Abnormal presentation of pregnancy and postpartum initial-onset systemic lupus erythematosus combined with diffuse alveolar hemorrhage: A case report.

Systemic lupus erythematosus (SLE) is an autoimmune disease that most commonly occurs in women of childbearing age. However, cases of SLE with abnormal pregnancy as the initial manifestation, involving the development of diffuse alveolar hemorrhage (DAH), have rarely been reported. Herein, we report the case of a young woman who underwent a cesarean section for fetal distress and growth restriction at 35 + 1 weeks' gestation. Following discharge, she experienced progressive worsening of anemia and chest tightness, which was later diagnosed as SLE complicated by DAH.

Impact of short-term exposure to ambient air pollution on osteoarthritis: a multi-city time-series analysis in Central-Eastern China.

Osteoarthritis (OA) is a threat to public health issue with high morbidity and disability worldwide. However, unequivocal evidence on the link between air pollution and OA remains little, especially in multi-study sites. This study aimed to explore the relationship between short-term exposure to main air pollutants and the risk of OA outpatient visits in multi-study sites. A multi-city time-series analysis was performed in Anhui Province, Central-Eastern China from January 1, 2015, to December 31, 2020. We used a two-stage analysis to assess the association between air pollution and daily OA outpatient visits. City-specific associations were estimated with a distributed lag nonlinear model and then pooled by random-effects or fixed-effects meta-analysis. Stratified analysis was conducted by gender, age, and season. Additionally, the disease burden of OA attributable to air pollutant exposure was calculated. A total of 35,700 OA outpatients were included during the study period. The pooled exposure-response curves showed that PM2.5 and PM10 concentrations below the reference values could increase the risk of OA outpatient visits. Concretely, per 10 ug/m3 increase in PM2.5 concentration was linked to an elevated risk of OA outpatient visits at lag 2 and lag 3 days, where the effect reached its highest value on lag 2 day (RR: 1.023, 95%CI: 1.005-1.041). We observed that a 10 µg/m3 increase in PM10 was positively correlated with OA outpatient visits (lag2 day, RR: 1.011, 95%CI: 1.001-1.025). Nevertheless, no statistical significance was discovered in gaseous pollutants (including SO2, O3, and CO). Additionally, a significant difference was found between cold and warm seasons, but not between different genders or age groups. This study reveals that particulate matter is an important factor for the onset of OA in Anhui Province, China. However, there is no evidence of a relationship of gaseous pollutants with OA in this area.

Seroprevalence of SARS-CoV-2-specific antibodies and vaccination-related adverse events in systemic lupus erythematosus and rheumatoid arthritis.

BACKGROUND: This study aimed to investigate the seroreactivity of Coronavirus disease 2019 (COVID-19) vaccination and its adverse events among systemic lupus erythematosus (SLE) patients, rheumatoid arthritis (RA) patients, and healthy controls (HCs). METHODS: A total of 60 SLE patients, 70 RA patients and 35 HCs, who received a complete inactivated COVID-19 vaccine (Vero cells) regimen, were recruited in the current study. Serum IgG and IgM antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) were determined by using chemiluminescent microparticle immunoassay (CMIA). RESULTS: There were no significant differences regarding the seroprevalences of IgG and IgM antibodies against SARS-CoV-2, and the self-reported vaccination-related adverse events among SLE patients, RA patients and HCs. The inactivated COVID-19 vaccines appeared to be well-tolerated and moderately immunogenic. In addition, case-only analysis indicated that in SLE patients, the disease manifestation of rash and anti-SSA autoantibody were associated with seroprevalence of IgG antibody against SARS-CoV-2, whereas the uses of ciclosporin and leflunomide had influence on the seroprevalence of IgM antibody against SARS-CoV-2. In RA patients, rheumatoid factor (RF) appeared to be associated with the seroprevalence of IgG antibody against SARS-CoV-2. CONCLUSION: Our study reveals that the seroprevalences of IgG and IgM antibodies against SARS-CoV-2 and vaccination-related adverse effects are similar among SLE, RA and HCs, suggesting that COVID-19 vaccine is safe and effective for SLE and RA patients to prevent from the pandemic of COVID-19.

Therapeutic Potential of Galectin-1 and Galectin-3 in Autoimmune Diseases.

