Causal association between helicobacter pylori and atherosclerosis: a two-sample Mendelian randomization.

BACKGROUND: Helicobacter pylori (H. pylori), according to a number of recent observational studies, is connected to atherosclerosis (AS). However, the link between H. pylori and AS is debatable. METHODS: In order to calculate the causal relationship between H. pylori and AS, we employed a two-sample Mendelian randomization (MR) analysis. The data for H. pylori were obtained from the IEU GWAS database ( https://gwas.mrcieu.ac.uk/datasets/ ) and the data for AS were obtained from the Finngen GWAS database ( https://r5.finngen.fi/ ). We selected single nucleotide polymorphisms with a threshold of 5 × 10-6 from earlier genome-wide association studies. MR was performed mainly using the inverse variance weighted (IVW) method. To ensure the reliability of the findings, We performed a leave-one-out sensitivity analysis to test for sensitivity. F-value was used to test weak instrument. RESULTS: A positive causal relationship between H. pylori OMP antibody levels and peripheral atherosclerosis was shown by our two-sample MR analysis (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.14-1.54, P = 0.26E-03) using IVW. Additionally, there was a causative link between coronary atherosclerosis and H. pylori VacA antibody levels (IVW OR = 1.06, 95% CI = 1.01-1.10, P = 0.016). All the F-values were above 10. CONCLUSIONS: This MR study discovered a causal link between H. pylori and AS. Different antibodies have different effects, so future researches are needed to figure out the exact mechanisms behind this link.

Comparison of polyvinyl alcohol copolymer with detachable balloons for the embolisation of direct carotid cavernous fistula: a single-centre experience.

OBJECTIVES: To characterise the safety, efficacy and cost of direct carotid-cavernous fistula (CCF) treatment using polyvinyl alcohol copolymer or detachable balloons. METHODS: We reviewed retrospectively patients with direct CCFs treated with either a detachable balloon or polyvinyl alcohol copolymer at our hospital from 2005 to 2015 and identified 94 patients with 105 CCFs. All patients had follow-up angiograms. The CCF occlusion rate, procedure complication rate, treatment expense and operation time were recorded. RESULTS: With a mean of 5.4 months of angiographic follow-up, the complete occlusion rate and recanalisation rate of the polyvinyl alcohol copolymer group was not significantly different from that of the detachable balloon group. The treatment expense was much higher and the operation time was much longer in the polyvinyl alcohol copolymer group than the detachable balloon group (P < 0.001). CONCLUSIONS: Embolisation of CCF with polyvinyl alcohol copolymer is as safe and effective as detachable balloon but has a much higher cost and longer operation time. KEY POINTS: • Carotid-cavernous fistula results from a damaged carotid artery. • Detachable balloons have been used with success for many years. • Some reported excellent outcomes after embolisation with polyvinyl alcohol copolymer. • Treatment expense is much higher in the polyvinyl alcohol copolymer group.

Rupture during the endovascular treatment of intracranial aneurysms: outcomes and technical aspects.

OBJECT: The purpose of this study was to determine the incidence and outcomes of intraprocedural rupture (IPR) during endovascular coil embolization of intracranial aneurysm at a single center and to explore the technical reasons and put forward corresponding preventive measures for the feared event to serve as references for other endovascular specialists. METHODS: The aneurysm database in our series was retrospectively reviewed. From April 2005 to March 2009, 176 aneurysms were consecutively treated with coils in 161 patients and IPR occurred in 12 patients. The medical records for the 12 patients were seriously examined. RESULTS: Of the 12 patients (6.8 %), four were men and eight were women with a median age of 56 years. An emergency "rescue clipping" of the lesion was carried out in two patients, parent artery occlusion was performed in two cases, endovascular treatment was terminated in one case and aneurysm coiling was rapidly completed in the remaining seven cases. Complete occlusion was achieved in nine aneurysms and incomplete occlusion in one. One patient died, yielding a mortality rate of 8.3 %. The follow-up duration was 6-30 months (median 14 months) and the mean Glasgow Outcome Scale score at the last follow-up examination was 4.3. CONCLUSIONS: The rate of IPR during endovascular coiling of intracranial aneurysms is quite low and the clinical outcome from this complication need not be catastrophic if managed appropriately. Improved operation skill and practical experience exchange among neuroradiologists are essential to lower the incidence or better patient prognoses.

Surgical cannulation of the superior ophthalmic vein for the treatment of previously embolized cavernous sinus dural arteriovenous fistulas: serial studies and angiographic follow-up.

