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Shimizu K, Aoki T, Etminan N, Hackenberg KAM, Tani S, Imamura H, Kataoka H, Sakai N. Associations Between Drug Treatments and the Risk of Aneurysmal Subarachnoid Hemorrhage: a Systematic Review and Meta-analysis. Transl Stroke Res 2023; 14:833-841. [PMID: 36242746 DOI: 10.1007/s12975-022-01097-2] [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: 05/07/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
There is increasing interest in drug therapy for preventing aneurysmal subarachnoid hemorrhage (aSAH). We aimed to comprehensively evaluate the association between drug use and the risk of aSAH. We searched PubMed and Scopus from the databases' inception until December 2021. Observational studies reporting the association between any drug therapy and aSAH were included. The odds ratios (ORs) for each drug used in aSAH were meta-analyzed with a random-effect model. According to the systematic review, 25 observational studies were eligible for the present study. Four therapeutic purpose-based classes (e.g., lipid-lowering agents) and 14 mechanism-based classes (e.g., statins) were meta-analyzed. Anti-hypertensive agents (OR, 0.50; 95% confidence interval [95% CI], 0.33-0.74), statins (OR, 0.55; 95% CI, 0.35-0.85), biguanides (OR, 0.57; 95% CI, 0.34-0.96), and acetylsalicylic acid (ASA) (OR, 0.62; 95% CI, 0.41-0.94) were inversely associated with the risk of aSAH. Non-ASA non-steroidal anti-inflammatory drugs (OR, 1.73; 95% CI, 1.07-2.79), selective cyclooxygenase-2 inhibitors (OR, 2.04; 95% CI, 1.24-3.35), vitamin K antagonists (OR, 1.50; 95% CI, 1.18-1.91), and dipyridamole (OR, 1.77; 95% CI, 1.23-2.54) were positively associated with the incidence of aSAH. There was also a trend toward a positive association between glucocorticoids (OR, 1.38; 95% CI, 0.97-1.94) and aSAH. The present study suggests that anti-hypertensive agents, statins, biguanides, and ASA are candidate drugs for preventing aSAH. By contrast, several drugs (e.g., anti-thrombotic drugs) may increase the risk of aSAH. Thus, the indications of these drugs in patients with intracranial aneurysms should be carefully determined.
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Affiliation(s)
- Kampei Shimizu
- Department of Neurosurgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Tomohiro Aoki
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Shoichi Tani
- Department of Neurosurgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
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2
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Sun ZH, Liu F, Kong LL, Ji PM, Huang L, Zhou HM, Sun R, Luo J, Li WZ. Interruption of TRPC6-NFATC1 signaling inhibits NADPH oxidase 4 and VSMCs phenotypic switch in intracranial aneurysm. Biomed Pharmacother 2023; 161:114480. [PMID: 37002575 DOI: 10.1016/j.biopha.2023.114480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Intracranial aneurysm (IA) is a frequent cerebrovascular disorder with unclear pathogenesis. The vascular smooth muscle cells (VSMCs) phenotypic switch is essential for IA formation. It has been reported that Ca2+ overload and excessive reactive oxygen species (ROS) are involved in VSMCs phenotypic switch. The transient receptor potential canonical 6 (TRPC6) and NADPH oxidase 4 (NOX4) are the main pathway to participate in Ca2+ overload and ROS production in VSMCs. Ca2+ overload can activate calcineurin (CN), leading to nuclear factor of activated T cell (NFAT) dephosphorylation to regulate the target gene's transcription. We hypothesized that activation of TRPC6-NFATC1 signaling may upregulate NOX4 and involve in VSMCs phenotypic switch contributing to the progression of IA. Our results showed that the expressions of NOX4, p22phox, p47phox, TRPC6, CN and NFATC1 were significantly increased, and VSMCs underwent a significant phenotypic switch in IA tissue and cellular specimens. The VIVIT (NFATC1 inhibitor) and BI-749327 (TRPC6 inhibitor) treatment reduced the expressions of NOX4, p22phox and p47phox and the production of ROS, and significantly improved VSMCs phenotypic switch in IA rats and cells. Consistent results were obtained from IA Trpc6 knockout (Trpc6-/-) mice. Furthermore, the results also revealed that NFATC1 could regulate NOX4 transcription by binding to its promoter. Our findings reveal that interrupting the TRPC6-NFATC1 signaling inhibits NOX4 and improves VSMCs phenotypic switch in IA, and regulating Ca2+ homeostasis may be an important therapeutic strategy for IA.
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Affiliation(s)
- Zheng-Hao Sun
- Department of Pharmacology, Basic Medicine College; Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education; Anhui Medical University, Hefei 230032, Anhui, China
| | - Fei Liu
- Department of neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China
| | - Liang-Liang Kong
- Department of Pharmacology, Basic Medicine College; Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education; Anhui Medical University, Hefei 230032, Anhui, China
| | - Peng-Min Ji
- Department of Pharmacology, Basic Medicine College; Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education; Anhui Medical University, Hefei 230032, Anhui, China
| | - Lei Huang
- Department of Pharmacology, Basic Medicine College; Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education; Anhui Medical University, Hefei 230032, Anhui, China
| | - Hui-Min Zhou
- Department of Pharmacology, Basic Medicine College; Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education; Anhui Medical University, Hefei 230032, Anhui, China
| | - Ran Sun
- Department of Pharmacology, Basic Medicine College; Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education; Anhui Medical University, Hefei 230032, Anhui, China
| | - Jing Luo
- Department of neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China.
| | - Wei-Zu Li
- Department of Pharmacology, Basic Medicine College; Key Laboratory of Anti-inflammatory and Immunopharmacology, Ministry of Education; Anhui Medical University, Hefei 230032, Anhui, China.
