Multiomics and blood-based biomarkers of moyamoya disease: protocol of Moyamoya Omics Atlas (MOYAOMICS).

BACKGROUND: Moyamoya disease (MMD) is a rare and complex cerebrovascular disorder characterized by the progressive narrowing of the internal carotid arteries and the formation of compensatory collateral vessels. The etiology of MMD remains enigmatic, making diagnosis and management challenging. The MOYAOMICS project was initiated to investigate the molecular underpinnings of MMD and explore potential diagnostic and therapeutic strategies. METHODS: The MOYAOMICS project employs a multidisciplinary approach, integrating various omics technologies, including genomics, transcriptomics, proteomics, and metabolomics, to comprehensively examine the molecular signatures associated with MMD pathogenesis. Additionally, we will investigate the potential influence of gut microbiota and brain-gut peptides on MMD development, assessing their suitability as targets for therapeutic strategies and dietary interventions. Radiomics, a specialized field in medical imaging, is utilized to analyze neuroimaging data for early detection and characterization of MMD-related brain changes. Deep learning algorithms are employed to differentiate MMD from other conditions, automating the diagnostic process. We also employ single-cellomics and mass cytometry to precisely study cellular heterogeneity in peripheral blood samples from MMD patients. CONCLUSIONS: The MOYAOMICS project represents a significant step toward comprehending MMD's molecular underpinnings. This multidisciplinary approach has the potential to revolutionize early diagnosis, patient stratification, and the development of targeted therapies for MMD. The identification of blood-based biomarkers and the integration of multiple omics data are critical for improving the clinical management of MMD and enhancing patient outcomes for this complex disease.

Integrated Transcriptomics and Metabolomics Analysis Reveals the Effects of Cutting on the Synthesis of Flavonoids and Saponins in Chinese Herbal Medicine Astragalus mongholious.

Astragali Radix, derived from the roots of Astragalus mongholicus, is a traditional Chinese medicine containing flavonoids and saponins as its key ingredients. With a shortage in the wild sources of the herbal plant, it is especially important to explore a cultivation mode for A. mongholicus for medicinal purposes. Cutting, a physical environmental stress method, was used in this study with the objective of improving the quality of this herbal legume. We found that cutting of the top 1/3 of the aboveground part of A. mongholicus during the fruiting period resulted in a significant increase in the content of flavonoids and saponins, as well as in root growth, including length, diameter, and dry weight. Furthermore, the leaves were sampled and analyzed using a combined transcriptome and metabolome analysis approach at five different time points after the treatment. Sixteen differentially expressed unigenes (DEGs) involved in the biosynthesis of flavonoids were identified; these were found to stimulate the synthesis of flavonoids such as formononetin and calycosin-7-O-ß-D-glucoside. Moreover, we identified 10 DEGs that were associated with the biosynthesis of saponins, including astragaloside IV and soyasaponin I, and found that they only regulated the mevalonic acid (MVA) pathway. These findings provide new insights into cultivating high-quality A. mongholicus, which could potentially alleviate the scarcity of this valuable medicinal plant.

Tumor Necrosis Factor Alpha-Induced Protein-3 Inhibits the Activation of Hepatic Stellate Cells by Regulating the p65 Molecule in the NF-κB Signaling Pathway.

Tumor necrosis factor alpha-induced protein-3, also called A20, is a zinc-finger protein that participates in various inflammatory responses; however, the putative relationship between A20 and hepatic fibrosis remains unelucidated. Therefore, we investigated the role and mechanism of action of A20 in activating hepatic stellate cells (HSC) during the progression of hepatic fibrosis. Cell counting kit-8 (CCK8), colony growth, transwell assays, cell cycle analysis, and apoptosis assays were performed to explore the effect of A20 on cell function in vitro. An interspecies intravenous injection of the adeno-associated virus was used to assess the in vivo role of A20. The regulation of A20 on p65 was detected using mass spectrometry and immunoprecipitation. Our findings revealed that A20 was highly expressed in the liver tissues of patients with hepatic fibrosis and that the expression level of A20 in the liver tissue was closely correlated with the stage of liver fibrosis. In the LX-2 cell line, the downregulation of A20 upregulated the expression of fibrosis-related proteins and increased the expression of inflammatory factors, indicating the activation of HSC and vice versa. In addition, overexpression of A20 in mice reduced the degree of liver fibrosis in thioacetamide model mice. Finally, co-immunoprecipitation demonstrated that A20 could interact with p65. Hence, A20 inhibits HSC activation by binding to p65.

