An artificial neural network was applied to construct an autoimmune-related signature predictive model of MMD. The immune characteristics, including immune cell infiltration, immune responses, and HLA gene expression in MMD, were explored using ssGSEA. The miRNA-gene regulatory network and the potential therapeutic drugs for hub genes were predicted. Results: A total of 260 DEARGs were identified in GSE157628 dataset. These genes were involved in immune-related pathways, infectious diseases, and autoimmune diseases. We identified six diagnostic genes by overlapping the three machine learning algorithms: CD38, PTPN11, NOTCH1, TLR7, KAT2B, and ISG15. A predictive neural network model was constructed based on the six genes and presented with great diagnostic ability with area under the curve (AUC) = 1 in the GSE157628 dataset and further validated by GSE141025 dataset. Immune infiltration analysis showed that the abundance of eosinophils, natural killer T (NKT) cells, Th2 cells were significant different between MMD and controls. The expression levels of HLA-A, HLA-B, HLA-C, HLA-DMA, HLA-DRB6, HLA-F, and HLA-G were significantly upregulated in MMD. Four miRNAs (mir-26a-5p, mir-1343-3p, mir-129-2-3p, and mir-124-3p) were identified because of their interaction at least with four hub DEARGs. Conclusion: Machine learning was used to develop a reliable predictive model for the diagnosis of MMD based on ARGs. The uncovered immune infiltration and gene-miRNA and gene-drugs regulatory network may provide new insight into the pathogenesis and treatment of MMD.
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Affiliation(s)
- Shifu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Ying Han
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital of Central South University, Changsha, Hunan, China,Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Qian Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Dong Tang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Jian Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China,Hydrocephalus Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Weng
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China,Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China,*Correspondence: Ling Weng,
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Angioarchitectural Factors Associated with Postoperative Cerebral Infarction in Ischemic Moyamoya Disease. Brain Sci 2022; 12:brainsci12101270. [PMID: 36291204 PMCID: PMC9599360 DOI: 10.3390/brainsci12101270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the angioarchitectural factors associated with postoperative cerebral infarction in ischemic moyamoya disease. Methods: Data on patients who underwent surgery for ischemic MMD from 1 October 2015 to 31 October 2020, at Peking University International Hospital were collected and retrospectively analyzed. General conditions such as patient sex, age, site of surgery, preoperative manifestations such as TIA attack and old cerebral infarction, and seven angioarchitectural factors of the MMD based on DSA were selected and measured. Statistical analysis was performed by the Pearson chi-square statistic, analysis of variance (ANOVA), and multifactor logistic regression analysis. Results: Age (OR, 0.969; 95%CI, 0.939–1.000; p = 0.049), A1stenosis (OR, 5.843; 95%CI, 1.730–19.732; p = 0.004), M1stenosis (OR, 6.206; 95%CI, 2.079–18.526; p = 0.001), PCA anomalies (OR, 4.367; 95%CI, 1.452–13.129; p = 0.049), Unstable compensation (OR, 5.335; 95%CI, 1.427–19.948; p = 0.013), TIA (OR, 4.264; 95%CI, 1.844–9.863; p = 0.001), Old cerebral infarction (OR, 2.972; 95%CI, 1.194–7.397; p = 0.019). The above seven factors can be used in the regression equation to predict the probability of postoperative cerebral infarction. The prediction accuracy is 90.2%. Conclusions: Age, TIA attack, old cerebral infarction, and five angioarchitectural factors of MMD are strongly associated with postoperative cerebral infarction. Seven factors, including age, TIA attack, old infarction, and four angioarchitectural factors, can be taken to quantify the probability of surgical cerebral infarction in MMD.
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21
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Long-Lasting Unruptured Large Intracranial Aneurysm in Bilateral Moyamoya Disease: Case Report. Case Rep Neurol Med 2022; 2022:2635724. [PMID: 36246053 PMCID: PMC9553707 DOI: 10.1155/2022/2635724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. The rupture risk of intracranial aneurysms in patients with moyamoya disease is higher than that in the general population. We report a confirmed case of moyamoya disease with bilateral middle cerebral artery (MCA) occlusion with a large and long-lasting aneurysm. Case. A 71-year-old woman visited the clinic with a large intracranial aneurysm. The patient was diagnosed with an ischemic stroke 2 months ago. She exhibited weakness in the left upper and lower extremities and dysarthria and was taking aspirin. The brain magnetic resonance imaging showed complete occlusion in the bilateral MCA proximal (M1) and a large 11 × 11 mm nonruptured cerebral aneurysm in the A3 segment of the left anterior cerebral artery. On transfemoral cerebral angiography, the patient was diagnosed with Suzuki grade VI moyamoya disease with bilateral MCA occlusion. After 7 years, the cerebral aneurysm size further increased, but it remained unruptured. Conclusions. Here, the patient had moyamoya disease with a large aneurysm, but aneurysmal rupture did not occur even after 7 years. Our case report might help in understanding the mechanisms of cerebral aneurysm occurrence and rupture in moyamoya patients.
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22
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Construction of Diagnosis Model of Moyamoya Disease Based on Convolution Neural Network Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4007925. [PMID: 35924108 PMCID: PMC9343212 DOI: 10.1155/2022/4007925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/03/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
Objective The convolutional neural network (CNN) was used to improve the accuracy of digital subtraction angiography (DSA) in diagnosing moyamoya disease (MMD), providing a new method for clinical diagnosis of MMD. Methods A total of 40 diagnosed with MMD by DSA in the neurosurgery department of our hospital were included. At the same time, 40 age-matched and sex-matched patients were selected as the control group. The 80 included patients were divided into training set (n = 56) and validation set (n = 24). The DSA image was preprocessed, and the CNN was used to extract features from the preprocessed image. The precision and accuracy of the preprocessed image results were evaluated. Results There was no significant difference in baseline data between the training set and validation set (P > 0.05). The precision and accuracy of the images before processing were 79.68% and 81.45%, respectively. After image processing, the precision and accuracy of the model are 96.38% and 97.59%, respectively. The area under the curve of the CNN algorithm model was 0.813 (95% CI: 0.718-0.826). Conclusion This diagnostic method based on CNN performs well in MMD detection.
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Spinal Versus General Anesthesia for Cesarean Delivery in Pregnant Women With Moyamoya Disease: A Retrospective Observational Study. Anesth Analg 2022; 135:617-624. [PMID: 35089266 DOI: 10.1213/ane.0000000000005919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Moyamoya disease, a rare chronic cerebrovascular disease with a fragile vascular network at the base of the brain, can cause ischemic or hemorrhagic strokes or seizures. Precise blood pressure control and adequate analgesia are important for patients with moyamoya disease to prevent neurological events such as ischemia and hemorrhage. This study aimed to compare the intraoperative mean arterial pressure of pregnant women with moyamoya disease according to the mode of anesthesia (general anesthesia versus spinal anesthesia) used during cesarean delivery. METHODS We retrospectively reviewed the medical records of 87 cesarean deliveries in 74 patients who had been diagnosed with moyamoya disease before cesarean delivery. The primary outcome, intraoperative maximum mean arterial pressure during anesthesia, was compared according to the type of anesthesia administered (general versus spinal anesthesia). Other perioperative hemodynamic data (lowest mean arterial pressure, incidence of hypotension, vasopressor use, and antihypertensive agent use), maternal neurologic symptoms, neonatal outcomes (Apgar scores <7, ventilatory support, and intensive care unit admission), maternal and neonatal length of stay, postoperative pain scores, and rescue analgesic use were assessed as secondary outcomes. RESULTS While the lowest blood pressure during anesthesia and incidence of hypotension did not differ between the 2 groups, the maximum mean arterial pressure during anesthesia was lower in the spinal anesthesia group than that in the general anesthesia group (104.8 ± 2.5 vs 122.0 ± 4.6; P = .002). Study data did not support the claim that maternal neurologic symptoms differ according to the type of anesthesia used (5.6% vs 9.3%; P = .628); all patients recovered without any sequelae. The postoperative pain scores were lower, and fewer rescue analgesics were used in the spinal anesthesia group than in the general anesthesia group. Other maternal and neonatal outcomes were not different between the 2 groups. CONCLUSIONS Compared with general anesthesia, spinal anesthesia mitigated the maximum arterial blood pressure during cesarean delivery and improved postoperative pain in patients with moyamoya disease.