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3
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Takeda R, Yamaguchi T, Hayashi S, Sano S, Kawame H, Kanki S, Taketani T, Yoshimura H, Nakamura Y, Kosho T. Clinical and molecular features of patients with COL1-related disorders: Implications for the wider spectrum and the risk of vascular complications. Am J Med Genet A 2022; 188:2560-2575. [PMID: 35822426 PMCID: PMC9545637 DOI: 10.1002/ajmg.a.62887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/14/2022] [Accepted: 06/19/2022] [Indexed: 01/24/2023]
Abstract
Abnormalities in type I procollagen genes (COL1A1 and COL1A2) are responsible for hereditary connective tissue disorders including osteogenesis imperfecta (OI), specific types of Ehlers-Danlos syndrome (EDS), and COL1-related overlapping disorder (C1ROD). C1ROD is a recently proposed disorder characterized by predominant EDS symptoms of joint and skin laxity and mild OI symptoms of bone fragility and blue sclera. Patients with C1ROD do not carry specific variants for COL1-related EDS, including classical, vascular, cardiac-valvular, and arthrochalasia types. We describe clinical and molecular findings of 23 Japanese patients with pathogenic or likely pathogenic variants of COL1A1 or COL1A2, who had either OI-like or EDS-like phenotypes. The final diagnoses were OI in 17 patients, classical EDS in one, and C1ROD in five. The OI group predominantly experienced recurrent bone fractures, and the EDS group primarily showed joint hypermobility and skin hyperextensibility, though various clinical and molecular overlaps between OI, COL1-related EDS, and C1ROD as well as intrafamilial phenotypic variabilities were present. Notably, life-threatening vascular complications (vascular dissections, arterial aneurysms, subarachnoidal hemorrhages) occurred in seven patients (41% of those aged >20 years) with OI or C1ROD. Careful lifelong surveillance and intervention regarding bone and vascular fragility could be required.
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Affiliation(s)
- Ryojun Takeda
- Department of Medical GeneticsShinshu University School of MedicineMatsumotoJapan,Division of Medical GeneticsNagano Children's HospitalAzuminoJapan,Life Science Research CenterNagano Children's HospitalAzuminoJapan
| | - Tomomi Yamaguchi
- Department of Medical GeneticsShinshu University School of MedicineMatsumotoJapan,Center for Medical GeneticsShinshu University HospitalMatsumotoJapan,Division of Clinical SequencingShinshu University School of MedicineMatsumotoJapan
| | | | - Shinichirou Sano
- Division of Endocrinology and MetabolismShizuoka Children's HospitalShizuokaJapan
| | - Hiroshi Kawame
- Division of Genomic Medicine Support and Genetic Counseling, Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan,Miyagi Children's HospitalSendaiJapan,Division of Clinical GeneticsJikei University HospitalTokyoJapan
| | - Sachiko Kanki
- Department of Thoracic and Cardiovascular SurgeryOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | - Takeshi Taketani
- Department of PediatricsShimane University Faculty of MedicineIzumoJapan
| | - Hidekane Yoshimura
- Department of OtorhinolaryngologyShinshu University School of MedicineMatsumotoJapan
| | - Yukio Nakamura
- Department of Orthopaedic SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Tomoki Kosho
- Department of Medical GeneticsShinshu University School of MedicineMatsumotoJapan,Division of Medical GeneticsNagano Children's HospitalAzuminoJapan,Center for Medical GeneticsShinshu University HospitalMatsumotoJapan,Division of Clinical SequencingShinshu University School of MedicineMatsumotoJapan,Research Center for Supports to Advanced ScienceShinshu UniversityMatsumotoJapan
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Chitwood CA, Shih ED, Amili O, Larson AS, Ogle BM, Alford PW, Grande AW. Biology and Hemodynamics of Aneurysm Rupture. Neurosurg Clin N Am 2022; 33:431-441. [DOI: 10.1016/j.nec.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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5
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Nabaei M. Cerebral aneurysm evolution modeling from microstructural computational models to machine learning: A review. Comput Biol Chem 2022; 98:107676. [DOI: 10.1016/j.compbiolchem.2022.107676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/13/2022] [Accepted: 03/30/2022] [Indexed: 11/03/2022]
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6
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The association between hemodynamics and wall characteristics in human intracranial aneurysms: a review. Neurosurg Rev 2021; 45:49-61. [PMID: 33913050 DOI: 10.1007/s10143-021-01554-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
Hemodynamics plays a key role in the natural history of intracranial aneurysms (IAs). However, studies exploring the association between aneurysmal hemodynamics and the biological and mechanical characteristics of the IA wall in humans are sparse. In this review, we survey the current body of literature, summarize the studies' methodologies and findings, and assess the degree of consensus among them. We used PubMed to perform a systematic review of studies that explored the association between hemodynamics and human IA wall features using different sources. We identified 28 publications characterizing aneurysmal flow and the IA wall: 4 using resected tissues, 17 using intraoperative images, and 7 using vessel wall magnetic resonance imaging (MRI). Based on correlation to IA tissue, higher flow conditions, such as high wall shear stress (WSS) with complex pattern and elevated pressure, were associated with degenerated walls and collagens with unphysiological orientation and faster synthesis. MRI studies strongly supported that low flow, characterized by low WSS and high blood residence time, was associated with thicker walls and post-contrast enhancement. While significant discrepancies were found among those utilized intraoperative images, they generally supported that thicker walls coexist at regions with prolonged residence time and that thinner regions are mainly exposed to higher pressure with complex WSS patterns. The current body of literature supports a theory of two general hemodynamic-biologic mechanisms for IA development. One, where low flow conditions are associated with thickening and atherosclerotic-like remodeling, and the other where high and impinging flow conditions are related to wall degeneration, thinning, and collagen remodeling.
