Publications by authors named "Xuesong Bai"

35 Publications

Hemodynamic Versus Anatomic Assessment of Symptomatic Atherosclerotic Middle Cerebral Artery Stenosis: the Relationship Between Pressure Wire Translesional Gradient and Angiographic Lesion Geometry.

Front Neurol 2021 11;12:671778. Epub 2021 Aug 11.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Intracranial cerebral atherosclerosis (ICAS) is a leading etiology of ischemic stroke. The diagnosis and assessment of intracranial stenosis are shifting from anatomic to hemodynamic for better risk stratification. However, the relationships between lesion geometry and translesional pressure gradient have not been clearly elucidated. Patients with symptomatic unifocal M1 middle cerebral artery (M1-MCA) stenosis were consecutively recruited. The translesional pressure gradient was measured with a pressure wire and was recorded as both mean distal/proximal pressure ratios (Pd/Pa) and translesional pressure difference (Pa-Pd). Lesion geometry measured on angiography was recorded as diameter stenosis, minimal lumen diameter, and lesion length. The correlations between pressure-derived and angiography-derived indices were then analyzed. Forty-three patients were analyzed. A negative correlation was found between Pd/Pa and diameter stenosis ( = -0.371; = 0.014) and between Pa - Pd and minimal lumen diameter ( = -0.507; = 0.001). A positive correlation was found between Pd/Pa and minimal lumen diameter ( = 0.411; = 0.006) and between Pa - Pd and diameter stenosis ( = 0.466; = 0.002). In a highly selected ICAS subgroup, geometric indices derived from angiography correlate significantly with translesional pressure gradient indices. However, the correlation strength is weak-to-moderate, which implies that anatomic assessment could only partly reflect hemodynamic status. Translesional pressure gradient measured by pressure wire may serve as a more predictive marker of ICAS severity. More factors need to be identified in further studies.
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http://dx.doi.org/10.3389/fneur.2021.671778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8385769PMC
August 2021

Risk Factors for New Ischemic Cerebral Lesions after Carotid Artery Stenting: A Systematic Review and Meta-analysis.

Ann Vasc Surg 2021 Aug 23. Epub 2021 Aug 23.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China; China International Neuroscience Institute (China-INI), No. 45 Changchun Street, Beijing, China; Department of Interventional Neuroradiology, Xuanwu Hospital, No. 45 Changchun Street, Capital Medical University, Beijing, China. Electronic address:

Introduction: New ischemic cerebral lesions (NICL) are commonly occur after carotid artery stenting (CAS) with an incidence rate ranging from 18 to 58% and are detected by diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI). Numerous studies have reported that NICL could increase the risk of future cerebrovascular events and cognitive impairment. This systematic review and meta-analysis aimed to identify risk factors for NICL after CAS.

Methods: Relevant literature reporting risk factors for NICL after CAS were searched. Randomized controlled trials, case-control studies, or cohort studies were included in accordance with the pre-specified eligibility criteria. The risk of bias was assessed using the Cochrane Collaboration criteria and the quality of evidence was assessed with the corresponding scale. Data were analyzed using the RevMan V. 5.3 analysis software.

Results: The final analyses included a total of 21 studies and 1,907 participants, including 764 NICL-positives and 1,143 NICL-negatives. Determinants for NICL-positivity were age (mean deviation (MD): 2.60; 95% confidence interval (CI): [1.53-3.68]), symptomatic carotid lesions (odds ratio (OR): 1.77; 95% CI: [1.39-2.25]) and smoking (OR: 0.74; 95% CI: [0.58-0.94]). For symptomatic patients, risk factors for NICL-positive included diabetes mellitus (OR: 1.76; 95% CI: [1.09-2.82]), but smoking (OR: 0.54; 95% CI: [0.31-0.93]) was a protective factor. Risk factors for centers with high NICL incidence were age (MD: 2.05; 95% CI: [0.93-3.17]) and symptomatic carotid lesions (OR: 1.77; 95% CI: [1.29-2.45]).

Conclusions: Older age and symptomatic carotid lesions are associated with an increased risk of post-CAS NICL whereas smoking is associated with a decreased risk. Risk factors for NICL in symptomatic patients is diabetes mellitus, while those for patients at centers with high incidence are age and symptomatic carotid lesions. Systematic review registration: CRD42019121129.
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http://dx.doi.org/10.1016/j.avsg.2021.05.031DOI Listing
August 2021

Individualized Prediction of Acute Pancreatitis Recurrence Using a Nomogram.