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Das S, Ray BK, Ghosh R, Sengupta S, Pandit A, Dubey S. Impact of COVID-19 pandemic in natural course of Moyamoya Angiopathy: an experience from tertiary-care-center in India. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:166. [PMID: 34924748 PMCID: PMC8665313 DOI: 10.1186/s41983-021-00412-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background COVID-19 mediated immune dysregulation and cytokine storm can precipitate and aggravate Moyamoya angiopathy (MMA), influencing its disease course. This index study was undertaken to prospectively evaluate the status of neurological symptoms of MMA in relation to COVID-19 affection. Methodology and results Follow-up MMA patients of institute’s Stroke-clinic were telephonically interview from 24th March to 30th September, 2020. The first call familiarized them with COVID-19 symptoms and neurological manifestations of MMA, followed by monthly-calls with predesigned questionnaire. Patients with suggestion of COVID-19 underwent nasopharyngeal-swab-testing for COVID-19 Reverse transcription-polymerase chain reaction (RT-PCR) positive cases were subjected to antibody levels for COVID-19 Enzyme-linked immunoassay (ELISA) 8–12 weeks after recovery. During symptomatic phase till 14 days of asymptomatic, they were contacted daily/alternate day. Any new onset/worsening of neurological symptoms were noted. The baseline clinico-radiological details were obtained from stroke-clinic registery. Subsequently, all data were analyzed and compared using descriptive statistics. Seventy four of 104 MMA patients could be contacted and enrolled. The mean age, time since last follow-up and compliance to previously prescribed medication were 23.5 ± 16.1 years, 9.2 ± 1.7 months and 90.5% (n = 67), respectively. Aggravation/new onset neurological symptom were seen in 64.3% (n = 9) of COVID-19 positive MMA (n = 14), of which 8 were seen among the 11 pediatric COVID-19 positive MMA [(Transient ischemic attacks) TIA-4, TIA with headache-1, seizure-2, stroke causing mortality-1]. Conclusion COVID-19 infection can potentiate MMA causing significant morbidity and mortality, especially in children. Providing optimal care for severe diseases (such as MMA) in developing countries during pandemic remains a challenge.
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Affiliation(s)
- Shambaditya Das
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, 52 1/A Sambhu Nath Pandit Road, Bhowanipore, Kolkata, West Bengal 700020 India
| | - Biman Kanti Ray
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, 52 1/A Sambhu Nath Pandit Road, Bhowanipore, Kolkata, West Bengal 700020 India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal India
| | - Samya Sengupta
- Department of General Medicine, Apollo Gleneagles Hospital, Kolkata, West Bengal India
| | - Alak Pandit
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal India
| | - Souvik Dubey
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, 52 1/A Sambhu Nath Pandit Road, Bhowanipore, Kolkata, West Bengal 700020 India
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Ma W, Cui C, Feng S, Li G, Han G, Liu J, Qin X, Hu Y, Wang M, Zhang L, Jin F. Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio in Patients With Newly Diagnosed Moyamoya Disease: A Cross-Sectional Study. Front Neurol 2021; 12:631454. [PMID: 34899551 PMCID: PMC8660107 DOI: 10.3389/fneur.2021.631454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Inflammation has been proven to be one of the key factors in the pathogenesis of moyamoya disease (MMD). Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are cheap and reliable biomarkers of inflammation. Nevertheless, evidence regarding the relationship among PLR and NLR in patients with MMD is limited. The focus of this subject was to explore the relationship between PLR and NLR in patients with newly diagnosed MMD. Patients and methods: A cross-sectional study was performed including 261 patients with diagnosed MMD for the first time who were enrolled from our hospital, from 24 March 2013 to 24 December 2018. The clinical characteristics were collected for each patient. Univariate analysis, smooth curve fitting and multivariate piecewise linear regression were showed. Results: The mean levels or median values (interquartile range) of PLR and NLR were 146.979 ± 51.203 and 2.241 (1.589–2.984), respectively. A significant positive correlation between PLR and NLR levels (P < 0.001) was showed by the univariate analysis. Furthermore, a non-linear relationship was detected between PLR and NLR by smooth curve fitting after adjusting for potential confounders. A multivariate piecewise linear regression model revealed a significant positive correlation between PLR and NLR when the PLR level was lower than 219.82 (β 0.012, 95% CI 0.005, 0.019; P = 0.001). PLR was also significantly positively associated with NLR when PLR concentrations were >219.82 (β 0.098, 95% CI 0.069, 0.128; P < 0.001). Conclusion: There seemed to be a positive association between PLR and NLR in patients with MMD. This may help to further explain the role of inflammation in the occurrence and progress of MMD.
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Affiliation(s)
- Wenyuan Ma
- Clinical Medical College, Jining Medical University, Jining, China
| | - Changmeng Cui
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Song Feng
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Genhua Li
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Guangkui Han
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Jilan Liu
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xianyun Qin
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yawei Hu
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Mengjie Wang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Lu Zhang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Feng Jin
- Shandong Provincial Key Laboratory of Stem Cells and Neuro-Oncology, Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
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Song X, Li Z. Co-existing of craniofacial fibrous dysplasia and cerebrovascular diseases: a series of 22 cases and review of the literature. Orphanet J Rare Dis 2021; 16:471. [PMID: 34736485 PMCID: PMC8567608 DOI: 10.1186/s13023-021-02102-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 10/24/2021] [Indexed: 01/11/2023] Open
Abstract
Background Craniofacial fibrous dysplasia is a fairly rare condition. Some literature have reported a few patients with craniofacial fibrous dysplasia suffering from vascular abnormalities. This study aimed to describe the possible coexistence of craniofacial fibrous dysplasia and cerebrovascular diseases for the first time. Method We retrospectively reviewed the 1175 patients with craniofacial fibrous dysplasia in Beijing Tiantan Hospital and the information of the 22 patients coexisted with cerebrovascular diseases were described. In addition, we performed a systematic review for cases of craniofacial fibrous dysplasia with vascular abnormalities. Result 22 out of 1175 patients (1.9%) were diagnosed with craniofacial fibrous dysplasia and cerebrovascular diseases including 9 intracranial aneurysms, 4 venous malformations, 2 arteriovenous malformations, 1 moyamoya disease, 2 intracranial venous stenosis and 4 cerebral ischemia with a mean age of 38.18 years old. Only 2 patients were managed surgically for craniofacial fibrous dysplasia and 6 patients were treated with neurosurgery for cerebrovascular diseases. 8 patients were closely followed and only 1 patient’s symptoms worsened. Conclusion Craniofacial fibrous dysplasia might cause constriction of the intracranial vessels and alteration of the overall hemodynamics of the intracranial vasculature resulting in various cerebrovascular diseases. Multimodal screening and examinations seems reasonable for patients with craniofacial fibrous dysplasia for throughout treatment and prognosis evaluations.
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Affiliation(s)
- Xiaowen Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No 119, Nansihuan xilu, Beijing, 100070, China.,China National Research Center for Neurological Disease, Beijing, China
| | - Zhi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No 119, Nansihuan xilu, Beijing, 100070, China. .,China National Research Center for Neurological Disease, Beijing, China.
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Mertens R, Graupera M, Gerhardt H, Bersano A, Tournier-Lasserve E, Mensah MA, Mundlos S, Vajkoczy P. The Genetic Basis of Moyamoya Disease. Transl Stroke Res 2021; 13:25-45. [PMID: 34529262 PMCID: PMC8766392 DOI: 10.1007/s12975-021-00940-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive spontaneous bilateral occlusion of the intracranial internal cerebral arteries (ICA) and their major branches with compensatory capillary collaterals resembling a “puff of smoke” (Japanese: Moyamoya) on cerebral angiography. These pathological alterations of the vessels are called Moyamoya arteriopathy or vasculopathy and a further distinction is made between primary and secondary MMD. Clinical presentation depends on age and population, with hemorrhage and ischemic infarcts in particular leading to severe neurological dysfunction or even death. Although the diagnostic suspicion can be posed by MRA or CTA, cerebral angiography is mandatory for diagnostic confirmation. Since no therapy to limit the stenotic lesions or the development of a collateral network is available, the only treatment established so far is surgical revascularization. The pathophysiology still remains unknown. Due to the early age of onset, familial cases and the variable incidence rate between different ethnic groups, the focus was put on genetic aspects early on. Several genetic risk loci as well as individual risk genes have been reported; however, few of them could be replicated in independent series. Linkage studies revealed linkage to the 17q25 locus. Multiple studies on the association of SNPs and MMD have been conducted, mainly focussing on the endothelium, smooth muscle cells, cytokines and growth factors. A variant of the RNF213 gene was shown to be strongly associated with MMD with a founder effect in the East Asian population. Although it is unknown how mutations in the RNF213 gene, encoding for a ubiquitously expressed 591 kDa cytosolic protein, lead to clinical features of MMD, RNF213 has been confirmed as a susceptibility gene in several studies with a gene dosage-dependent clinical phenotype, allowing preventive screening and possibly the development of new therapeutic approaches. This review focuses on the genetic basis of primary MMD only.
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Affiliation(s)
- R Mertens
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin, Germany
| | - M Graupera
- Vascular Biology and Signalling Group, ProCURE, Oncobell Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Barcelona, Spain
| | - H Gerhardt
- Integrative Vascular Biology Laboratory, Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - A Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - E Tournier-Lasserve
- Department of Genetics, NeuroDiderot, Lariboisière Hospital and INSERM UMR-1141, Paris-Diderot University, Paris, France
| | - M A Mensah
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Genetics and Human Genetics, Berlin, Germany.,BIH Biomedical Innovation Academy, Digital Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Mundlos
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Genetics and Human Genetics, Berlin, Germany.,Max Planck Institute for Molecular Genetics, RG Development & Disease, Berlin, Germany
| | - P Vajkoczy
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin, Germany.
