Endovascular coiling versus microsurgical clipping for ruptured intracranial aneurysms: a meta-analysis and systematic review.

BACKGROUND: The purpose of this analysis is to evaluate the current evidence with regard to the effectiveness and safety between coiling and clipping in patients with ruptured intracranial aneurysms (RIAs). METHODS: We performed a meta-analysis that compared clipping with coiling between July 2000 and September 2021. PubMed, EMBASE, and the Cochrane Library were searched for related articles systematically. And the treatment efficacy and postoperative complications were analyzed. RESULTS: We identified three randomized controlled trials and thirty-seven observational studies involving 60,875 patients with ruptured cerebral aneurysms. The summary results showed that coiling was related a better quality of life (mRS0-2; OR=1.327; CI=1.093-1.612; p<0.05), a higher risk of mortality (OR=1.116; CI=1.054-1.180; p<0.05), higher rate of rebleeding (RR=1.410; CI=1.092-1.822; p<0.05), lower incidence of vasospasm (OR=0.787; CI=0.649-0.954; p<0.05), higher risk of hydrocephalous (RR=1.143; CI=1.043-1.252; p<0.05), lower risk of cerebral infarction (RR=0.669; CI=0.596-0.751; p<0.05), lower risk of neuro deficits (RR=0.720; CI=0.582-0.892; p<0.05), and a lower rate of complete occlusion (OR=0.495; CI=0.280-0.876; p<0.05). CONCLUSION: Coiling was significantly associated with a better life quality (mRS0-2), a lower incidence of postoperative complications, and a higher rate of mortality, rebleeding, hydrocephalous, and a lower rate of complete occlusion than clipping.

Reconstruction clipping of ruptured anterior circulation aneurysms via supraorbital lateral keyhole approach.

BACKGROUND: Intracranial aneurysm (IA) is a serious disease. Analyze and review the cases of anterior circulation ruptured IA by supraorbital lateral keyhole approach, and summarize the experiences of this approach. METHODS: Retrospective analysis of 16 cases of ruptured anterior circulation IA in our department from January 2019 to June 2020, CT angiography (CTA) was performed before operation. Analyzing the IA's parameters by 3D-CT reconstruction. The IA was clipped by supraorbital lateral keyhole approach combined with the 3D-skull reconstruction. Extraventricular drainage was performed before craniotomy. Intraoperative neurophysiological monitoring was performed during the operation. After operation, fluorescein angiography and vascular ultrasound were performed to check the clipping effect. Intracranial pressure monitor was performed postoperatively. CTA was reexamined one week after operation. The modified Rankin Scale (MRS) was performed 6 months after operation. RESULTS: There were 7 males (43.8%) and 9 females (56.2%), and the average age is 52.31 ± 11.12 years old. Among them, 11 patients (68.8%) were anterior communicating artery aneurysms and 5 (31.2%) were middle cerebral artery aneurysms. All patients were out of hospital within 10 days without any death, without cerebral infarction, cerebrospinal fluid leakage and neurological impairments. About mRS score, after 6 months follow-up, 8 cases (50%) had 0 point, 4 cases (25%) had 1 point, and 4 cases (25%) had 2 points. CONCLUSIONS: For ruptured anterior circulation IA, the supraorbital lateral keyhole approach combined with ventricular drainage, intraoperative electrophysiological monitoring, and intraoperative vascular ultrasound is a safe and minimally invasive treatment. The application of reconstruction clipping can reconstruct the diameter of parent vessel and reduce the recurrence rate of IA.

Association of CDKN2A/CDKN2B Gene Polymorphisms with Increased Susceptibility to Intracranial Aneurysm in a Chinese Han Population.

OBJECTIVE: Several studies have reported that single-nucleotide polymorphisms (SNPs) of the CDKN2A/CDKN2B gene on chromosome 9p21.3 are associated with increased risk of intracranial aneurysm (IA). However, the association between IAs and SNPs of CDKN2A/CDKN2B in Chinese Han people is yet to be evaluated. This study examined the association of the SNPs rs10811661 and rs4977574 with IA in the Chinese Han population. METHODS: A total of 595 IA patients and 600 sex- and age-matched controls were enrolled in the study. Peripheral blood was collected and stored at -80°C until use. CDKN2A/CDKN2B was identified using polymerase chain reaction-ligase detection reaction. SNP genotyping was performed for rs10811661 and rs4977574 using a MassArray system. Associations between these two SNPs and IAs was tested with χ2 or Fisher's exact tests and multivariate logistic regression. RESULTS: rs10811661 and rs4977574 were significantly associated with IA. The frequency of rs10811661-T in IA was higher than in controls (OR 1.26, 95% CI 1.07-1.49; P<0.01). There was no significant difference in frequency of haplotype between control subjects and IA patients. CONCLUSION: rs10811661 and rs4977574 on 9p21.3 were strongly associated with genetic susceptibility to IA in the Chinese Han population, which emphasizes a need for further investigation.

