Streptococcus suis （S. suis） is a Gram-positive, facultatively anaerobic coccus that has been implicated as the cause of a wide range of clinical disease syndromes in swine and other domestic animals. S. suis has al...Streptococcus suis （S. suis） is a Gram-positive, facultatively anaerobic coccus that has been implicated as the cause of a wide range of clinical disease syndromes in swine and other domestic animals. S. suis has also been implicated in disease in humans, especially anaong abattoir workers, swine and pork handlers. Here we report a case of streptococcal toxic shock syndrome（STSS） caused by S. suis in a 59-year-old man. Despite of intensive treatment, the patient died of shock with multiple organ failure 14 h after admission. One bacterial isolate obtained from blood culture was identified to the species level by biochemical tests and serological tests as S. suis serotype 2. Identification was confirmed by PCR amplification of genes encoding 16sRNA of S. suis and the capsule of S. suis serotype 2（cps 23）. Genes encoding virulence factors were also detected. An investigation to identify the source of S. suis revealed that several days before admission the affected man had been handling sick pigs or their meat. Transmission may occur through breaks in the skin of feet with tinea due to that no measures for personal protection was taken. This case should highten awareness of the potential for occupational exposure and human infection with S. suis.展开更多
Background Previous studies on the risk factors and prognosis of acute stroke in pregnancy and puerperium(ASPP)mainly used European and American national healthcare databases,lacking detailed patient-level data and pr...Background Previous studies on the risk factors and prognosis of acute stroke in pregnancy and puerperium(ASPP)mainly used European and American national healthcare databases,lacking detailed patient-level data and precise event timing.Aim(1)To identify the risk factors and prognostic factors for ASPP,(2)to assess the risk of recurrent stroke,particularly during subsequent pregnancies,and(3)to evaluate offspring prognosis.Design This study is a retrospective,observational,nationwide,multicenter research project planned to include 400 ASPP patients from 36 centers across 22 provinces in China,from 2015 to 2024.ASPP is defined as acute ischemic or hemorrhagic stroke during pregnancy or within 6 weeks postpartum,confirmed by neuroimaging.Two matched groups will be included for comparison:400 pregnant/puerperal participants without a stroke history and 400 nonpregnant/puerperal participants with a recent stroke,matched by age and/or stroke etiology.Methods All participants will be followed up through telephone interviews.The initial follow-up is scheduled to take place between December 2024 and February 2025.The follow-up phase will consist of three rounds,each lasting 3 months and conducted every 3 years.Primary outcomes include unfavorable functional outcomes(mRS>2 or EQ-5D index score<0.7)at follow-up for Aim 1,recurrent strokes(neuroimaging-confirmed)for Aim 2,and neonatal asphyxia(Apgar scoring)and future development(ASQ-3)of offspring for Aim 3.Discussion The ASPP study is the first nationwide multicenter study to systematically evaluate the risk factors,prognosis,and risk of recurrent stroke in ASPP patients,particularly during subsequent pregnancies.This research may offer new insights into the long-term impacts of pregnancy-related stroke.展开更多
Background: Ankylosing spondylitis was reported to associate with an increased risk of cerebrovascular diseases. In this article, we aimed to report the first case of ankylosing spondylitis associated with moyamoya di...Background: Ankylosing spondylitis was reported to associate with an increased risk of cerebrovascular diseases. In this article, we aimed to report the first case of ankylosing spondylitis associated with moyamoya disease treated with encephalo-duroarterio-synangiosis. Case presentation: A 9-year-old boy with ankylosing spondylitis appeared a symptom of repeated transient ischemic attacks which performed as left hemiparesis. Magnetic resonance angiography showed a typical finding of left anterior cerebral artery, bilateral middle cerebral arteries and the supraclinoid portion of the right internal carotid artery stenosis with an abnormal vascular network at the base of the brain, diagnosed with moyamoya disease. He received a medication treatment but did not underwent revascularization surgery. After three months, ankylosing spondylitis symptoms got some relief, whereas transient ischemic attacks was more frequency. Due to the bad cerebral blood flow on acetazolamide computed tomography perfusion and poor clinical manifestation, he underwent a right encephalo-duroarterio-synangiosis. Postoperatively, the symptoms of transient ischemic attacks disappeared. Conclusions: We reported the first case of ankylosing spondylitis associated with moyamoya disease. Moyamoya disease could appear in patients with ankylosing spondylitis. Revascularization surgery probably is an effective treatment for preventing preoperative ischemic events recurrence.展开更多
