Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury - A Meta-Analysis of Randomized Controlled Trials.

Background: Traumatic brain injury (TBI) is a serious medical condition that often leads to significant morbidity and mortality. Decompressive craniectomy (DC) is now widely recognized as a primary or secondary treatment option for managing intracranial pressure (ICP) in patients with severe TBI. However, there is a lack of clarity in reviews regarding the impact of DC on TBI outcomes. Objectives: The aim of this study is to evaluate the effectiveness of DC in terms of overall mortality and long-term prognosis among patients with TBI. Materials and Methods: We conducted a systematic search of four common databases to include all parallel-arm randomized controlled trials (RCTs). We selected studies that reported outcomes for TBI cases, with DC as a treatment option. The outcomes examined included reduction in mortality, ICP levels, and the proportion of patients with a Glasgow Outcome Scale score >4. Results: Our review finally included eight RCTs [n = 1458, with 749 and 709 patients in the DC and control groups, respectively]. The weighted mean difference for ICP was estimated at -4.01 (95% Confidence interval [CI]: -5.31--2.71), indicating a statistically significant reduction in ICP levels in the DC group compared to the control group. The pooled risk ratio was 0.67 (95% CI: 0.51-0.89), suggesting a statistically significant 31% decrease in mortality levels in the DC group. Subgroup and sensitivity analyzes were also conducted to address heterogeneity. Discussion and Conclusion: In conclusion, based on our meta-analysis, we find that DC can be considered a crucial surgical intervention for reducing mortality among patients with TBI when compared to control groups.

Hsa_circ_0031608: A Potential Modulator of VSMC Phenotype in the Rupture of Intracranial Aneurysms.

Background and Purpose: Phenotypic modulation of vascular smooth muscle cells (VSMCs) plays an important role in the development of intracranial aneurysms (IAs). Growing evidence has demonstrated that circular RNAs (circRNAs) may serve as a potential modulator of VSMC phenotype in various vascular diseases. This study aimed to assess the potential function of circRNAs in the rupture of IAs and VSMC phenotypic modulation. Methods: Using surgically dissected human ruptured (n = 8) and unruptured (n = 8) IA lesions, differentially expressed circRNAs were screened by transcriptomic sequencing and verified using qRT-PCR. Based on the screened circRNA, we predicted and screened the combined miRNA and downstream mRNAs to construct circRNA-miRNA-mRNA networks. Further in vitro experiments were performed to investigate the relationship between the validated circRNA and the phenotypic switching of VSMCs. Results: We found 1,373 differentially expressed genes in ruptured versus unruptured aneurysms. The top five dysregulated circRNAs were selected for qRT-PCR validation. We found hsa_circ_0031608 was both highly expressed in ruptured IAs and pro-inflammatory transformation of VSMCs. Then, a regulatory circRNA-miRNA-mRNA with one circRNA node, six miRNA nodes, and 84 mRNA nodes was constructed. GO analysis and KEGG pathway enrichment analysis were performed on mRNAs in the network. Then, a PPI network was built based on these mRNAs and five hub genes were identified (FOXO3, DICER1, CCND2, IGF1R, and TNRC6B) by the cytoHubba plugin in Cytoscape software. In vitro, overexpression of hsa_circ_0031608 influenced the expression of VSMC phenotypic markers validated by qPCR and Western blotting. Furthermore, hsa_circ_0031608 promoted the migration and proliferation capacity of VSMCs. Conclusion: hsa_circ_0031608 regulated the phenotypic modulation of VSMCs and played an important role in the rupture of IAs. The specific mechanism should be further studied and confirmed.

Different Scores Predict the Value of Hemorrhagic Transformation after Intravenous Thrombolysis in Patients with Acute Ischemic Stroke.

