scholarly journals Risk Factors for Cerebral Aneurysm Rupture in Mongolia

2021 ◽  
Author(s):  
Matthias Bechstein ◽  
Amarjargal Gansukh ◽  
Boldbat Regzengombo ◽  
Oyun Byambajav ◽  
Lukas Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical History ◽  
Cerebral Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Imaging Modality ◽  
Treatment Options ◽  
Time Estimation ◽  
Developed Countries ◽  
Aneurysm Rupture ◽  
Risk Of Rupture

Abstract Purpose Identification of country-specific demographic, medical, lifestyle, and geoenvironmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. First-time estimation of the crude national incidence of aneurysmal subarachnoid hemorrhage (aSAH). Methods A retrospective analysis of all intracranial digital subtraction angiographies (DSA) acquired in Mongolia during the 2‑year period 2016–2017 (1714 examinations) was performed. During this period, DSA was used as primary diagnostic imaging modality for acute severe neurological symptoms in the sole hospital nationwide dedicated to neurological patients. The catchment area of the hospital included the whole country. Patients with incidental and ruptured aneurysms were reviewed with respect to their medical history and living conditions. The data was used to install a Mongolian aneurysm registry. Results The estimated annual crude incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied for the Mongolian population: A medical history of hypertension, smoking or the presence of multiple aneurysms led to a higher relative risk of rupture. In contrast, female gender was not associated with a higher risk in this national cohort. Males pursuing a traditional nomadic living may exhibit a specifically high risk of rupture. Conclusion Disease management of over 200 individuals/year with aSAH constitutes a socioeconomic burden in Mongolia. Efforts to raise awareness of the risk factors hypertension and smoking among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options are currently under consideration.

Developmental Hip Dysplasia

2019 ◽  
pp. 297-300
Author(s):  
Dorothy L. Gilbertson-Dahdal
Keyword(s):  
Risk Factors ◽  
Problem Solving ◽  
Imaging Modality ◽  
Treatment Options ◽  
Hip Dislocation ◽  
Clinical Findings ◽  
Developmental Dysplasia ◽  
Developmental Hip Dysplasia ◽  
Hormonal Factors ◽  
Dysplasia Of The Hip

Chapter 112 focuses on developmental dysplasia of the hip, which includes a spectrum of abnormalities ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Pathophysiology, clinical findings, and screening studies are explored. The pathophysiology is multifactorial including mechanical, genetic and hormonal factors. Imaging strategies, findings, and treatment options are also discussed. Screening US, which is the imaging modality of choice, is performed on infants with predisposing risk factors. Outcome is quite variable with many cases resolving spontaneously without treatment whereas others stabilize with acetabular dysplasia. Treatment options include immobilization and surgery. MRI is used for problem solving in postoperative patients.

scholarly journals Inflammation in Murine Aneurysm Healing: The Role of CXCL1

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Devan Patel ◽  
Kartik Motwani ◽  
Koji Hosaka ◽  
Brian L Hoh
Keyword(s):  
Data Collection ◽  
Cerebral Aneurysm ◽  
Treatment Options ◽  
Neutralizing Antibody ◽  
Neutrophil Infiltration ◽  
Flow Chamber ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
The Right

Abstract INTRODUCTION Cerebral aneurysm rupture results in subarachnoid hemorrhage which has a mortality of up to 40%. Current prophylactic treatment options include surgical clipping, flow diversion, and endovascular coiling. A significant drawback of coiling is that up to 20% of aneurysms recur and require retreatment due to insufficient fibrotic healing. Thus, it is crucial to develop more effective treatments. As inflammation appears to be critical in cerebral aneurysm pathophysiology, it is necessary to investigate aneurysm healing in the context of key inflammatory mediators. Using a novel in Vitro flow chamber model, we found increased expression of CXCL1, a neutrophil chemoattractant, at arterial bifurcations and in aneurysms. We hypothesized that CXCL1 is a key mediator in aneurysm healing. METHODS Using our murine aneurysm healing model, aneurysms were created in the right common carotid artery of female C57BL/6 mice using elastase. Three weeks later, aneurysms were implanted with either poly (lactic-co-glycolic acid) (PLGA) + CXCL1—coated coils or PLGA only—coated coils. Three weeks after coil implantation, aneurysms were harvested for data collection. In a subsequent experiment, the same aneurysm model was used but all mice were coiled with PLGA-coated coils. Animals were randomly assigned to receive intraperitoneal injections of either CXCL1 neutralizing antibody or IgG control. Three weeks after coiling, aneurysms were harvested for data collection. RESULTS Animals treated with PLGA + CXCL1—coated coils had significantly decreased aneurysm healing than those treated with PLGA only—coated coils (21.8% vs 39.8%, P = .048). Animals treated with CXCL1 neutralizing antibody had significantly increased aneurysm healing compared to IgG control (63.8% vs 42.4%, P = .00012). CXCL1 neutralizing antibody also decreased neutrophil infiltration into the aneurysm compared to IgG control (2.0 cells/hpf vs 5.4 cells/hpf, P = .03). CONCLUSION Our findings suggest CXCL1 decreases murine aneurysm healing after coil implantation. Therapeutic intervention with CXCL1 neutralizing antibody appears to increase aneurysm healing by decreasing neutrophil infiltration.

