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Kirschen GW, Brown L, Davis J, Kim D, Berman DJ, Al-Khindi T, Caplan J, Osborne SM. A Case Report of Spontaneous Vaginal Delivery Under General Anesthesia in a Patient With a Large Cerebral Aneurysm. Cureus 2024; 16:e53822. [PMID: 38465162 PMCID: PMC10924630 DOI: 10.7759/cureus.53822] [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: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Cerebral aneurysms are rarely encountered in pregnancy. Their antepartum and intrapartum management remain clinically challenging, primarily due to concern regarding potential rupture. We present a case of a patient in preterm labor at risk for imminent delivery with a 10mm cerebral aneurysm. She was recommended for cesarean section (CS), yet delivered via spontaneous vaginal delivery in the operating room after induction of general anesthesia for the intended CS. Her aneurysm and neurologic function remained intact postpartum. Cerebral aneurysms <5mm are unlikely to undergo significant growth during pregnancy. The presence of a cerebral aneurysm is not automatically a contraindication to the Valsalva maneuver. The recommendation for which patients with unruptured cerebral aneurysms should deliver by CS, operative vaginal delivery, or unassisted vaginal delivery (i.e., which patients should avoid Valsalva maneuver intrapartum), is complex and requires multidisciplinary discussion.
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Affiliation(s)
- Gregory W Kirschen
- Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Lucy Brown
- Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Joy Davis
- Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Dan Kim
- Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - David J Berman
- Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Timour Al-Khindi
- Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Justin Caplan
- Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Shannon M Osborne
- Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, USA
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2
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Xu T, Yu X, Zhou S, Wu Y, Deng X, Wu Y, Wang S, Gao X, Nie S, Zhou C, Sun J, Huang Y. DNA methylation and mRNA expression of glutathione S-transferase alpha 4 are associated with intracranial aneurysms in a gender-dependent manner. Front Genet 2023; 13:1079455. [PMID: 36699470 PMCID: PMC9868450 DOI: 10.3389/fgene.2022.1079455] [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: 11/05/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023] Open
Abstract
Objective: We performed a case-control study to investigate the correlation between DNA methylation and mRNA expression of the glutathione S-transferase alpha 4 (GSTA4) gene and the risk of intracranial aneurysm (IA) in the Chinese Han population. Methods: After propensity score matching, 44 pairs of cases and controls were collected in this study. Fasting blood samples were collected for DNA and RNA extraction within 24 h of admission. Nine CpG dinucleotides were selected from the GSTA4 promoter region for DNA methylation pyrosequencing. mRNA expression of GSTA4 was measured by quantitative real-time polymerase chain reaction (RT-qPCR). In vitro cell experiments were conducted to verify the association between 5-aza-2'-deoxycytidine induced DNA hypomethylation and GSTA4 mRNA expression. Results: The mean methylation level of GSTA4 was much lower in IA patients, especially in IA patients, especially in unruptured IA (UIA), than that in controls (IA vs. Control, p < .001; ruptured IA (RIA) vs. Control, p = .005; UIA vs. Control, p < .001). With sex stratification, we further found that the association between GSTA4 methylation and IA risk presented only in women (mean methylation level: IA vs. Control, p < .001; RIA vs. Control, p = .009; UIA vs. Control, p < .001). GSTA4 mRNA expression was significantly higher in the IA group than in the control group (p < .01) and negatively correlated with DNA methylation in all individuals (r = -.746, p < .001). DNA hypomethylation can increase GSTA4 mRNA expression in human primary artery smooth muscle cells. The receiver operating characteristic (ROC) curve showed that GSTA4 mean methylation (AUC = .80, p < .001) was a reliable predictor of women intracranial aneurysm, among which CpG 1 exhibited the best predictive value (AUC = .89, p < .001). In addition, GSTA4 expression levels could also predict the risk of IA in women (AUC = .87, p = .005). Conclusion: Decreased DNA methylation and increased mRNA expression of the GSTA4 gene are associated with the risk of IA in women.