Surface Performance of Nano-CrN/TiN Multi-Layered Coating on the Surface of Ti Alloy.

Surface coating has been widely used to ameliorate the surface properties of Ti alloys. In this study, high-power pulsed magnetically controlled sputtering technology was used to successfully prepare a nano-CrN/TiN multi-layered coating on the surface of a TC4 Ti alloy. The surface of the obtained coating was uniform, dense, and free of obvious defects. With the decrease in modulation period, the optimal growth of the nano-CrN/TiN multi-layered coating was changed from a (220) crystal surface to (111) and a (200) crystal surface. Compared to the single-layered CrN or TiN coating, the nano-multi-layered coating had higher hardness and lower wear rate. Furthermore, the hardness and the wear resistance increased with the decrease in the modulation period. This presented an optimal modulation period of 6 nm. Meanwhile, the resistance of the obtained coating to high-temperature oxidation at 800 °C was also significantly improved.

Screening of high-efficiency nitrogen-fixing bacteria from the traditional Chinese medicine plant Astragalus mongolicus and its effect on plant growth promotion and bacterial communities in the rhizosphere.

BACKGROUND: Astragalus mongolicus Bunge is used in traditional Chinese medicine and is thus cultivated in bulk. The cultivation of A. mongolicus requires a large amount of nitrogen fertilizer, increasing the planting cost of medicinal materials and polluting the environment. Isolation and screening of plant growth-promoting rhizobacteria (PGPR) and exploring the nitrogen fixation potential of A. mongolicus rhizosphere microorganisms would effectively reduce the production cost of A. mongolicus. RESULTS: This study used A. mongolicus roots and rhizosphere soil samples from Longxi County of Gansu Province, Jingle County, and Hunyuan County of Shanxi Province, China, to isolate and identify nitrogen-fixing bacteria. Through nitrogen fixation efficiency test, single strain inoculation test, and plant growth-promoting characteristics, three strains, Bacillus sp. J1, Arthrobacter sp. J2, and Bacillus sp. G4 were selected from 86 strains of potential nitrogen-fixing bacteria, which were the most effective in promoting the A. mongolicus growth and increasing the nitrogen, phosphorus, and potassium content in plants. The antagonistic test showed that these bacteria could grow smoothly under the co-culture conditions. The J1, J2, and G4 strains were used in a mixed inoculum and found to enhance the biomass of A. mongolicus plants and the accumulation of the main medicinal components in the field experiment. Mixed bacterial agent inoculation also increased bacterial diversity and changed the structure of the bacterial community in rhizosphere soil. Meanwhile, the relative abundance of Proteobacteria increased significantly after inoculation, suggesting that Proteobacteria play an important role in plant growth promotion. CONCLUSIONS: These findings indicate that specific and efficient PGPRs have a significant promoting effect on the growth of A. mongolicus, while also having a positive impact on the structure of the host rhizosphere bacteria community. This study provides a basis for developing a nitrogen-fixing bacterial fertilizer and improving the ecological planting efficiency of A. mongolicus.

Mismatch between infrastructure supply and demand within a 15-minute living circle evaluation in Fuzhou, China.