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Rallo MS, Akel O, Gurram A, Sun H. Experimental animal models for moyamoya disease and treatment: a pathogenesis-oriented scoping review. Neurosurg Focus 2021; 51:E5. [PMID: 34469865 DOI: 10.3171/2021.6.focus21284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Moyamoya disease (MMD) is an intracranial steno-occlusive pathology characterized by progressive narrowing of proximal large vessels, including the terminal internal carotid arteries (ICAs), middle cerebral arteries, or anterior cerebral arteries. Named for the "puff of smoke" appearance of the anomalous vascularization visualized on cerebral angiography, MMD lacks a well-defined etiology, although significant insights have been made, including the identification of a susceptibility gene, RNF213, in humans with the disease. A limitation to advancing the understanding and treatment of MMD has been the lack of experimental animal models that authentically reflect the clinical pathogenesis. In an effort to analyze characteristics of currently available models and identify strategies for future model generation, the authors performed a scoping review of experimental animal models that have been used to study MMD. METHODS A systematic search of PubMed, Web of Science, and Scopus was performed to identify articles describing animal models used to study MMD. Additional articles were identified via citation searching. Study selection and data extraction were performed by two independent reviewers based on defined inclusion and exclusion criteria. RESULTS A total of 44 articles were included for full-text review. The methods used to generate these animal models were broadly classified as surgical (n = 25, 56.8%), immunological (n = 7, 15.9%), genetic (n = 6, 13.6%), or a combination (n = 6, 13.6%). Surgical models typically involved permanent ligation of one or both of the common carotid arteries or ICAs to produce chronic cerebral hypoperfusion. Genetic models utilized known MMD or cerebrovascular disease-related genes, such as RNF213 or ACTA2, to induce heritable cerebral vasculopathy. Finally, immunological models attempted to induce vasculitis-type pathology by recapitulating the inflammatory milieu thought to underlie MMD. CONCLUSIONS Models generated for MMD have involved three general approaches: surgical, immunological, and genetic. Although each reflects a key aspect of MMD pathogenesis, the failure of any individual model to recapitulate the development, progression, and consequences of the disease underscores the importance of future work in developing a multietiology model.
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Wang C, Sun C, Zhao Y, Song H, Li Z, Jin F, Cui C. RNF213 gene silencing upregulates transforming growth factor β1 expression in bone marrow-derived mesenchymal stem cells and is involved in the onset of Moyamoya disease. Exp Ther Med 2021; 22:1024. [PMID: 34373710 PMCID: PMC8343649 DOI: 10.3892/etm.2021.10456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/12/2020] [Indexed: 12/11/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic and progressive cerebrovascular occlusion disease, the precise etiology of which is poorly understood. Ring finger protein 213 (RNF213) has been previously identified as a susceptibility gene that serves an important role in angiogenesis, where it has been shown to be closely associated with the onset of MMD. Patients with MMD exhibit increased expression levels of various pro-inflammatory molecules and angiogenic factors. Under certain conditions, bone marrow mesenchymal stem cells (BMSCs) have the ability to differentiate to form neuron-like and microglia-like cells. In the present study, a total of 40 MMD patients and 40 healthy individuals were enrolled. ELISA assays revealed that the expression of serum vascular endothelial growth factor (VEGF) and transforming growth factor β1 (TGF-β1) were higher than that in healthy controls. Furthermore, rat BMSCs (rBMSCs) were isolated and cultured using the whole bone marrow adherence method, which were then phenotyped using flow cytometry. Osteogenic and adipogenic differentiation were determined by using Alizarin red and oil red O staining, respectively. RNF213 was knocked-down using a lentivirus-mediated short hairpin RNA system in passage three rBMSCs, and successful transfection of the RNF213 was confirmed by RT-qPCR and fluorescence imaging. The expression levels of VEGF and TGF-β1 in these rBMSCs were measured on days 7 and 14, respectively. The results demonstrated that RNF213 knockdown upregulated TGF-β1 at both protein and mRNA levels, but did not exert any effect on VEGF gene expression. In conclusion, these findings suggested that that RNF213 knockdown may contribute to aberrant TGF-β1 expression via a pathway that remains to be unidentified, indicating that quantitative changes in RNF213 gene expression may serve an important role in the pathogenesis of MMD.
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Affiliation(s)
- Changshui Wang
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Cuilian Sun
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Yueshu Zhao
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Huimin Song
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Zhengyou Li
- Department of Neurosyrgery, Shandong Province Western Hospital, Shandong Province ENT Hospital, Jinan, Shandong 250022, P.R. China
| | - Feng Jin
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Changmeng Cui
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
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Kundishora AJ, Peters ST, Pinard A, Duran D, Panchagnula S, Barak T, Miyagishima DF, Dong W, Smith H, Ocken J, Dunbar A, Nelson-Williams C, Haider S, Walker RL, Li B, Zhao H, Thumkeo D, Marlier A, Duy PQ, Diab NS, Reeves BC, Robert SM, Sujijantarat N, Stratman AN, Chen YH, Zhao S, Roszko I, Lu Q, Zhang B, Mane S, Castaldi C, López-Giráldez F, Knight JR, Bamshad MJ, Nickerson DA, Geschwind DH, Chen SSL, Storm PB, Diluna ML, Matouk CC, Orbach DB, Alper SL, Smith ER, Lifton RP, Gunel M, Milewicz DM, Jin SC, Kahle KT. DIAPH1 Variants in Non-East Asian Patients With Sporadic Moyamoya Disease. JAMA Neurol 2021; 78:993-1003. [PMID: 34125151 PMCID: PMC8204259 DOI: 10.1001/jamaneurol.2021.1681] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
Importance Moyamoya disease (MMD), a progressive vasculopathy leading to narrowing and ultimate occlusion of the intracranial internal carotid arteries, is a cause of childhood stroke. The cause of MMD is poorly understood, but genetic factors play a role. Several familial forms of MMD have been identified, but the cause of most cases remains elusive, especially among non-East Asian individuals. Objective To assess whether ultrarare de novo and rare, damaging transmitted variants with large effect sizes are associated with MMD risk. Design, Setting, and Participants A genetic association study was conducted using whole-exome sequencing case-parent MMD trios in a small discovery cohort collected over 3.5 years (2016-2019); data were analyzed in 2020. Medical records from US hospitals spanning a range of 1 month to 1.5 years were reviewed for phenotyping. Exomes from a larger validation cohort were analyzed to identify additional rare, large-effect variants in the top candidate gene. Participants included patients with MMD and, when available, their parents. All participants who met criteria and were presented with the option to join the study agreed to do so; none were excluded. Twenty-four probands (22 trios and 2 singletons) composed the discovery cohort, and 84 probands (29 trios and 55 singletons) composed the validation cohort. Main Outcomes and Measures Gene variants were identified and filtered using stringent criteria. Enrichment and case-control tests assessed gene-level variant burden. In silico modeling estimated the probability of variant association with protein structure. Integrative genomics assessed expression patterns of MMD risk genes derived from single-cell RNA sequencing data of human and mouse brain tissue. Results Of the 24 patients in the discovery cohort, 14 (58.3%) were men and 18 (75.0%) were of European ancestry. Three of 24 discovery cohort probands contained 2 do novo (1-tailed Poisson P = 1.1 × 10-6) and 1 rare, transmitted damaging variant (12.5% of cases) in DIAPH1 (mammalian diaphanous-1), a key regulator of actin remodeling in vascular cells and platelets. Four additional ultrarare damaging heterozygous DIAPH1 variants (3 unphased) were identified in 3 other patients in an 84-proband validation cohort (73.8% female, 77.4% European). All 6 patients were non-East Asian. Compound heterozygous variants were identified in ena/vasodilator-stimulated phosphoproteinlike protein EVL, a mammalian diaphanous-1 interactor that regulates actin polymerization. DIAPH1 and EVL mutant probands had severe, bilateral MMD associated with transfusion-dependent thrombocytopenia. DIAPH1 and other MMD risk genes are enriched in mural cells of midgestational human brain. The DIAPH1 coexpression network converges in vascular cell actin cytoskeleton regulatory pathways. Conclusions and Relevance These findings provide the largest collection to date of non-East Asian individuals with sporadic MMD harboring pathogenic variants in the same gene. The results suggest that DIAPH1 is a novel MMD risk gene and impaired vascular cell actin remodeling in MMD pathogenesis, with diagnostic and therapeutic ramifications.