Galectins are a highly conserved protein family that binds to ß-galactosides. Different members of this family play a variety of biological functions in physiological and pathological processes such as angiogenesis, regulation of immune cell activity, and cell adhesion. Galectins are widely distributed and play a vital role both inside and outside cells. They can regulate homeostasis and immune function in vivo through mechanisms such as apoptosis. Recent studies have indicated that galectins exhibit pleiotropic roles in inflammation. Furthermore, emerging studies have found that galectins are involved in the occurrence and development of autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), type 1 diabetes (T1D), and systemic sclerosis (SSc) by regulating cell adhesion, apoptosis, and other mechanisms. This review will briefly discuss the biological characteristics of the two most widely expressed and extensively explored members of the galectin family, galectin-1 and galectin-3, as well as their pathogenetic and therapeutic roles in autoimmune diseases. This information may provide a novel and promising therapeutic target for autoimmune diseases.

Association between non-optimal temperature and hospitalizations for gout in Anqing, China: a time-series analysis.

Previous studies have found that non-optimal temperature influences the development of gout, but the results have been inconsistent. The present study aimed to explore the effects of high temperature and high temperature variation on hospitalizations for gout in Anqing, China. We collected daily data on air pollutants, meteorological factors, and hospitalizations for gout between 1January 2016 and 31 December 2020 in Anqing City, China. We used Poisson generalized linear regression model and a distributed lag non-linear model (DLNM) to explore the relationship of high temperature, diurnal temperature range (DTR), and temperature change between neighboring days (TCN) with hospitalizations for gout. Stratified analysis by gender (male, female) and age (<65 years, ≥65 years) was conducted. Hospitalizations for gout attributed to high temperature, high DTR, and high TCN were also quantified. A total of 8675 hospitalized patients with gout were reported during the study period. We observed that exposure to high temperature was linked with an increased risk of hospitalizations for gout (lag 0, RR: 1.081, 95% confidence interval (CI): 1.011, 1.155). Exposure to high DTR was also associated with increased risk of hospitalizations for gout (lag9, RR: 1.017, 95% CI: 1.001,1.035). A large drop in temperature between neighboring days was associated an increased risk of hospitalizations for gout (lag 0-2 days, RR: 1.234, 95% CI: 1.017, 1.493). Stratified analysis results revealed that older adults and men were more sensitive to high-level DTR exposure than their counterparts. Nearly 15% of hospitalizations for gout could be attributable to high temperature (attributable fraction: 14.93%, 95% CI: 5.99%, 22.11%). This study suggests that high temperature and high temperature variation may trigger hospitalizations for gout, indicating that patients with gout need to take proactive actions in the face of days with non-optimal temperature.

The Relationship Between Ambient Air Pollution and Hospitalizations for Gout in a Humid Subtropical Region of China.

OBJECTIVE: Gout is a chronic disease caused by the deposition of sodium urate (MSU) crystals. Available data on the association between environmental hazards and gout are scarce. The present study was present to investigate the relationship between short-term exposure to air pollution and hospitalizations for acute gout from 2016 to 2020 in Anqing City, China. METHODS: Daily records of hospital admissions for acute gout in Anqing from 1 January 2016 to 31 December 2020 were retrieved from the tertiary first-class hospitals in Anqing. Air pollutants and meteorological data were obtained from the China Environmental Monitoring Station and China Meteorological Data Service Center respectively. We used a time-series analysis to explore the association between air pollution (NO2, O3, and CO) and hospitalizations for acute gout, and conducted stratified analyses by gender, age and season. RESULTS: We observed an association between NO2 and hospitalizations for gout (lag 0, relative risk (RR):1.022, 95% confidence interval (CI):1.004-1.041). For every 1 mg/m3 increase in CO concentration, hospitalizations for gout increased by 3.9% (lag 11 days, RR=1.039, 95% CI: 1.004-1.076). Intriguingly, there was a negative association between O3 and hospitalizations for gout (lag0, RR=0.986, 95% CI: 0.976-0.996). Stratified analyses showed that exposure to high levels of NO2 was considered to be more vulnerable to gout in cold season. CONCLUSION: Our study showed that short-term exposure to NO2 and CO has a significant effect on hospitalizations for acute gout.