Pancreas 2021 Jul;50(6):873-878

Clinical Research Center, Dazhou Central Hospital, Dazhou, China.

Objectives: The objective of this study was to develop and validate a model, based on the blood biochemical (BBC) indexes, to predict the recurrence of acute pancreatitis patients.

Methods: We retrospectively enrolled 923 acute pancreatitis patients (586 in the primary cohort and 337 in the validation cohort) from January 2014 to December 2016. Aiming for an extreme imbalance between recurrent acute pancreatitis (RAP) and non-RAP patients (about 1:4), we designed BBC index selection using least absolute shrinkage and selection operator regression, along with an ensemble-learning strategy to obtain a BBC signature. Multivariable logistic regression was used to build the RAP predictive model.

Results: The BBC signature, consisting of 35 selected BBC indexes, was significantly higher in patients with RAP (P < 0.001). The area under the curve of the receiver operating characteristic curve of BBC signature model was 0.6534 in the primary cohort and 0.7173 in the validation cohort. The RAP predictive nomogram incorporating the BBC signature, age, hypertension, and diabetes showed better discrimination, with an area under the curve of 0.6538 in the primary cohort and 0.7212 in the validation cohort.

Conclusions: Our study developed a RAP predictive nomogram with good performance, which could be conveniently and efficiently used to optimize individualized prediction of RAP.
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http://dx.doi.org/10.1097/MPA.0000000000001839DOI Listing
July 2021

Application of multi-label classification models for the diagnosis of diabetic complications.

BMC Med Inform Decis Mak 2021 06 7;21(1):182. Epub 2021 Jun 7.

Department of Endocrinology, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, 29 Xinglongxiang Road, Changzhou City, 213000, Jiangsu Province, China.

Background: Early diagnosis for the diabetes complications is clinically demanding with great significancy. Regarding the complexity of diabetes complications, we applied a multi-label classification (MLC) model to predict four diabetic complications simultaneously using data in the modern electronic health records (EHRs), and leveraged the correlations between the complications to further improve the prediction accuracy.

Methods: We obtained the demographic characteristics and laboratory data from the EHRs for patients admitted to Changzhou No. 2 People's Hospital, the affiliated hospital of Nanjing Medical University in China from May 2013 to June 2020. The data included 93 biochemical indicators and 9,765 patients. We used the Pearson correlation coefficient (PCC) to analyze the correlations between different diabetic complications from a statistical perspective. We used an MLC model, based on the Random Forest (RF) technique, to leverage these correlations and predict four complications simultaneously. We explored four different MLC models; a Label Power Set (LP), Classifier Chains (CC), Ensemble Classifier Chains (ECC), and Calibrated Label Ranking (CLR). We used traditional Binary Relevance (BR) as a comparison. We used 11 different performance metrics and the area under the receiver operating characteristic curve (AUROC) to evaluate these models. We analyzed the weights of the learned model and illustrated (1) the top 10 key indicators of different complications and (2) the correlations between different diabetic complications.

Results: The MLC models including CC, ECC and CLR outperformed the traditional BR method in most performance metrics; the ECC models performed the best in Hamming loss (0.1760), Accuracy (0.7020), F1_Score (0.7855), Precision (0.8649), F1_micro (0.8078), F1_macro (0.7773), Recall_micro (0.8631), Recall_macro (0.8009), and AUROC (0.8231). The two diabetic complication correlation matrices drawn from the PCC analysis and the MLC models were consistent with each other and indicated that the complications correlated to different extents. The top 10 key indicators given by the model are valuable in medical application.

Conclusions: Our MLC model can effectively utilize the potential correlation between different diabetic complications to further improve the prediction accuracy. This model should be explored further in other complex diseases with multiple complications.
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http://dx.doi.org/10.1186/s12911-021-01525-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182940PMC
June 2021

Annexin A1 protects against cerebral ischemia-reperfusion injury by modulating microglia/macrophage polarization via FPR2/ALX-dependent AMPK-mTOR pathway.

J Neuroinflammation 2021 May 22;18(1):119. Epub 2021 May 22.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.