Background Moyamoya disease(MMD)is a rare and complex cerebrovascular disorder characterized by the progressive narrowing of the internal carotid arteries and the formation of compensatory collateral vessels.The etiol...Background Moyamoya disease(MMD)is a rare and complex cerebrovascular disorder characterized by the progressive narrowing of the internal carotid arteries and the formation of compensatory collateral vessels.The etiology of MMD remains enigmatic,making diagnosis and management challenging.The MOYAOMICS project was initiated to investigate the molecular underpinnings of MMD and explore potential diagnostic and therapeutic strategies.Methods The MOYAOMICS project employs a multidisciplinary approach,integrating various omics technologies,including genomics,transcriptomics,proteomics,and metabolomics,to comprehensively examine the molecular signatures associated with MMD pathogenesis.Additionally,we will investigate the potential influence of gut microbiota and brain-gut peptides on MMD development,assessing their suitability as targets for therapeutic strategies and dietary interventions.Radiomics,a specialized field in medical imaging,is utilized to analyze neuroimaging data for early detection and characterization of MMD-related brain changes.Deep learning algorithms are employed to differentiate MMD from other conditions,automating the diagnostic process.We also employ single-cellomics and mass cytometry to precisely study cellular heterogeneity in peripheral blood samples from MMD patients.Conclusions The MOYAOMICS project represents a significant step toward comprehending MMD’s molecular underpinnings.This multidisciplinary approach has the potential to revolutionize early diagnosis,patient stratification,and the development of targeted therapies for MMD.The identification of blood-based biomarkers and the integration of multiple omics data are critical for improving the clinical management of MMD and enhancing patient outcomes for this complex disease.展开更多
Programmed cell death protein-1(PD-1)-mediated immunosuppression has been proposed to contribute to the limited clinical efficacy of chimeric antigen receptor T(CAR-T)cells in solid tumors.We generated PD-1 and T cell...Programmed cell death protein-1(PD-1)-mediated immunosuppression has been proposed to contribute to the limited clinical efficacy of chimeric antigen receptor T(CAR-T)cells in solid tumors.We generated PD-1 and T cell receptor(TCR)deficient mesothelin-specific CAR-T(MPTK-CAR-T)cells using CRISPR-Cas9 technology and evaluated them in a dose-escalation study.A total of 15 patients received one or more infusions of MPTK-CAR-T cells without prior lymphodepletion.No dose-limiting toxicity or unexpected adverse events were observed in any of the 15 patients.The best overall response was stable disease(2/15 patients).Circulating MPTK-CAR-T cells peaked at days 7–14 and became undetectable beyond 1 month.TCR-positive CAR-T cells rather than TCR-negative CAR-T cells were predominantly detected in effusion or peripheral blood from three patients after infusion.We further confirmed the reduced persistence of TCR-deficient CAR-T cells in animal models.Our results establish the preliminary feasibility and safety of CRISPR-engineered CAR-T cells with PD-1 disruption and suggest that the natural TCR plays an important role in the persistence of CAR-T cells when treating solid tumors.展开更多