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of transorbital puncture for the retreatment of previously embolized cavernous sinus dural arteriovenous fistulas (DAVFs) via a superior ophthalmic vein (SOV) approach. MATERIALS AND METHODS: During a 12-year period, 9 consecutive patients with previously embolized cavernous sinus DAVFs underwent retreatment via the transorbital SOV approach. RESULTS: All of the nine cases of previously embolized cavernous sinus DAVFs were successfully embolized. Clinical follow-ups were conducted in all nine cases at the duration of 17-141 months (61.22 ± 39.13 months). No recanalization occurred during the follow-up period. A subtle ptosis appeared in two patients and disappeared in one of the two cases after a 4-year follow-up. One patient suffered from paroxysmal positional vertigo and bruit for nearly 2 years after the treatment, but the follow-up angiography demonstrated no recurrence. One patient had persistent visual impairment caused by the initial venous stasis retinopathy. One patient with a history of a procedure-related transient decrease in visual acuity had it return to the normal level. The remaining four cases had clear improvement in the ocular symptoms and became completely asymptomatic during the follow-up period. No patient worsened or developed new symptoms. CONCLUSION: The approach of surgical cannulation of the SOV for the retreatment of previously embolized cavernous sinus DAVFs was proved feasible and efficient, especially when the transarterial and transfemoral venous approaches were inaccessible. However, if the SOV is not dilated enough or is located deeply in the orbit, transorbital venous puncture access may not be possible.

Use of covered stents to treat complex cerebrovascular diseases: Expert consensus.

The treatment of complex cerebrovascular diseases (CCVDs) at the skull base, such as complex intracranial aneurysms, carotid-cavernous sinus fistulas, and intracranial artery traumatic injuries, is a difficult clinical problem despite advances in endovascular and surgical therapies. Covered stents or stent graft insertion is a new concept for endovascular treatment that focuses on arterial wall defect reconstruction, differing from endovascular lesion embolization or flow diverter therapies. In recent years, covered stents specifically designed for cerebrovascular treatment have been applied in the clinical setting, allowing thousands of patients with CCVDs to undergo intraluminal reconstruction treatment and achieving positive results, even in the era of flow diverters. Since there is no unified reference standard for the application of covered stents for treating CCVDs, it is necessary to further standardize and guide the clinical application of this technique. Thus, we organized authoritative experts in the field of neurointervention in China to write an expert consensus, which aims to summarize the results of covered stent insertion in the treatment of CCVDs and propose suitable standards for its application in the clinical setting. Based on the contents of this consensus, clinicians can use individualized intraluminal reconstruction treatment techniques for patients with CCVDs.

Erratum: Stent retriever thrombectomy combined with local thrombolytic therapy for cerebral venous sinus thrombosis: A case report.

[This corrects the article DOI: 10.3892/etm.2017.5043.].

Stent retriever thrombectomy combined with local thrombolytic therapy for cerebral venous sinus thrombosis: A case report.

The present study reports the effect of successful treatment of cerebral venous sinus thrombosis (CVST) with stent retriever thrombectomy combined with local thrombolytic therapy. Medical records of 29 patients were retrospectively analyzed following a diagnosis of CVST with magnetic resonance venography (MRV) or digital subtraction angiography (DSA). Systemic anticoagulation was the initial treatment in all patients following admission. In group A, stent retriever thrombectomy combined with local thrombolytic therapy was performed on 14 patients who met the criteria of endovascular therapy. Stent-assisted angioplasty was also performed when patients presented with venous sinus stenosis. A total of 15 patients in group B received systemic anticoagulant treatment. Subsequently, warfarin was administered orally for 3 to 12 months as a continuous anticoagulant therapy. International normalized ratio was monitored when patients were receiving anticoagulant therapy. Additionally, clinical presentation, decision to escalate therapy, recanalization, Glasgow Coma Scale, modified Rankin Scale (mRS) and the clinical outcome was assessed. A total of 14 patients (9 female patients, 5 male patients), with ages ranging from 17 to 57 years, met the criteria of endovascular therapy. The clinical symptoms of 12 patients had improved after receiving endovascular therapy and only 2 patients suffered from intracranial hemorrhage following the procedure. Complete recanalization of venous sinus was exhibited in 10/14 (71.4%) patients in group A when compared with 1/15 (6.7%) patients in group B. mRS were improved in the 12-month follow-up in groups A and B when compared with that at admission. In the present study, patients with acute CVST treated with stent retriever thrombectomy combined with local thrombolytic therapy had a favorable outcome. To conclude, the present study provides a treatment option in treating CVST, particularly for patients that present with evident cortical venous outflow stasis or deteriorate neurology, despite appropriate anticoagulant therapy.