Association of MALAT-1 gene single nucleotide polymorphisms with genetic susceptibility to systemic lupus erythematosus.

Background: Abnormal expression and function of long non-coding RNAs (lncRNAs) are closely related to the pathogenesis of systemic lupus erythematosus (SLE). In this study, we aimed to investigate the association of lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT-1) gene single-nucleotide polymorphisms (SNPs) with susceptibility and clinical characteristics of SLE patients. Methods: A case-control study including 489 SLE patients and 492 healthy controls was conducted. Four MALAT-1 SNPs (rs4102217, rs591291, rs11227209, and rs619586) were genotyped in all subjects, their correlation with SLE susceptibility and clinical characteristics were also analyzed. Results: Results showed that the rs4102217 locus was associated with the risk of SLE. In recessive models, the GG+CG genotype of rs4102217 was associated with the decreased risk of SLE compared to CC (p = 0.036, OR = 0.348, 95% CI: 0.124-0.975). In additive models, the GG genotype of rs4102217 was associated with the decreased risk of SLE compared to CC (p = 0.040, OR = 0.355, 95% CI: 0.127-0.996). However, no association was found between MALAT-1 gene polymorphism and clinical manifestations of SLE (all p > 0.05). Conclusion: In summary, MALAT-1 rs4102217 is associated with susceptibility to SLE, suggesting that MALAT-1 may play a role in SLE.

Impact of IL-10 gene polymorphisms and its interaction with environment on susceptibility to systemic lupus erythematosus.

This study aims to explore the impact of interleukin (IL)-10 single nucleotide polymorphisms (SNPs) and its interaction with environment on the risk of systemic lupus erythematosus (SLE). Chi-square testing method was used to investigate whether the distributions for genotype of four SNPs were differed from Hardy-Weinberg equilibrium (HWE). Logistic regression was used to test the association between IL-10 SNPs and SLE risk. The best interaction combinations between IL-10 SNPs and environmental factors were assessed by generalized multifactor dimensionality reduction (GMDR). Both rs1800896-G and rs1800871-T alleles were associated with increased risk of SLE, the odds ratios (ORs) (95% confidence interval (CI)) for the two SNPs were 1.68 (1.25-2.09) and 1.47 (1.12-1.94), respectively. Then, we used the GMDR method to analyze the high-order interactions of four SNPs within IL-10 gene and environmental factors on SLE risk. We found a significant interaction combination (two-locus model with P = 0.001) between rs1800896 and smoking, after adjusting for gender, age, body mass index (BMI), and alcohol drinking. We also used two-variable stratified analysis by logistic regression to analyze the synergistic effect between two variables (rs1800896 and smoking), which had significant significance in GMDR model. We found that current smokers with rs1800896-AG or GG genotype have the highest SLE risk, compared with never smokers with the rs1800896-AA genotype, OR (95% CI) = 2.24 (1.52-3.58). The rs1800896-G and rs1800871-T alleles and interaction between rs1800896 and current smoking were all associated with increased risk of SLE.

[Straw Returning Plus Nitrogen Fertilizer Affects the Soil Microbial Community and Organic Carbon Mineralization in Karst Farmland].

The use of straw returning plus nitrogen fertilizer on farmland is one of the important agronomic practices for adjusting soil organic carbon (SOC) transformations. To explore the mechanisms of straw and nitrogen fertilizer application on straw and SOC mineralization in long-term fertilized soils, an incubation experiment with the 13C isotope tracing technique was conducted, which involved three long-term fertilized models in typical karst soils (no fertilization, inorganic fertilization, and a combination of inorganic fertilization and straw). To study the mechanisms of 13C-labeled straw and SOC mineralization, four treatments were designed as follows:no straw and nitrogen (control), and straw combined with three levels of nitrogen fertilizer (0, 214.0, and 571.0 mg·kg-1 soil). The results showed that cumulative mineralization amounts of straw-derived organic carbon in long-term fertilized soils were markedly higher than those in non-fertilized soil. Straw-derived organic carbon mineralization was significantly affected by nitrogen fertilizer levels. The positive priming effects (PE) in long-term fertilized soils were much lower than those in non-fertilized soil. The PE was decreased at the low nitrogen fertilizer level but increased at the high nitrogen fertilizer level. The principal component analysis (PCA) of phospholipid fatty acids (PLFAs) indicated that the soil microbial community structure was greatly affected by the long-term fertilization models and combined straw and nitrogen fertilizer application. Moreover, the content of PLFAs in soil microorganisms, namely, bacteria and fungi, were remarkably increased by the straw plus nitrogen fertilizer (values increased by 40.3%-53.0%, 41.1%-62.6%, and 60.5%-148.6% compared with control), but levels were not significantly affected by nitrogen fertilizer levels alone. The ratios between PLFAs of soil gram-positive and gram-negative bacteria (G+/G-) decreased and were stable at around 0.8. The structure equation models (SEM) demonstrated that the combination of straw and nitrogen affected the soil gram-positive and gram-negative bacteria structure and increased the soil DOC content, which promoted the decomposition of straw and affected the mineralization of SOC. These results indicate that straw returning plus low nitrogen fertilizer can improve the SOC sequestration capacity in karst farmland.