Background:Surgery is a conventional mature treatment for moyamoya disease(MMD).However,whether surgery is also an effective therapy for epileptic type MMD has seldom been investigated systematically.The study aims to...Background:Surgery is a conventional mature treatment for moyamoya disease(MMD).However,whether surgery is also an effective therapy for epileptic type MMD has seldom been investigated systematically.The study aims to summarize the pooled postoperative incidence of seizure and cerebral infarction in pediatric patients with epileptic type moyamoya disease.Method:The study was a systematic review and critical appraisal with a meta-analysis of cohort studies,both prospective and retrospective.Studies were identified by a computerized search of PubMed,Embase,Web of Science,Wanfang,and CNKI databases.In a literature search,a total of 7 cohort studies were identified.The I2statistic was used to quantify heterogeneity.A fixed-effect model was used to synthesize the results.The linear regression test of funnel plot asymmetry was used to estimate the potential publication bias.Results:The pooled estimated postoperative incidence of seizure in pediatric patients with epileptic type moyamoya disease was 23.44%.The pooled estimated postoperative incidence of cerebral infarction in pediatric patients with epileptic type moyamoya disease was 9.12%.Low substantial heterogeneity and potential publication bias were present.Conclusions:Evidence from this study suggests that the postoperative incidence of seizure and cerebral infarction is relatively low.Surgery is an effective and secure therapy for pediatric patients with epileptic type moyamoya disease.展开更多
Objective The aims of this study are to clarify the long-term outcomes of brainstem arteriovenous malformations(AVMs)after different management modalities.Methods The authors retrospectively reviewed 61 brainstem AVMs...Objective The aims of this study are to clarify the long-term outcomes of brainstem arteriovenous malformations(AVMs)after different management modalities.Methods The authors retrospectively reviewed 61 brainstem AVMs in their institution between 2011 and 2017.The rupture risk was represented by annualised haemorrhagic rate.Patients were divided into five groups:conservation,microsurgery,embolisation,stereotactic radiosurgery(SRS)and embolisation+SRS.Neurofunctional outcomes were evaluated by the modified Rankin Scale(mRS).Subgroup analysis was conducted between different management modalities to compare the long-term outcomes in rupture or unruptured cohorts.Results All of 61 brainstem AVMs(12 unruptured and 49 ruptured)were followed up for an average of 4.5 years.The natural annualised rupture risk was 7.3%,and the natural annualised reruptured risk in the ruptured cohort was 8.9%.13 cases were conservative managed and 48 cases underwent intervention(including 6 microsurgery,12 embolisation,21 SRS and 9 embolisation+SRS).In the selection of interventional indication,diffuse nidus were often suggested conservative management(p=0.004)and nidus involving the midbrain were more likely to be recommended for intervention(p=0.034).The risk of subsequent haemorrhage was significantly increased in partial occlusion compared with complete occlusion and conservative management(p<0.001,p=0.036,respectively).In the subgroup analysis,the follow-up mRS scores of different management modalities were similar whether in the rupture cohort(p=0.064)or the unruptured cohort(p=0.391),as well as the haemorrhage-free survival(p=0.145).In the adjusted Bonferroni correction analysis of the ruptured cohort,microsurgery and SRS could significantly improve the obliteration rate compared with conservation(p<0.001,p=0.001,respectively)and SRS may have positive effect on avoiding new-onset neurofunctional deficit compared with microsurgery and embolisation(p=0.003,p=0.003,respectively).Conclusions Intervention has similar neurofunctional outcomes as conservation in these brainstem AVM cohorts.If intervention is adopted,partial obliteration should be avoided because of the high subsequent rupture risk.展开更多
background Evidence on the natural angiographic course of moyamoya disease(MMD)is lacking.It takes about 6 months for waiting for revascularisation surgery.The issue of when to perform subtraction angiography(DSA)for ...background Evidence on the natural angiographic course of moyamoya disease(MMD)is lacking.It takes about 6 months for waiting for revascularisation surgery.The issue of when to perform subtraction angiography(DSA)for follow-up remains unclear.We investigated the natural course of MMD by DSA and attempted to determine the best interval to perform the follow-up DSA.Methods This is a single-centre cohort study of Chinese MMD inpatients treated from 1 January 2015 to 31 August 2019.Their angiographic findings were evaluated on Suzuki stage and collateral circulation between two follow-ups of the same hemisphere.results A total of 110 patients who met the criteria were enrolled in this study.After a median 6 months follow-up,five patients(4.5%)had progression,four females and one male.Time interval of progression ranged from 4 to 137 months with a mean of 61.4 months.Of five patients with progression,four had unilateral lesion(two ipsilateral and two contralateral)and one had bilateral lesions.Collateral circulation was changed in three of five patients.Conclusions The angiographic evidence of progression in MMD was rare in the short-term follow-up,and most patients with progression had initial unilateral involvement.DSA re-examination may be not needed in patients with bilateral MMD,but needed in unilateral MMD.展开更多