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Affiliation(s)
- Adam J. Kundishora
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Samuel T. Peters
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson
| | - Amélie Pinard
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Daniel Duran
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson
| | | | - Tanyeri Barak
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
- Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
- Yale Program on Neurogenetics, Yale School of Medicine, New Haven, Connecticut
| | - Danielle F. Miyagishima
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
- Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
- Yale Program on Neurogenetics, Yale School of Medicine, New Haven, Connecticut
| | - Weilai Dong
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, New York
| | - Hannah Smith
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Jack Ocken
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Ashley Dunbar
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Shozeb Haider
- Department of Pharmaceutical and Biological Chemistry, University College London School of Pharmacy, London, United Kingdom
| | - Rebecca L. Walker
- Department of Neurology, Center for Autism Research and Treatment, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Boyang Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Dean Thumkeo
- Department of Drug Discovery Medicine, Kyoto University, Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Arnaud Marlier
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Phan Q. Duy
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Nicholas S. Diab
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin C. Reeves
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | | | | | - Amber N. Stratman
- Department of Cell Biology and Physiology, Washington University School of Medicine, St Louis, Missouri
| | - Yi-Hsien Chen
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Shujuan Zhao
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Isabelle Roszko
- Department of Developmental Biology, Center of Regenerative Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Qiongshi Lu
- Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison
| | - Bo Zhang
- Department of Developmental Biology, Center of Regenerative Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Shrikant Mane
- Yale Center for Genome Analysis, West Haven, Connecticut
| | | | | | | | | | | | - Daniel H. Geschwind
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles
| | - Shih-Shan Lang Chen
- Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Phillip B. Storm
- Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michael L. Diluna
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Charles C. Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Darren B. Orbach
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Seth L. Alper
- Division of Nephrology and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Edward R. Smith
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard P. Lifton
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, New York
| | - Murat Gunel
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Dianna M. Milewicz
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Kristopher T. Kahle
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut
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Liu H, Tao N, Wang Y, Yang Y, He X, Zhang Y, Zhou Y, Liu X, Feng X, Sun M, Xu F, Su Y, Li L. A novel homozygous mutation of the PCNT gene in a Chinese patient with microcephalic osteodysplastic primordial dwarfism type II. Mol Genet Genomic Med 2021; 9:e1761. [PMID: 34331829 PMCID: PMC8457697 DOI: 10.1002/mgg3.1761] [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: 06/27/2020] [Revised: 05/15/2021] [Accepted: 07/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Microcephalic osteodysplastic primordial dwarfism type II (MOPD II) is a rare autosomal recessive disorder characterized by severe pre‐ and postnatal growth restrictions, microcephaly, skeletal dysplasia, severe teeth deformities, and typical facial features. Previous studies have shown that MOPD II is associated with mutations in the pericentrin (PCNT) gene. Methods We evaluated the clinical features of a 10‐year and 7‐month‐old Chinese girl with MOPD II. Subsequently, next‐generation sequencing and flow cytometry were performed to investigate genetic characteristics and the expression of PCNT protein respectively. Results The patient presented with short stature, microcephaly, typical craniofacial features, teeth deformity, thrombocytosis, and a delayed bone age (approximately 7 years). No abnormality in growth hormone or insulin‐like growth factor 1 was detected. Notably, the patient was found to carry a novel homozygous PCNT mutation (c.6157G>T, p.Glu2053Ter), which was inherited from her healthy heterozygous parents. Meanwhile, significant deficiency of PCNT expression was identified in the patient. Conclusion Our study identified a novel PCNT mutation associated with MOPD II, expanded the mutation spectrum of the PCNT gene and improved our understanding of the molecular basis of MOPD II.
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Affiliation(s)
- Haifeng Liu
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Na Tao
- Department of Endocrinology, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Yan Wang
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Yang Yang
- Department of Endocrinology, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Xiaoli He
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Yu Zhang
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Yuantao Zhou
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Xiaoning Liu
- Department of Pharmacy, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Xingxing Feng
- Department of Clinical Laboratory, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Meiyuan Sun
- Department of Endocrinology, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Fang Xu
- Department of Endocrinology, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Yanfang Su
- Department of Endocrinology, Kunming Children's Hospital, Kunming, Yunnan, China
| | - Li Li
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming, Yunnan, China
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Wan J, Ling W, Zhengshan Z, Xianbo Z, Lian D, Kai W. Association of HLA-DQA2 and HLA-B With Moyamoya Disease in the Chinese Han Population. NEUROLOGY-GENETICS 2021; 7:e592. [PMID: 34095496 PMCID: PMC8176556 DOI: 10.1212/nxg.0000000000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Abstract
Objective An HLA imputation was conducted to explore the relationship between HLA and patients with moyamoya disease (MMD) in the Chinese Han population. Methods In this study, we performed an association analysis of the major histocompatibility complex region in 2,786 individuals of Chinese Han ancestry (2,031 controls and 755 patients with MMD), through a widely used HLA imputation method. Results We identified that the variant rs3129731 (odds ratio [OR] = 1.79, p = 3.69 × 10−16) located between the MTCO3P1 and HLA-DQA2 is a major genetic risk factor for MMD. In addition to this variant, found in the conditional association analysis, we also detected another independent signal, rs1071817 (OR = 0.62, p = 1.20 × 10−11), in HLA-B. Conclusions Our research suggests that the genetic polymorphism of HLA-DQA2 and HLA-B could be a genetic predisposing factor for MMD in Chinese Han. This may provide some evidence for further HLA-related studies of patients with MMD of Chinese Han ethnicity and indicates that MMD is an immune-related disease.
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Affiliation(s)
- Jiang Wan
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Wei Ling
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Zhang Zhengshan
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Zuo Xianbo
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Duan Lian
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
| | - Wang Kai
- Department of Neurology (J.W.), the First Affiliated Hospital of Anhui Medical University, the School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, Department of Neurology (J.W.), Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University; the School of Mental Health and Psychological Sciences (W.L.), Anhui Medical University, Anhui Province, Institute of Artificial Intelligence (W.L.), Hefei Comprehensive National Science Center. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.L.), Hefei; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.L), Anhui Province; Department of Neurosurgery (Z.Z.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; Department of Dermatology (Z.X.), the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province; Key Laboratory of Dermatology (Z.X.), Anhui Medical University, Ministry of Education, Hefei, Anhui Province; State Key Lab of Dermatology Incubation Center (Z.X.), Anhui Medical University, Hefei, China; Department of Neurosurgery (D.L.), the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th Hospital of PLA), Beijing; the School of Mental Health and Psychological Sciences (W.K.), Anhui Medical University, Anhui Province; Institute of Artificial Intelligence (W.K.), Hefei Comprehensive National Science Center; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders (W.K.), Hefei, Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health (W.K.), Anhui Province, China
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PHACES Syndrome and Associated Anomalies: Risk Associated With Small and Large Facial Hemangiomas. AJR Am J Roentgenol 2021; 217:507-514. [PMID: 34036811 DOI: 10.2214/ajr.20.23488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. PHACES syndrome includes posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities, and sternal defect with or without supraumbilical raphe. Usually, brain imaging is performed when facial hemangiomas are larger than 5 cm. Data on associated anomalies regardless of hemangioma size are sparse. The objective of this study was to determine, first, the prevalence of PHACES-like associated anomalies in a large sample of infants with all sizes of segmental facial or periorbital focal infantile hemangioma and, second, whether the cutaneous localization of the hemangioma correlates with the type of anomalies present. MATERIALS AND METHODS. The records of all patients of a vascular anomalies practice who had a diagnosis of segmental facial or periorbital focal infantile hemangioma and who had clinical photographs and brain MRI available were reviewed. The clinical photographs were reviewed to determine the localization by segment and lateralization. MRI was reviewed by two experienced pediatric radiologists. If present, cardiovascular anomalies, sternal defects, and eye anomalies were recorded. The criteria for definite and possible PHACES were used. RESULTS. The study included 122 children (90 girls, 32 boys; mean age, 16.6 months). Forty-five (36.9%) children had a facial infantile hemangioma larger than 5 cm. Twenty-two patients (18.0%) had PHACES or possible PHACES syndrome. Cerebrovascular structural anomalies were seen in 14 of 22 and brain anomalies in 6 of 22 patients with PHACES syndrome but in none and one of the patients in the group without PHACES (p < .001). Cardiovascular anomalies were seen in six patients and ocular anomalies in eight patients. All but one of them had PHACES syndrome. CONCLUSION. Clinical concern about associated extracutaneous anomalies is warranted for all children with facial segmental or periorbital focal infantile hemangiomas, including those with small hemangiomas. Further studies are needed to correlate cerebrovascular anomalies with the clinical evolution of hemangiomas and their effects on cerebral perfusion.
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Li L, Liu P, Wang R, Huang Y, Luo J, Jiao L, Tao Z, Zheng Y, Fan J, Zhao H, Han Z, Luo Y. Pathophysiological Significance of Neutrophilic Transfer RNA-Derived Small RNAs in Asymptomatic Moyamoya Disease. Cells 2021; 10:1086. [PMID: 34062929 PMCID: PMC8147334 DOI: 10.3390/cells10051086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
Understanding asymptomatic moyamoya disease (aMMD), for which treatment options are currently limited, is key to the development of therapeutic strategies that will slow down the progression of this disease, as well as facilitate the discovery of therapeutic targets for symptomatic MMD. Newly found transfer RNA-derived small RNAs (tsRNAs) perform potential regulatory functions in neovascularization, which is a well-known pathological manifestation of MMD. In this study, the neutrophilic tsRNA transcriptome in aMMD was profiled using next-generation RNA sequencing in five patients and five matched healthy subjects. A negative binominal generalized log-linear regression was used to identify differentially expressed (DE)-tsRNAs in aMMD. Gene Ontology and functional pathway analyses were used to identify biological pathways involved with the targeted genes of the DE-tsRNAs. Four tsRNAs were selected and validated using quantitative reverse transcription polymerase chain reaction. In total, 186 tsRNAs were DE between the two groups. Pathophysiological events, including immune response, angiogenesis, axon guidance, and metabolism adjustment, were enriched for the DE-tsRNAs. The expression levels of the four DE-tsRNAs were consistent with those in the neutrophilic transcriptome. These aberrantly expressed tsRNAs and their targeted pathophysiological processes provide a basis for potential future interventions for aMMD.