The comparison of STA-MCA bypass and BMT for symptomatic internal carotid artery occlusion disease: a systematic review and meta-analysis of long-term outcome.

BACKGROUND: Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery is now being widely used in moyamoya disease, and its therapeutic value in SICAO remains divergent. METHODS: A systematic search was performed in PubMed, EMBASE, and Cochrane Databases in Feb. 2020 and updated in Jun. 2019. We have strict inclusion and exclusion criteria. Cochrane Bias Risk Assessment Tool was used to assess the quality of included RCTs. Review Manager 5.3 was used for analysis results in terms of comparing the STA-MCA bypass and BMT. For dichotomous variable outcomes, risk ratios (RRs) and 95% confidence intervals (95%CIs) were calculated for the assessment. RESULTS: The total patient cohort consisted of 2419 patients, of whom 1188 (49.1%) patients had been grouped in STA-MCA bypass and 1231 (50.9%) patients had been divided into the BMT group. Mean follow-up of included patients was 29 months. The RR of the seven studies was 1.01, and the 95% confidence interval was .89-1.15, with statistical significance, Z = .13, P = .89, sustaining that STA-MCA bypass was not superior to BMT in symptomatic carotid artery occlusion disease. CONCLUSIONS: STA-MCA bypass and BMT were associated with similar rates of a composite of long-term stroke. And the risk of long-term overall stroke was mildly higher with BMT. At present, each patient should receive more precise treatment, by reasonably assessing the individual differences of each patient to reduce the recurrence rate of stroke.

Meta-Analysis of Pterional Versus Supraorbital Keyhole Approach for Clipping Intracranial Aneurysms: Direct Comparison of Approach-Related Complications.

BACKGROUND: The supraorbital keyhole approach (SKA) and pterional approach (PA) have been recommended for clipping intracranial aneurysms (IAs). We conducted a meta-analysis to systematically and comprehensively compare the clinical outcomes between the 2 approaches. METHODS: We retrieved potential academic studies that had compared the clinical outcomes of SKA and PA for clipping IAs from the Cochrane Library, Medline, PubMed, and EMBASE databases. The references of the identified studies were carefully reviewed to ensure that all available documents had been included in the present study. The meta-analysis was conducted in accordance with the acknowledged PRISMA (prioritized reported items for systematic review and meta-analysis) guidelines. RESULTS: A total of 8 studies with 1016 participants were included in our study. Of these 1016 patients with IAs, 518 were assigned to the SKA group and 498 to the PA group. Our results showed that the SKA is preferable for clipping IAs compared with the PA because of its shorter operative time (weighted mean difference, -3.163; 95% confidence interval [CI], -5.577 to -0.749; P = 0.01) and length of stay, especially for the patients with unruptured IAs (weighted mean difference, -52.107; 95% CI, -81.597 to -22.618). However, a lower risk of postoperative infection was found in the SKA group (4.6% vs. 8.5%; odds ratio, 0.398; 95% CI, 0.186-0.850; P = 0.017), which seemed to derive from the ruptured IAs (OR, 0.330; 95% CI, 0.136-0.800; P = 0.014). However, no significant difference was found in the incidence of frontal sinus opening, completed occlusion, procedural complications, intraoperative rupture, postoperative hematoma, or cerebral vessel spasm. CONCLUSIONS: The SKA was associated with a shorter length of stay and operation time and a lower risk of postoperative infection. Hence, the SKA seems to be equally effective and safe for clipping IAs compared with PA and should be recommended for surgeons who have acquired sufficient experience with this technique owing to its advantages compared with the PA.

[Construction and expression of the recombinant plasmid pGEX-Sj14-3-3 of Schistosoma japonicum in BL21(DE3)].

OBJECTIVE: To construct and research the expression of the recombinant plasmid pGEX-Sj14-3-3 in Escherichia coli BL21 (DE3). METHODS: Sj14-3-3 gene was amplified by RT-PCR from template of the total RNA extracted from adult worms of S. japonicum, and then cloned into the vector pGEX-1gammaT to construct pGEX-Sj14-3-3. The recombinant plasmid pGEX-Sj14-3-3 was transformed into E. coli BL21 (DE3). BL21 (pGEX-Sj14-3-3) was induced with isopropyl-beta-D-thiogalactopyranosid (IPTG), and the expressed products were identified by SDS-PAGE and Western blot. RESULTS: A 399 bp fragment of Sj14-3-3 coding gene was successfully amplified by RT-PCR and cloned into the vector pGEX-1gammaT, and the recombinant plasmid pGEX-Sj14-3-3 was constructded successfully. The molecular mass of the expressed recombinant protein was proximately 40 000 Dolton as detected by SDS-PAGE. The amount of the expressed protein was about 21% of the total bacterial protein. Western blot confirmed that the expressed protein could be recognized by the immune sera from rabbit infected with Schistosoma japonicum. CONCLUSION: The recombinant plasmid pGEX-Sj14-3-3 was successfully constructed. The Sj14-3-3 protein was highly expressed in E. coli and the expressed recombinant protein possessed specific antigenicity.