Background:This study aimed to investigate the value of high field-strength intraoperative magnetic resonance imaging(iMRI)-guided stereotactic biopsy in the surgery of intracranial space-occupying lesions.Methods:A t...Background:This study aimed to investigate the value of high field-strength intraoperative magnetic resonance imaging(iMRI)-guided stereotactic biopsy in the surgery of intracranial space-occupying lesions.Methods:A total of 87 patients who underwent stereotactic biopsy of intracranial lesions in the Peking University International Hospital from March 2016 to August 2018 were retrospectively surveyed;among these,50 patients underwent MRI-guided stereotactic biopsy using the Leksell frame(iMRI group)and 37 cases received traditional stereotactic biopsy using the Leksell frame(control group).The accuracy rates and complications of the two groups were compared.Results:A 100%positive diagnosis was observed in all cases(n=50)in the iMRI group.In 4 cases,the biopsy site was clearly found to have deviated from the target point,and the biopsy was performed again.The control group had 33 cases(86.5%)with positive diagnosis.No severe complications like neural functional deficit were observed in the iMRI group,while two patients developed bleeding at the puncture site(1 case receiving surgery to remove the hematoma)in the control group.There were no deaths in either group.Conclusion:iMRI-assisted stereotactic biopsy can confirm the target position and adjust the puncture path in real time.Compared to the traditional stereotactic biopsy technique,the iMRI method has a higher positive diagnostic rate,though surgical trauma and complications have no significant difference.展开更多
Hypoperfusion and hyperperfusion could be causes of early postoperative complications that lead to neurological deterioration in patients with moyamoya diseases (MMD) after superficial temporal artery (STA) and middle...Hypoperfusion and hyperperfusion could be causes of early postoperative complications that lead to neurological deterioration in patients with moyamoya diseases (MMD) after superficial temporal artery (STA) and middle cerebral artery (MCA) anastomosis. Here, the authors described a case of child-onset bilateral MMD that manifested transient cerebral ischemia in the contralateral hemisphere after left STA-MCA bypass in young adulthood. A new onset of cerebral ischemia in the contralateral hemisphere and transient neurological deterioration suggested the fragile hemodynamics of MMD during early perioperative period. Serial evaluation of postoperative cerebral hemodynamics and perfusion might facilitate targeted management in patients with unstable or advanced MMD.展开更多
文摘Streptococcus suis （S. suis） is a Gram-positive, facultatively anaerobic coccus that has been implicated as the cause of a wide range of clinical disease syndromes in swine and other domestic animals. S. suis has also been implicated in disease in humans, especially anaong abattoir workers, swine and pork handlers. Here we report a case of streptococcal toxic shock syndrome（STSS） caused by S. suis in a 59-year-old man. Despite of intensive treatment, the patient died of shock with multiple organ failure 14 h after admission. One bacterial isolate obtained from blood culture was identified to the species level by biochemical tests and serological tests as S. suis serotype 2. Identification was confirmed by PCR amplification of genes encoding 16sRNA of S. suis and the capsule of S. suis serotype 2（cps 23）. Genes encoding virulence factors were also detected. An investigation to identify the source of S. suis revealed that several days before admission the affected man had been handling sick pigs or their meat. Transmission may occur through breaks in the skin of feet with tinea due to that no measures for personal protection was taken. This case should highten awareness of the potential for occupational exposure and human infection with S. suis.
基金supported by the China Postdoctoral Science Foundation(2024M762182).