Rapid urbanization has gradually increased the contradiction between the demand and supply of urban resources. The quantitative optimization and adjustment of the infrastructure of the 15-min living circle is conducive to the scientific formulation of living circle planning guidelines, and also allows the evaluation of the effectiveness and practicality of policies. We investigate the spatial allocation pattern of infrastructure construction, the actual service capacity of facilities, and the spatial matching of facility service supply and residents' demand from the spatial dimension. Taking Fuzhou City as an example, this study uses multi-source network big data to accurately quantify the supply and demand, and constructs a 15-min living circle facility service supply evaluation system based on the kernel density analysis method, the network analysis method, and the supply and demand matching model. We propose infrastructure enhancement strategies in conjunction with the current status of Fuzhou's urban development. This study also further explores the factors influencing the spatial distribution of basic service facilities and the construction status of community living circles in China. The results show that (a) The distribution of infrastructure presents a different spatial distribution pattern from the actual service supply within the living circle. (b) The infrastructure service in the main area of Fuzhou can basically cope with the demand of residents, but there is still a mismatch between supply and demand. The areas with insufficient supply are mainly distributed in the periphery of the study area. (c) In order to further improve the construction of community living circle, we should first focus on the sub-districts with low service supply level and insufficient supply. According to the specific distribution of facilities, the number of public service facilities should be increased or decreased based on the demand of residents. This paper enriches the practical application of multi-source network big data in urban infrastructure construction, provides a guideline for the spatial layout and resource allocation of infrastructure in 15-min living circles in other cities.

Establishment of hypertension risk nomograms based on physical fitness parameters for men and women: a cross-sectional study.

Objective: This study aims to establish hypertension risk nomograms for Chinese male and female adults, respectively. Method: A series of questionnaire surveys, physical assessments, and biochemical indicator tests were performed on 18,367 adult participants in China. The optimization of variable selection was conducted by running cyclic coordinate descent with 10-fold cross-validation through the least absolute shrinkage and selection operator (LASSO) regression. The nomograms were built by including the predictors selected through multivariable logistic regression. Calibration plots, receiver operating characteristic curves (ROC), decision curve analysis (DCA), clinical impact curves (CIC), and net reduction curve plots (NRC) were used to validate the models. Results: Out of a total of 18 variables, 5 predictors-namely age, body mass index, waistline, hipline, and resting heart rate-were identified for the hypertension risk predictive model for men with an area under the ROC of 0.693 in the training set and 0.707 in the validation set. Seven predictors-namely age, body mass index, body weight, cardiovascular disease history, waistline, resting heart rate, and daily activity level-were identified for the hypertension risk predictive model for women with an area under the ROC of 0.720 in the training set and 0.748 in the validation set. The nomograms for both men and women were externally well-validated. Conclusion: Gender differences may induce heterogeneity in hypertension risk prediction between men and women. Besides basic demographic and anthropometric parameters, information related to the functional status of the cardiovascular system and physical activity appears to be necessary.

Comparison of Long-Term Outcomes in Ruptured Diffuse Brain Arteriovenous Malformations Between Interventional Therapy and Conservative Management.

Brain arteriovenous malformations (AVMs) with a diffuse nidus structure present a therapeutic challenge due to their complexity and elevated risk of hemorrhagic events. This study examines the long-term effectiveness of interventional therapy versus conservative management in reducing hemorrhagic stroke or death in patients with ruptured diffuse AVMs. The analysis was conducted based on a multi-institutional database in China. Patients were divided into two groups: conservative management and interventional therapy. Using propensity score matching, patients were compared for the primary outcome of hemorrhagic stroke or death and the secondary outcomes of disability and neurofunctional decline. Out of 4286 consecutive AVMs in the registry, 901 patients were eligible. After matching, 70 pairs of patients remained with a median follow-up of 4.0 years. The conservative management group showed a trend toward higher rates of the primary outcome compared to the interventional group (4.15 vs. 1.87 per 100 patient-years, P = 0.090). While not statistically significant, intervention reduced the risk of hemorrhagic stroke or death by 55% (HR, 0.45 [95% CI 0.18-1.14], P = 0.094). No significant differences were observed in secondary outcomes of disability (OR, 0.89 [95% CI 0.35-2.26], P = 0.813) and neurofunctional decline (OR, 0.65 [95% CI 0.26 -1.63], P = 0.355). Subgroup analysis revealed particular benefits in interventional therapy for AVMs with a supplemented S-M grade of II-VI (HR, 0.10 [95% CI 0.01-0.79], P = 0.029). This study suggests a trend toward lower long-term hemorrhagic risks with intervention when compared to conservative management in ruptured diffuse AVMs, especially within supplemented S-M grade II-VI subgroups. No evidence indicated that interventional approaches worsen neurofunctional outcomes.

