Background: Delayed cerebral ischemia (DCI) is the main cause of death and disability after intracranial aneurysm rupture. Previous studies have shown that smoking can lead to DCI after intracranial aneurysm rupture. However, some recent studies have shown that nicotine, as the main ingredient of tobacco, can cause cerebral vasodilation. This view has led to a debate about the relationship between smoking and DCI. This study aims to determine the relationship between smoking and DCI.Methods: A systematic literature search was performed according to PRISMA guidelines. The Cochrane Library, Web of Science, PubMed, and Embase online databases were searched for studies published up to September 2020. All studies related to smoking and DCI were included in the analysis. The R and RevMan software were used for data analysis, and random or fixed model analysis was selected depending on the degree of heterogeneity. Publication bias was examined by using the Begg–Mazumdar test and using contour-enhanced funnel plots with trim method.Results: A total of eight original articles (12 cohorts) with 10,722 patients were included in this meta-analysis. There were statistically significant higher rates of DCI in the smoking group than in the non-smoking group (RRtotal = 1.16, 95%CI: 1.05–1.27). After heterogeneity among cohorts was removed by sensitivity analysis, there was still a statistically significant difference in the incidence of DCI between the smoking and non-smoking groups (RRtotal = 1.13, 95%CI: 1.07–1.20).Conclusions: Although the effects of nicotine as the main component of tobacco are unclear in terms of cerebral vessels, the present study suggests that smoking is a risk factor for DCI in patients with ruptured aneurysm.
Purpose: To explore the influencing factors of volume hemorrhage in ruptured anterior circulation aneurysms, so as to identify the characteristics of anterior circulation aneurysms with high volume of hemorrhage, and to provide advice for clinical diagnosis and treatment for those aneurysms. Methods: We retrospectively reviewed 437 cases of ruptured anterior intracranial aneurysms in our center between the years 2012 and 2017. According to the inclusion criteria, a total of 100 qualified patients were screened out. We collected demographic characteristics, environmental exposure, and admission status of enrolled patients. In addition, morphological parameters and location of aneurysms were also included. The semiautomatic threshold method was used to measure the volume of hemorrhage. According to the results, the patients were divided into the group with high blood volume and low blood volume. Univariate and multivariate logistic regression analyses were used to discover the related factors affecting the bleeding volume. Results: In univariable analysis, pulse pressure ( P = 0.014) showed a significant difference at the P < 0.05 test level. In terms of aneurysm morphology, the irregular shape ( P < 0.001), calcification ( P = 0.001), and flow angle ( P = 0.006) showed significant statistical differences between the two groups at the P < 0.01 level ( P < 0.01). Multivariate logistic regression analysis showed that irregular shape (OR = 5.370 P = 0.002 < 0.05), large flow angle (OR = 1.033 P = 0.016 < 0.05), and calcification (OR = 5.460 P = 0.003 < 0.05) were risk factors for volume of hemorrhage in ruptured anterior circulation aneurysms. The influence of hypertension history was at critical state (OR = 2.877 P = 0.051 > 005). Conclusions: According to our analysis results, intracranial anterior circulation aneurysms with irregular shapes, calcifications, and large flow angle are more dangerous. Aneurysms with these characteristics often have a large amount of hemorrhage, requiring timely treatment in clinical practice.
BackgroundBrain arteriovenous malformation (BAVM) arises as congenital vascular abnormalities with a significant risk for intracerebral hemorrhage (ICH). RNA sequencing technology has been recently used to investigate the mechanism of diseases owing to its ability to identify the gene changes on a transcriptome-wide level. In this study, we aimed to gain insights into the potential mechanism involved in BAVM rupture. MethodsSixty-five BAVM nidus samples were collected among which 28 were ruptured and 37 were un-ruptured. Then next-generation RNA sequencing were performed on all of them to obtain differential expressed genes (DEGs) between these two groups. In addition, bioinformatics analysis was performed to evaluate the involved biological processes and pathways by GO and KEGG analysis. Finally, univariate Cox regression analysis was utilized to obtain the early rupture-prone DEGs. Results: A total of 951 genes were differentially expressed between ruptured and un-ruptured BAVM group, of which 740 genes were up-regulated and 211 genes were down-regulated in ruptured BAVMs. Then bioinformatics analysis showed the biological processes and pathways related to the inflammatory processes and extracellular matrix organization were significantly enriched. Meanwhile, some of down-regulated genes are involved in cell adhesion and genes participating in response to muscle activity, as well as the terms about nervous system development. Finally, one hundred and twenty-five genes, a large number of which were involved in inflammation, were correlated with the early rupture of BAVMs. Conclusions: The up-regulated genes in ruptured BAVM group were involved in inflammatory processes and extracellular matrix organization while some of the down-regulated genes were participating in cell adhesion and myofibril assembly, indicating the role of enhanced inflammation and reduced vessel strength in BAVMs rupture.
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