文摘Background Previous studies on the risk factors and prognosis of acute stroke in pregnancy and puerperium(ASPP)mainly used European and American national healthcare databases,lacking detailed patient-level data and precise event timing.Aim(1)To identify the risk factors and prognostic factors for ASPP,(2)to assess the risk of recurrent stroke,particularly during subsequent pregnancies,and(3)to evaluate offspring prognosis.Design This study is a retrospective,observational,nationwide,multicenter research project planned to include 400 ASPP patients from 36 centers across 22 provinces in China,from 2015 to 2024.ASPP is defined as acute ischemic or hemorrhagic stroke during pregnancy or within 6 weeks postpartum,confirmed by neuroimaging.Two matched groups will be included for comparison:400 pregnant/puerperal participants without a stroke history and 400 nonpregnant/puerperal participants with a recent stroke,matched by age and/or stroke etiology.Methods All participants will be followed up through telephone interviews.The initial follow-up is scheduled to take place between December 2024 and February 2025.The follow-up phase will consist of three rounds,each lasting 3 months and conducted every 3 years.Primary outcomes include unfavorable functional outcomes(mRS>2 or EQ-5D index score<0.7)at follow-up for Aim 1,recurrent strokes(neuroimaging-confirmed)for Aim 2,and neonatal asphyxia(Apgar scoring)and future development(ASQ-3)of offspring for Aim 3.Discussion The ASPP study is the first nationwide multicenter study to systematically evaluate the risk factors,prognosis,and risk of recurrent stroke in ASPP patients,particularly during subsequent pregnancies.This research may offer new insights into the long-term impacts of pregnancy-related stroke.
文摘Background: Ankylosing spondylitis was reported to associate with an increased risk of cerebrovascular diseases. In this article, we aimed to report the first case of ankylosing spondylitis associated with moyamoya disease treated with encephalo-duroarterio-synangiosis. Case presentation: A 9-year-old boy with ankylosing spondylitis appeared a symptom of repeated transient ischemic attacks which performed as left hemiparesis. Magnetic resonance angiography showed a typical finding of left anterior cerebral artery, bilateral middle cerebral arteries and the supraclinoid portion of the right internal carotid artery stenosis with an abnormal vascular network at the base of the brain, diagnosed with moyamoya disease. He received a medication treatment but did not underwent revascularization surgery. After three months, ankylosing spondylitis symptoms got some relief, whereas transient ischemic attacks was more frequency. Due to the bad cerebral blood flow on acetazolamide computed tomography perfusion and poor clinical manifestation, he underwent a right encephalo-duroarterio-synangiosis. Postoperatively, the symptoms of transient ischemic attacks disappeared. Conclusions: We reported the first case of ankylosing spondylitis associated with moyamoya disease. Moyamoya disease could appear in patients with ankylosing spondylitis. Revascularization surgery probably is an effective treatment for preventing preoperative ischemic events recurrence.
基金supported by the National Natural Science Foundation of China(82301451)the National Key Research and Development Program of China(2021YFC2500502).
文摘Background Moyamoya disease(MMD)is a rare and complex cerebrovascular disorder characterized by the progressive narrowing of the internal carotid arteries and the formation of compensatory collateral vessels.The etiology of MMD remains enigmatic,making diagnosis and management challenging.The MOYAOMICS project was initiated to investigate the molecular underpinnings of MMD and explore potential diagnostic and therapeutic strategies.Methods The MOYAOMICS project employs a multidisciplinary approach,integrating various omics technologies,including genomics,transcriptomics,proteomics,and metabolomics,to comprehensively examine the molecular signatures associated with MMD pathogenesis.Additionally,we will investigate the potential influence of gut microbiota and brain-gut peptides on MMD development,assessing their suitability as targets for therapeutic strategies and dietary interventions.Radiomics,a specialized field in medical imaging,is utilized to analyze neuroimaging data for early detection and characterization of MMD-related brain changes.Deep learning algorithms are employed to differentiate MMD from other conditions,automating the diagnostic process.We also employ single-cellomics and mass cytometry to precisely study cellular heterogeneity in peripheral blood samples from MMD patients.Conclusions The MOYAOMICS project represents a significant step toward comprehending MMD’s molecular underpinnings.This multidisciplinary approach has the potential to revolutionize early diagnosis,patient stratification,and the development of targeted therapies for MMD.The identification of blood-based biomarkers and the integration of multiple omics data are critical for improving the clinical management of MMD and enhancing patient outcomes for this complex disease.
基金This research was supported by grants from the National Key Research and Development Program of China(No.2019YFC1316205 to J.N.)National Natural Science Foundation of China(Nos.31991171 and 81830002 to W.D.H.,81773269 and 31722036 to H.Y.W.)Strategic Priority Research Program of the Chinese Academy of Sciences(No.XDA16010503 to H.Y.W.).