Background: Cerebral ischemia-reperfusion (I/R) injury is a major cause of early complications and unfavorable outcomes after endovascular thrombectomy (EVT) therapy in patients with acute ischemic stroke (AIS). Recent studies indicate that modulating microglia/macrophage polarization and subsequent inflammatory response may be a potential adjunct therapy to recanalization. Annexin A1 (ANXA1) exerts potent anti-inflammatory and pro-resolving properties in models of cerebral I/R injury. However, whether ANXA1 modulates post-I/R-induced microglia/macrophage polarization has not yet been fully elucidated.

Methods: We retrospectively collected blood samples from AIS patients who underwent successful recanalization by EVT and analyzed ANXA1 levels longitudinally before and after EVT and correlation between ANXA1 levels and 3-month clinical outcomes. We also established a C57BL/6J mouse model of transient middle cerebral artery occlusion/reperfusion (tMCAO/R) and an in vitro model of oxygen-glucose deprivation and reoxygenation (OGD/R) in BV2 microglia and HT22 neurons to explore the role of Ac2-26, a pharmacophore N-terminal peptide of ANXA1, in regulating the I/R-induced microglia/macrophage activation and polarization.

Results: The baseline levels of ANXA1 pre-EVT were significantly lower in 23 AIS patients, as compared with those of healthy controls. They were significantly increased to the levels found in controls 2-3 days post-EVT. The increased post-EVT levels of ANXA1 were positively correlated with 3-month clinical outcomes. In the mouse model, we then found that Ac2-26 administered at the start of reperfusion shifted microglia/macrophage polarization toward anti-inflammatory M2-phenotype in ischemic penumbra, thus alleviating blood-brain barrier leakage and neuronal apoptosis and improving outcomes at 3 days post-tMCAO/R. The protection was abrogated when mice received Ac2-26 together with WRW4, which is a specific antagonist of formyl peptide receptor type 2/lipoxin A4 receptor (FPR2/ALX). Furthermore, the interaction between Ac2-26 and FPR2/ALX receptor activated the 5' adenosine monophosphate-activated protein kinase (AMPK) and inhibited the downstream mammalian target of rapamycin (mTOR). These in vivo findings were validated through in vitro experiments.

Conclusions: Ac2-26 modulates microglial/macrophage polarization and alleviates subsequent cerebral inflammation by regulating the FPR2/ALX-dependent AMPK-mTOR pathway. It may be investigated as an adjunct strategy for clinical prevention and treatment of cerebral I/R injury after recanalization. Plasma ANXA1 may be a potential biomarker for outcomes of AIS patients receiving EVT.
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http://dx.doi.org/10.1186/s12974-021-02174-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140477PMC
May 2021

Safety and efficacy of transcarotid artery revascularisation versus carotid endarterectomy: protocol for a systematic review and meta-analysis study.

BMJ Open 2021 05 4;11(5):e043039. Epub 2021 May 4.

China International Neuroscience Institute (China-INI), Beijing, China

Introduction: In recent years, the transcarotid artery revascularisation (TCAR) with flow reversal technique has been developed to treat carotid artery stenosis. The superiority of TCAR over transfemoral carotid artery stenting has been demonstrated. However, the safety and efficacy of TCAR and carotid endarterectomy remain unclear. This study aims to introduce a protocol for a systematic review and meta-analysis to compare the morbidity and mortality rates between TCAR and carotid endarterectomy in the treatment of atherosclerotic carotid artery stenosis.

Methods And Analysis: This protocol was drafted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. Herein, major databases will be searched, including Medline, Web of Science, Embase and the Cochrane Library, and randomised controlled trials and high-quality observational studies will be included. We will screen all studies published from January 2000 to March 2021. Bias risk will be evaluated using the Cochrane Collaboration criteria or Methodological Index for Non-randomised Studies criteria, depending on the study type. Two reviewers will select eligible studies and extract the data independently. The primary outcome will include stroke or death during the perioperative period and follow-up. Subgroup and sensitivity analyses will be performed to explore any potential sources of heterogeneity. Specific results will be described in a narrative form when available eligible studies are insufficient for meta-analysis. Publication bias will be assessed using a funnel plot.

Ethics And Dissemination: This study will summarise and analyse the existing literature; hence, ethics approval will not be required. The final results may be published at a relevant academic conference or in a journal.