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7
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Neurovascular disease, diagnosis, and therapy: Brain aneurysms. HANDBOOK OF CLINICAL NEUROLOGY 2020; 176:121-134. [PMID: 33272392 DOI: 10.1016/b978-0-444-64034-5.00001-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) have a prevalence of 3% in the adult population worldwide. The majority of UIAs are incidental findings, but some UIAs cause cranial nerve palsies, brainstem compression, ischemic events, or epileptic seizures. The most frequent clinical presentation of intracranial aneurysms is, however, rupture and thereby subarachnoid hemorrhage (SAH). To avoid SAH with its fatal consequences, patients with UIAs require counseling by dedicated and interdisciplinary neurovascular specialists. For the purpose of assessment and decision-making for the management of patients with UIAs, numerous aspects have to be considered: radiological characteristics, clinical symptoms, estimated rupture risk of an individual aneurysm as well as patient- and aneurysm-related risks of preventive repair. Generally, two management options exist: observation with follow-up imaging or preventive repair. This chapter discusses current data on pathogenesis, clinical presentation, diagnostics, risk factors for rupture and preventive repair, and guidance tools for the management of patients with UIAs according to current evidence.
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8
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Zhao MG, Peng C, Li LM, Chen L, Zhang HF. Circulating Treg cells from patients with cerebral aneurysms displayed deficiency in ICOS expression and function. Clin Exp Pharmacol Physiol 2020; 47:1923-1931. [PMID: 32726458 DOI: 10.1111/1440-1681.13388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 07/12/2020] [Accepted: 07/21/2020] [Indexed: 12/23/2022]
Abstract
Inducible costimulator (ICOS) is a member of the CD28 family. When activated, ICOS signalling promotes FOXP3 CNS2 gene demethylation and stabilizes Treg differentiation. Cerebral aneurysm (CA) is the local ballooning of the cerebral vasculature, characterized by higher levels of inflammation mediators and tissue remodelling. FOXP3+ Treg cell dysfunction may contribute to CA pathogenesis. In this study, the expression and function of ICOS in Treg cells was investigated. Circulating CD4+ CD25hi T cells from CA subjects demonstrated significantly lower levels of ICOS expression than circulating CD4+ CD25hi T cells from healthy subjects. In both healthy subjects and CA subjects, FOXP3+ Treg cells were highly concentrated in the ICOS+ fraction of CD4+ CD25hi T cells. Anti-ICOS costimulation, in combination with anti-CD3 and IL-2, significantly increased FOXP3 expression in CD4+ CD25hi ICOS+ T cells but not in CD4+ CD25hi ICOS- T cells. In addition, anti-CD3/IL-2 and anti-ICOS costimulation significantly elevated the expression of IL-10 and TGF-β, decreased the expression of IL-17, and enhanced CD4+ CD25hi ICOS+ T cell-mediated suppression of autologous CD4+ CD25- Tconv proliferation. Interestingly, CD4+ CD25hi ICOS+ T cells from CA subjects presented lower responsiveness toward anti-ICOS costimulation than CD4+ CD25hi ICOS+ T cells from healthy subjects. Overall, these results demonstrated that ICOS signalling could significantly improve FOXP3 expression and enhance Treg functional potency. However, circulating Treg cells from CA patients displayed reduced ICOS expression and lower responsiveness toward anti-ICOS stimulation.
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Affiliation(s)
- Ming-Guang Zhao
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Cheng Peng
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Li-Ming Li
- Institute of Biotechnology, College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Lu Chen
- Postgraduate Training Base of General Hospital of Northern Theater Command, Jinzhou Medical University, Shenyang, China
| | - Hai-Feng Zhang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
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9
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Li S, Shi Y, Liu P, Song Y, Liu Y, Ying L, Quan K, Yu G, Fan Z, Zhu W. Metformin inhibits intracranial aneurysm formation and progression by regulating vascular smooth muscle cell phenotype switching via the AMPK/ACC pathway. J Neuroinflammation 2020; 17:191. [PMID: 32546267 PMCID: PMC7298751 DOI: 10.1186/s12974-020-01868-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background The regulation of vascular smooth muscle cell (VSMC) phenotype plays an important role in intracranial aneurysm (IA) formation and progression. However, the underlying mechanism remains unclear. Metformin is a 5′ AMP-activated protein kinase (AMPK) agonist that has a protective effect on vasculature. The present study investigated whether metformin modulates VSMC phenotype switching via the AMPK/acetyl-CoA carboxylase (ACC) pathway during IA pathogenesis. Methods Adult male Sprague-Dawley rats (n = 80) were used to establish an elastase-induced IA model. The effects of metformin on AMPK activation and VSMC phenotype modulation were examined. We also established a platelet-derived growth factor (PDGF)-BB-induced VSMC model and analyzed changes in phenotype including proliferation, migration, and apoptosis as well as AMPK/ACC axis activation under different doses of metformin, AMPK antagonist, ACC antagonist, and their combinations. Results Metformin decreased the incidence and rupture rate of IA in the rat model and induced a switch in VSMC phenotype from contractile to synthetic through activation of the AMPK/ACC pathway, as evidenced by upregulation of VSMC-specific genes and decreased levels of pro-inflammatory cytokines. AMPK/ACC axis activation inhibited the proliferation, migration, and apoptosis of VSMCs, in which phenotypic switching was induced by PDGF-BB. Conclusions Metformin protects against IA formation and rupture by inhibiting VSMC phenotype switching and proliferation, migration, and apoptosis. Thus, metformin has therapeutic potential for the prevention of IA.