文摘Programmed cell death protein-1(PD-1)-mediated immunosuppression has been proposed to contribute to the limited clinical efficacy of chimeric antigen receptor T(CAR-T)cells in solid tumors.We generated PD-1 and T cell receptor(TCR)deficient mesothelin-specific CAR-T(MPTK-CAR-T)cells using CRISPR-Cas9 technology and evaluated them in a dose-escalation study.A total of 15 patients received one or more infusions of MPTK-CAR-T cells without prior lymphodepletion.No dose-limiting toxicity or unexpected adverse events were observed in any of the 15 patients.The best overall response was stable disease(2/15 patients).Circulating MPTK-CAR-T cells peaked at days 7–14 and became undetectable beyond 1 month.TCR-positive CAR-T cells rather than TCR-negative CAR-T cells were predominantly detected in effusion or peripheral blood from three patients after infusion.We further confirmed the reduced persistence of TCR-deficient CAR-T cells in animal models.Our results establish the preliminary feasibility and safety of CRISPR-engineered CAR-T cells with PD-1 disruption and suggest that the natural TCR plays an important role in the persistence of CAR-T cells when treating solid tumors.
文摘Background:Surgery is a conventional mature treatment for moyamoya disease(MMD).However,whether surgery is also an effective therapy for epileptic type MMD has seldom been investigated systematically.The study aims to summarize the pooled postoperative incidence of seizure and cerebral infarction in pediatric patients with epileptic type moyamoya disease.Method:The study was a systematic review and critical appraisal with a meta-analysis of cohort studies,both prospective and retrospective.Studies were identified by a computerized search of PubMed,Embase,Web of Science,Wanfang,and CNKI databases.In a literature search,a total of 7 cohort studies were identified.The I2statistic was used to quantify heterogeneity.A fixed-effect model was used to synthesize the results.The linear regression test of funnel plot asymmetry was used to estimate the potential publication bias.Results:The pooled estimated postoperative incidence of seizure in pediatric patients with epileptic type moyamoya disease was 23.44%.The pooled estimated postoperative incidence of cerebral infarction in pediatric patients with epileptic type moyamoya disease was 9.12%.Low substantial heterogeneity and potential publication bias were present.Conclusions:Evidence from this study suggests that the postoperative incidence of seizure and cerebral infarction is relatively low.Surgery is an effective and secure therapy for pediatric patients with epileptic type moyamoya disease.
基金supported by Natural Science Foundation of China(81571110,81771234 to YZ,81500995 to XC,81801140 to LM)Bai Qian Wan Talent Plan(2017A07).
文摘Objective The aims of this study are to clarify the long-term outcomes of brainstem arteriovenous malformations(AVMs)after different management modalities.Methods The authors retrospectively reviewed 61 brainstem AVMs in their institution between 2011 and 2017.The rupture risk was represented by annualised haemorrhagic rate.Patients were divided into five groups:conservation,microsurgery,embolisation,stereotactic radiosurgery(SRS)and embolisation+SRS.Neurofunctional outcomes were evaluated by the modified Rankin Scale(mRS).Subgroup analysis was conducted between different management modalities to compare the long-term outcomes in rupture or unruptured cohorts.Results All of 61 brainstem AVMs(12 unruptured and 49 ruptured)were followed up for an average of 4.5 years.The natural annualised rupture risk was 7.3%,and the natural annualised reruptured risk in the ruptured cohort was 8.9%.13 cases were conservative managed and 48 cases underwent intervention(including 6 microsurgery,12 embolisation,21 SRS and 9 embolisation+SRS).In the selection of interventional indication,diffuse nidus were often suggested conservative management(p=0.004)and nidus involving the midbrain were more likely to be recommended for intervention(p=0.034).The risk of subsequent haemorrhage was significantly increased in partial occlusion compared with complete occlusion and conservative management(p<0.001,p=0.036,respectively).In the subgroup analysis,the follow-up mRS scores of different management modalities were similar whether in the rupture cohort(p=0.064)or the unruptured cohort(p=0.391),as well as the haemorrhage-free survival(p=0.145).In the adjusted Bonferroni correction analysis of the ruptured cohort,microsurgery and SRS could significantly improve the obliteration rate compared with conservation(p<0.001,p=0.001,respectively)and SRS may have positive effect on avoiding new-onset neurofunctional deficit compared with microsurgery and embolisation(p=0.003,p=0.003,respectively).Conclusions Intervention has similar neurofunctional outcomes as conservation in these brainstem AVM cohorts.If intervention is adopted,partial obliteration should be avoided because of the high subsequent rupture risk.