Abstract WP94: Emphysema: A Potential Risk Factor for Ruptured Cerebral and Aortic Aneurysms

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ali Mahta ◽  
Alexander E Merkler ◽  
Michael E Reznik ◽  
Hooman Kamel
Keyword(s):  
Risk Factors ◽  
Aortic Aneurysm ◽  
Cox Regression ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Predictor Variable ◽  
Incidence Rates ◽  
Aneurysm Rupture ◽  
Aortic Aneurysms ◽  
Ruptured Aortic Aneurysm ◽  
Increased Risk

Background: Whether emphysema is associated with the development and rupture of cerebral and abdominal aortic aneurysms is unclear. Methods and Materials: We performed a retrospective cohort study using outpatient and impatient claims data from a nationally representative 5% sample of Medicare beneficiaries > 66 years of age. Our predictor variable was emphysema and our outcome was a hospitalization for aneurysmal subarachnoid hemorrhage (SAH) or ruptured aortic aneurysm. All predictors and outcomes were defined using previously reported International Classification of Diseases, 9 th Revision, Clinical Modification ( ICD-9-CM ) diagnosis code algorithms. Survival statistics were used to calculate incidence rates and Cox regression was used to measure the association between emphysema and outcomes while adjusting for demographics and previously reported risk factors for aneurysm rupture: hypertension, diabetes, and tobacco and alcohol use. Results: We identified 133,337 patients with emphysema and 1,484,760 patients without emphysema. Over a mean follow-up period of 4.3 (+/-1.9) years, we identified 5,396 cases of aneurysm rupture, 477 of which occurred in patients with emphysema. The annual incidence of aneurysm rupture was 159 (95% confidence interval [CI], 146-174) per 100,000 in patients with emphysema and 74 (95% CI, 72-76) per 100,000 in patients without emphysema. After adjusting for demographics and other risk factors, emphysema was independently associated with aneurysm rupture (hazard ratio [HR], 1.6; 95% CI, 1.4-1.8). In secondary analyses, emphysema was associated with both aneurysmal SAH (HR, 1.4; 95% CI, 1.2-1.6) and ruptured aortic aneurysm (HR, 2.1; 95% CI, 1.7-2.5). Conclusion: Patients with emphysema faced an increased risk of developing SAH and aortic aneurysm rupture. This finding is consistent with the hypothesis that protease/anti-protease imbalance, which is seen in emphysema, may play a role in vessel wall weakening and the development and rupture of aneurysms.

scholarly journals Today and Future of Age-Related Macular Degeneration

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Kang Liu ◽  
Bolin Xie
Keyword(s):  
Risk Factors ◽  
Macular Degeneration ◽  
Effective Treatment ◽  
Treatment Options ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Age Related ◽  
New Directions ◽  
Genetic Mechanisms

Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 in developed countries. Understanding of the pathologic process, genetic mechanisms, and risk factors of this disease has the benefit of seeking newer and more effective treatment options. Current clinical therapy for AMD shows a dramatic change from a decade ago. Anti-VEGF drug therapy is regarded as the more effective treatment for neovascular AMD now, especially combining PDT therapy. In the future, the genetic and biochemical therapies may be the promising treatments for AMD. This paper will focus on the progress of pathology, candidate genes of AMD, risk factors, and the existing drugs or surgical therapies available, in order to present some new directions of care with the prospect of improved vision in many patients suffered from AMD.