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Affiliation(s)
- Sichen Li
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road Middle, Shanghai, 200040, People's Republic of China.,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China
| | - Yuan Shi
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road Middle, Shanghai, 200040, People's Republic of China.,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China
| | - Peixi Liu
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road Middle, Shanghai, 200040, People's Republic of China.,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China
| | - Yaying Song
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Rd, Shanghai, 200025, People's Republic of China.,Neuroscience and Neuroengineering Research Center, Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yingjun Liu
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road Middle, Shanghai, 200040, People's Republic of China.,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China
| | - Lingwen Ying
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Kai Quan
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road Middle, Shanghai, 200040, People's Republic of China.,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China
| | - Guo Yu
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road Middle, Shanghai, 200040, People's Republic of China.,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China
| | - Zhiyuan Fan
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road Middle, Shanghai, 200040, People's Republic of China.,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road Middle, Shanghai, 200040, People's Republic of China. .,Neurosurgical Institute of Fudan University, Shanghai, People's Republic of China.
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10
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Hackenberg KAM, Rajabzadeh-Oghaz H, Dreier R, Buchholz BA, Navid A, Rocke DM, Abdulazim A, Hänggi D, Siddiqui A, Macdonald RL, Meng H, Etminan N. Collagen Turnover in Relation to Risk Factors and Hemodynamics in Human Intracranial Aneurysms. Stroke 2020; 51:1624-1628. [PMID: 32192404 DOI: 10.1161/strokeaha.120.029335] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Determinants for molecular and structural instability, that is, impending growth or rupture, of intracranial aneurysms (IAs) remain uncertain. To elucidate this, we endeavored to estimate the actual turnover rates of the main molecular constituent in human IA (collagen) on the basis of radiocarbon (14C) birth dating in relation to IA hemodynamics. Methods- Collagen turnover rates in excised human IA samples were calculated using mathematical modeling of 14C birth dating data of collagen in relation to risk factors and histological markers for collagen maturity/turnover in selected IA. Hemodynamics were simulated using image-based computational fluid dynamics. Correlation, logistic regression, and receiver operating characteristic analyses were performed. Results- Collagen turnover rates were estimated in 46 IA (43 patients); computational fluid dynamics could be performed in 20 IA (20 patients). The mean collagen turnover rate (γ) constituted 126% (±1% error) per year. For patients with arterial hypertension, γ was greater than 2600% annually, whereas γ was distinctly lower with 32% (±1% error) per year for patients without risk factors, such as smoking and hypertension. There was a distinct association between histological presence of rather immature collagen in human IA and the presence of modifiable risk factors. Spatial-temporal averaged wall shear stress predicted rapid collagen turnover (odds ratio, 1.6 [95% CI, 1.0-2.7]). Receiver operating characteristic analysis demonstrated a good test accuracy (area under the curve, 0.798 [95% CI, 0.598-0.998]) for average wall shear stress with a threshold ≥4.9 Pa for rapid collagen turnover. Conclusions- Our data indicate that turnover rates and stability of collagen in human IA are strongly associated with the presence of modifiable risk factors and aneurysmal hemodynamics. These findings underline the importance of strict risk factor modification in patients with unruptured IA. Future should include more detailed risk factor data to establish a more causal understanding of hemodynamics and the rupture risk of individual IA.
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Affiliation(s)
- Katharina A M Hackenberg
- From the Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany (K.A.M.H., A.A., D.H., N.E.)
| | - Hamidreza Rajabzadeh-Oghaz
- Department of Mechanical and Aerospace Engineering, Canon Stroke and Vascular Research Center (H.R.-O.), University at Buffalo, New York
| | - Rita Dreier
- Institute for Physiological Chemistry and Pathobiochemistry, Westfalian Wilhelms-University, Münster, Germany (R.D.)
| | - Bruce A Buchholz
- Center for Accelerator Mass Spectrometry (B.A.B.), Lawrence Livermore National Laboratory, Livermore, CA
| | - Ali Navid
- Biosciences and Biotechnology Division (A.N.), Lawrence Livermore National Laboratory, Livermore, CA
| | - David M Rocke
- Biosciences and Biotechnology Division (A.N.), Lawrence Livermore National Laboratory, Livermore, CA
| | - Amr Abdulazim
- From the Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany (K.A.M.H., A.A., D.H., N.E.)
| | - Daniel Hänggi
- From the Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany (K.A.M.H., A.A., D.H., N.E.)
| | - Adnan Siddiqui
- Department of Neurosurgery, Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences (A.S.), University at Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences (A.S.), University at Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Jacobs Institute (A.S.), University at Buffalo, New York
| | - R Loch Macdonald
- Department of Neurological Surgery, UCSF Fresno, CA (R.L.M.).,Department of Surgery, University of Toronto, Ontario, Canada (R.L.M.)
| | - Hui Meng
- Department of Mechanical and Aerospace Engineering, Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences (H.M.), University at Buffalo, New York.,Department of Biomedical Engineering, Jacobs School of Medicine and Biomedical Sciences (H.M.), University at Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences (H.M.), University at Buffalo, New York
| | - Nima Etminan
- From the Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany (K.A.M.H., A.A., D.H., N.E.)