[Clinical efficiency of interventional therapy on internal carotid-posterior communicating artery aneurysm].

OBJECTIVE: To evaluate the effect of endovascular embolization of internal carotid-posterior communicating artery (IC-PC) aneurysm. METHODS: 145 patients with IC-PC aneurysms underwent endovascular embolization through the microcatheter under digital subtraction angiography (DSA). Of the 145 cases, 55 patients with 62 aneurysms were embolized by mechanical detachable spiral (MDS) and 90 patients with 106 aneurysms were embolized by Guglielmi detachable coil (GDC) or electrical detachable coil (EDC). RESULTS: 168 aneurysms in 145 patients, 96 of which with 100% embolization, 45 with 95% embolization, 15 with 90% embolization, and 12 with less than 90% embolization, were embolized successfully. During the surgery, aneurysm rupture occurred in 3 cases, cerebral vasospasm in 5, and cerebral infarction in 1 case. 118 cases were cured, 23 improved, and 3 died. 17 patients were followed-up by DSA, 3 aneurysms recurred and 2 were totally embolized with EDC for the second time. CONCLUSION: Endovascular embolization is a safe and effective therapeutic method for IC-PC aneurysm.

[Digital subtraction angiography and preoperative embolization for meningiomas].

OBJECTIVE: To investigate the diagnostic value of digital subtraction angiography (DSA) and the clinical efficacy of preoperative embolization for miningiomas. METHODS: Fifty-eight patients with meningioma were examined by DSA, and preoperative embolization was performed in patients whose miningiomas were supplied predominantly by the external carotid artery (ECA). RESULTS: In 43 patients, the meningiomas was exclusively or predominantly supplied by ECA, and the feeding arteries were embolized with particles of 250-350 microm through catherization of ECA. The blood supply of the tumor in 31 patients was completely blocked, and partial occlusion through embolization was performed in 12 patients. No complications in relation to the embolization occurred. Fifty-three patients underwent total removal of the meningiomas and the others had partial removal 1-7 days following DSA and embolization, with tumor-associated intraoperative hemorrhage of 600 ml on average. CONCLUSION: DSA has important diagnostic value for meningiomas, and preoperative embolization can be safe and effective to reduce bleeding, shorten the operation time and prevent postoperative complications.

[Mechanism of Ca2+ on the hyperthermia-induced apoptosis of rat hippocampal neurons in vitro].

OBJECTIVE: To study the mechanism of Ca(2+) on the apoptosis induced by hyperthermia in neonate rat hippocampal neurons to provide the applicative evidence of dantrolene for preventing brain injuries. METHODS: Dantrolene, Ca(2+) specific blocking agent, was used in the hyperthermia-induced apoptosis of primary hippocampal neurons in vitro to observe its effect on the apoptosis, fluorescent intensity, and dynamic change of Ca(2+) by flowcytometry and laser confocal microscopy. RESULTS: The rate of apoptosis was decreased significantly after hyperthermia treatment by dantrolene sodium. The intracellular Ca(2+) fluorescent intensity in 42 degrees C treatment group (107.35 +/- 6.0) was significantly lower than that in control group (159.12 +/- 33.8). The concentration of Ca(2+) began to decrease 20 approximately 25 s after adding dantrolene sodium, and reached the lowest level about 50 s later, and then kept lower than the basal level. CONCLUSION: Dantrolene sodium has an important protective effect on hippocampal neurons apoptosis induced by hyperthermia and may have some applicative value of preventing heat-induced brain injury.

Traumatic basilar-cavernous fistula associated with aneurysm of basilar artery.

A 19-year-old boy's left temporal region was struck by a screwdriver, he immedietly lost consciousness for several minutes, when he came back he had a serious headache and obvious left ptosis. CT scanning showed an intracranial air accumulation and obvious traumatic subarachnoid hemorrhage (SAH), 2 weeks later magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed a traumatic aneurysm in basilar artery. Digital subtraction angiography (DSA) was performed 4 weeks later, revealing a basilar-cavernous fistula and a saccular aneurysm of the basilar artery in his head. After the patient was treated with endovascular embolization therapies twice and with mechanical detachable spiral (MDS) for 5 months the patient was cured finally.