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Affiliation(s)
- Tianqi Xu
- Department of Neurology, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China.,Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China
| | - Xi Yu
- Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Shenjun Zhou
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China.,Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yiwen Wu
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Xinpeng Deng
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yuefei Wu
- Department of Neurology, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Shiyi Wang
- Department of Neurology, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China.,Medical School of Ningbo University, Ningbo, China
| | - Xiang Gao
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Sheng Nie
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Chenhui Zhou
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China.,Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Jie Sun
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yi Huang
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China.,Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
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Zhao J, Xu T, Zhou S, Zhang J, Wu Y, Zhou C, Sun J, Gao X, Huang Y. DNA methylation of the MAP3K10 gene may participate in the development of intracranial aneurysm. Gene X 2023; 851:147024. [DOI: 10.1016/j.gene.2022.147024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/04/2022] Open
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Zhu H, Tan J, Wang Z, Wu Z, Zhou W, Zhang Z, Li M, Zhao Y. Bioinformatics analysis constructs potential ferroptosis-related ceRNA network involved in the formation of intracranial aneurysm. Front Cell Neurosci 2022; 16:1016682. [PMCID: PMC9612944 DOI: 10.3389/fncel.2022.1016682] [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: 08/11/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIntracranial aneurysm (IA) causes more than 80% of nontraumatic subarachnoid hemorrhages (SAHs). The mechanism of ferroptosis involved in IA formation remains unclear. The roles played by competitive endogenous RNA (ceRNA) regulation networks in many diseases are becoming clearer. The goal of this study was to understand more fully the ferroptosis-related ceRNA regulation network in IA.Materials and methodsTo identify differentially expressed genes (DEGs), differentially expressed miRNAs (DEMs), and differentially expressed lncRNAs (DELs) across IA and control samples, the GEO datasets GSE122897 and GSE66239 were downloaded and analyzed with the aid of R. Ferroptosis DEGs were discovered by exploring the DEGs of ferroptosis-related genes of the ferroptosis database. Potentially interacting miRNAs and lncRNAs were predicted using miRWalk and StarBase. Enrichment analysis was also performed. We utilized the STRING database and Cytoscape software to identify protein-protein interactions and networks. DAB-enhanced Prussian blue staining was used to detect iron in IA tissues.ResultsIron deposition was evident in IA tissue. In all, 30 ferroptosis DEGs, 5 key DEMs, and 17 key DELs were screened out for constructing a triple regulatory network. According to expression regulation of DELs, DEMs, and DEGs, a hub triple regulatory network was built. As the functions of lncRNAs are determined by their cellular location, PVT1-hsa-miR-4644-SLC39A14 ceRNA and DUXAP8-hsa-miR-378e/378f-SLC2A3 ceRNA networks were constructed.ConclusionCeRNA (PVT1-hsa-miR-4644-SLC39A14 and DUXAP8-hsa-miR-378e/378f-SLC2A3) overexpression networks associated with ferroptosis in IA were established.
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Liu Q, Leng X, Yang J, Yang Y, Jiang P, Li M, Mo S, Yang S, Wu J, He H, Wang S. Stability of unruptured intracranial aneurysms in the anterior circulation: nomogram models for risk assessment. J Neurosurg 2022; 137:675-684. [PMID: 35061990 DOI: 10.3171/2021.10.jns211709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The probable stability of the lesion is critical in guiding treatment decisions in unruptured intracranial aneurysms (IAs). The authors aimed to develop multidimensional predictive models for the stability of unruptured IAs. METHODS Patients with unruptured IAs in the anterior circulation were prospectively enrolled and regularly followed up. Clinical data were collected, IA morphological features were assessed, and adjacent hemodynamic features were quantified with patient-specific computational fluid dynamics modeling. Based on multivariate logistic regression analyses, nomograms incorporating these factors were developed in a primary cohort (patients enrolled between January 2017 and February 2018) to predict aneurysm rupture or growth within 2 years. The predictive accuracies of the nomograms were compared with the population, hypertension, age, size, earlier rupture, and site (PHASES) and earlier subarachnoid hemorrhage, location, age, population, size, and shape (ELAPSS) scores and validated in the validation cohort (patients enrolled between March and October 2018). RESULTS Among 231 patients with 272 unruptured IAs in the primary cohort, hypertension, aneurysm location, irregular shape, size ratio, normalized wall shear stress average, and relative resident time were independently related to the 2-year stability of unruptured IAs. The nomogram including clinical, morphological, and hemodynamic features (C+M+H nomogram) had the highest predictive accuracy (c-statistic 0.94), followed by the nomogram including clinical and morphological features (C+M nomogram; c-statistic 0.89), PHASES score (c-statistic 0.68), and ELAPSS score (c-statistic 0.58). Similarly, the C+M+H nomogram had the highest predictive accuracy (c-statistic 0.94) in the validation cohort (85 patients with 97 unruptured IAs). CONCLUSIONS Hemodynamics have predictive values for 2-year stability of unruptured IAs treated conservatively. Multidimensional nomograms have significantly higher predictive accuracies than conventional risk prediction scores.