Risk Factors for Acute Subdural Hematoma From Intracranial Aneurysm Rupture

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 264-269 ◽  
Author(s):  
J. Matthijs Biesbroek ◽  
Gabriel J.E. Rinkel ◽  
Ale Algra ◽  
Jan Willem Berkelbach van der Sprenkel
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysm ◽  
Subdural Hematoma ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Rare Complication ◽  
Aneurysm Rupture ◽  
Posterior Communicating Artery ◽  
Acute Subdural Hematoma ◽  
Vertebral Aneurysm ◽  
Risk Ratios

Abstract BACKGROUND: An acute subdural hematoma (aSDH) is a rare complication of aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor clinical condition on admission and poor outcome. Risk factors for the development of an aSDH from aneurysmal rupture are unknown and may help our understanding of how an aSDH develops. OBJECTIVE: To identify risk factors for the development of an aSDH from intracranial aneurysm rupture. METHODS: Patients were selected from our prospectively collected single-center SAH database. From all 1757 patients fulfilling prespecified inclusion criteria, 63 had an aSDH. We assessed sex, age, smoking, hypertension, history of SAH, sentinel headache, location of the ruptured aneurysm, and intracerebral hemorrhage (ICH) as risk factors for an aSDH. Univariable and multivariable risk ratios with corresponding 95% confidence intervals (CIs) were calculated for characteristics with Poisson regression. RESULTS: Multivariable risk ratios were 1.021 (95% CI: 1.001-1.042) for each year increase in age, 2.3 (95% CI: 1.3-3.8) for posterior communicating artery aneurysms, 3.0 (95% CI: 1.5-6.0) for sentinel headache, and 5.2 (95% CI: 3.1-8.9) for ICH. None of the 95 patients (0%; 95% CI: 0%-3.8%) with a ruptured vertebrobasilar aneurysm had an aSDH, which was statistically significantly lower than at other sites (P = .02 for basilar aneurysm; P = .04 for vertebral aneurysm). None of the other studied characteristics had a statistically significant association with an aSDH. CONCLUSION: Increasing age, sentinel headache, ICH, and aneurysms at the posterior communicating artery are independent risk factors for an aSDH. Patients with a basilar or vertebral aneurysm have a low risk of an aSDH.

Abstract 2731: CFD Reveals Hemodynamic Differences Between Unruptured And Ruptured Intracranial Aneurysms During Observation

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Hiroyuki Takao ◽  
Yuichi Murayama ◽  
Toshihiro Ishibashi ◽  
Ichiro Yuki ◽  
Shinobu Otsuka ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Significant Risk ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Medium Size ◽  
Hemodynamic Parameters ◽  
Natural Risk ◽  
Risk Of Rupture ◽  
Significant Difference

Background and Purpose: Although various studies have been performed, the mechanism leading to the rupture of cerebral aneurysms has not yet been elucidated. Accurate assessment of cerebral aneurysm rupture risk is important because current treatments carry a small but significant risk that can exceed the small natural risk of rupture. Various hemodynamic parameters have been proposed for estimating the risk of rupture of cerebral aneurysms, with limited success. We evaluated several hemodynamic parameters to predict rupture in a dataset of initially unruptured aneurysms in which some aneurysms ruptured during follow-up observation. Methods: Geometry of the aneurysm and blood vessels was extracted from CTA images and analyzed using a mathematical formula for fluid flow under pulsatile blood flow conditions. Fifty side-wall internal carotid posterior communicating artery (ICA-pcom) aneurysms and fifty middle cerebral artery (MCA) bifurcation aneurysms of medium size were investigated for Energy loss (EL), Pressure Loss Coefficient (PLC), wall-shear-stress (WSS) and oscillatory shear index (OSI). During a follow-up observation period, 6 ICA-pcom and 7 MCA aneurysms ruptured (44 and 43 remained unruptured, respectively, with the same location and a similar size as the ruptured cases). Results: A significant difference in the minimum WSS between aneurysms that ruptured and those that remained unruptured was noted only in ICA aneurysms (P<0.001). EL showed higher tendency in ruptured aneurysms but statistically not significant. For PLC, a significant difference was noted in both ICA (P<0.001) and MCA (P<0.001) aneurysms. All other parameters did not show significant differences between the two groups. Conclusion: A significant difference was noted in WSSMIN only in ICA aneurysms. For PLC, a significant difference was noted in both ICA and MCA aneurysms, suggesting that PLC may be one, out of possibly other useful parameters to predict cerebral aneurysm rupture.