OBJECTIVE: To evaluate the value of the Alberta stroke project early CT score (ASPECTS), DRAGON score, SEDAN score, and HAT score in predicting hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS). METHODS: The clinical data of 248 AIS patients treated with intravenous thrombolysis in our hospital from December 2017 to December 2019 were analyzed. According to the prognosis, all patients were divided into the non-HT group (n = 200) and the HT group (n = 48). Univariate analysis and multivariate logistic regression models were used to analyze clinical data to determine the influencing factors of HT after intravenous thrombolysis in AIS patients. The receiver operating characteristic curve was used to evaluate the ASPECTS, DRAGON, SEDAN, and HAT scores to the value of predicting HT after intravenous thrombolysis in AIS patients. RESULTS: The lower the ASPECTS score and the higher the DRAGON, SEDAN, and HAT scores, the higher the incidence of HT after intravenous thrombolysis in AIS patients (P < 0.05). The results of multivariate logistic regression analysis showed that the patient's age, atrial fibrillation, baseline NIHSS score, early signs of infarction on admission with head CT, time from onset to thrombolytic therapy, and thrombolytic drugs were all independent factors affecting intravenous thrombolysis in AIS patients (P < 0.05). The area under the curve (AUC) of the predictive value of ASPECTS for HT is 0.895 (95% CI 0.813-0.977). When the optimal cutoff value is 0.607, the sensitivity is 100% and the specificity is 60.7%. The AUC of the predictive value of DRAGON for HT is 0.877 (95% CI 0.790-0.964). When the optimal cutoff value is 0.665, the sensitivity is 84.4% and the specificity is 82.1%. The AUC of the predictive value of SEDAN for HT is 0.764 (95% CI 0.638-0.890). When the optimal cutoff value is 0.474, the sensitivity is 78.6% and the specificity is 68.8%. The AUC of the predictive value of HAT for HT is 0.777 (95% CI 0.651-0.903). When the optimal cutoff value is 0.509, the sensitivity is 68.8% and the specificity is 82.1%. CONCLUSION: The lower the ASPECTS score and the higher the DRAGON, SEDAN, and HAT scores, the higher the incidence of HT in AIS patients. The patient's age, atrial fibrillation, baseline NIHSS score, early signs of infarction on admission with head CT, time from onset to thrombolytic therapy, and thrombolytic drugs are all independent factors affecting HT in AIS patients. The scores of ASPECTS, DRAGON, SEDAN and HAT have certain value in predicting HT after intravenous thrombolysis in AIS patients, and the predicted value of ASPECTS score is the best.

Long Noncoding RNA SNHG14 Promotes Ischemic Brain Injury via Regulating miR-199b/AQP4 Axis.

BACKGROUND: Ischemic stroke is the leading cause of disability worldwide. Long noncoding RNAs (lncRNAs) play important roles in the pathogenesis of cerebral ischemia. This study aimed to investigate the role and mechanism of lncRNA small nucleolar RNA host gene 14 (SNHG14) in ischemic brain injury. METHODS: Cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) in mice. The expression of SNHG14 in MCAO mouse model was detected by quantitative real-time PCR (qRT-PCR). The levels of SNHG14, microRNA-199b (miR-199b) and aquaporin 4 (AQP4) in oxygen-glucose deprivation (OGD)-stimulated BV2 cells were determined by qRT-PCR or western blot assay. Cell proliferation and apoptosis were assessed by Cell Counting Kit-8 (CCK-8) assay and flow cytometry. The levels of pro-inflammatory cytokines were measured by enzyme-linked immunosorbent assay (ELISA). The levels of oxidative stress markers were examined using commercial kits. The relationships among SNHG14, miR-199b and AQP4 were confirmed by dual-luciferase reporter assay, RNA immunoprecipitation assay and RNA pull-down assay. RESULTS: SNHG14 was up-regulated in MCAO mouse model. Depletion of SNHG14 lessened cerebral ischemia in MCAO mouse model. SNHG14 silencing inhibited inflammation and oxidative stress in OGD-exposed BV2 cells. MiR-199b level was decreased, while AQP4 level was increased in OGD-treated BV2 cells. Knockdown of miR-199b reversed the effect of SNHG14 knockdown on ischemic damage in OGD-stimulated BV2 cells. Moreover, AQP4 overexpression abolished the effect of miR-199b on ischemic injury in OGD-treated BV2 cells. Furthermore, SNHG14 indirectly regulate AQP4 expression by sponging miR-199b. CONCLUSIONS: Knockdown of SNHG14 attenuated ischemic brain injury by inhibiting inflammation and oxidative stress through the miR-199b/AQP4 axis.

Feasibility and midterm outcomes of endovascular embolization for true posterior communicating artery aneurysms.