Donor hepatic artery reconstruction based on human embryology: A case report.

BACKGROUND: Embryonic hepatic artery anatomy simplifies its identification during liver transplantation. Injuries to the donor hepatic artery can cause complications in this process. The hepatic artery's complex anatomy in adults makes this step challenging; however, during embryonic development, the artery and its branches have a simpler relationship. By restoring the embryonic hepatic artery anatomy, surgeons can reduce the risk of damage and increase the procedure's success rate. This approach can lead to improved patient outcomes and lower complication rates. CASE SUMMARY: In this study, we report a case of donor liver preparation using a donor hepatic artery preparation based on human embryology. During the preparation of the hepatic artery, we restored the anatomy of the celiac trunk, superior mesenteric artery, and their branches to the state of the embryo at 5 wk. This allowed us to dissect the variant hepatic artery from the superior mesenteric artery and left gastric artery during the operation. After implanting the donor liver into the recipient, we observed normal blood flow in the donor hepatic artery, main hepatic artery, and variant hepatic artery, without any leakage. CONCLUSION: Donor hepatic artery preparation based on human embryology can help reduce the incidence of donor hepatic artery injuries during liver transplantation.

Long-term outcomes of microsurgery and stereotactic radiosurgery as the first-line treatment for arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data.

BACKGROUND: This study aimed to compare the risk and benefit profile of microsurgery (MS) and stereotactic radiosurgery (SRS) as the first-line treatment for unruptured and ruptured arteriovenous malformations (AVMs). MATERIALS AND METHODS: The authors included AVMs underwent MS or SRS as the first-line treatment from a nationwide prospective multicenter registry in mainland China. The authors used propensity score-matched methods to balance baseline characteristics between the MS and SRS groups. The primary outcomes were long-term hemorrhagic stroke or death, and the secondary outcomes were long-term obliteration and neurological outcomes. Subgroup analyses and sensitivity analyses with different study designs were performed to confirm the stability of our findings. RESULTS: Of the 4286 consecutive AVMs in the registry from August 2011 to December 2021; 1604 patients were eligible. After matching, 244 unruptured and 442 ruptured AVMs remained for the final analysis. The mean follow-up duration was 7.0 years in the unruptured group and 6.1 years in the ruptured group. In the comparison of primary outcomes, SRS was associated with a higher risk of hemorrhagic stroke or death both in the unruptured and ruptured AVMs (unruptured: hazard ratio 4.06, 95% CI: 1.15-14.41; ruptured: hazard ratio 4.19, 95% CI: 1.58-11.15). In terms of the secondary outcomes, SRS was also observed to have a significant disadvantage in long-term obliteration [unruptured: odds ratio (OR) 0.01, 95% CI: 0.00-0.04; ruptured: OR 0.09, 95% CI: 0.05-0.15]. However, it should be noted that SRS may have advantages in preventing neurofunctional decline (unruptured: OR 0.56, 95% CI: 0.27-1.14; ruptured: OR 0.41, 95% CI: 0.23-0.76). The results of subgroup analyses and sensitivity analyses were consistent in trend but with slightly varied powers. CONCLUSIONS: This clinical practice-based real-world study comprehensively compared MS and SRS for AVMs with long-term outcomes. MS is more effective in preventing future hemorrhage or death and achieving obliteration, while the risk of neurofunctional decline should not be ignored.

Intraoperative Hemodynamics of Parasylvian Cortical Arteries for Predicting Postoperative Symptomatic Cerebral Hyperperfusion after Direct Revascularization in Patients with Moyamoya Disease: A Preliminary Study.