基金supported by the National Key Technology Research and Development Programme of the Ministry of Science and Technology of China(grants 2006BAI01A13 and 2015BAI12B04)Beijing Municipal Organisation Department Talents Project(grant 2015000021469 G219)+1 种基金Beijing Municipal ST Commission(grant D161100003816005)National Natural Science Foundation of China(grant 81701137).
文摘background Evidence on the natural angiographic course of moyamoya disease(MMD)is lacking.It takes about 6 months for waiting for revascularisation surgery.The issue of when to perform subtraction angiography(DSA)for follow-up remains unclear.We investigated the natural course of MMD by DSA and attempted to determine the best interval to perform the follow-up DSA.Methods This is a single-centre cohort study of Chinese MMD inpatients treated from 1 January 2015 to 31 August 2019.Their angiographic findings were evaluated on Suzuki stage and collateral circulation between two follow-ups of the same hemisphere.results A total of 110 patients who met the criteria were enrolled in this study.After a median 6 months follow-up,five patients(4.5%)had progression,four females and one male.Time interval of progression ranged from 4 to 137 months with a mean of 61.4 months.Of five patients with progression,four had unilateral lesion(two ipsilateral and two contralateral)and one had bilateral lesions.Collateral circulation was changed in three of five patients.Conclusions The angiographic evidence of progression in MMD was rare in the short-term follow-up,and most patients with progression had initial unilateral involvement.DSA re-examination may be not needed in patients with bilateral MMD,but needed in unilateral MMD.
文摘Background:This study aimed to investigate the value of high field-strength intraoperative magnetic resonance imaging(iMRI)-guided stereotactic biopsy in the surgery of intracranial space-occupying lesions.Methods:A total of 87 patients who underwent stereotactic biopsy of intracranial lesions in the Peking University International Hospital from March 2016 to August 2018 were retrospectively surveyed;among these,50 patients underwent MRI-guided stereotactic biopsy using the Leksell frame(iMRI group)and 37 cases received traditional stereotactic biopsy using the Leksell frame(control group).The accuracy rates and complications of the two groups were compared.Results:A 100%positive diagnosis was observed in all cases(n=50)in the iMRI group.In 4 cases,the biopsy site was clearly found to have deviated from the target point,and the biopsy was performed again.The control group had 33 cases(86.5%)with positive diagnosis.No severe complications like neural functional deficit were observed in the iMRI group,while two patients developed bleeding at the puncture site(1 case receiving surgery to remove the hematoma)in the control group.There were no deaths in either group.Conclusion:iMRI-assisted stereotactic biopsy can confirm the target position and adjust the puncture path in real time.Compared to the traditional stereotactic biopsy technique,the iMRI method has a higher positive diagnostic rate,though surgical trauma and complications have no significant difference.
基金the Ministry of Science and Technology of China,National Key Technology Research and Development Program(2015BAI12B04,2013BAI09B03)Beijing Institute for Brain Disorders grant(BIBD-PXM2013_014226_07_000084)+1 种基金National Natural Science Foundation of China(H090681271313 and H090681571110 to Y.L.Zhao and 81500995 to X.L.Chen)China Scholarship Council(201508110252 to L.Ma).
文摘Hypoperfusion and hyperperfusion could be causes of early postoperative complications that lead to neurological deterioration in patients with moyamoya diseases (MMD) after superficial temporal artery (STA) and middle cerebral artery (MCA) anastomosis. Here, the authors described a case of child-onset bilateral MMD that manifested transient cerebral ischemia in the contralateral hemisphere after left STA-MCA bypass in young adulthood. A new onset of cerebral ischemia in the contralateral hemisphere and transient neurological deterioration suggested the fragile hemodynamics of MMD during early perioperative period. Serial evaluation of postoperative cerebral hemodynamics and perfusion might facilitate targeted management in patients with unstable or advanced MMD.