[Three-dimensional CT angiography with volume rendering for the detection of intracranial aneurysms].

OBJECTIVE: To evaluate the value of three-dimensional CT angiography (3D-CTA) with volume rendering (VR) for the detection of intracranial aneurysm. METHODS: Axial CT images were obtained by helical CT scanning on 45 patients with intracranial aneurysms, 15 males and 30 females, aged 63.9 (33-79 years). The primitive data were entered into the Silicon Graphics O2 board to be treated. VR technique was adopted to reconstruct 3D-CTA imaging, aided by multiplanar reformation to obtain the total volume of aneurysm. Among the 45 patients 25 underwent DSA simultaneously, 21 underwent clamping of aneurysm, and 3 underwent GDC thrombosis. RESULTS: Fifty-nine intracranial aneurysms were detected in 45 patients by 3D-CTA, including 32 small aneurysms (< or = 5 mm). 3D-CTA with VR well demonstrated aneurysms and provided useful information including the site, shape, size and spatial relationship to the surrounding vessels and bony structures. CONCLUSION: A quick, reliable, and relatively noninvasive diagnostic tool for intracranial aneurysms, 3D-CTA with VR delineates the aneurysmal morphology in detail, and provides useful information for choosing and planning microsurgical or endovascular treatment.

[Endovascular embolization of cerebral arteriovenous malformation].

OBJECTIVE: To evaluate the effect of endovascular embolization with alpha-NBCA on cerebral arteriovenous malformation with NBCA and emphasize the mainpoint of the embolizing technique. METHODS: 469 patients with cerebral arteriovenous malformation underwent endovascular embolization with alpha-NBCA by using microcatheter under digital subtraction angiography. RESULTS: 469 patients were treated successfully, 467 cases recovered clinically, 2 patients died. 469 patients underwent embolization therapy 1 108 times, ranging 1 to 8 times with an average of 2.3 times. 100% embolization was achieved in 155 cases, 90% approximately 100% in 93, 80% approximately 90% in 105, 70% approximately 80% in 78, 60% approximately 70% in 27, below 60% in 11. Nineteen cases received gamma-knife (or X-knife) therapy alone. 117 cases received gamma-knife (or X-knife) therapy after embolization, 32 cases received operations. Six cases suffered from different complications: 1 case with cerebral infarction recovered after urokinase injection, 4 cases suffered from intracranial hemorrhage, and 1 suffered from catheter resorting in nidus. CONCLUSION: Endovascular embolization is a safe, reliable and effective treatment for cerebral arteriovenous malformation.

[Changes in Ca2+ concentration mediated by N-methyl-D-aspartate receptor in PO/AH neurons of anoxic SD rats].

OBJECTIVE: To study the changes of Ca2+ concentration mediated by N-methyl-D-aspartate (NMDA) receptor in the neurons in the preoptic area/anterior hypothalamus (PO/AH) of anoxic SD rats by investigating the properties of NMDA receptor. METHODS: The effects of NMDA receptor agonist NMDA and antagonist vaproic acid (VPA) on the [Ca2+]i in PO/AH neurons were observed in SD rats with anoxia. RESULTS: Under normal condition, the fluorescencet ratio was 0.95, which increased obviously in response to treatment with NMDA at 40 s and reached the peak value, 2.054, after 25 s with an increment of (109+/-52) %. After the addition of the agonist, the peak value reached 3.783 in 30 s and maintained the high level. The concentration of Ca2+ increased by (286+/-91) % after the treatment with NMDA. While in the anoxia group, the concentration of Ca2+ decreased by (103+/-45)% after the addition of VPA. CONCLUSIONS: The increase in the concentration of Ca2+ results predominantly from the opening of NMDA receptor channel which allows Ca2+ influx. VPA may decrease the activity of NMDA receptor to reduce the Ca2+ concentration for the protection of the neurons against anoxia.

[Structural features of the smooth muscle cells in the medial layer of the bifurcation of fetal cerebral arteries].

OBJECTIVE: To study the structural and histogenetic features of the smooth muscle cells (SMCs) in the medial layer of the bifurcation of human cerebral arteries in fetus. METHOD: Segments of the cerebral arteries from the circle of Willis including the bifurcations of normal human fetuses were sectioned in 1 of the 3 orthogonal planes, wherein the three- dimensional medial layer structure composed of SMCs was observed with light microscope. RESULT: Microscopic observation identified 1.1 to 9.0 SMC layers in the medial layer of the cerebral arteries from the circle of Willis in the fetuses at different weeks before birth, and 30.3% of the specimens were found to have focal defects of the medial SMC layers at the bifurcation of the developing arteries. CONCLUSION: The number of SMC layers consisted in the medial layers of the cerebral arteries develops with the fetal growth, and the identification of congenital anomaly of the medial SMCs may help verify the hypothetical pathogenesis for cerebral saccular aneurysms.