Objective. The search for methods by which to predict the risks of cerebral hyperperfusion syn-drome (CHS) in adults with moyamoya disease (MMD), including those utilizing new biomarkers, still deserves further research. The objective of this study was to investigate the association between the hemodynamics of parasylvian cortical arteries (PSCAs) and postoperative CHS. Methods. A consecutive number of adults with MMD who had undergone direct bypass between September 2020 and December 2022 were recruited. Intraoperative microvascular doppler ultrasonography (MDU) was performed to evaluate the hemodynamics of PSCAs. The intraoperative flow direction, mean value of velocity (MVV) of recipient artery (RA) and bypass graft were recorded. According to flow direction after bypass, RA was divided into entering sylvian (RA.ES) and leaving sylvian (RA.LS) subtypes. Univariate, multivariate, and ROC analyses of the risk factors for postoperative CHS were performed. Results. A total of 16 (15.09%) cases in 106 consecutive hemispheres (101 patients) sat-isfied the postoperative CHS criteria. According to univariate analysis, advanced Suzuki stage, MVV of RA before bypass, and fold increase of MVV in RA.ES after bypass were significantly associated with postoperative CHS (p < 0.05). Multivariate analysis indicated that left-operated hemisphere (OR (95%CI), 4.58 (1.05-19.97), p = 0.043), advanced Suzuki stage (OR (95%CI), 5.47 (1.99-15.05), p = 0.017), and fold increase of MVV in RA.ES (OR (95%CI), 1.17 (1.06-1.30), p = 0.003) were statistically significantly associated with the occurrence of CHS. The cut-off value of fold increase of MVV in RA.ES was 2.7-fold (p < 0.05). Conclusions. Left-operated hemisphere, advanced Suzuki stage, and postoperative fold increase of MVV in RA.ES were potential risk factors for postoperative CHS. Intraoperative MDU was useful for evaluating hemodynamics and predicting CHS.

Corrigendum: Development and validation of a model for predicting the risk of brain arteriovenous malformation rupture based on three-dimensional morphological features.

[This corrects the article DOI: 10.3389/fneur.2022.979014.].

CT Angiography Radiomics Combining Traditional Risk Factors to Predict Brain Arteriovenous Malformation Rupture: a Machine Learning, Multicenter Study.

This study aimed to develop a machine learning model for predicting brain arteriovenous malformation (bAVM) rupture using a combination of traditional risk factors and radiomics features. This multicenter retrospective study enrolled 586 patients with unruptured bAVMs from 2010 to 2020. All patients were grouped into the hemorrhage (n = 368) and non-hemorrhage (n = 218) groups. The bAVM nidus were segmented on CT angiography images using Slicer software, and radiomic features were extracted using Pyradiomics. The dataset included a training set and an independent testing set. The machine learning model was developed on the training set and validated on the testing set by merging numerous base estimators and a final estimator based on the stacking method. The area under the receiver operating characteristic (ROC) curve, precision, and the f1 score were evaluated to determine the performance of the model. A total of 1790 radiomics features and 8 traditional risk factors were contained in the original dataset, and 241 features remained for model training after L1 regularization filtering. The base estimator of the ensemble model was Logistic Regression, whereas the final estimator was Random Forest. In the training set, the area under the ROC curve of the model was 0.982 (0.967-0.996) and 0.893 (0.826-0.960) in the testing set. This study indicated that radiomics features are a valuable addition to traditional risk factors for predicting bAVM rupture. In the meantime, ensemble learning can effectively improve the performance of a prediction model.

CandiHap: a haplotype analysis toolkit for natural variation study.

Haplotype blocks greatly assist association-based mapping of casual candidate genes by significantly reducing genotyping effort. The gene haplotype could be used to evaluate variants of affected traits captured from the gene region. While there is a rising interest in gene haplotypes, much of the corresponding analysis was carried out manually. CandiHap allows rapid and robust haplotype analysis and candidate identification preselection of candidate causal single-nucleotide polymorphisms and InDels from Sanger or next-generation sequencing data. Investigators can use CandiHap to specify a gene or linkage sites based on genome-wide association studies and explore favorable haplotypes of candidate genes for target traits. CandiHap can be run on computers with Windows, Mac, or UNIX platforms in a graphical user interface or command line, and applied to any species, such as plant, animal, and microbial. The CandiHap software, user manual, and example datasets are freely available at BioCode (https://ngdc.cncb.ac.cn/biocode/tools/BT007080) or GitHub (https://github.com/xukaili/CandiHap). Supplementary information: The online version contains supplementary material available at 10.1007/s11032-023-01366-4.