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Affiliation(s)
- Lingzhi Li
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
| | - Ping Liu
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
| | - Rongliang Wang
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing 100000, China
| | - Yuyou Huang
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (J.L.); (L.J.)
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (J.L.); (L.J.)
| | - Zhen Tao
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing 100000, China
| | - Yangmin Zheng
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
| | - Junfen Fan
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing 100000, China
| | - Haiping Zhao
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing 100000, China
| | - Ziping Han
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
| | - Yumin Luo
- Department of Neurology, Institute of Cerebrovascular Diseases Research, Xuanwu Hospital, Capital Medical University, Beijing 100000, China; (L.L.); (P.L.); (R.W.); (Y.H.); (Z.T.); (Y.Z.); (J.F.); (H.Z.)
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing 100000, China
- Beijing Institute for Brain Disorders, Beijing 100000, China
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Zhang X, Yin L, Jia X, Zhang Y, Liu T, Zhang L. iTRAQ-based Quantitative Proteomic Analysis of Dural Tissues Reveals Upregulated Haptoglobin to be a Potential Biomarker of Moyamoya Disease. CURR PROTEOMICS 2021. [DOI: 10.2174/1570164617666191210103652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Moyamoya Disease (MMD) is a rare cerebrovascular disease with a high rate
of disability and mortality. Immune reactions have been implicated in the pathogenesis of MMD, however,
the underlying mechanism is still unclear.
Objective:
To identify proteins related to MMD specially involved in the immunogenesis, we performed
a proteomic study.
Methods:
In this work, dural tissues or plasma from 98 patients with MMD, 17 disease controls without
MMD, and 12 healthy donors were included. Proteomic profiles of dural tissues from 4 MMD and
4 disease controls were analyzed by an isobaric tag for relative and absolute quantitation (iTRAQ)-
based proteomics. The immune-related proteins were explored by bioinformatics and the key MMDrelated
proteins were verified by western blot, multiple reaction monitoring methods, enzyme-linked
immunosorbent assay, and tissue microarray.
Results:
1,120 proteins were identified, and 82 MMD-related proteins were found with more than 1.5
fold difference compared with those in the control samples. Gene Ontology analysis showed that 29
proteins were immune-related. In particular, Haptoglobin (HP) was up-regulated in dural tissue and
plasma of MMD samples compared to the controls, and its up-regulation was found to be sex- and
MMD Suzuki grade dependent. Through Receiver Operating Characteristic (ROC) analysis, HP can
well discriminate MMD and healthy donors with the Area Under the Curve (AUC) of 0.953.
Conclusion:
We identified the biggest protein database of the dura mater. 29 out of 82 differentially
expressed proteins in MMD are involved in the immune process. Of which, HP was up-regulated in
dural tissue and plasma of MMD, with sex- and MMD Suzuki grade-dependence. HP might be a potential
biomarker of MMD.
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Affiliation(s)
- Xiaojun Zhang
- The 85th Hospital of the Chinese People's Liberation Army, Shanghai 200052, China
| | - Lin Yin
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xiaofang Jia
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yujiao Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Tiefu Liu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Lijun Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
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Das S, Dubey S, Pandit A, Ray BK. Moyamoya angiopathy unmasking systemic lupus erythematosus. BMJ Case Rep 2021; 14:14/1/e239307. [PMID: 33504534 PMCID: PMC7843324 DOI: 10.1136/bcr-2020-239307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 47-year-old woman with history of seizure disorder (semiology of seizure unknown), not well controlled with antiepileptic drugs since last 30 years presented with 1-year history of intermittent throbbing headache. On the day prior to admission, she experienced worst headache, followed by loss of consciousness. On regaining consciousness, she had neck pain without any focal neurological deficit, but examination was marked by positive meningeal signs. She had history of oral ulceration, photosensitivity and small joints pain for which no medical consultancy was sought until. Following relevant investigations, this case came out to be moyamoya angiopathy secondary to underlying systemic lupus erythematosus. She was put on immunosuppressive and immunomodulator as per recommendations. Among neurological symptoms, headache improved dramatically without any further seizure recurrence till the 6 months of follow-up.
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Affiliation(s)
- Shambaditya Das
- Department of Neurology, Institute of Postgraduate Medical Education and Research, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Souvik Dubey
- Department of Neurology, Institute of Postgraduate Medical Education and Research, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Alak Pandit
- Department of Neurology, Institute of Postgraduate Medical Education and Research, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Department of Neurology, Institute of Postgraduate Medical Education and Research, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
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Oh WO, Shim KW, Yeom I, Park IT, Heo Y. Features and diversity of symptoms of moyamoya disease in adolescents: A cluster analysis. J Adv Nurs 2021; 77:2319-2327. [PMID: 33426712 DOI: 10.1111/jan.14723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
AIMS The purpose of this study is to explore the symptoms experienced by adolescents with moyamoya disease and to identify the characteristics of each symptom cluster associated with moyamoya disease. DESIGN A retrospective and descriptive design, which is a secondary data analysis study based on electronic medical record data from hospitals. METHODS To assess the symptoms associated with moyamoya disease, a qualitative study was conducted on 12 adolescents, 12 caregivers and 12 experts on moyamoya disease. According to a qualitative study, 12 main symptoms (limb weakness, numbness, pins and needles, difficulty in speech, blurred vision, facial paralysis, hand tremors, involuntary movements, convulsions, dizziness, nausea/vomiting and headaches) were selected. Data were collected around these symptoms. The data collection was carried out through the Electronic Medical Record (EMR) data of 303 adolescents aged 13-19 who were diagnosed with moyamoya disease (ICD 10 Code: I67.5) between January 2010-December 2019 in a hospital in Seoul, South Korea. Cluster analysis was applied to identify symptom clusters with the hierarchical cluster agglomerative approach. We used the log-likelihood distance to measure the similarity of variables. Proximity between groups of variables was measured using the two-step method. RESULTS The physical symptoms experienced by adolescents with moyamoya disease were 'limb weakness' - the most common - followed by a 'headache,' 'difficulty in speech,' and 'nausea/vomiting.' A total of five symptom clusters were derived: cluster 1 was characterized by 'limb weakness'; cluster 2 participants were asymptomatic or experienced 'convulsions'; cluster 3 experienced 'difficulty in speech' and 'facial paralysis'; cluster 4 is prone to 'dizziness' and 'pins and needles'; and cluster 5 displays 'headaches' and 'nausea/vomiting'. CONCLUSION This study offers a multidimensional approach for identifying differences in clinical symptoms of moyamoya disease among adolescents. IMPACT These results will help provide interventions concerning the characteristics of the symptoms of moyamoya disease among adolescents.
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Affiliation(s)
- Won-Oak Oh
- College of Nursing, Korea University, Seoul, South Korea
| | - Kyu Won Shim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University Health System, Seoul, Korea
| | - Insun Yeom
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University Health System, Seoul, Korea
| | - Il Tae Park
- College of Nursing, Korea University, Seoul, South Korea
| | - YooJin Heo
- College of Nursing, Korea University, Seoul, South Korea
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Church EW, Qaiser R, Bell-Stephens TE, Bigder MG, Chow EK, Han SS, El-Sayed YY, Steinberg GK. Pregnancy after direct cerebral bypass for moyamoya disease. J Neurosurg 2021; 134:10-16. [PMID: 31731267 DOI: 10.3171/2019.8.jns191372] [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: 05/28/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Moyamoya disease (MMD) disproportionately affects young to middle-aged women. The main treatment for this challenging disease is cerebral bypass surgery. Vascular neurosurgeons often need to counsel women regarding pregnancy following bypass for MMD, but there is a paucity of data. The authors set out to examine neurological and obstetric outcomes in an extensive cohort of MMD patients who had pregnancies following cerebral revascularization at the Stanford Medical Center. METHODS The authors identified all patients at their institution who underwent cerebral bypass for MMD from 1990 through 2018 and who later became pregnant. Some of these patients also had pregnancies prior to undergoing bypass surgery, and the authors examined these pregnancies as well. They performed a chart review and brief telephone survey to identify obstetric complications, transient ischemic attacks (TIAs), and strokes. Neurological and obstetric outcomes were compared to published rates. They also compared pre- and post-bypass pregnancy complication rates using logistic regression techniques. RESULTS There were 71 pregnancies among 56 women whose mean age was 30.5 years. Among 59 post-bypass pregnancies, there were 5 (8%) perinatal TIAs. There were no MRI-confirmed strokes or strokes with residual deficits. Among 12 pre-bypass pregnancies, there were 3 (25%) TIAs and 2 (17%) MRI-confirmed strokes. There were no hemorrhagic complications in either group. In the generalized estimating equations analysis, performing cerebral revascularization prior to pregnancy versus after pregnancy was associated with lower odds of perinatal stroke or TIA (OR 0.15, p = 0.0061). Nine pregnancies (13%) were complicated by preeclampsia, and there was one (1%) instance of eclampsia. The overall rate of cesarean delivery was 39%. There were 2 miscarriages, both occurring in the first trimester. There were no maternal deaths. CONCLUSIONS The authors present neurological and obstetric outcomes data in a large cohort of MMD patients. These data indicate that post-bypass pregnancy is accompanied by low complication rates. There were no ischemic or hemorrhagic strokes among post-bypass pregnant MMD patients. The rate of obstetric complications was low overall. The authors recommend close collaboration between the vascular neurosurgeon and the obstetrician regarding medical management, including blood pressure goals and continuation of low-dose aspirin.