[Effects of ellagic acid on inflammation and oxidative stress induced by AKT gene transfection in mice with fatty liver disease].

To study the effects of ellagic acid(EA)on inflammation and oxidative stress in mice with fatty liver disease induced by AKT gene transfection,the 20 female FVB mice were randomly divided into normal control group,model group and ellagic acid administration group(150,300 mg·kg~(-1)·d~(-1))(n=5).EA experimental groups and model group were using a high pressure into the tail vein transfection plasmid AKT.The next day,EA was started to administered continuously for 5 weeks after the AKT gene transfection,while the model group and the normal control group were given the same amount of saline.After the administration,the liver tissue and serum of mice were taken.HE and oil red O staining were using to observe the histopathological changes in liver;liver function to detect the serum and liver tissue as well as MDA and SOD levels;real-time quantitative PCR(RT-qPCR)was used to measure the mR-NA expression of NF-κB and TNF-α;Western blot and immunohistochemistry were used to measure the expression of NF-κB,TNF-αand COX-2 in liver tissue.RESULTS:: show that after AKT gene transfection,the model group had significant increase in the serum levels of AST,ALT,elevated the levels of MDA and decreased the levels of SOD in serum and liver tissue,aggravated histopathology degeneration and Liver inflammation,and significantly higher expression of NF-κB,TNF-α,IL-6,COX-2 and other inflammatory-related factors in liver tissue.EA administration group significant reductions in the serum levels of AST,ALT,and improved in hepatocyte fatty degeneration and liver inflammation,lower the levels of MDA and increased the levels of SOD in serum and liver tissue,and significant reductions in the expression of NF-κB,TNF-α,IL-6 and COX-2 in liver tissue.These results suggest that EA has obvious anti-inflammatory effect and inhibits oxidative stress and EA has a significant therapeutic effecton AKT gene inducing fatty liver,and the mechanism possibly by inhibiting inflammatory factors of NF-κB,TNF-α,IL-6,COX-2 and anti-oxidative stress-related.

[Effect of Soil Moisture and Temperature on the Soil Inorganic Carbon Release of Brown Limestone Soil in the Karst Region of Southwestern China].

In order to understand the influence of environmental factors on the carbonate conversion of the Karst soil, typical brown limestone and red soil samples were collected from the Karst ecosystem, and a 100-day incubation experiment was conducted. The characteristics of inorganic carbon release from the soil under three temperature gradients (15, 25, and 35℃) and water contents (30%, 65%, and 100% WHC) were studied by adding 14C-CaCO3 for 100 d. The results showed that under the different soil moisture and temperature conditions, the maximum rate and the cumulative amount of inorganic carbon release from the soil over 100 days varied between 0.7-16.8 mg·(kg·d)-1and 5.9-29.4 mg·kg-1, respectively, in the brown limestone soil, and varied between 39.7-103.3 mg·(kg·d)-1 and 83.3-135.1 mg·kg-1, respectively in the red soil. Under drought conditions (30% WHC), the cumulative amount of inorganic carbon release was the highest for the two soils and increased with increasing temperature. At 65% WHC and 100% WHC, increasing temperature can still promote inorganic carbon release from the soil. The temperature sensitivity of the soil inorganic carbon release in the brown limestone soil is greater than that of the red soil, which is significantly affected by soil moisture. The soil pH and MBC content were remarkably increased after adding CaCO3, and the difference between the two soils was significant. The variance partition showed that temperature and soil moisture can explain 7.6% and 2.0% of the soil inorganic carbon release variability, respectively. In conclusion, warming and drought aggravate inorganic carbon release from brown limestone soil in the southwestern Karst region. Therefore, in the context of global warming and more frequent extreme precipitation events, the effects of soil moisture and temperature on inorganic carbon conversion in soil should be fully considered when studying the soil carbon cycle and its dynamic changes in southwestern Karst. This research can provide a scientific basis for further understanding the influence of climate change on the global carbon cycle.