[Diagnosis of chronic schistosomiasis japonicum with the recombinant Sj26GST-Sj32 fusion protein by ELISA].

OBJECTIVE: To study the feasibility of rSj26GST-Sj32-IgG-ELISA for diagnosis of chronic schistosomiasis japonicum. METHODS: The Escherichia coli BL21 (DE3) with recombinant plasmid pET32alphaSj26GST-Sj32 were induced with isopropy-beta-D-thiogalactopyranosid (IPTG), and the expression product was analyzed by SDS-PAGE and purified by Ni-NTA kits. Schistosoma japonicum (Sj) adult worm antigen(SjAWA) was produced by routine method. The IgG antibodies were detected with the sera of chronic schistosomiasis japonicum by ELISA using recombinant Sj26GST-Sj32 (rSj26GST-Sj32) fusion protein and SjAWA, while the controls included the sera of patients with clonorchiasis, paragonimiasis westermani, alveolar echinococcosis, cystic echinococcosis, hepatitis B, pulmonary tuberculosis and healthy people. RESULTS: The sensitivity and specificity of rSj26GST-Sj32 fusion protein were 95.00% (38/40) and 97.67% (42/43) respectively, they were 92.50% (37/40) and 97.67% (42/43) respectively in SjAWA groups. There were no difference in sensitivity and specificity between rSj26GST-Sj32 and SjAWA (P > 0.05). There were different cross reactions in clonorchiasis sinensis and paragonimiasis westermani between the two methods. The cross reaction with SjAWA was 20.00% (2/10) in patients with alveolar echinococcosis, but no cross reaction with rSj26GST-Sj32 (P > 0.05). CONCLUSION: rSj26-Sj32-IgG-ELISA probably could be applied to immunodiagnosis for chronic schistosomiasis japonicum.

[Detection of specific IgG in the sera of patients with chronic schistosomiasis japonica by dot-ELISA with the recombinant Sj26-Sj32 fusion protein].

OBJECTIVE: To study the diagnostic value of the Dot ELISA with rSj26-Sj32 fusion protein for chronic schistosomiasis japonica. METHODS: rSj26-Sj32 fusion protein and SjAWA were used to establish the HRP-IgG-Dot-ELISA. Serum samples from patients with chronic schistosomiasis japonica (40 cases), clonorchiasis sinensis (21 cases), paragonimiasis westermani(13 cases), alveolar echinococcosis (10 cases), cystic echinococcosis(9 cases), hepatitis B(20 cases), pulmonary tuberculosis (20 cases) and healthy persons (43 cases) were examined. RESULTS: Sensitivity and specificity were respectively 92.5% (37/40) and 95.4% (41/43) for rSj26-Sj32-Dot-ELISA and 95.0% (38/40) and 93.0% (40/43) for SjAWA-Dot-ELISA, and there was no significant difference between two antigens (P > 0.05). There were different cross reactions to the sera of patients with clonorchiasis sinensis, paragonimiasis westermani or alveolar echinococcosis, but no cross reaction to the sera of patients with cystic echinococcosis, hepatitis B or pulmonary tuberculosis. The positive and negative predictive value and efficiency of diagnosis of rSj26-Sj32-Dot-ELISA for chronic schistosomiasis japonica were 84.1% (37/44), 97.7% (129/132), and 94.3% (166/176), respectively, and those of SjAWA-Dot-ELISA were 77.6% (38/49), 98.4% (125/127), and 92.6% (163/176), respectively. There was no significant difference between the two methods (P > 0.05). CONCLUSION: rSi26-Si32 fusion protein can be applied to immunodiagnosis for chronic schistosomiasis japonica.

[Study on diagnosis of chronic schistosomiasis japonicum with rSj26-Sj32 fusion protein].

AIM: To study whether rSj26-Sj32 fusion protein can be used for diagnosis of chronic schistosomiasis japonicum. METHODS: ELISA, Dot-ELISA and dipstick were performed to detect the IgG in the sera of patients with chronic schistosomiasis japonicum using the antigens of rSj26-Sj32 fusion protein and SjAWA. The control sera were taken from health donors and the patients with clonorchiasis sinensis, paragonimiasis westermani, alveolar echinococcosis and cystic echinococcosis. RESULTS: The sensitivity of the three methods was 95.00%, 92.50% and 92.50% respectively, whereas the specificity of the three methods was 97.67%, 95.35% and 97.67%, respectively. CONCLUSION: The rSj26-Sj32 fusion protein has therapeutic potential for immunodiagnosis of chronic schistosomiasis japonicum.