8
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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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12
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Duan L, Wei L, Tian Y, Zhang Z, Hu P, Wei Q, Liu S, Zhang J, Wang Y, Li D, Yang W, Zong R, Xian P, Han C, Bao X, Zhao F, Feng J, Liu W, Cao W, Zhou G, Zhu C, Yu F, Yang W, Meng Y, Wang J, Chen X, Wang Y, Shen B, Zhao B, Wan J, Zhang F, Zhao G, Xu A, Zhang X, Liu J, Zuo X, Wang K. Novel Susceptibility Loci for Moyamoya Disease Revealed by a Genome-Wide Association Study. Stroke 2018; 49:11-18. [PMID: 29273593 DOI: 10.1161/strokeaha.117.017430] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 10/23/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Moyamoya disease (MMD) is a rare cerebral vasculopathy characterized by bilateral internal carotid artery stenosis and often leads to stroke in children or young adults. Although familial inheritance is well recognized, the genetic basis of MMD remains poorly understood.
Methods—
A 2-stage genome-wide association study was conducted involving 1492 cases and 5084 controls. In the discovery stage, logistic regression was used to test associations, and imputation was conducted based on genotyped single-nucleotide polymorphisms (SNPs). In the validation stage, the top significant SNPs were again genotyped in an independent cohort. Fixed-effects inverse variance-weighted meta-analysis was used in the combined discovery and validation samples. Furthermore, association analysis was conducted in subgroups using patient clinical data.
Results—
The study identified 10 novel risk loci with genome-wide significance (
P
<5×10
−8
) and confirmed a previously reported locus on 17q25. No significant SNP showed evidence of heterogeneity between the 2 stages. Cumulatively, these SNPs explained 14.76% of disease risk variance—a substantial proportion of the 39.02% of risk variance explained by all genome-wide genotyped SNPs. One SNP, rs9916351 in
RNF213
(
P
combined
=4.57×10
−54
; odds ratio, 1.96), showed a stronger genetic effect on early-onset than late-onset MMD (
P
=0.003). Two novel SNPs in genes regulating homocysteine metabolism, rs9651118 in
MTHFR
(
P
combined
=2.49×10
−19
; odds ratio, 0.65) and rs117353193 in
TCN2
(
P
combined
=6.15×10
−13
; odds ratio, 1.43), were associated with high-serum homocysteine in MMD cases. Additionally, another SNP associated with MMD (rs2107595 in
HDAC9
;
P
combined
=1.49×10
−29
; odds ratio, 1.64) was previously implicated in large-vessel disease. Tissue enrichment analysis showed that the genes of associated loci were highly expressed in the immune system (false discovery rate, <0.05).
Conclusions—
This study identifies several novel susceptibility genes for MMD. The association with homocysteine metabolism and the immune system enrichment of susceptibility gene expression suggest that therapeutic interventions targeting these pathways may be effective approaches for MMD treatment.
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Affiliation(s)
- Lian Duan
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Ling Wei
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Yanghua Tian
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Zhengshan Zhang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Panpan Hu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Qiang Wei
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Sugang Liu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jun Zhang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Yuyang Wang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Desheng Li
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Weizhong Yang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Rui Zong
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Peng Xian
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Cong Han
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Xiangyang Bao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Feng Zhao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jie Feng
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Wei Liu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Wuchun Cao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Guoping Zhou
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Chunyan Zhu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Fengqiong Yu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Weimin Yang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Yu Meng
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jingye Wang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Xianwen Chen
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Yu Wang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Bing Shen
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Bing Zhao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jinghai Wan
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Fengyu Zhang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Gang Zhao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Aimin Xu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Xuejun Zhang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jianjun Liu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Xianbo Zuo
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Kai Wang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
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