Prospero Registration Number: CRD42020178691.
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http://dx.doi.org/10.1136/bmjopen-2020-043039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098965PMC
May 2021

Factors Influencing Recanalization After Mechanical Thrombectomy With First-Pass Effect for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Front Neurol 2021 9;12:628523. Epub 2021 Apr 9.

China International Neuroscience Institute, Beijing, China.

First-pass effect (FPE) is increasingly recognized as a predictor of good outcome in large vessel occlusion (LVO). This systematic review and meta-analysis aimed to elucidate the factors influencing recanalization after mechanical thrombectomy (MT) with FPE in treating acute ischemic stroke (AIS). Main databases were searched for relevant randomized controlled trials (RCTs) and observational studies reporting influencing factors of MT with FPE in AIS. Recanalization was assessed by the modified thrombolysis in cerebral ischemia (mTICI) score. Both successful (mTICI 2b-3) and complete recanalization (mTICI 2c-3) were observed. Risk of bias was assessed through different scales according to study design. The statistic was used to evaluate the heterogeneity, while subgroup analysis, meta-regression, and sensitivity analysis were performed to investigate the source of heterogeneity. Visual measurement of funnel plots was used to evaluate publication bias. A total of 17 studies and 6,186 patients were included. Among them, 2,068 patients achieved recanalization with FPE. The results of meta-analyses showed that age [mean deviation (MD):1.21,95% confidence interval (CI): 0.26-2.16; = 0.012], female gender [odds ratio (OR):1.12,95% CI: 1.00-1.26; = 0.046], diabetes mellitus (DM) (OR:1.17,95% CI: 1.01-1.35; = 0.032), occlusion of internal carotid artery (ICA) (OR:0.71,95% CI: 0.52-0.97; = 0.033), occlusion of M2 segment of middle cerebral artery (OR:1.36,95% CI: 1.05-1.77; = 0.019), duration of intervention (MD: -27.85, 95% CI: -42.11-13.58; < 0.001), time of onset to recanalization (MD: -34.63, 95% CI: -58.45-10.81; = 0.004), general anesthesia (OR: 0.63,95% CI: 0.52-0.77; < 0.001), and use of balloon guide catheter (BGC) (OR:1.60,95% CI: 1.17-2.18; = 0.003) were significantly associated with successful recanalization with FPE. At the same time, age, female gender, duration of intervention, general anesthesia, use of BGC, and occlusion of ICA were associated with complete reperfusion with FPE, but M2 occlusion and DM were not. Age, gender, occlusion site, anesthesia type, and use of BGC were influencing factors for both successful and complete recanalization after first-pass thrombectomy. Further studies with more comprehensive observations indexes are need in the future.
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http://dx.doi.org/10.3389/fneur.2021.628523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062801PMC
April 2021

endothelialization and neointimal hyperplasia assessment after rabbit carotid endarterectomy with bovine pericardium.

Ann Transl Med 2021 Mar;9(6):471

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Background: Previous studies have reported that the use of a patch in carotid endarterectomy (CEA) surgery can reduce the rate of restenosis and perioperative complications. The goal of this study was to compare the short- and medium-term outcomes of endothelialization and neointimal hyperplasia of patch closure (PC) angioplasty in CEA with direct closure (DC) in a rabbit model. A bovine pericardial patch (BPP) was used in the PC procedures.

Methods: Two carotid arteries were dried by air flow to simulate endarterectomy and selected for PC and DC in each rabbit. Different animals were sacrificed at 1, 2, 3, 4, and 8 weeks after the procedure. The endarterectomized segments were extracted and examined microscopically with histopathological and immunohistochemical analysis, and electron-microscopy measurements.

Results: In all, 19 rabbits were included in this study; 3 rabbits were placed in a 2-week postoperative group and 4 rabbits were placed in the 1-, 3-, 4-, and 8-week postoperative group respectively. Hematoxylin-eosin (HE) staining showed neointima on the PC side at an early stage (1-week postoperatively), and intimal hyperplasia could be seen on both sides. Immunohistochemical analysis showed that Ki-67 was higher on the PC side than on the DC side at an early stage (1,661.5±1,122.9 cells/mm, P=0.060). In the 2-week postoperative group, von Willebrand factor (vWF) was higher on the DC side (-377.0±155.6 cells/mm, P=0.052). Alpha-smooth muscle actin (α-SMA) values were comparable on both sides (P>0.05). Electron microscopy measurements showed that functional endothelial cells exhibited a cobblestone-like morphology and were nicely elongated in the direction of blood flow.