PURPOSE: Endovascular treatment (EVT) of true posterior communicating artery (PcomA) aneurysms has been rarely reported. This study reports the outcomes on a single-center cohort with true PcomA aneurysms who underwent EVT. METHODS: Between June 2011 and June 2017, clinical data from 42 patients with 43 true PcomA aneurysms who underwent EVT were retrieved from a prospectively maintained single-center database. Endovascular techniques, perioperative complications, clinical outcomes, and angiographic results were retrospectively evaluated. RESULTS: All aneurysms were treated successfully. Treatment modalities included simple coiling in 30 aneurysms, balloon-assisted coiling in two, and stent-assisted coiling in 11 cases. Immediate angiograms showed complete occlusion in 23 aneurysms (53.5%), residual neck in 8 cases (18.6%), and residual sac in 12 (27.9%). No procedure-related complications or mortality were observed. Of the 34 aneurysms that underwent angiographic follow-up at an average duration of 7.1 months post-procedure, complete occlusion was achieved in 22 (64.7%), neck remnant in eight (23.5%), and residual sac in four (11.8%) aneurysms, respectively. Six aneurysms (18.2%) that underwent conventional coiling developed recanalization and required retreatment. Seven cases that received stent-assisted coiling did not develop recurrence. Clinical follow-up (mean, 24.3 months) of all patients demonstrated no neurologic deterioration or (re)bleeding. CONCLUSION: EVT of the true PcomA aneurysm is a safe and feasible procedure but may be associated with recurrence in midterm follow-up, requiring close surveillance and potential retreatment.

Long-term changes in the personality and psychopathological profile of opiate addicts after nucleus accumbens ablative surgery are associated with treatment outcome.

OBJECTIVE: To investigate the long-term outcome and changes of the personality and psychopathological profile of opiate addicts after bilateral stereotactic nucleus accumbens (NAc) ablative surgery. METHODS: 60 patients were followed up for 5 years and abstinent status and adverse events were evaluated. NAc lesion volumes and locations were obtained by postoperative MRI scans. The Chinese version of the Eysenck Personality Questionnaire (EPQ-RSC), the Symptom Checklist-90-Revised (SCL-90-R), the Beck Depression Inventory (BDI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the World Health Organization's Quality of Life Questionnaire - Brief Version (WHOQOL-BREF) were administered to the patients before and 5 years after the stereotactic surgery. RESULTS: The total abstinence rate of all patients in their 5th postoperative year was 47.4%. The abstinent patients had a significantly larger lesion volume than the relapsed ones, but a larger lesion volume also increased the risk of adverse events. 5 years after surgery, the abstinent patients showed significant decreases on the Psychoticism (EPQ-P) and Neuroticism (EPQ-N) scores by EPQ-RSC, a significant decline on the Global Severity Index and the subscores in all 10 dimensions by SCL-90-R, significant decreases on the BDI and Y-BOCS scores, and significant improvements on the scores of all domains by WHOQOL-BREF, while for the relapsed patients, only the subscores of obsessive-compulsive by SCL-90-R and the Y-BOCS scores significantly decreased. Postoperative analysis revealed that the abstinent patients had a significantly better score than the relapsed ones by various instruments, and NAc lesion volumes and locations did not correlate with the outcome of any of these instruments. CONCLUSION: The bilateral ablation of NAc by stereotactic neurosurgery was a feasible method for alleviating psychological dependence on opiate drugs and preventing a relapse. Long-term follow-up suggested that surgery can improve the personality and psychopathological profile of opiate addicts with a trend towards normal levels, provided persistent abstinence can be maintained; relapse, on the other hand, may ruin this effect.

Dopamine depletion increases the power and coherence of high-voltage spindles in the globus pallidus and motor cortex of freely moving rats.

Studies on patients with Parkinson's disease and in animal models have observed enhanced synchronization of oscillations in several frequency bands within and between the cortical-basal ganglia (BG) structures. Recent research has also shown that synchronization of high-voltage spindles (HVSs) in the cortex, striatum and substantia nigra pars reticulate is increased by dopamine depletion. However, more evidence is needed to determine whether HVS activity in the whole cortex-BG network represents homologous alteration following dopamine depletion. As the globus pallidus (GP) is in a central position to propagate and synchronize oscillations in the cortical-BG circuits, we employed local-field potentials and electrocorticogram to simultaneously record oscillations in the GP and primary (M1) and secondary (M2) motor cortices on freely moving 6-hydroxydopamine (6-OHDA) lesioned and control rats. Results showed that HVS episodes recorded from GP, and M2 and M1 cortex areas were more numerous and longer in 6-OHDA lesioned rats compared to controls. Relative power associated with HVS activity in the GP, and M2 and M1 cortices of 6-OHDA lesioned rats was significantly greater than that for control rats. Coherence values for HVS activity between the GP, and M2 and M1 cortex areas were significantly increased by dopamine depletion. Time lag between the M1 cortex HVS and GP HVS was significantly shorter for dopamine depleted than normal rats. Findings indicate a crucial rule for dopamine in the regulation of HVS activity in the whole cortical-BG circuit, and suggest a close relationship between abnormally synchronized HVS oscillations in the cortex-BG network and Parkinson's disease.