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Affiliation(s)
- Qingyuan Liu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Xinyi Leng
- 4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Junhua Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Yi Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Pengjun Jiang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Maogui Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shaohua Mo
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shuzhe Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Jun Wu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Hongwei He
- 3Department of Neurointervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; and
| | - Shuo Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
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Axier A, Rexiati N, Wang Z, Cheng X, Su R, Aikeremu R, Aisha M. Effect of hemodynamic changes on the risk of intracranial aneurysm rupture: a systematic review and meta-analysis. Am J Transl Res 2022; 14:4638-4647. [PMID: 35958447 PMCID: PMC9360874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE In this study, the hemodynamic parameters of ruptured intracranial aneurysms (IAs) in various studies were summarized and analyzed to provide predictive parameters for IA rupture in clinical work. METHODS We searched PubMed, Web of science, Embase, and Cochrane databases for articles published before December 2021 to collect data on hemodynamic parameters associated with IA rupture. Differences in wall shear stress (WSS), oscillatory shear index (OSI), and low wall shear stress area (LSA) between ruptured and unruptured IAs in the literature were summarized and analyzed, and the standardized mean difference (SMD) of 95% CI was calculated by Review Manager 5.3. RESULTS By searching and screening the literature, this meta-analysis included 17 studies comprising 1,373 IA patients. In the ruptured aneurysm group, the level of WSS decreased significantly, while OSI and LSA increased obviously. CONCLUSION Low WSS, high OSI, and high LSA are closely related to the rupture of IAs, indicating the role of WSS, OSI, and LSA as important hemodynamic parameters for predicting the rupture of IAs in clinical work.
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Affiliation(s)
- Aximujiang Axier
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Nizamidingjiang Rexiati
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Zengliang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Xiaojiang Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Riqing Su
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Rexidan Aikeremu
- Department of Medical Record Management, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Maimaitili Aisha
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
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7
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Liu Q, Wu J, Luo Y, Chen L. Effect and Blood Flow Parameters of Biomaterials-Based Endovascular Interventional Embolization and Craniotomy Clipping in the Treatment of Cerebral Aneurysms. J Biomed Nanotechnol 2022; 18:259-267. [PMID: 35180920 DOI: 10.1166/jbn.2022.3237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: The effects of interventional embolization and craniotomy clipping on the treatment of intracranial aneurysms were investigated in this study, as well as their influence on the hemodynamics of postoperative patients. Methods: 102 patients with intracranial aneurysms were selected as the research objects, and they were rolled into an experimental (group A) and a control group (group B) according to the random number table method, with 51 cases in each group. The group A was treated with intravascular interventional embolization, and the group B received craniotomy clipping. Besides, a biodegradable magnesium titanium alloy biological stent was independently developed in this study, which was applied to endovascular interventional embolization in the group A. The hemodynamic model was established by using three-dimensional (3D) computer hemodynamic numerical simulation technology. Besides, the effects of all the patients before and after treatment were evaluated, in terms of blood pressure (BP), average wall shear stress (WSS) (AWSS), AWSS gradient (AWSSG), oscillatory shear index (OSI), aneurysm formation index (AFI), gradient oscillation number (GON), and intraoperative complication rate. Results: After 3 days of treatment, the