Association of embolization with long-term outcomes in brain arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data.

BACKGROUND: Brain arteriovenous malformations (AVMs) account for 25% of hemorrhagic strokes in young adults. Although embolization has been widely performed as a stand-alone procedure to cure brain AVM, it is undermined whether patients benefit from this treatment. This study aimed to compare the long-term outcome of hemorrhagic stroke or death in patients with either conservative management or stand-alone embolization for AVM. METHODS: The study population was derived from a nationwide multicenter prospective collaboration registry (the MATCH registry) between August 2011 and August 2021. The propensity score-matched survival analysis was performed in the overall and stratified AVM cases (unruptured and ruptured), respectively, to compare the long-term outcome of hemorrhagic stroke or death, and neurological status. The efficacy of distinct embolization strategies was also evaluated. Hazard ratios (HRs) with 95% CI were calculated using Fine-Gray competing risk models. RESULTS: Of the 3682 consecutive AVMs, 906 underwent either conservative management or embolization as the stand-alone management strategy. After propensity score matching, a total of 622 (311 pairs) patients constituted an overall cohort. The unruptured and ruptured subgroups were composed of 288 cases (144 pairs) and 252 cases (126 pairs), respectively. In the overall cohort, embolization did not prevent long-term hemorrhagic stroke or death compared with conservative management [2.07 vs. 1.57 per 100 patient-years; HR, 1.28 (95% CI, 0.81-2.04)]. Similar results were maintained in both unruptured AVMs [1.97 vs. 0.93 per 100 patient-years; HR, 2.09 (95% CI, 0.99-4.41)] and ruptured AVMs [2.36 vs. 2.57 per 100 patient-years; HR, 0.76 (95% CI, 0.39-1.48)]. Stratified analysis showed that the target embolization might be beneficial for unruptured AVMs [HR, 0.42 (95% CI, 0.08-2.29)], while the curative embolization improved the outcome of ruptured AVMs [HR, 0.29 (95% CI, 0.10-0.87)]. The long-term neurological status was similar between these two strategies. CONCLUSIONS: This prospective cohort study did not support a substantial superiority of embolization over conservative management for AVMs in preventing long-term hemorrhagic stroke or death.

Effect of accessory hepatic artery reconstruction on prognosis in orthotopic liver transplantation: a single center experience.

BACKGROUND: In orthotopic liver transplantation (OLT), preserving an aberrant hepatic artery (AHA) can increase the number of arterial anastomoses and may lead to arterial-related complications. AHA includes accessory hepatic artery and replaced hepatic artery. Herein, the purpose of our research is to evaluate the requirement for accessory anastomosis in OLT. METHODS: We retrospectively reviewed a total of 95 patients who underwent OLT in our hospital between April 2020 and December 2022. We found seven cases of donor livers with accessory HA. The method of arterial anastomosis and details of the diagnosis and treatment of complications were collated. RESULTS: Among 95 consecutive patients with OLT, complications occurred in two of seven patients-patient 2 had an accessory right hepatic artery, while patient 5 had an accessory left hepatic artery. Patient 2 showed bile leakage leading to rupture and bleeding of the accessory HA anastomosis after OLT, and was treated with interventional coil embolization. In patient 5, hepatic artery thrombosis and accessory HA occlusion were treated with embolization and thrombolysis of the splenic artery and left gastric artery. During the intervention, we also found that the internal hepatic artery and accessory HA had communicating branches. After treatment, both patients remain healthy with no complications such as liver necrosis or liver abscess. CONCLUSION: An AHA can be ligated when assessed as an accessory artery. This can reduce the incidence of arterial complications, contribute to the perioperative management of liver transplantation (LT) patients, and improve the prognosis of LT.

A Localization and Mapping Algorithm Based on Improved LVI-SAM for Vehicles in Field Environments.