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Affiliation(s)
| | - Rabia Qaiser
- 1Department of Neurosurgery and Stanford Stroke Center
| | | | - Mark G Bigder
- 1Department of Neurosurgery and Stanford Stroke Center
| | - Eric K Chow
- 1Department of Neurosurgery and Stanford Stroke Center
- 2Quantitative Sciences Unit, and
| | - Summer S Han
- 1Department of Neurosurgery and Stanford Stroke Center
- 2Quantitative Sciences Unit, and
| | - Yasser Y El-Sayed
- 3Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Stanford University School of Medicine, Stanford, California
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Yang H, Zhang L, Wang M, Wang J, Chen L, Lu H. Clinical features of and risk factors for intracranial aneurysms associated with moyamoya disease. Int J Stroke 2020; 16:542-550. [PMID: 33176625 DOI: 10.1177/1747493020967224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The clinical features of aneurysms associated with moyamoya disease (MMD) and risk factors for the formation and rupture of aneurysms are not well defined. AIMS In this study, we retrospectively analyzed clinical data of MMD patients and examined the potential risk factors for the formation and rupture of aneurysms in these patients. METHODS The medical records of all MMD patients in our hospital from April 2012 to May 2019 were reviewed. The logistic regression analysis was used to determine the independent association between various potential risk factors and the presence or rupture of intracranial aneurysms in MMD patients. RESULTS Of 2230 MMD patients, 182 (8.2%) cases had intracranial aneurysms. The mean age of onset in patients with aneurysms was 47.2 years, which was significantly higher when compared with those without aneurysms (p < 0.001). In logistic regression analysis, age of onset remained significantly associated with the presence of intracranial aneurysms, while female gender, hypertension, diabetes mellitus, and coronary artery disease were not. Besides, intracranial aneurysms were significantly associated with intracranial hemorrhage in MMD patients (odds ratio [OR] = 5.19; 95% confidence interval [CI], 3.80-7.09). About 60% aneurysms >5 mm in size, and 62.1% aneurysms with irregularly shaped morphology were ruptured. Aneurysms located in basilar tip, collateral or moyamoya vessels were more likely to present with rupture. CONCLUSIONS Age was an important risk factor for intracranial aneurysms formation in MMD patients. Aneurysms increased the risk of intracerebral hemorrhage in MMD patients, and their ruptures were correlated with aneurysms size, location, and morphology.
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Affiliation(s)
- Hecheng Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Limin Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Menghan Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Jingtao Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Lijie Chen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Hong Lu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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40
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Pabst L, Carroll J, Lo W, Truxal KV. Moyamoya syndrome in a child with Legius syndrome: Introducing a cerebral vasculopathy to the SPRED1 phenotype? Am J Med Genet A 2020; 185:223-227. [PMID: 33078527 DOI: 10.1002/ajmg.a.61921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 11/11/2022]
Abstract
Legius syndrome is a disorder of the RAS and mitogen-activated protein kinase (MAPK) pathway first described in 2007 by Eric Legius, et al., that has been considered a milder phenotype than reported in the RASopathy neurofibromatosis type 1 (NF1). However, with approximately 200 cases reported in the literature, the Legius syndrome phenotype remains to be fully characterized. We report a child who presented with moyamoya syndrome and who has Legius syndrome due to a pathogenic variant in SPRED1. Vascular complications such as moyamoya syndrome have been reported in NF1. However, this association has not been reported in Legius syndrome. This child's case may represent an expansion of the clinical phenotype of Legius syndrome, and further study is needed. We emphasize the importance of obtaining neuroimaging studies in patients with Legius syndrome who present with new neurologic deficits.
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Affiliation(s)
- Lisa Pabst
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, US
| | - Jennifer Carroll
- Division of Genetic and Genomic Medicine, Department of Internal Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, US
| | - Warren Lo
- Division of Neurology, Depts. Of Pediatrics and Neurology, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio, US
| | - Kristen V Truxal
- Division of Genetic and Genomic Medicine, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, US
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Zhu B, Liu X, Zhen X, Li X, Wu M, Zhang Y, Zhao Z, Zhang D, Zhao J. RNF213 gene polymorphism rs9916351 and rs8074015 significantly associated with moyamoya disease in Chinese population. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:851. [PMID: 32793695 DOI: 10.21037/atm-20-1040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Gene polymorphism especially Ring Finger Protein 213 (RNF213) p.R4810K is one of the main cause of moyamoya disease (MMD) in Asian populations, especially among Japanese people. However, missense mutation may not explain the reduced frequency of MMD in Chinese patients. We performed a hospital based case-control study in a Chinese population to elucidate the possible underlying reasons. Methods Five gene polymorphism loci, namely, rs35692831, rs9916351, rs9913636, rs8074015 and rs112735431, were included. A total of 98 patients and 114 healthy controls were enrolled in the study. Genomic DNA was genotyped by Mass Array methods. Results A significant difference was observed between patients and healthy controls in rs9916351, rs9913636, and rs8074015 loci under three genotypes and allelic models (P<0.01). Logistic regression analysis revealed the significant differences under the dominant, recessive and additional model in rs9916351 [odds ratio (OR) =4.173, 95% confidence interval (CI): 2.290-7.606, P<0.001; OR =3.152, 95% CI: 1.585-6.267, P=0.001; OR =0.199, 95% CI: 1.727-3.764, P<0.001; respectively] and rs8074015 (OR =0.359, 95% CI: 0.206-0.627, P<0.001; OR =0.348, 95% CI: 0.148-0.81, P=0.015; OR =0.208, 95% CI: 0.311-0.703, P<0.001; respectively), even adjusting for age and gender. In addition, the haplotype rs9913636-rs8074015 under "GACG" showed significant association with MMD. Conclusions Our results had revealed the polymorphism of RNF213 rs9916351 and rs8074015 were significantly associated with MMD especially in Chinese population.
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Affiliation(s)
- Bin Zhu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorder, Beijing, China
| | - Xueke Zhen
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Xixi Li
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingfen Wu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorder, Beijing, China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorder, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorder, Beijing, China
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Idiculla PS, Gurala D, Philipose J, Rajdev K, Patibandla P. Cerebral Cavernous Malformations, Developmental Venous Anomaly, and Its Coexistence: A Review. Eur Neurol 2020; 83:360-368. [PMID: 32731220 DOI: 10.1159/000508748] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebral cavernous malformations (CCMs) are intracranial vascular malformations that can exist as a single lesion or mixed vascular lesions. The most common mixed form is the coexistence of CCM with an associated developmental venous anomaly (DVA). In this paper, we aim to give a comprehensive review of CCM, DVA, and their coexistence as mixed lesions. A PubMed search using the keywords "Cerebral cavernous malformations, Developmental venous anomaly, Mixed Cerebral cavernous malformations with Developmental venous anomaly" was done. All studies in the English language in the past 10 years were analyzed descriptively for this review. SUMMARY The search yielded 1,249 results for "Cerebral cavernous malformations," 271 results for "Developmental venous anomaly," and 5 results for "Mixed Cerebral cavernous malformations with Developmental venous anomaly." DVA is the most common intracranial vascular malformation, followed by CCM. CCM can have a wide array of clinical presentations like hemorrhage, seizures, or focal neurological deficits or can also be an incidental finding on brain imaging. DVAs are benign lesions by nature; however, venous infarction can occur in a few patients due to acute thrombosis. Mixed CCM with DVA has a higher risk of hemorrhage. CCMs are angiographically occult lesion, and cerebral digital subtraction angiography is the gold standard for the diagnosis of DVA. Mixed lesions, on the other hand, are best diagnosed with magnetic resonance imaging, which has also been effective in detecting specific abnormalities. Asymptomatic lesions are treated through a conservative approach, while clinically symptomatic lesions need surgical management. CONCLUSION Individual CCM or DVA lesions have a benign course; however, when they coexist in the same individual, the hemorrhagic risk is increased, which prompts for rapid diagnosis and treatment.