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11
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Maumus-Robert S, Debette S, Bérard X, Mansiaux Y, Tubert-Bitter P, Pariente A. Risk of Intracranial Aneurysm and Dissection and Fluoroquinolone Use: A Case-Time-Control Study. Stroke 2020; 51:994-997. [PMID: 31964291 DOI: 10.1161/strokeaha.119.028490] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Fluoroquinolone use is associated with an increased risk of aortic aneurysm and dissection. We investigated this risk of arterial wall injury on intracranial arteries, given the similar pathophysiological mechanisms for aneurysm and dissection in both types of arteries. Methods- A case-time-control study was conducted using French National Insurance databases covering >60 million inhabitants. Cases were aged ≥18 years with first ruptured intracranial aneurysm and dissection between 2010 and 2015. For each case, fluoroquinolone use was compared between the exposure-risk window (day 30-day 1 before the outcome) and matched control windows (day 120-day 91, day 150-day 121, and day 180-day 151) and adjusted for time-varying confounders; potential time-trend for exposure was controlled using an age- and sex-matched reference group. Amoxicillin use was studied similarly for indication bias controlling. The potential excess of risk conveyed by fluoroquinolones was assessed by the ratio of OR for fluoroquinolones to that for amoxicillin. Results- Of the 7443 identified cases, 75 had been exposed to fluoroquinolones in the prior 180 days, including 16 in the 30-day at-risk window (385/97 cases exposed to amoxicillin, respectively). The adjusted OR for fluoroquinolones was 1.26 (95%CI, 0.65-2.41) and that for amoxicillin of 1.36 (95% CI, 1.05-1.78). Ratio of OR for fluoroquinolones to that for amoxicillin was estimated at 0.92 (95% CI, 0.46-1.86). Result was similar when extending outcome definition to unruptured events (ratio of OR for fluoroquinolones to that for amoxicillin, 0.97 [95% CI, 0.61-1.53]). Conclusions- This study did not evidence an excess of risk of intracranial aneurysm or dissection with fluoroquinolone use.
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Affiliation(s)
- Sandy Maumus-Robert
- From the Team Pharmacoepidemiology (S.M.-R., Y.M., A.P.), Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, France
| | - Stéphanie Debette
- Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, France.,Department of Neurology, CHU de Bordeaux, France (S.D.)
| | - Xavier Bérard
- Unit of Vascular Surgery, Hôpital Pellegrin, CHU de Bordeaux, University of Bordeaux, France (X.B.)
| | - Yohann Mansiaux
- From the Team Pharmacoepidemiology (S.M.-R., Y.M., A.P.), Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, France
| | - Pascale Tubert-Bitter
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Villejuif, France (P.T.-B.)
| | - Antoine Pariente
- From the Team Pharmacoepidemiology (S.M.-R., Y.M., A.P.), Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, France.,Service de Pharmacologie Médicale, Pôle de Santé Publique, CHU de Bordeaux, France (A.P.)
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12
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Radiocarbon Tracers in Toxicology and Medicine: Recent Advances in Technology and Science. TOXICS 2019; 7:toxics7020027. [PMID: 31075884 PMCID: PMC6631948 DOI: 10.3390/toxics7020027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/09/2023]
Abstract
This review summarizes recent developments in radiocarbon tracer technology and applications. Technologies covered include accelerator mass spectrometry (AMS), including conversion of samples to graphite, and rapid combustion to carbon dioxide to enable direct liquid sample analysis, coupling to HPLC for real-time AMS analysis, and combined molecular mass spectrometry and AMS for analyte identification and quantitation. Laser-based alternatives, such as cavity ring down spectrometry, are emerging to enable lower cost, higher throughput measurements of biological samples. Applications covered include radiocarbon dating, use of environmental atomic bomb pulse radiocarbon content for cell and protein age determination and turnover studies, and carbon source identification. Low dose toxicology applications reviewed include studies of naphthalene-DNA adduct formation, benzo[a]pyrene pharmacokinetics in humans, and triclocarban exposure and risk assessment. Cancer-related studies covered include the use of radiocarbon-labeled cells for better defining mechanisms of metastasis and the use of drug-DNA adducts as predictive biomarkers of response to chemotherapy.
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13
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WANG Y, JIN J. [Roles of macrophages in formation and progression of intracranial aneurysms]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:204-213. [PMID: 31309760 PMCID: PMC8800668 DOI: 10.3785/j.issn.1008-9292.2019.04.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Studies have shown that chronic inflammatory response plays a key role in intracranial aneurysms (IA) formation and progression, and macrophages regulate the formation and progression of IA through a variety of pathways. Bone marrow monocyte-derived macrophages and resident-tissue macrophages infiltrate the vessel wall, after infiltration macrophages are polarized into various polarization phenotypes dominated by M1-like and M2-like cells. Polarized phenotypes of macrophages can regulate the formation and progression of intracranial aneurysms by releasing cytokines and regulating the inflammatory response of other immune cells, as well as release different cytokines to regulate the process of extracellular matrix remodeling. Some important progresses have been made in the clinical detection and treatment in targeting macrophages. This review provides a summary on the pathogenesis of IA and potential drug targets to prevent the formation and rupture of intracranial aneurysms.