BP, AWSS, and AWSSG of patients from the two groups were higher than those before treatment. The index values of the group A were greater markedly than the values of the group B (P < 0.05); the BP of the group A and the group B at the 0th day, 1st day, 3rd day, 5th day, and 7th day after treatment was 21±5.1 Versus 20.1±4.7, 22±4.8 Versus 21.1± 5.17, 26±6.2 Versus 22.31±5.21, 27±5.77 Versus 24.02±5.11, and 30±6.09 Versus 24.99±5.03, respectively; AWSSG values were 120±10.11 Versus 120.1±10.98, 130.1±10.36 Versus 123.3±11.06, 162.5±9.92 Versus 131.31±10.97, 171±8.13 Versus 155.02±8.36, and 200.1±7.22 Versus 180.01±8.98 in turn. GON and OSI were both decreased, and the values of various indexes in the group A were sharply lower than those of the group B (P < 0.05); the values of GON at the 0th day, 1st day, 3rd day, 5th day, and 7th day after treatment in the group A and the group B were 0.077±0.01 Versus 0.08±0.011, 0.07±0.012 Versus 0.073 ± 0.01, 0.051 ± 0.02 Versus 0.071 ± 0.011, 0.045 ± 0.01 Versus 0.069 ± 0.011, and 0.042 ± 0.012 Versus 0.063±0.013, respectively; OSI values were 4.8±0.51 Versus 4.9±0.52, 3.6±0.52 Versus 3.62±0.51, 2.82±0.51 Versus 3.1 ± 0.57, 1.9 ± 0.512 Versus 2.91 ± 0.51, and 0.5 ± 0.51 Versus 1.8 ± 0.501 in turn. By comparing the intraoperative complications and postoperative mortality risk score (MRS) of patients in the two groups, it was found that the incidence of intraoperative complications and postoperative MRS scores in the group A were lower steeply than those of the group B, suggesting that endovascular interventional embolization had a better effect on the treatment of intracranial aneurysms. Conclusion: Endovascular interventional embolization based on biodegradable magnesium alloy coated scaffold could better improve the distribution of shear stress on the vascular wall, stabilize vascular blood flow, and achieve better therapeutic effect for patients.
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Affiliation(s)
- Qiao Liu
- Department of Neurosurgery, The First People's Hospital of Jingmen, Jingmen, 448000, Hubei, P. R. China
| | - Jinding Wu
- Department of Neurosurgery, The First People's Hospital of Jingmen, Jingmen, 448000, Hubei, P. R. China
| | - Yong Luo
- Department of Neurosurgery, The First People's Hospital of Jingmen, Jingmen, 448000, Hubei, P. R. China
| | - Lvan Chen
- Department of Neurosurgery, The First People's Hospital of Jingmen, Jingmen, 448000, Hubei, P. R. China
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Merritt WC, Berns HF, Ducruet AF, Becker TA. Definitions of intracranial aneurysm size and morphology: A call for standardization. Surg Neurol Int 2021; 12:506. [PMID: 34754556 PMCID: PMC8571384 DOI: 10.25259/sni_576_2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/13/2021] [Indexed: 11/04/2022] Open
Abstract
Background Intracranial aneurysms (IAs) are classified based on size (maximal dome diameter) as well as additional parameters such as neck diameter and dome-to-neck ratio (DNR). The neurosurgical literature includes a wide variety of definitions for both IA size and neck classifications. Standardizing the definitions of IA size and wide-neck classifications would help eliminate inconsistencies and potential misunderstandings of aneurysm morphology and rupture risk. Methods We queried the MEDLINE (EBSCO) database using the terms "unruptured IA" and ("small" or "medium" or "large") and filtered based on publication date, language, and scholarly journals. The resulting articles and their references were further screened for eligibility. This identified 286 records, of which 104 were excluded, leaving 182 articles for analysis. The review found several different IA size classifications and neck classifications. Results A review of the existing literature describing size and neck classifications revealed 13 size classifications for small aneurysms, four classifications for medium aneurysms, 15 classifications for large aneurysms, and one classification for giant aneurysms. There were also seven different wide-neck classifications found. Conclusion It is imperative that a standardization in classification be implemented to help interventionalists make the most informed decisions regarding emerging treatment options as new endovascular technologies and devices are emerging with indications based around these classifications. Based on the database findings, this article recommends standardized quantitative measurement ranges for IA size and neck classifications.