Conclusions: The use of BPP in PC angioplasty during CEA can maintain stability and also provide rapid endothelialization. PC with BPP has comparable ability of efficient endothelialization with DC, but is more likely to have early endothelialization.
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http://dx.doi.org/10.21037/atm-20-8103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039648PMC
March 2021

General anesthesia versus conscious sedation for endovascular therapy in acute ischemic stroke: A systematic review and meta-analysis.

J Clin Neurosci 2021 Apr 25;86:10-17. Epub 2021 Jan 25.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China; Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address:

Background: Endovascular thrombectomy (EVT) is the first-line treatment for patients with acute ischemic stroke (AIS). However, the optimal anesthetic modality during EVT is unclear. Therefore, this systematic review and meta-analysis is aimed to summarize the current literatures from RCTs to provide new clinical evidence of choosing anesthetic modality for AIS patients when receiving EVT.

Methods: Literature search was conducted in following databases, EMBASE, MEDLINE, Web of Science, and the Cochrane Library, for relevant randomized controlled trials (RCTs) comparing general anesthesia (GA) and conscious sedation (CS) for AIS patients during EVT. We used the Cochrane Collaboration criteria for assessment of risk bias of included studies. The heterogeneity of outcomes was assessed by Istatistic.

Results: 5 RCTs with 498 patients were included. GA was conducted in 251 patients and CS in 247 patients. EVT under GA in AIS patients had higher rates of successful recanalization (RR: 1.13, 95% CI: 1.04-1.23; P = 0.004; I = 40.6%) and functional independence at 3 months (RR: 1.28, 95% CI: 1.05-1.55; P = 0.013; I = 18.2%) than CS. However, GA was associated with higher risk of mean arterial pressure (MAP) drop (RR: 1.71, 95% CI: 1.19-2.47; P < 0.01; I = 80%) and pneumonia (RR: 2.32, 95% CI: 1.23-4.37; P = 0.009; I = 33.5%). There was no difference between GA and CS groups in mortality at 3 months, interventional complications, intracerebral hemorrhage and cerebral infarction after 30 days.

Conclusions: GA was superior over CS in successful recanalization and functional independence at 3 months when performing EVT in AIS patients. However, GA was associated with higher risk of MAP drop and pneumonia. Therefore, results of ongoing RCTs will provide new clinical evidence of anesthetic modality selection during EVT in the future.
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http://dx.doi.org/10.1016/j.jocn.2021.01.012DOI Listing
April 2021

Risk factors for cholesterol polyp formation in the gallbladder are closely related to lipid metabolism.

Lipids Health Dis 2021 Mar 22;20(1):26. Epub 2021 Mar 22.

Department of General Surgery, Xuanwu Hospital, The First Clinical Medical College, Capital Medical University, No.45 Changchun Street, Beijing, China.

Background: The purpose of this study was to assess the risk factors for cholesterol polyp formation in the gallbladder.

Methods: This was a multicenter retrospective study based on pathology. From January 2016 to December 2019, patients who underwent cholecystectomy and non-polyp participants confirmed by continuous ultrasound follow-ups were reviewed. Patients in the cholesterol polyp group were recruited from three high-volume centers with a diagnosis of pathologically confirmed cholesterol polyps larger than 10 mm. Population characteristics and medical data were collected within 24 h of admission before surgery. The non-polyp group included participants from the hospital physical examination center database. They had at least two ultrasound examinations with an interval longer than 180 days. Data from the final follow-up of the non-polyp group were analyzed. The risk factors for cholesterol polyp formation were analyzed by comparing the two groups.