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Affiliation(s)
| | - Dhineshreddy Gurala
- Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Jobin Philipose
- Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
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Church EW, Bell-Stephens TE, Bigder MG, Gummidipundi S, Han SS, Steinberg GK. Clinical Course of Unilateral Moyamoya Disease. Neurosurgery 2020; 87:1262-1268. [PMID: 32710766 DOI: 10.1093/neuros/nyaa284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/25/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The natural history of unilateral moyamoya disease (MMD) progressing to bilateral MMD remains an enigma in modern vascular neurosurgery. Few, small series with limited follow-up have reported relatively high rates of contralateral stenosis progression. OBJECTIVE To review our large series of unilateral MMD patients and evaluate radiographic and surgical progression rates, and identify any factors associated with progression. METHODS We included all unilateral MMD cases treated from 1991 to 2017 in an observational study. We examined time to contralateral radiographic progression and contralateral progression requiring surgery. Using Cox regression analysis, we evaluated factors potentially associated with contralateral progression. RESULTS There were 217 patients treated for unilateral MMD. About 71% were female, and the average age at first surgery was 33.8 yr. Average follow-up was 5.8 yr (range 1-22 yr). A total of 18 patients (8.3%) developed contralateral progression. And 8 of these (3.7%) developed progression requiring bypass surgery. Baseline stenosis and hyperlipidemia (HLD) were significantly associated with radiographic progression (hazard ratio [HR] = 9.7, P = .006; HR = 4.0, P = .024). Baseline stenosis was associated with surgical progression (HR = 44.2, P = .002). Results were similar when controlling for possible confounders using multivariate regression. CONCLUSION Previous series showed relatively high rates of progression in unilateral MMD (15%-30%), but these studies were small and long-term follow-up was rarely available. Our large series indicates that the rate of progression is lower than previously reported but still warrants yearly noninvasive screening. These data may provide indirect support for statin therapy in MMD.
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Affiliation(s)
- Ephraim W Church
- Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California
| | - Teresa E Bell-Stephens
- Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California
| | - Mark G Bigder
- Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California
| | - Santosh Gummidipundi
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Summer S Han
- Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California.,Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Gary K Steinberg
- Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California
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44
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Ge P, Zhang Q, Ye X, Liu X, Deng X, Wang J, Wang R, Zhang Y, Zhang D, Zhao J. Modifiable Risk Factors Associated With Moyamoya Disease: A Case-Control Study. Stroke 2020; 51:2472-2479. [PMID: 32640948 DOI: 10.1161/strokeaha.120.030027] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The cause of moyamoya disease (MMD) remains unknown. We aimed to investigate the association between modifiable risk factors and MMD in a prospective, case-control study. METHODS Clinical and laboratory characteristics were evaluated in consecutively recruited adult patients with MMD and age-matched healthy control individuals. The potential risk factors for MMD were estimated by logistic regression analysis. RESULTS Our prospective study included 138 adult patients and 138 healthy control subjects. Logistic regression analyses showed that increased body mass index (odds ratio [OR], 1.121 [95% CI, 1.018-1.234]; P=0.020) and homocysteine (OR, 1.201 [95% CI, 1.081-1.334]; P=0.001) were associated with higher risk of MMD. Whereas increased albumin (OR, 1.043 [95% CI, 1.004-1.082]; P=0.028) and high-density lipoprotein cholesterol (OR, 1.043 [95% CI, 1.004-1.082]; P=0.028) were correlated with a lower risk of MMD. Furthermore, homocysteine (OR, 1.070 [95% CI, 1.010-1.134]; P=0.023) was significantly related to unilateral lesions. CONCLUSIONS Increased body mass index and homocysteine were associated with a higher risk of MMD. In contrast, increased albumin and high-density lipoprotein cholesterol were correlated with a lower risk of MMD. Furthermore, increased homocysteine was related to a higher prevalence of unilateral MMD. More attention should be paid to the modifiable risk factors of MMD, as these might help us finding its cause and new therapeutic regimen. Registration: URL: http://www.chictr.org. Unique identifier: ChiCTR2000031412.
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Affiliation(s)
- Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Xingju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Jia Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.)
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, China (P.G., Q.Z., X.Y., X.L., X.D., J.W., R.W., Y.Z., D.Z., J.Z.).,Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China (J.Z.)
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45
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Doherty RJ, Caird J, Crimmins D, Kelly P, Murphy S, McGuigan C, Tubridy N, King MD, Lynch B, Webb D, O'Neill D, McCabe DJH, Boers P, O'Regan M, Moroney J, Williams DJ, Cronin S, Javadpour M. Moyamoya disease and moyamoya syndrome in Ireland: patient demographics, mode of presentation and outcomes of EC-IC bypass surgery. Ir J Med Sci 2020; 190:335-344. [PMID: 32562218 DOI: 10.1007/s11845-020-02280-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are no previously published reports regarding the epidemiology and characteristics of moyamoya disease or syndrome in Ireland. AIMS To examine patient demographics, mode of presentation and the outcomes of extracranial-intracranial bypass surgery in the treatment of moyamoya disease and syndrome in Ireland. METHODS All patients with moyamoya disease and syndrome referred to the National Neurosurgical Centre during January 2012-January 2019 were identified through a prospective database. Demographics, clinical presentation, radiological findings, surgical procedures, postoperative complications and any strokes during follow-up were recorded. RESULTS Twenty-one patients were identified. Sixteen underwent surgery. Median age at diagnosis was 19 years. Fifteen were female. Mode of presentation was ischaemic stroke in nine, haemodynamic TIAs in eight, haemorrhage in three and incidental in one. Sixteen patients had Moyamoya disease, whereas five patients had moyamoya syndrome. Surgery was performed on 19 hemispheres in 16 patients. The surgical procedures consisted of ten direct (STA-MCA) bypasses, five indirect bypasses and four multiple burr holes. Postoperative complications included ischaemic stroke in one patient and subdural haematoma in one patient. The median follow-up period in the surgical group was 52 months; there was one new stroke during this period. Two patients required further revascularisation following recurrent TIAs. One patient died during follow-up secondary to tumour progression associated with neurofibromatosis type 1. CONCLUSIONS Moyamoya is rare but occurs in Caucasians in Ireland. It most commonly presents with ischaemic symptoms. Surgical intervention in the form of direct and indirect bypass is an effective treatment in the majority of cases.
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Affiliation(s)
- Ronan J Doherty
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - John Caird
- Departments of Neurology and Neurosurgery, Temple Street Children's University Hospital, Dublin, Ireland
| | - Darach Crimmins
- Departments of Neurology and Neurosurgery, Temple Street Children's University Hospital, Dublin, Ireland
| | - Peter Kelly
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Niall Tubridy
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Mary D King
- Departments of Neurology and Neurosurgery, Temple Street Children's University Hospital, Dublin, Ireland
| | - Bryan Lynch
- Departments of Neurology and Neurosurgery, Temple Street Children's University Hospital, Dublin, Ireland
| | - David Webb
- Department of Neurology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Desmond O'Neill
- Stroke Service and Departments of Neurology and Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
| | - Dominick J H McCabe
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Stroke Service and Departments of Neurology and Geriatric Medicine, Tallaght University Hospital, Dublin, Ireland
- Vascular Neurology Research Foundation, Tallaght University Hospital, Dublin, Ireland
- Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK
| | - Peter Boers
- Department of Neurology, University Hospital Limerick, Limerick, Ireland
| | - Mary O'Regan
- Department of Neurology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Joan Moroney
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
| | | | - Simon Cronin
- Department of Neurology, Cork University Hospital and University College Cork, Cork, Ireland
| | - Mohsen Javadpour
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
- Royal College of Surgeons in Ireland, Dublin, Ireland.
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46
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Yang YS, Ryu GW, Park CG, Yeom I, Shim KW, Choi M. Mood and Stress Evaluation of Adult Patients With Moyamoya Disease in Korea: Ecological Momentary Assessment Method Using a Mobile Phone App. JMIR Mhealth Uhealth 2020; 8:e17034. [PMID: 32449687 PMCID: PMC7281123 DOI: 10.2196/17034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/29/2020] [Accepted: 02/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background Moyamoya disease (MMD) is a known progressive obstructive cerebrovascular disorder. Monitoring and managing mood and stress are critical for patients with MMD, as they affect clinical outcomes. The ecological momentary assessment (EMA) method is a longitudinal study design by which multiple variable assessments can be performed over time to detect momentary fluctuations and changes in psychological dimensions such as mood and stress over time. Objective This study aimed to identify predicting factors associated with momentary mood and stress at both the within-person and between-person levels and to examine individual fluctuation of mood over time in the short term using an EMA method combined with a mobile phone app. Methods Participants aged older than 18 years were recruited from a tertiary hospital in Seoul, Korea, between July 2018 and January 2019. The PsyMate scale for negative affect (NA) and positive affect (PA) and the Trier Inventory for Chronic Stress Scale were uploaded on patient mobile phones. Using a mobile app, data were collected four times a day for 7 days. Pearson correlations and mixed modeling were used to predict relationships between repeatedly measured variables at both the between-person and within-person levels. Results The mean age of the 93 participants was 40.59 (SD 10.06) years, 66 (71%) were female, and 71 (76%) were married. Participants provided 1929 responses out of a possible 2604 responses (1929/2604, 74.08%). The mean momentary NA and PA values were 2.15 (SD 1.12) and 4.70 (SD 1.31) out of 7, respectively. The momentary stress value was 2.03 (SD 0.98) out of 5. Momentary NA, PA, and stress were correlated (P<.001) and varied over time in relation to momentary variables. Common momentary variables associated with momentary mood and stress at both the within-person (level 1) and between-person (level 2) levels were identified. Momentary NA increased when being alone and being at the hospital at both levels, whereas momentary PA increased when eating or drinking, resting, being at a café, restaurant or a public place but decreased when being alone at both levels. Momentary stress increased when being at the office, at a public place, or as the time of the day went by but decreased when resting or during the weekend. Different factors affecting mood and stress at different levels were identified. Fluctuations in individual momentary mood over time at the within-person level were captured. Conclusions The EMA method using a mobile phone app demonstrated its ability to capture changes in mood and stress in various environmental contexts in patients with MMD. The results could provide baseline information for developing interventions to manage negative mood and stress of patients with MMD based on the identified predictors affecting mood and stress at two different levels.