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Affiliation(s)
- William C Merritt
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff
| | - Holly F Berns
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States
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9
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Wang Z, Zhou S, Zhao J, Nie S, Sun J, Gao X, Lenahan C, Lin Z, Huang Y, Chen G. Tobacco Smoking Increases Methylation of Polypyrimidine Tract Binding Protein 1 Promoter in Intracranial Aneurysms. Front Aging Neurosci 2021; 13:688179. [PMID: 34295240 PMCID: PMC8292010 DOI: 10.3389/fnagi.2021.688179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
Abstract
DNA methylation at the gene promoter region is reportedly involved in the development of intracranial aneurysm (IA). This study aims to investigate the methylation levels of polypyrimidine tract-binding protein 1 (PTBP1) in IA, as well as its potential to predict IA. Forty-eight patients with IA and 48 age- and sex-matched healthy controls were recruited into this study. Methylation levels of CpG sites were determined via bisulfite pyrosequencing. The PTBP1 levels in the blood were determined using a real-time quantitative reverse transcription-polymerase chain reaction test. Significant differences were found between IAs and controls in CpG1 (p = 0.001), CpG2 (p < 0.001), CpG3 (p = 0.037), CpG4 (p = 0.003), CpG5 (p = 0.006), CpG6 (p = 0.02), and mean methylation (p < 0.001). The mRNA level of PTBP1 in the blood was much lower in IAs compared with controls (p = 0.002), and the PTBP1 expression was significantly associated with DNA methylation promoter levels in individuals (r = −0.73, p < 0.0001). In addition, stratification analysis comparing smokers and non-smokers revealed that tobacco smokers had significantly higher levels of DNA methylation in PTBP1 than non-smokers (p = 0.002). However, no statistical difference in PTBP1 methylation was found between ruptured and unruptured IA groups (p > 0.05). The ROC analyses of curves revealed that PTBP1 methylation may be a predictor of IA regardless of sex (both sexes, area under curve (AUC) = 0.78, p < 0.0001; male, AUC = 0.76, p = 0.002; female, AUC = 0.79, p < 0.0001). These findings suggest that long-term tobacco smoke exposure led to DNA methylation in the promoter region of the PTBP1 gene, which further decreased PTBP1 gene expression and participated in the pathogenesis of IA. The methylation of PTBP1 may be a potential predictive marker for the occurrence of IA.
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Affiliation(s)
- Zhepei Wang
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, China.,Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shengjun Zhou
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, China.,Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jikuang Zhao
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, China.,Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Nie
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, China
| | - Jie Sun
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, China
| | - Xiang Gao
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, China
| | - Cameron Lenahan
- Burrell College of Osteopathic Medicine, Las Cruces, NM, United States
| | - Zhiqin Lin
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, China
| | - Yi Huang
- Department of Neurosurgery, Ningbo Hospital, Zhejiang University School of Medicine, Ningbo, China.,Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gao Chen
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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10
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Yang Y, Liu Q, Jiang P, Yang J, Li M, Chen S, Mo S, Zhang Y, Ma X, Cao Y, Cui D, Wu J, Wang S. Multidimensional predicting model of intracranial aneurysm stability with backpropagation neural network: a preliminary study. Neurol Sci 2021; 42:5007-5019. [PMID: 33725231 DOI: 10.1007/s10072-021-05172-8] [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: 05/30/2020] [Accepted: 03/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The stability of intracranial aneurysms (IAs) may involve in multidimensional factors. Backpropagation (BP) neural network could be adopted to support clinical work. This preliminary study aimed to delve into the feasibility of BP neural network in assessing the risk of IA rupture/growth and to prove the advantage of multidimensional model over single/double-dimensional model. METHODS Thirty-six IA patients were recruited from a prospective registration study (ChiCTR1900024547). All patients were followed up until aneurysm ruptured/grew or 36 months after being diagnosed with the IAs. The multidimensional data regarding clinical, morphological, and hemodynamic characteristics were acquired. Hemodynamic analyses were conducted with patient-specific models. Based on these characteristics, seven models were built with BP neural network (the ratio of training set to validation set as 8:1). The area under curves (AUC) was calculated for subsequent comparison. RESULTS Forty-five characteristics were determined from 36 patients with 37 IAs. In the models based on the single dimension of IA characteristics, only morphological characteristics exhibited high performance in assessing 3-year IA stability (AUC = 0.703, P = 0.035). Among the models integrating two dimensions of IA characteristics, clinical-morphological (AUC = 0.731, P = 0.016), clinical-hemodynamic (AUC = 0.702, P = 0.036), and morphological-hemodynamic (AUC = 0.785, P = 0.003) models were capable of assessing the risk of 3-year IA rupture/growth. Moreover, the models including all three dimensions exhibited the maximum predicting significance (AUC = 0.811, P = 0.001). CONCLUSION The present preliminary study reported that BP neural network might support assessing the 3-year stability of IAs. Models based on multidimensional characteristics could improve the assessment accuracy for IA rupture/growth.