Results: A total of 4714 participants were recruited, including 376 cholesterol polyp patients and 4338 non-polyp participants. In univariate analysis, clinical risk factors for cholesterol polyps were age, male sex, higher body mass index (BMI), higher low-density lipoprotein (LDL), lower high-density lipoprotein (HDL), and higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. In multivariate logistic analysis, independent risk factors were age > 50 years (odds ratio [OR] = 3.02, 95% confidence interval [CI] 2.33-3.91, P < 0.001], LDL > 2.89 mmol/L (OR = 1.38, 95% CI 1.08-1.78, P = 0.011), lower HDL (OR = 1.78 95% CI 1.32-2.44, P < 0.001), AST > 40 IU/L (OR = 3.55, 95% CI 2.07-6.07, P < 0.001), and BMI > 25 kg/m (OR = 1.32, 95% CI 1.01-1.72, P = 0.037).

Conclusions: Age, LDL, HDL, AST, and BMI are strong risk factors for cholesterol polyp formation. Older overweight patients with polyps, accompanied by abnormal lipid levels, are at high risk for cholesterol polyps.
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http://dx.doi.org/10.1186/s12944-021-01452-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983281PMC
March 2021

Facial Nerve Length Influence on Vestibular Schwannoma Microsurgery Outcomes.

World Neurosurg 2021 06 16;150:e400-e407. Epub 2021 Mar 16.

Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute, XuanWu Hospital, Capital Medical University, Beijing, China. Electronic address:

Objective: Facial nerve (FN) function preservation is the primary goal during vestibular schwannoma (VS) resection. Many factors are linked to postoperative FN outcomes. In the present study, we evaluated the association between FN length and VS surgical outcomes.

Methods: We included 70 consecutive patients who had undergone VS microsurgery between October 2019 and November 2020. The clinical data were prospectively obtained from the patients. The relative FN (rFN) length was obtained by subtracting the contralateral FN length from the ipsilateral FN length as measured using DSI Studio software (available at: http://dsi-studio.labsolver.org/).

Results: The postoperative FN function was House-Brackmann grade I in 47 of the 70 patients (67.1%), grade II in 10 (14.3%), and grade III in 13 (18.6%). Gross total resection (GTR) was performed in 61 patients (87.1%). A residual tumor was retained to preserve FN function in 9 of the 70 patients (12.9%), and rFN length was measured (mean diameter, 20.8 mm; range, 2.5-51.5]). On multivariate analysis, the rFN length was significantly associated with the extent of tumor resection. The receiver operating characteristic curve indicated that the cutoff value for rFN length to predict for intraoperative near total resection versus GTR was 36.6 mm, with a specificity and sensitivity of 93.4% and 88.9%, respectively.

Conclusions: The rFN length is important for predicting surgical outcomes. An rFN length >36.6 mm might indicate difficulty in achieving GTR with preservation of FN function. Therefore, the rFN length could become an objective indicator for neurosurgeons to predict the difficulty of GTR to preserve FN function.
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http://dx.doi.org/10.1016/j.wneu.2021.03.024DOI Listing
June 2021

Cognitive rehabilitation interventions after stroke: protocol for a systematic review and meta-analysis of randomized controlled trials.

Syst Rev 2021 03 4;10(1):66. Epub 2021 Mar 4.

Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China.

Background: Stroke is the second leading cause of death worldwide, and 53.4% of stroke survivors suffer from post-stroke cognitive impairment. Post-stroke cognitive impairment can increase hospitalization rate and cost of care and decrease the quality of life of stroke patients. To date, multiple cognitive rehabilitation interventions have been tested in stroke populations with post-stroke cognitive impairment. However, the most efficacious intervention has not been established. This systematic review aims to compare the efficacy of cognitive rehabilitation interventions for patients with post-stroke cognitive impairment.

Methods: We will search MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, PubMed, and clinical trial registries to identify eligible randomized clinical trials with no restrictions in the date of publication and language. Studies conducted with patients aged 18 or over, with the presence of cognitive impairment after being diagnosed with stroke will be included. Studies will be restricted to randomized controlled trials comparing a cognitive rehabilitation intervention with another intervention. The primary outcome is any clinical changes in the general or specific cognitive domain (e.g., executive function, attention, memory, or perception). The secondary outcomes that will be collected include adverse effects (e.g., stroke, disability, or mortality) and quality of life. Two independent reviewers will assess articles to identify trials eligible for inclusion. Data extraction and risk of bias assessment of the included studies will also be done independently. Any discrepancies will be solved by discussion, or a third reviewer will be consulted if necessary. A meta-analysis will be carried out if appropriate.