Quickly grasping the surrounding environment's information and the location of the vehicle is the key to achieving automatic driving. However, accurate and robust localization and mapping are still challenging for field vehicles and robots due to the characteristics of emptiness, terrain changeability, and Global Navigation Satellite System (GNSS)-denied in complex field environments. In this study, an LVI-SAM-based lidar, inertial, and visual fusion using simultaneous localization and mapping (SLAM) algorithm was proposed to solve the problem of localization and mapping for vehicles in such open, bumpy, and Global Positioning System (GPS)-denied field environments. In this method, a joint lidar front end of pose estimation and correction was designed using the Super4PCS, Iterative Closest Point (ICP), and Normal Distributions Transform (NDT) algorithms and their variants. The algorithm can balance localization accuracy and real-time performance by carrying out lower-frequency pose correction based on higher-frequency pose estimation. Experimental results from the complex field environment show that, compared with LVI-SAM, the proposed method can reduce the translational error of localization by about 4.7% and create a three-dimensional point cloud map of the environment in real time, realizing the high-precision and high-robustness localization and mapping of the vehicle in complex field environments.

Risk factors of postoperative cerebral hyperperfusion syndrome and its relationship with clinical prognosis in adult patients with moyamoya disease.

BACKGROUND: To investigate the incidence, risk factors, and clinical prognosis of cerebral hyperperfusion syndrome (CHS) after superficial temporal artery-middle cerebral artery anastomosis combined with encephalo-duro-arterio-synangiosis (STA-MCA/EDAS) in adult patients with moyamoya disease (MMD). METHODS: The clinical data of 160 adult patients with MMD treated by STA-MCA/EDAS from January 2016 to January 2017 were retrospectively analyzed. According to CHS diagnosis, MMD patients were divided into CHS and non-CHS group. Univariate and multivariate analysis of risk factors and Kaplan-Meier curve of stroke-free survival for CHS were performed. RESULTS: A total of 12 patients (7.5%) developed postoperative CHS, of which 4 patients (2.5%) presented with cerebral hemorrhage. Univariate and multivariate analysis showed moyamoya vessel on the surgical hemisphere (OR = 3.04, 95% CI = 1.02-9.03, P = 0.046) and left operated hemisphere (OR = 5.16, 95% CI = 1.09-21.34, P = 0.041) were independent risk factors for CHS. The other variables, such as age, gender, presentation, hypertension, diabetes, smoking, mean mRS score on admission, modified Suzuki stage and pre-infarction stage on surgical hemisphere, and bypass patency, had no association with postoperative CHS (P > 0.05). At final follow-up with average 38 months, there were 18 out of 133 patients (13.5%, 4.91% per person year) presented with newly developed complications. There was no significant difference between newly developed complications, mean mRS scores, and Kaplan-Meier curve of stroke-free survival in patients with and without CHS (P > 0.05). CONCLUSION: The concentration of moyamoya vessels and left operated hemisphere was independent risk factors for CHS, which could not affect the clinical prognosis if treated timely and properly. The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.

Circulating Inflammatory Cytokine Associated with Poor Prognosis in Moyamoya Disease: A Prospective Cohort Study.

Inflammation is a key factor in the development of moyamoya disease. However, the cytokine distribution in moyamoya disease and its impact on prognosis remain unclear. A total of 204 patients with moyamoya disease were enrolled in this study. The peripheral blood was analyzed for baseline data and cytokines, which included IL-6, IL-1ß, IL-2R, IL-8, and TNF-α. Patients with the RNF213 mutation and those without the mutation were compared in terms of their differences in cytokines. A mRS score ≥2 was defined as a poor prognosis, and a mRS score <2 was described as a good prognosis, and differences in cytokines were compared between the two groups. Regression analysis was performed to identify markers affecting prognosis. TNF-α and IL-6 levels were higher in the group without the RNF213 mutation compared to the mutation group. Multivariate stepwise regression analysis indicated that the G3 subgroup of IL-6 and the G4 subgroup of TNF-α were the independent risk factors for adverse prognosis in adults with moyamoya disease (OR 3.678, 95% CI [1.491, 9.074], p = 0.005; OR 2.996, 95% CI [1.180, 7.610], p = 0.021). IL-6 and TNF-α were associated with poor prognosis in adult patients with moyamoya disease.