Diffusion characteristics of the fornix in patients with Alzheimer's disease.

White matter degradation is a major part of the pathogenesis of Alzheimer's disease (AD). The fornix is the predominant outflow tract from the hippocampus, and alterations to its microstructure in patients with AD are still being explored. Diffusion tensor imaging (DTI) is an in vivo neuroimaging technique that can provide unique information about alterations in tissue microstructure, which can indicate underlying neurobiological process at the microstructural level. In this prospective study, DTI was used to assess and analyze the microstructural features of the fornix in subjects with AD (n = 17), mild cognitive impairment (MCI; n = 12) and healthy controls (n = 17). DTI was performed using Explore DTI software and the FSL package. Within the fornix, patients with AD showed decreased fractional anisotropy values and length of fiber tracts of the fornix relative to healthy controls, but higher mean diffusivity values. MCI subjects showed a trend towards elevated mean diffusivity values in the fornix. The data suggest that DTI provides supporting information on the microstructural alteration of the fornix in patients with AD, and that these diffusion characteristics of the fornix may be helpful for the clinical diagnosis of AD.

Anti-C1q antibody is a valuable biological marker for prediction of renal pathological characteristics in lupus nephritis.

The aim of this study is to investigate the association of serum anti-C1q antibody levels with renal pathological characteristics in SLE patients with lupus nephritis. Fifty-two patients with biopsy-proven lupus nephritis were enrolled. Serum anti-C1q levels (units per milliliter) were measured before renal biopsy using ELISA kit. A cross-sectional study analyzed the association of anti-C1q antibody levels with SLE global activity, nephritic activity, and renal histopathology. Thirty-nine of 52 patients (75 %) were positive for anti-C1q antibody. Anti-C1q antibody levels were positively correlated with the values for the SLE Disease Activity Index (r = 0.628, p < 0.001), anti-nucleosome (r = 0.591, p < 0.001), and anti-dsDNA antibody (r = 0.507, p < 0.001), but negatively correlated to serum C3 (r = -0.626, p < 0.001) and C4 (r = -0.57, p < 0.001). The prevalence of anti-C1q in patients with proliferative LN (class III + class IV) was higher than those with mesangial LN (class II), but there is no statistical significance. Among different ISN/RPS classification, serum anti-C1q antibody level was highest in patients with class IV, followed by class III. The concentration of anti-C1q in patients with class IV was higher than those in class II [50.00 (23.00, 97.70) vs 20.25 (7.16, 54.78) U/ml, p<0.05]. The levels of anti-C1q antibody were positively correlated with renal active indices (r = 0.59, p < 0.001) while negatively correlated with chronic indices (r = -0.326, p < 0.05). Moreover, anti-C1q antibody was found to be positively associated with glomerular C1q deposition. These findings indicate that serum anti-C1q antibody is a valuable noninvasive biological marker for prediction of renal histopathology in lupus nephritis. Low or negative anti-C1q antibody titers might influence therapeutic decisions in SLE.

[Study on the chemical constituents of Leptopus chineseis].

OBJECTIVE: To study the chemical constituents of the ethyl ether extract of the Leptopus chineseis. METHODS: The chemical constituents were isolated by means of chromatography and identified by spectra data and physicochemical characters. RESULTS: Three compounds were isolated and identified as friedelane-2alpha, 3beta-diols (1), betulinic acid (2) and 3beta-O-trans-coumaroylbetulinic acid (3). CONCLUSION: The compounds are isolated from Leptopus chineseis for the first time.