Discussion: This systematic review for patients with post-stroke cognitive impairment will assess the efficacy of cognitive rehabilitation interventions. And our results will help clinical decision-making and support the development of clinical practice guidelines.

Trial Registration: Systematic review registration: PROSPERO CRD42020173988.
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http://dx.doi.org/10.1186/s13643-021-01607-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931553PMC
March 2021

Mechanical Thrombectomy in Nonagenarians: a Systematic Review and Meta-analysis.

Transl Stroke Res 2021 06 2;12(3):394-405. Epub 2021 Feb 2.

China International Neuroscience Institute (China-INI), Beijing, China.

This systematic review and meta-analysis aimed to summarize the current literature on mechanical thrombectomy (MT) in nonagenarians and to provide updated clinical evidence of its feasibility, effectiveness, and safety in nonagenarians. PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for relevant randomized controlled trials and observational studies that reported the clinical outcomes of nonagenarians with acute ischemic stroke after undergoing mechanical thrombectomy. Risk of bias was assessed using different scales. I statistic was used to evaluate the heterogeneity of the results, while meta-regression and sensitivity analyses were performed to investigate the source of heterogeneity. Thirteen studies and 657 patients were included. The estimated rate of successful revascularization was 80.82% (95% confidence interval [CI]: 77.48-83.97%), and the rate of favorable outcome (modified Rankin score [mRS] 0-2) was 21.60% (95% CI: 13.81-30.41%). The rate of good outcome (mRS score 0-3) was 23.08% (95% CI: 18.88-27.55%). The estimated risk of death during hospitalization was 20.55% (95% CI: 15.93-25.55%), while the mortality rate at 3 months was 44.38% (95% CI: 33.66-55.36%). The rate of intracranial hemorrhage (ICH) occurrence was 12.84% (95% CI: 5.27-22.68%), while the rate of symptomatic intracranial hemorrhage (sICH) was 3.52% (95% CI: 1.67-5.85%). The rate of hospital-related complications was 26.93% (95% CI: 10.53-47.03%). MT in nonagenarians demonstrated a high rate of successful revascularization. Conversely, the rate of futile revascularization is high with a low functional independence proportion. Therefore, MT should not be indiscriminately advocated in nonagenarians. Satisfactory results require careful selection of patients. Further high-quality studies are needed to clarify the selection algorithm.
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http://dx.doi.org/10.1007/s12975-021-00894-5DOI Listing
June 2021

Technique Nuances for Functional Preservation of Lower Cranial Nerves during Surgical Management of Ventral Foramen Magnum Meningiomas Via a Dorsal Lateral Approach.

World Neurosurg 2021 02 1;146:e1242-e1254. Epub 2020 Dec 1.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address:

Background: This study established novel technique nuances in surgery for ventral foramen magnum meningiomas (vFMMs) via a dorsal lateral approach.

Methods: From July 2012 to July 2019, 37 patients with vFMMs underwent tumor resection surgery and were operated on with a dorsal lateral approach. Two safe zones were selected as the entrance of the surgical corridor. Safe zone I was located between the dural attachment of the first dental ligament (FDL) and the branches of C1; safe zone II lay between the dural attachment of the FDL and the jugular foramen. The tumor was debulked first through safe zone I and then through safe zone II. The tumor was removed through a trajectory from the caudal to cephalad to allow tumor debulking from below and downward delivery, away from the brainstem and lower cranial nerves.

Results: Thirty-three patients underwent gross total resection, and 4 patients underwent subtotal resection. Four patients transiently required a nasogastric feeding tube. All patients recovered within 3 months postoperatively. Three patients (8.1%) developed permanent mild hoarseness and dysphagia as a result of postoperative damage of cranial nerves IX and X. One patient underwent tracheotomy. No patient experienced tumor recurrence during the follow-up period.

Conclusions: We established a minimal retraction principle, in which the selection of 2 safe zones as the entrance of the surgical corridor, tumor removal from the inferior to superior direction, and debulking followed by devascularization were the key elements to implement the minimal retraction principle in vFMM surgery.
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http://dx.doi.org/10.1016/j.wneu.2020.11.140DOI Listing
February 2021

GIT1 overexpression promotes epithelial-mesenchymal transition and predicts poor prognosis in hepatocellular carcinoma.

Bioengineered 2021 12;12(1):30-43

Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University , Yangzhou, Jiangsu, P.R. China.