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Affiliation(s)
| | - Jinghua JIN
- 金静华(1975-), 女, 博士, 副教授, 硕士生导师, 主要从事神经退行性疾病和脑血管疾病的发病机制研究, E-mail:
,
https://orcid.org/0000-0001-6086-3340
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14
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Sandgaard E, Troldborg A, Lauridsen SV, Gyldenholm T, Thiel S, Hvas AM. Changes in the Lectin Pathway Following Intracerebral or Spontaneous Subarachnoid Hemorrhage. Mol Neurobiol 2019; 56:78-87. [PMID: 29675579 DOI: 10.1007/s12035-018-1066-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/08/2018] [Indexed: 12/13/2022]
Abstract
Previous research indicates that the complement system is activated after occurrence of intracerebral hemorrhage (ICH) and spontaneous subarachnoid hemorrhage (SAH). The role of the lectin pathway (LP) of the complement system in this activation has only scarcely been investigated. The aim of this study was to determine the plasma concentration of the LP proteins in patients with ICH or SAH at admission compared to healthy individuals. Secondly, ICH and SAH patients were followed during the initial 24 h of disease, to investigate changes in LP protein concentrations during the critical acute phase. This prospective, observational study included 30 ICH and 33 SAH patients. EDTA plasma samples were collected at admission, 6 and 24 h after symptom onset. Time-resolved immuno-flourometric assays (TRIFMA) were used to measure all proteins of the LP in patient samples and in samples from age- and gender-matched healthy individuals. Compared to healthy individuals, ICH and SAH patients had increased levels of H-ficolin (p = 0.04, p = 0.03), M-ficolin (both p < 0.0001), and MAp44 (both p = 0.01) at admission. M-ficolin, H-ficolin, CL-L1, MASP-1, MASP-3, and MAp44 decreased significantly in both ICH and SAH patients during the initial 24 h after symptom onset. In conclusion, we observed significant differences in lectin pathway protein concentrations between patients with ICH or SAH and healthy individuals. Significant dynamics in lectin pathway protein levels were demonstrated during the initial 24 h after symptom onset. This indicates a potential role of the LP proteins during the acute phase of SAH and ICH.
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Affiliation(s)
- E Sandgaard
- Centre for Hemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - A Troldborg
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Department of Biomedicine, Health Aarhus University, Vennelyst Boulevard 4, 8000, Aarhus C, Denmark
| | - S V Lauridsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - T Gyldenholm
- Centre for Hemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - S Thiel
- Department of Biomedicine, Health Aarhus University, Vennelyst Boulevard 4, 8000, Aarhus C, Denmark
| | - Anne-Mette Hvas
- Centre for Hemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
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15
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Parshin D, Lipovka A, Dubovoy A, Vasilyeva M, Kuznetsova E, Sergeevichev D. Different stages of the evolution of cerebral aneurysms: joint analysis of mechanical test data and histological analysis of aneurysm tissue. EPJ WEB OF CONFERENCES 2019. [DOI: 10.1051/epjconf/201922101028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In practical neurosurgery, an important issue is determining the status of the aneurysm and predicting its further growth, rupture or stabilization. The main approaches for the study of risk analysis asessment are computational hydrodynamics and analysis of the mechanics of the wall of cerebral aneurysm. In this paper, an analysis of various sections of the wall of cerebral aneurysm is given, combining mechanical test data and histological examination data. It was shown that, along with significant differences in mechanics, a different degree of calcification is observed in the tissue, which indicates a different level of impaired transport of substances inside the tissue.
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16
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Petridis AK, Kamp MA, Cornelius JF, Beez T, Beseoglu K, Turowski B, Steiger HJ. Aneurysmal Subarachnoid Hemorrhage. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:226-236. [PMID: 28434443 DOI: 10.3238/arztebl.2017.0226] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 08/29/2016] [Accepted: 11/28/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) is associated with a mortality of more than 30%. Only about 30% of patients with SAB recover sufficiently to return to independent living. METHODS This article is based on a selective review of pertinent literature retrieved by a PubMed search. RESULTS Acute, severe headache, typically described as the worst headache of the patient's life, and meningismus are the characteristic manifestations of SAH. Computed tomog raphy (CT) reveals blood in the basal cisterns in the first 12 hours after SAH with approximately 95% sensitivity and specificity. If no blood is seen on CT, a lumbar puncture must be performed to confirm or rule out the diagnosis of SAH. All patients need intensive care so that rebleeding can be avoided and the sequelae of the initial bleed can be minimized. The immediate transfer of patients with acute SAH to a specialized center is crucially important for their outcome. In such centers, cerebral aneurysms can be excluded from the circulation either with an interventional endovascular procedure (coiling) or by microneurosurgery (clipping). CONCLUSION SAH is a life-threatening condition that requires immediate diagnosis, transfer to a neurovascular center, and treatment without delay.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, Düsseldorf University Hospital; Department of Diagnostic and Interventional Radiology, Düsseldorf University Hospital; Department of Diagnostic and Interventional Radiology, Düsseldorf University Hospital
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17
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Ravindra VM, de Havenon A, Gooldy TC, Scoville J, Guan J, Couldwell WT, Taussky P, MacDonald JD, Schmidt RH, Park MS. Validation of the unruptured intracranial aneurysm treatment score: comparison with real-world cerebrovascular practice. J Neurosurg 2017; 129:100-106. [PMID: 28984518 DOI: 10.3171/2017.4.jns17548] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the unruptured intracranial aneurysm treatment score (UIATS) recommendations with the real-world experience in a quaternary academic medical center with a high volume of patients with unruptured intracranial aneurysms (UIAs). METHODS All patients with UIAs evaluated during a 3-year period were included. All factors included in the UIATS were abstracted, and patients were scored using the UIATS. Patients were categorized in a contingency table assessing UIATS recommendation versus real-world treatment decision. The authors calculated the percentage of misclassification, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. RESULTS A total of 221 consecutive patients with UIAs met the inclusion criteria: 69 (31%) patients underwent treatment and 152 (69%) did not. Fifty-nine (27%) patients had a UIATS between -2 and 2, which does not offer a treatment recommendation, leaving 162 (73%) patients with a UIATS treatment recommendation. The UIATS was significantly associated with treatment (p < 0.001); however, the sensitivity, specificity, and percentage of misclassification were 49%, 80%, and 28%, respectively. Notably, 51% of patients for whom treatment would be recommended by the UIATS did not undergo treatment in the real-world cohort and 20% of patients for whom conservative management would be recommended by UIATS had intervention. The area under the ROC curve was 0.646. CONCLUSIONS Compared with the authors' experience, the UIATS recommended overtreatment of UIAs. Although the UIATS could be used as a screening tool, individualized treatment recommendations based on consultation with a cerebrovascular specialist are necessary. Further validation with longitudinal data on rupture rates of UIAs is needed before widespread use.