[Recurrence of cerebral aneurysm after embolization by mechanical detachable spiral: report of one case].

A patient with cerebral aneurysm received embolism therapy using mechanical detachable spiral, but the aneurysm recurred because of absorption of the coil. Secondary embolism therapy was successfully implemented using Guglielmi detachable coil.

[Traumatic basilar-cavernous fistula complicated by basilar artery aneurysm: report of one case].

A 19-years-old boy was admitted after brain trauma with subarachnoid hemorrhage, left oculomotor nerve palsy, elevated pressure in the cavernous sinus and intracranial noise. The diagnosis of traumatic basilar-cavernous fistula complicated with basilar artery aneurysm was established by digital subtraction angiography. After endovascular occlusion of the vessels twice using detachable coils, the patient was cured without relapse during the 2-year follow-up. It is at the time being second report globally and the first one in China.

[Differentiation of bone marrow-derived stem cells in injured rat brain tissue].

OBJECTIVE: To investigate the differentiation of bone marrow-derived stem cells (BMDSCs) migrated from blood circulation and resided in the injured brain tissue. METHODS: Brain injury model was established by iridectomy in the right cerebral cortex of female SD rats. Twenty-four hours after brain injury, the female rats received the implantation of green fluorescence protein (GFP)-labeled BMDSCs from male SD rats and were sacrificed at 2, 4 and 8 weeks after the implantation. Fluorescent immunohistochemistry for CD11b and glial fibrillary acidic protein (GFAP) on the brain sections was used to detect the GFP-positive cells. RESULTS: One week after the transplantation of the GFP-labeled BMDSCs, 3.53% of the peripheral blood white cells were GFP-positive; at 4 weeks and 8 weeks, a significant number of GFP-positive cells were found at the injury sites, some of which expressed CD11b and others expressed GFAP. CONCLUSION: GFP-labeled BMDSCs can migrate to the injured brain tissue and differentiate into cells that express microglia- and astrocytes-specific antigens.

[Endovascular embolization for traumatic carotid-cavernous fistula].

OBJECTIVE: To evaluate the choice of approaches, surgical techniques and clinical outcome of endovascular embolization for treating traumatic carotid cavernous fistula (TCCF). METHODS: A retrospective analysis of 119 patients with TCCF was conducted, in whom totally 128 embolizations were performed. In these procedures, the femoral artery approach was adopted in 112 cases, femoral vein approach in 5 cases, and superior ophthalmic vein approach in 2 cases. For the embolization materials, balloons were used in 101 cases, microcoils in 13 cases, both materials in 2 cases, and lyophilized dura mater in 3 cases. After the embolization procedures, 110 patients were followed-up for 3 months to 10 years, and 29 patients reexamined with angiography. RESULTS: Successful embolization for TCCF in a single procedure was achieved in 111 cases, and failure occurred due to balloon leakage in 8 cases, all embolized successfully in a second attempt. The total success rate was 100% in these cases, with a rate of internal carotid artery patency of 90.8% (108/119). No perioperative mortality or complication occurred, nor was TCCF recurrence seen during the follow-up. CONCLUSIONS: In general, TCCF can be successfully treated by balloon embolization via the femoral artery, while microcoil embolization has better performance for small fistula. Embolization can be done through venous approach when the internal carotid artery is ligated or occluded, and no procedure should be performed at the convenient expense of the internal carotid artery. Right choices of the approaches and embolization materials are key to the success of the procedure.

[Interventional treatment of dural arteriovenous fistula].

OBJECTIVES: To summarize the characteristics of interventional treatment of dural arteriovenous fistulae (DAVFs) and improve clinical curative effects. METHODS: The clinical data from 135 patients with DAVFs were analyzed retrospectively. RESULTS: Seventy-four patients were cured, 53 were significantly improved, 8 unchange, and 1 died of intracranial haemorrhage. CONCLUSIONS: Clinical presentations and prognosis of DAVF depend on the types of venous drainage. Compression of the affected carotid artery and endovascular embolization are safe and effective.