Does cognitive decline/dementia increase Delirium risk after stroke?

BACKGROUND: Delirium is a common contributor to mortality and hospital costs in stroke patients. Different observational studies have showed inconsistent results regarding the association between cognitive decline/dementia and delirium after acute stroke. Therefore, we performed this meta-analysis with the aim of determining whether cognitive decline/dementia is related to the risk of delirium after acute stroke. METHODS: We systematically searched PubMed, Embase, Google Scholar, and Web of Science for relevant studies from inception to September 2020. We calculated the pooled odds ratio (OR) with 95% confidence interval (CI) by using fixed or random effects models based on heterogeneity measured by the I2 index. RESULTS: The association between cognitive decline/dementia and post-stroke delirium was examined in 13 studies with 3183 participants. After pooled analysis, we found that cognitive decline/dementia was significantly associated with susceptibility to delirium in post-stroke patients (OR = 3.70, 95%CI: 2.90-4.71, P < 0.001). Subgroup analysis suggested that cognitive decline/dementia was associated with an increased risk of delirium in Caucasians (OR = 3.73, 95%CI: 2.73-5.11, P < 0.001), non-Caucasians (OR = 3.65, 95%CI: 2.50-5.33, P < 0.001), samples with <200 subjects (OR = 3.70, 95%CI: 2.17-6.31, P < 0.001), samples with ≥200 subjects (OR = 3.70, 95%CI: 2.82-4.85, P < 0.001), studies published in 1990-2009 (OR = 3.17, 95%CI: 1.48-6.77, P = 0.003), and studies published in 2010-2020 (OR = 3.76, 95%CI: 2.92-4.86, P < 0.001). CONCLUSIONS: We identified an association between cognitive decline/dementia and the risk of developing delirium. Cognitive decline/dementia may be a promising predictor for delirium in post-stroke patients.

Association of E-Selectin gene rs5361 polymorphism with ischemic stroke susceptibility: a systematic review and Meta-analysis.

BACKGROUND: Over the years, a number of published studies showed that E-Selectin gene rs5361 (S128R, Ser128Arg, A561C) variants were associated with the risk of ischemic stroke (IS). However, the results of those case-control studies were still equivocal. Therefore, we performed this meta-analysis to clarify the relationship between E-Selectin gene rs5361 polymorphism and IS risk. METHODS: We searched the Web of Science, PubMed, VIP, CNKI (China National Knowledge Infrastructure) and Wanfang databases for obtainning the eligible studies according to the inclusion and exclusion criteria. Odds ratios (ORs) with its 95% confidence intervals (CIs) were calculated to evaluate the relationship of E-Selectin gene rs5361 polymorphism with IS susceptibility under the dominant and allelic model with fixed or random effects model. RESULTS: Totally, 13 studies with 2888 cases and 2976 controls were selected in this systematic review and meta-analysis This meta-analysis obtained that E-Selectin gene rs5361variants contributed to increase the risk of IS (C vs. A: OR = 2.23, 95%CI = 1.70-2.92, p < 0.001). We also performed a sub-analysis by ethnicity, the results indicated that rs5361 variants were related to an increased risk of IS (East Asian population: C vs. A: OR = 1.97, 95%CI =1.58-2.45, p < 0.001; African population: C vs. A: OR = 5.52, 95%CI = 3.48-8.76, p < 0.001; Caucasian population: C vs. A: OR =1.67, 95%CI =1.32-2.10, p < 0.001). CONCLUSIONS: Therefore, our meta-analysis suggested that C allele, AA and AC genotypes of E-Selectin gene rs5361 variants were related to an increased risk of IS in overall populations.

MT1JP inhibits glioma progression via negative regulation of miR-24.

Long noncoding RNAs have been reported to be dysregulated and have pivotal roles in various human malignancies, including glioma. Previous studies revealed that metallothionein 1J (MT1JP) has important regulatory functions in the development of gastric cancer. However, the biological role and potential mechanism of MT1JP in glioma remain unknown. The present study suggested that MT1JP expression was significantly downregulated in glioma tissues and glioma cell lines, and the decreased expression of MT1JP was associated with glioma progression and poor survival of patients with glioma. Additionally, overexpression of MT1JP significantly inhibited the proliferation and invasion of glioma cells. Furthermore, it was revealed that MT1JP interacted with microRNA-24 (miR-24), which has previously been reported as an oncogene in glioma, negatively regulating its expression level. Rescue experiments revealed that the tumor suppressive functions of MT1JP may be mediated by the negative regulation of miR-24. Collectively, the data suggested that MT1JP inhibited the progression of glioma by negatively regulating miR-24 and may serve as a novel diagnostic biomarker and therapeutic target for glioma.

Penetrating transorbital injury by a coloring pencil in a 3-year-old child: A case report.

A transorbital penetrating injury by a foreign body is an extremely rare type of injury, and its severity is often difficult to estimate by examination of the superficial wound alone. Thus, such injuries are challenging for neurosurgeons to investigate and manage. We herein present a peculiar case involving a 3-year-old girl with a penetrating transorbital skull-base injury caused by a coloring pencil and discuss the anatomical location of the foreign body, radiological examination findings, diagnosis, and treatment strategy. The pencil was completely removed by manual extraction. Follow-up investigations confirmed a good outcome. Multidisciplinary cooperation, radiological examination, correct diagnosis, timely treatment, and detailed follow-up studies are necessary to manage penetrating transorbital skull-base injuries caused by foreign bodies. The orbital walls are very thin in children, and the orbital roof and superior orbital fissure are often penetrated by foreign bodies in cases such as that described herein. The anatomical location of the foreign body influences the clinical management strategy.