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Affiliation(s)
| | - Adam de Havenon
- 2Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - Timothy C Gooldy
- 3Department of Neurosurgery, University of Florida School of Medicine, Gainesville, Florida
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18
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Subarachnoid Hemorrhage in Germany Between 2010 and 2013: Estimated Incidence Rates Based on a Nationwide Hospital Discharge Registry. World Neurosurg 2017; 104:516-521. [DOI: 10.1016/j.wneu.2017.05.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 11/23/2022]
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19
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Rinaldo L, Lanzino G. Increased Age Associated with Reduced Likelihood of Recurrence After Coiling of Ruptured Aneurysms. World Neurosurg 2017; 100:381-387. [DOI: 10.1016/j.wneu.2017.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 12/01/2022]
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20
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Cyron CJ, Humphrey JD. Growth and Remodeling of Load-Bearing Biological Soft Tissues. MECCANICA 2017; 52:645-664. [PMID: 28286348 PMCID: PMC5342900 DOI: 10.1007/s11012-016-0472-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The past two decades reveal a growing role of continuum biomechanics in understanding homeostasis, adaptation, and disease progression in soft tissues. In this paper, we briefly review the two primary theoretical approaches for describing mechano-regulated soft tissue growth and remodeling on the continuum level as well as hybrid approaches that attempt to combine the advantages of these two approaches while avoiding their disadvantages. We also discuss emerging concepts, including that of mechanobiological stability. Moreover, to motivate and put into context the different theoretical approaches, we briefly review findings from mechanobiology that show the importance of mass turnover and the prestressing of both extant and new extracellular matrix in most cases of growth and remodeling. For illustrative purposes, these concepts and findings are discussed, in large part, within the context of two load-bearing, collagen dominated soft tissues - tendons/ligaments and blood vessels. We conclude by emphasizing further examples, needs, and opportunities in this exciting field of modeling soft tissues.
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Affiliation(s)
- C J Cyron
- Institute for Computational Mechanics, Technische Universität München, Garching, Germany
| | - J D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
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21
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Etminan N, Macdonald R. Management of aneurysmal subarachnoid hemorrhage. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:195-228. [DOI: 10.1016/b978-0-444-63600-3.00012-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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22
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Homogenized constrained mixture models for anisotropic volumetric growth and remodeling. Biomech Model Mechanobiol 2016; 16:889-906. [DOI: 10.1007/s10237-016-0859-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
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23
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Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol 2016; 12:699-713. [DOI: 10.1038/nrneurol.2016.150] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wu J, Shadden SC. Stability analysis of a continuum-based constrained mixture model for vascular growth and remodeling. Biomech Model Mechanobiol 2016; 15:1669-1684. [PMID: 27116383 DOI: 10.1007/s10237-016-0790-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 04/08/2016] [Indexed: 01/27/2023]
Abstract
A stabilizing criterion is derived for equations governing vascular growth and remodeling. We start from the integral state equations of the continuum-based constrained mixture theory of vascular growth and remodeling and obtain a system of time-delayed differential equations describing vascular growth. By employing an exponential form of the constituent survival function, the delayed differential equations can be reduced to a nonlinear ODE system. We demonstrate the degeneracy of the linearized system about the homeostatic state, which is a fundamental cause of the neutral stability observations reported in prior studies. Due to this degeneracy, stability conclusions for the original nonlinear system cannot be directly inferred. To resolve this problem, a sub-system is constructed by recognizing a linear relation between two states. Subsequently, Lyapunov's indirect method is used to connect stability properties between the linearized system and the original nonlinear system, to rigorously establish the neutral stability properties of the original system. In particular, this analysis leads to a stability criterion for vascular expansion in terms of growth and remodeling kinetic parameters, geometric quantities and material properties. Numerical simulations were conducted to evaluate the theoretical stability criterion under broader conditions, as well as study the influence of key parameters and physical factors on growth properties. The theoretical results are also compared with prior numerical and experimental findings in the literature.
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Affiliation(s)
- Jiacheng Wu
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Shawn C Shadden
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA.
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25
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Jung KH, Chu K, Lee ST, Shin YW, Lee KJ, Park DK, Yoo JS, Kim S, Kim M, Lee SK, Roh JK. Experimental Induction of Cerebral Aneurysms by Developmental Low Copper Diet. J Neuropathol Exp Neurol 2016; 75:455-63. [PMID: 27030743 DOI: 10.1093/jnen/nlw020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Optimal models are needed to understand the pathophysiology of human cerebral aneurysms (CA). We investigated the development of experimental CA by decreasing the activity of lysyl oxidases by dietary copper deficiency from the time of gestation and then augmenting vascular stress by angiotensin II infusion in adulthood. Rats were fed copper-free, low-copper, or normal diets at different time periods from gestation to adulthood. The incidences of CAs were evaluated and autopsies performed to determine the coexistence of cardiovascular diseases. A copper-free diet from gestation was associated with high mortality rates (79.1%) resulting from rupture of ascending aorta aneurysms; a low-copper diet led to acceptable mortality rates (13.6%) and produced CAs and subarachnoid hemorrhage in 46.4% and 3.6% of animals, respectively. Higher proportions of CAs (up to 33.3%) in the rats primed for copper deficiency from gestation ruptured following angiotensin II infusion from adulthood. Gene expression array analyses of the CAs indicated that genes involving extracellular matrix and vascular remodeling were altered in this model. This model enables future research to understand the entire pathogenetic basis of CA development and rupture in association with systemic vasculopathies.