P3708Prognostic significance of electrocardiographic changes after subarachnoid hemorrhage

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yuba ◽  
Y Kimura ◽  
T Mukaida ◽  
T Aoyama ◽  
H Hirano ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Glasgow Coma Scale ◽  
Cerebral Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Qt Prolongation ◽  
Autonomic Nerve ◽  
World Federation ◽  
Coma Scale ◽  
Traumatic Subarachnoid Hemorrhage

Abstract Background and purpose Many reports have examined electrocardiographic (ECG) changes after subarachnoid hemorrhage from long ago; however, there are few reports on the prognosis of patients who have an ECG abnormality. Therefore, in this study, the prognoses of patients with subarachnoid hemorrhage showing abnormal ECG findings were retrospectively analyzed. Methods Over 30 months from January 2014 to June 2016, 199 patients (mean age, 61.1±17.0 years; 46.7% male) admitted with a subarachnoid hemorrhage (SAH) were enrolled. To assess the mechanism underlying abnormal ECG in the SAH, predictor variables, such as demographics (age, sex, and body surface area), hemodynamics (heart rate and systolic blood pressure), blood biochemical results, neurological assessments (Glasgow Coma Scale), and computed tomography (CT) severity classification (World Federation of Neurosurgical Societies classification) were recorded. The subarachnoid hemorrhage was classified into either the cerebral aneurysm rupture group (N=132) or traumatic subarachnoid hemorrhage group (N=67) and analyzed. Results In the cerebral aneurysm rupture group, the QT prolongation was significantly increased compared with the traumatic subarachnoid hemorrhage group (424.8±87.7 ms vs. 400.5±95.8 ms, P<0.05). There was a correlation between consciousness level (Glasgow Coma Scale) on admission and QT prolongation, and significant QT prolongation was observed in critical patients (Pearson's correlation coefficient test P=0.04). ST changes correlated with CT classification severity (WFNS classification), and the most severe group (WFNS Grade 5) showed significant ST changes. On admission, the cerebral aneurysm rupture group and 97.0% in the traumatic subarachnoid hemorrhage group. Conclusions Significantly prolonged QT and ST changes are noted in patients with severe aneurysmal subarachnoid hemorrhage. The cause of the ECG abnormality in subarachnoid hemorrhage patients is not yet understood. A small number of experimental animal models have shown that electrocardiogram abnormalities associated with subarachnoid hemorrhage develop in the brain stem, and an autonomic nerve abnormality may also be involved. A D-dimer is positively correlated with both aneurysm trauma and traumatic subarachnoid hemorrhage and may be used for auxiliary diagnosis of a subarachnoid hemorrhage.

scholarly journals NAFLD-Related Hepatocarcinoma: The Malignant Side of Metabolic Syndrome

Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 2034
Author(s):  
Anna Michelotti ◽  
Marco de Scordilli ◽  
Lorenza Palmero ◽  
Michela Guardascione ◽  
Mario Masala ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Trials ◽  
Fatty Liver Disease ◽  
Treatment Options ◽  
Developed Countries ◽  
Molecular Pathways ◽  
Alcoholic Fatty Liver ◽  
Common Cancer ◽  
Alcoholic Fatty Liver Disease ◽  
Related Mortality

Hepatocellular carcinoma (HCC) is the seventh most common cancer worldwide and the second leading cause of cancer-related mortality. HCC typically arises within a cirrhotic liver, but in about 20% of cases occurs in absence of cirrhosis. Among non-cirrhotic risk factors, non-alcoholic fatty liver disease (NAFLD) currently represents the most important emerging cause of HCC in developed countries. It has been estimated that annual incidence of HCC among patients with non-cirrhotic NAFLD is approximately 0.1–1.3 per 1000 patients/year and ranges from 0.5% to 2.6% among patients with non-alcoholic steatohepatitis (NASH) cirrhosis. However, only a few clinical trials enrolling HCC patients actually distinguished NAFLD/NASH-related cases from other non-cirrhotic causes and therefore evidence is still lacking in this subset of patients. This review aims to describe the biology underpinning NAFLD development, to investigate the main molecular pathways involved in its progression to NASH and HCC and to describe how different pathogenetic mechanisms underlying the onset of HCC can have an impact in clinical practice. We hereby also provide an overview of current HCC treatment options, with a particular focus on the available data on NAFLD-related cases in practice-changing clinical trials.

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