[Age features of pure leukoaraiosis in non-demented outpatients].

OBJECTIVE: To investigate the aging features of pure leukoaraiosis (LA) in non-demented outpatients. METHODS: The outpatients with age older than 40 years, without taking cholesterol lowering and B vitamin medications and with mini-mental state examination more than 24 scores were selected from July 2008 to December. 2009 in Beijing Tiantan Hospital. LA was defined with MRI. Patients were classified into two groups i.e. LA group consisting of 138 patients with leukoaraiosis but without lacunar lesions and cortical infarcts and a control group consisting of 124 patients without any lesion in brain. Age and other vascular risk factors were also investigated. RESULTS: Age of the patients in the LA group was significantly higher than that in the control group (P<0.001). Multivariable logistic regression analysis showed that age was independently associated with pure LA (OR 1.080, 95%CI 1.042-1.120), after adjusting sex, vascular risk factors and presence of atherosclerosis in cervical arteries. If age-stratification was further considered, logistic regression analysis showed that OR (95%CI) for LA was 2.693 (95%CI 1.103-6.575) in a 60-69 year group and 13.527 (95%CI 3.319-55.131) in a ≥70 year group as compared with a 40-49 year group. CONCLUSION: Age is a determining risk factor for pure LA and patients with age older than 60 years are at high risk of LA.

Increased serum interleukin 17 in patients with systemic lupus erythematosus.

Interleukin 17 (IL-17) is a Th17 cytokine associated with inflammation, autoimmunity and defense against some bacteria, it has been implicated in many chronic autoimmune diseases including psoriasis, multiple sclerosis and systemic sclerosis. However, whether IL-17 plays a role in the pathogenesis of systemic lupus erythematosus (SLE) remains unclear. In the present study, we aimed to investigate the serum IL-17 level in patients with SLE and it's associations with disease manifestations and activity. Fifty-seven patients with SLE and 30 healthy volunteers were recruited. Serum IL-17 levels were examined by enzyme linked immunosorbent assay (ELISA). Statistic analyzes were performed by SPSS 10.01. Results show that serum IL-17 levels were significantly elevated in SLE patients as compared with normal controls. Nevertheless, no associations of serum IL-17 level with clinical and laboratory parameters were found; no significant difference regarding serum IL-17 level between SLE patients with nephritis and those without nephritis was found; no significant difference was found between Less active SLE and More active SLE; Correlation analysis between serum IL-17 levels and SLEDAI showed no association. Taken together, our results indicate increased serum IL-17 levels in SLE patients, suggesting that this cytokine may trigger the inflammatory process in SLE. However, no associations of serum IL-17 level with disease manifestations were found. Therefore, further studies are required to confirm this preliminary data.

[Correlation between plasma level of homocysteine and cerebral large-artery atherosclerosis].

OBJECTIVE: To identify whether high level of plasma homocysteine is an independent risk factor for potential cerebral large-artery atherosclerotic stenosis determined by digital subtraction angiography (DSA) in patients with ischemic stroke. METHODS: 276 adult patients with ischemic stroke experienced DSA were selected, and 224 patients with potential large-artery atherosclerotic stenosis (grade > 50%, not less than one of vascular) and 52 controls without stenosis or mild grade (grade < or = 50%) were included. Plasma homocysteine level was analyzed and conventional risk factors of cerebral stroke such as sex and age, hypertension, diabetes, long-smoking, long-alcohol and plasma levels of triglyceride, high-density lipoprotein, low-density lipoprotein was evaluated in 276 subjects. RESULTS: The proportion of subjects with high level of plasma homocysteine (> 15 micromol/L) was significantly higher in patients with potential atherosclerotic stenosis than those without (38.8% versus 15.4%; OR 3.49, 95% CI 1.57 - 7.77, P = 0.001). Based on multivariable stepwise logistic regression model, the odds ratio of homocysteine levels was 4.10 (95% CI 1.80 - 9.32, P = 0.001) with additional adjustment for conventional risk factors. The effect of homocysteine was more pronounced in the presence of hypertension (OR = 4.89), old age (OR = 4.79) and low level of plasma high density lipoprotein (OR = 10.46). CONCLUSIONS: It is suggested that high level of plasma homocysteine is an independent risk factor for cerebral large-artery atherosclerosis. The effect of homocysteine is more pronounced in the presence of other risk factors of ischemic stroke.

Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients.

OBJECTIVE: To assess the safety and clinical efficacy of stenting for patients with symptomatic M1 stenosis of middle cerebral artery (MCA), and to assess the significance of classification based on location, morphology, and access of intracranial stenosis (LMA classification) in MCA stenting. METHODS: Forty patients with 42 symptomatic M1 stenoses refractory to medical therapy were enrolled in this study. The lesions were situated at M1 trunk (n=13), M1 origin (n=12), and M1 bifurcation (n=17), respectively, which were classified into type N (nonbifurcation lesions, n=13) and type A (prebifurcation, n=11), B (postbifurcation, n=14), C (lesion across the nonstenotic ostium of its branch, n=1), D (across the stenotic ostium of its branch, n=2), F (combinative lesions of prebifurcation and its small branch ostium, n=1) locations, morphologically into type A (n=15), B (n=23) and C (n=4) lesions, and into type I (mild-to-moderate tortuosity and smooth access, n=17), II (severe tortuosity and/or irregular arterial wall, n=18), and III (excessively severe tortuosity, n=7) accesses. RESULTS: The technical successful rate was 97.6% for total lesions and 100%, 100%, and 85.7% for types I, II, and III accesses, respectively. The total complication rate was 10%. The mortality was 2.5% (1/40 patients), and 0%, 0%, and 25% for types A, B, and C lesions, respectively. During the median 10 months follow-up, there was no recurrence of transient ischemic attack or stroke in 38 available patients. Among 8 stenting vessels of seven patients with six-month follow-up angiography, 7 showed good patency and one showed restenosis. CONCLUSIONS: Stenting appears to be an effective and feasible therapy for symptomatic M1 stenoses, but also appears to have the higher periprocedural complications, which need strict procedural and periprocedural management to reduce the mortality and morbidity. The LMA classification seems to be helpful to work out the individual therapy and predict the results of stenting. A further study is needed to confirm the benefits of stenting of MCA stenosis.

[Symptomatic intracranial artery stenosis: angiographic classifications and stent-assisted angioplasty].

OBJECTIVE: To assess the safety and efficacy of stent-assisted angioplasty (SAA) for symptomatic intracranial artery stenosis, and to evaluate preliminarily the significance of classification of location, morphology and access (LMA classification) of intracranial artery stenosis in SAA. METHODS: Forty-two patients with symptomatic intracranial artery stenosis (diameter reduction: 50% - 74%, n = 15; >or= 75%, n = 27), located in middle cerebral artery (n = 27), intracranial internal carotid artery (n = 4), intracranial vertebral artery (n = 7) and basilar artery (n = 4) respectively, refractory to medical therapy were enrolled in this study. RESULTS: LMA classification: 23 of the forty-two lesions (54.8%) located at the site of bifurcation, which were classified according to the location into type A (n = 8), B (n = 11), C (n = 2), D (n = 1) and F (n = 1) respectively. Type A, B and C lesions were 19, 19 and 4 respectively in the light of morphologic classification. Type I, II and III accesses were 15, 23 and 4 respectively in the light of access classification. TECHNIQUE: The technical successful rate of SAA was 95.2% (40/42) for the group overall, and 100% (15/15), 94.7% (22/23), and 75% (3/4) for type I, II, III accesses, respectively. The rate of periprocedural complication and death was 9.5% (4/42), including acute occlusion (n = 1) and high perfusion syndrome (n = 3). After emergency measures, 3 patients were cured completely, and the remaining one with severe MCA trunk stenosis of type C lesion died of subarachnoid hemorrhage (2.4%). During a clinical follow-up period ranging from 1 to 18 months (median 8 months), 39 patients receiving SAA have been still free from ischemic events. There was no restenosisfound angiographically 6 months (n = 7) and 12 months (n = 4) after SAA. CONCLUSIONS: Our results suggest that under rigorous control of procedural and periprocedural measures, SAA appears to be a safe and effective therapy for symptomatic intracranial stenoses of type A and B lesions, but it is not risk-free for type C lesions. The LMA classification is helpful for predicting the results of SAA and to design the procedure. However, further study is needed.