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Affiliation(s)
- Keun-Hwa Jung
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Kon Chu
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Soon-Tae Lee
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Yong-Won Shin
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Keon-Joo Lee
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Dong-Kyu Park
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Jung-Suk Yoo
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Soyun Kim
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Manho Kim
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Sang Kun Lee
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR)
| | - Jae-Kyu Roh
- From the Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (KHJ, KC, STL, YWS, KJL, DKP, JSY, SK, MK, SKL, JKR); Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea (KHJ, KC, STL, MK, SKL); and Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea (JKR).
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Etminan N, Brown RD, Beseoglu K, Juvela S, Raymond J, Morita A, Torner JC, Derdeyn CP, Raabe A, Mocco J, Korja M, Abdulazim A, Amin-Hanjani S, Al-Shahi Salman R, Barrow DL, Bederson J, Bonafe A, Dumont AS, Fiorella DJ, Gruber A, Hankey GJ, Hasan DM, Hoh BL, Jabbour P, Kasuya H, Kelly ME, Kirkpatrick PJ, Knuckey N, Koivisto T, Krings T, Lawton MT, Marotta TR, Mayer SA, Mee E, Pereira VM, Molyneux A, Morgan MK, Mori K, Murayama Y, Nagahiro S, Nakayama N, Niemelä M, Ogilvy CS, Pierot L, Rabinstein AA, Roos YBWEM, Rinne J, Rosenwasser RH, Ronkainen A, Schaller K, Seifert V, Solomon RA, Spears J, Steiger HJ, Vergouwen MDI, Wanke I, Wermer MJH, Wong GKC, Wong JH, Zipfel GJ, Connolly ES, Steinmetz H, Lanzino G, Pasqualin A, Rüfenacht D, Vajkoczy P, McDougall C, Hänggi D, LeRoux P, Rinkel GJE, Macdonald RL. The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus. Neurology 2015; 85:881-9. [PMID: 26276380 PMCID: PMC4560059 DOI: 10.1212/wnl.0000000000001891] [Citation(s) in RCA: 262] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/18/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. METHODS An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* = 0 indicating excellent agreement and vr* = 1 indicating poor agreement). RESULTS The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1-4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1-4.4) for panel members and 4.5 (95% CI 4.3-4.6) for external reviewers (p = 0.017). Mean Likert scores were 4.2 (95% CI 4.1-4.3) for interventional reviewers (n = 56) and 4.1 (95% CI 3.9-4.4) for noninterventional reviewers (n = 12) (p = 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019-0.033). CONCLUSIONS This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA.
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Affiliation(s)
- Nima Etminan
- Author affiliations are provided at the end of the article.
| | - Robert D Brown
- Author affiliations are provided at the end of the article
| | - Kerim Beseoglu
- Author affiliations are provided at the end of the article
| | - Seppo Juvela
- Author affiliations are provided at the end of the article
| | - Jean Raymond
- Author affiliations are provided at the end of the article
| | - Akio Morita
- Author affiliations are provided at the end of the article
| | - James C Torner
- Author affiliations are provided at the end of the article
| | | | - Andreas Raabe
- Author affiliations are provided at the end of the article
| | - J Mocco
- Author affiliations are provided at the end of the article
| | - Miikka Korja
- Author affiliations are provided at the end of the article
| | - Amr Abdulazim
- Author affiliations are provided at the end of the article
| | | | | | | | | | - Alain Bonafe
- Author affiliations are provided at the end of the article
| | - Aaron S Dumont
- Author affiliations are provided at the end of the article
| | | | - Andreas Gruber
- Author affiliations are provided at the end of the article
| | | | - David M Hasan
- Author affiliations are provided at the end of the article
| | - Brian L Hoh
- Author affiliations are provided at the end of the article
| | - Pascal Jabbour
- Author affiliations are provided at the end of the article
| | | | | | | | | | - Timo Koivisto
- Author affiliations are provided at the end of the article
| | - Timo Krings
- Author affiliations are provided at the end of the article
| | | | | | | | - Edward Mee
- Author affiliations are provided at the end of the article
| | | | | | | | - Kentaro Mori
- Author affiliations are provided at the end of the article
| | | | | | - Naoki Nakayama
- Author affiliations are provided at the end of the article
| | - Mika Niemelä
- Author affiliations are provided at the end of the article
| | | | - Laurent Pierot
- Author affiliations are provided at the end of the article
| | | | | | - Jaakko Rinne
- Author affiliations are provided at the end of the article
| | | | | | - Karl Schaller
- Author affiliations are provided at the end of the article
| | - Volker Seifert
- Author affiliations are provided at the end of the article
| | | | - Julian Spears
- Author affiliations are provided at the end of the article
| | | | | | - Isabel Wanke
- Author affiliations are provided at the end of the article
| | | | | | - John H Wong
- Author affiliations are provided at the end of the article
| | | | | | | | | | | | | | - Peter Vajkoczy
- Author affiliations are provided at the end of the article
| | | | - Daniel Hänggi
- Author affiliations are provided at the end of the article
| | - Peter LeRoux
- Author affiliations are provided at the end of the article
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Etminan N, Macdonald RL. Computational Fluid Dynamics and Intracranial Aneurysms: Higher Mathematics Meets Complex Biology. World Neurosurg 2015; 83:1017-9. [PMID: 25731798 DOI: 10.1016/j.wneu.2015.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
| | - R Loch Macdonald
- Division of Neurosurgery, St. Michael's Hospital, Keenan Research Centre for Biomedical Science and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Surgery, University of Toronto, Ontario, Canada
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