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Affiliation(s)
- Yong Sook Yang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Gi Wook Ryu
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Insun Yeom
- Department of Pediatric Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Won Shim
- Department of Pediatric Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
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47
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Geng C, Cui C, Guo Y, Wang C, Zhang J, Han W, Jin F, Chen D, Jiang P. Metabolomic Profiling Revealed Potential Biomarkers in Patients With Moyamoya Disease. Front Neurosci 2020; 14:308. [PMID: 32372905 PMCID: PMC7186471 DOI: 10.3389/fnins.2020.00308] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/16/2020] [Indexed: 11/13/2022] Open
Abstract
Metabolomics is increasingly used to observe metabolic patterns and disease-specific metabolic biomarkers. However, serum metabolite analysis of moyamoya disease (MMD) is rarely reported. We investigated serum metabolites in MMD and compared them with those of healthy controls (HCs) using a non-targeted gas chromatography-mass spectrometry (GC-MS) approach to identify metabolic biomarkers associated with MMD. Forty-one patients with MMD diagnosed by cerebral angiography and 58 HCs were recruited for our study. Comparative analyses (univariate, multivariate, correlation, heatmaps, receiver operating characteristi curves) were performed between MMD patients and HCs. Twenty-five discriminating serum metabolic biomarkers between MMD patients and HCs were identified. Compared with HCs, MMD patients had higher levels of phenol, 2-hydroxybutyric acid, L-isoleucine, L-serine, glycerol, pelargonic acid, L-methionine, myristic acid, pyroglutamic acid, palmitic acid, palmitoleic acid, stearic acid, octadecanamide, monoglyceride (MG) (16:0/0:0/0:0), and MG (0:0/18:0/0:0), and lower levels of L-alanine, L-valine, urea, succinic acid, L-phenylalanine, L-threonine, L-tyrosine, edetic acid, and oleamide. These metabolic biomarkers are involved in several pathways and are closely associated with the metabolism of amino acids, lipids, carbohydrates, and carbohydrate translation. A GC-MS-based metabolomics approach could be useful in the clinical diagnosis of MMD. The identified biomarkers may be helpful to develop an objective diagnostic method for MMD and improve our understanding of MMD pathogenesis.
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Affiliation(s)
- Chunmei Geng
- Jining First People's Hospital, Jining Medical University, Jining, China
| | - Changmeng Cui
- Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China
| | - Yujin Guo
- Jining First People's Hospital, Jining Medical University, Jining, China
| | - Changshui Wang
- Department of Clinical Translational Medicine, Jining Life Science Center, Jining, China
| | - Jun Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenxiu Han
- Jining First People's Hospital, Jining Medical University, Jining, China
| | - Feng Jin
- Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China
| | - Dan Chen
- Jining First People's Hospital, Jining Medical University, Jining, China
| | - Pei Jiang
- Jining First People's Hospital, Jining Medical University, Jining, China
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48
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Ryu GW, Yang YS, Choi M, Shim KW. Lived experiences of adult patients with moyamoya disease: A qualitative case study. Jpn J Nurs Sci 2020; 17:e12332. [DOI: 10.1111/jjns.12332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 01/03/2020] [Accepted: 01/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Gi Wook Ryu
- Mo‐Im Kim Nursing Research InstituteYonsei University College of Nursing Seoul Republic of Korea
| | - Yong Sook Yang
- Mo‐Im Kim Nursing Research InstituteYonsei University College of Nursing Seoul Republic of Korea
| | - Mona Choi
- Mo‐Im Kim Nursing Research InstituteYonsei University College of Nursing Seoul Republic of Korea
| | - Kyu Won Shim
- Department of Pediatric Neurosurgery, Severance Children's HospitalYonsei University College of Medicine Seoul Republic of Korea
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49
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Lu J, Xia Q, Yang T, Qiang J, Liu X, Ye X, Wang R. Electroencephalographic features in pediatric patients with moyamoya disease in China. Chin Neurosurg J 2020; 6:3. [PMID: 32922932 PMCID: PMC7398412 DOI: 10.1186/s41016-019-0179-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/13/2019] [Indexed: 11/13/2022] Open
Abstract
Background Moyamoya disease (MMD) is a relatively important and common disease, especially in East Asian children. There are few reports about EEG in children with MMD in China till now. This study is aimed to analyze the electroencephalographic features of MMD in pediatric patients in China preliminarily. Methods Pediatric patients with MMD who were hospitalized in Peking University International Hospital and Beijing Tiantan Hospital from January 2016 to December 2018 were collected. Clinical and electroencephalography (EEG) findings were analyzed retrospectively. Results A total of 110 pediatric patients with MMD were involved, and 17 (15.5%) cases had a history of seizure or epilepsy. Ischemic stroke was associated with a 1.62-fold relative risk of seizure. A subset of 15 patients with complete EEG data was identified. Indications for EEG in patients with MMD included limb shaking, unilateral weakness, or generalized convulsion. Abnormal EEG was seen in 14 (93.3%) cases, with the most common findings being focal slowing 12 (80.0%), followed by epileptiform discharge 10 (66.7%), and diffuse slowing 9 (60.0%). “Re-build up” phenomenon on EEG was observed in one patient. Conclusions Seizure and abnormal background activity or epileptiform discharge on EEG were common in pediatric patients with MMD. EEG may play a role in differential diagnosis among the transient neurological events in MMD such as transient ischemic attack and seizure.
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Affiliation(s)
- Jia Lu
- Department of Neurology, Peking University International Hospital, No.1 Life Park Road, Changping District, Beijing, 102206 China
| | - Qing Xia
- Department of Neurology, Peking University International Hospital, No.1 Life Park Road, Changping District, Beijing, 102206 China
| | - Tuanfeng Yang
- Department of Neurology, Peking University International Hospital, No.1 Life Park Road, Changping District, Beijing, 102206 China
| | - Jun Qiang
- Department of Neurology, Peking University International Hospital, No.1 Life Park Road, Changping District, Beijing, 102206 China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, No.1 Life Park Road, Changping District, Beijing, 102206 China
| | - Xun Ye
- Department of Neurosurgery, Peking University International Hospital, Beijing, 102206 China.,Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, 100070 China
| | - Rong Wang
- Department of Neurosurgery, Peking University International Hospital, Beijing, 102206 China.,Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, 100070 China
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50
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Yang J, Song GF, Li HB, Zhang SH, Yang FY. Clinical efficacy of extracranial-intracranial bypass for the treatment of adult patients with moyamoya disease: A protocol of systematic review of randomized controlled trials. Medicine (Baltimore) 2019; 98:e18211. [PMID: 31804345 PMCID: PMC6919537 DOI: 10.1097/md.0000000000018211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Moyamoya disease (MMD) is a major health concern associated with blocked arteries at the base of the brain. The aim of this study will synthesize the current evidence of the efficacy and safety of extracranial-intracranial bypass (EIB) for the treatment of adult patients with MMD. METHODS A systematically and comprehensively literature search will be performed in PubMed, EMBASE, Web of Science, CENTRAL, CINAHL, AMED, CBM, and CNKI to identify relevant randomized controlled trails (RCTs) investigating the efficacy and safety of EIB for treating MMD. We will search all above electronic databases from their inception to the July 30, 2019. Two review authors will independently perform study selection, data extraction, and conduct risk of bias evaluation using Cochrane risk of bias tool. We will also explore heterogeneity across studies. RevMan 5.3 software will be applied for statistical analysis performance. RESULTS This study will evaluate the efficacy and safety of EIB for the treatment of adult patients with MMD. CONCLUSION The results of this study will provide latest evidence of the efficacy and safety of EIB for MMD. DISSEMINATION AND ETHICS This study is based on published studies, thus, no ethical consideration is needed. The results of this study are expected to be published in peer-reviewed journals or will be presented on conference meeting.Systematic review registration: PROSPERO CRD42019155839.
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Affiliation(s)
| | | | | | | | - Fu-yi Yang
- Department of Neurology, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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