Endovascular coiling versus surgical clipping for aneurysmal subarachnoid hemorrhage: A meta-analysis of randomized controlled trials.

BACKGROUND: Aneurysmal subarachnoid hemorrhage is a relatively rare cause of stroke, carrying a bad prognosis of mortality and disability. The current standard procedure, neurosurgical clipping, has failed to achieve satisfactory outcomes. Therefore, endovascular detachable coils have been tested as an alternative. This meta-analysis was aimed to compare the outcomes of surgical clipping and endovascular coiling in aneurysmal subarachnoid hemorrhage. MATERIALS AND METHODS: Relevant randomized trials up to June 2018 were identified from Medline, Central, and Web of Science. Data for poor outcomes (Modified Rankin Scale [mRS] scores 3 to 6) at 2-3 months, 1 year, and 3-5 years were extracted and analyzed as odds ratios (ORs) with 95% confidence intervals (CIs), using RevMan software. RESULTS: Five studies (2780: 1393 and 1387 patients in the coiling and clipping arms, respectively) were included in the current analysis. The overall effect estimate favored endovascular coiling over surgical clipping in terms of reducing poor outcomes (death or dependency, mRS > 2) at 1 year (OR = 0.67, 95% CI: 0.57-0.79) and 3-5 years (OR = 0.8, 95% CI: 0.67-0.96). Moreover, coiling was associated with a significantly lower rate of cerebral ischemia (OR = 0.37, 95% CI: 0.16-0.86). Postprocedural mortality (OR = 0.79, 95% CI: 0.6-1.05) and rebleeding (OR = 1.15, 95% CI: 0.75-1.78) rates were comparable between the two groups. However, technical failure was significantly more common with coiling interventions than with clipping surgeries (OR = 2.84, 95% CI: 1.86-4.34). CONCLUSION: Our analysis suggests that coiling can be a better alternative to clipping in terms of surgical outcomes. Further improvements in the coiling technique and training may improve the outcomes of this procedure.

Anti-vascular endothelial growth factor in glioblastoma: a systematic review and meta-analysis.

Glioblastoma is one of the most common primary brain tumors in adults. The current treatment strategies failed to achieve satisfactory outcomes. Anti-vascular endothelial growth factor (anti-VEGF) agents have been proposed to enhance the survival and quality of life in these patients. To investigate this, different databases were searched in addition to hand searching. Relevant studies were screened and only ten randomized controlled trials (RCTs) met the eligibility criteria; six of them were considered for meta-analysis. Eligible RCTs were assessed regarding risk of bias using the Cochrane tool. Relevant data were extracted and meta-analysis was conducted using the random effects model analysis on RevMan software. One thousand seventy-eight patients in the anti-VEGF group and 946 patients in the control group were available for analysis. No statistically significant improvement in the overall survival (OS) was detected for anti-VEGF (OR 0.87, 95% CI 0.7-1.09, p = 0.23) or bevacizumab subgroup (OR 0.84, 95% CI 0.65-1.08, p = 0.17) compared to standard therapy alone. However, the progression-free survival (PFS) showed a significant improvement with both anti-VEGF (OR 0.76, 95% CI 0.65-0.89, p = 0.0007) and bevacizumab subgroup (OR 0.75, 95% CI 0.65-0.87, p = 0.0001). In conclusion, anti-VEGF agents can improve the PFS but not OS in glioblastoma patients. The current evidence is not satisfactory to declare a new therapeutic line. Further RCTs with sharply determined outcomes and assessment methods are required.

Clivus Inflammatory Pseudotumor Associated with Immunoglobulin G4-Related Disease.

BACKGROUND: Immunoglobulin G4 (IgG4)-related disease is a more recently recognized syndrome. It is characterized by increasing IgG4-positive plasma cells and lymphocyte infiltration. Reports of intracranial pseudotumors associated with IgG4-related disease are very rare. We report a rare case of clivus pseudotumor associated with IgG4-related disease mimicking meningioma. CASE DESCRIPTION: A 50-year-old man presented with abducens paralysis of the right eye. Brain magnetic resonance imaging revealed a uniformly enhanced mass located in the right upper clivus area, and meningioma was highly suspected. The tumor was totally resected via a retrosigmoid approach craniotomy, which achieved sufficient decompression of the right abducens nerve. Postoperative pathology revealed IgG4-related disease with IgG4 strongly positive on immunohistochemical staining. The patient had no history of autoimmune disease. Postoperative laboratory data revealed no elevation of either IgG (6.94 g/L) or IgG4 (0.131 g/L). Follow-up contrast MRI showed the lesion had disappeared. CONCLUSIONS: Although several cases of intrasellar hypophysitis have been reported, reports of intracranial pseudotumors associated with IgG4-related disease are rare. Special attention is required when the differential diagnosis includes meningioma. Preoperative diagnosis is very important because inflammatory pseudotumors associated with IgG4-related disease could be treated with steroid therapy, avoiding surgery.