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Affiliation(s)
- Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Pengjun Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Junhua Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Maogui Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Shanwen Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Shaohua Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Yanan Zhang
- Department of Blood Transfusion, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xuesheng Ma
- Medical Image Center, Tongxinyiliao, Tsinghua Tongfang Science and Technology Mansion, No. 1 Wangzhuang Road, Haidian District, Beijing, 100083, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Deqi Cui
- Medical Image Center, Tongxinyiliao, Tsinghua Tongfang Science and Technology Mansion, No. 1 Wangzhuang Road, Haidian District, Beijing, 100083, China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
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Liu H, Guo W, Xiang S, Hu P, Sun F, Gao J, Zhang X, Wang P, Jing W, Zhang L, Yang X, Duan C, He M, Zhang H, Qu Y. The natural course of unruptured intracranial aneurysms in a Chinese cohort: protocol of a multi-center registration study in CIAP. J Transl Med 2019; 17:349. [PMID: 31640726 PMCID: PMC6805494 DOI: 10.1186/s12967-019-2092-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) accounts for 4.4% of cerebral vascular disease, which is one of the leading causes of death in China. Rupture of intracranial aneurysms (IAs) is the most common cause of SAH. The natural history of unruptured IAs (UIAs) and the risk factors for rupture are among the key issues regarding the pathogenesis of IA and SAH that remain unclear in the Chinese population. METHODS The China Intracranial Aneurysm Project (CIAP) is a prospective, observational, multicenter registry study of the natural courses, risk factors for the onset and rupture, treatment methods, comorbidity management and other aspects of intracranial aneurysms. To date, there are five studies in the CIAP. CIAP-1 is a prospective observational cohort study of UIAs. More than 5000 patients who will be followed for at least 1 year are expected to be enrolled in this cohort. These participants come from more than 20 centers that represent different regions in China. Enrollment began on May 1, 2017, and will take approximately 5 years. A nationwide online database of UIAs will be built. Participants' basic, lifestyle, clinical and follow-up information will be collected. The blood samples will be stored in the Central Biological Specimen Bank. Strict standards have been established and will be followed in this study to ensure efficient implementation. DISCUSSION The natural course of UIAs in the Chinese population will be explored in this registry study. In addition, the risk factors for the rupture of the UIAs and the joint effect of those factors will be analyzed. The present study aims to create a nationwide database of UIAs and investigate the natural course of UIAs in China. Trial registration The Natural Course of Unruptured Intracranial Aneurysms in a Chinese Cohort (ClinicalTrials.gov Identifier: NCT03117803). Registered: July 5, 2017.
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Affiliation(s)
- Haixiao Liu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Wei Guo
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Sishi Xiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feifei Sun
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Junmei Gao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xiaoyang Zhang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ping Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Wenting Jing
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lei Zhang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuanzhi Duan
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Min He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China.
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12
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Methylation of the CDKN2A Gene Increases the Risk of Brain Arteriovenous Malformations. J Mol Neurosci 2019; 69:316-323. [DOI: 10.1007/s12031-019-01360-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
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