Globally, hepatocellular carcinoma (HCC) is one of the most common causes of cancer-associated mortalities. It has a high rate of metastasis and recurrence, which predict a poor prognosis. G-protein-coupled receptor (GPCR)-kinase interacting protein-1 (GIT1) is a multifunctional scaffold protein that mediates the progression of various tumors. Studies have correlated GIT1 with HCC, however, these correlations have not been fully elucidated. Therefore, we aimed at evaluating the expression of GIT1 in HCC tissues and cells, and to investigate its role and potential mechanisms in HCC progression. The expression levels of GIT1 in HCC tissues and other cancers was determined by using the Oncomine and TCGA databases. Functional analysis of GIT1 in HCC was evaluated through and experiments, whereby, HCC cells were transfected with synthetically overexpressed and short hairpin RNA (shRNA) lentivirus-mediated plasmids. Kaplan-Meier and Cox regression methods were used to establish the associations between GIT1 and clinical outcomes of 158 HCC patients. GIT1 was found to be elevated in HCC tissues where it promoted the invasion, migration, and proliferation of HCC cells. Moreover, the overexpression of GIT1 prompted epithelial-mesenchymal transition (EMT) by activating extracellular regulated kinase 1/2 (ERK1/2) pathway, which was shown to be reversed by SCH772984, a specific ERK1/2 inhibitor. GIT1 was also found to be associated with malignant features of HCC, leading to a poorer prognosis. In conclusion, GIT1 promotes HCC progression by inducing EMT and may reflect the course of HCC patients.
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http://dx.doi.org/10.1080/21655979.2020.1855914DOI Listing
December 2021

Endovascular treatment versus standard medical treatment for acute basilar artery occlusion: protocol for a systematic review and meta-analysis.

BMJ Open 2020 11 27;10(11):e040415. Epub 2020 Nov 27.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

Introduction: Acute basilar artery occlusion (BAO) can cause posterior circulation stroke. There are two predominant therapies for BAO: standard medical treatment (SMT) and SMT plus endovascular thrombectomy (EVT). However, a conclusive systematic comparison of the safety and efficacy of SMT and those of SMT plus EVT for the treatment of BAO is lacking. Thus, a systematic review and meta-analysis is needed to evaluate the safety and efficacy of SMT and SMT plus EVT for the treatment of BAO.

Methods And Analysis: This protocol is drafted referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines. We will search eligible studies from four main databases including MEDLINE, Web of Science, Cochrane Library and Embase. Randomised controlled trials (RCTs) and observational studies published before 1 October 2020 will be included. Two reviewers in our team will conduct the study selection and data extraction independently. Risk of bias will be assessed by Cochrane Collaboration criteria and the Newcastle-Ottawa scale for RCTs and observational studies, respectively. We will assess the good functional outcomes defining the modified Rankin scale score ≤2 at 90 days after treatment, short-term stroke severity as National Institutes of Health Stroke Scale score at 24 hours after intervention, and successful recanalisation as a modified Thrombolysis in Cerebral Infarction scale score of ≥2b after intervention. Also, safety outcomes will be assessed. The performance of this meta-analysis will depend on the quantity of included studies. The assessment of study heterogeneity will be performed by the I statistic. If there is mild heterogeneity (I<20%) of intervention outcomes in included studies, the fixed-effect model will be applied; otherwise, the random-effect model will be performed. Subgroup analyses and an assessment of publication bias will also be conducted with sufficient data.

Ethics And Dissemination: No collection of primary data from patients is needed. Therefore, the ethical approval is unnecessary. The results may be presented in a peer-reviewed journal and related conferences.

Prospero Registration Number: CRD42020176764.
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http://dx.doi.org/10.1136/bmjopen-2020-040415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703427PMC
November 2020

Correlation between intracranial vertebral artery stenosis diameter measured by digital subtraction angiography and cross-sectional area measured by optical coherence tomography.

J Neurointerv Surg 2020 Nov 23. Epub 2020 Nov 23.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

Background: Intracranial vertebral artery (V4 segment) stenosis quantification traditionally uses the narrowest stenosis diameter. However, the stenotic V4 lumen is commonly irregularly shaped. Optical coherence tomography (OCT) allows a more precise calculation of V4 geometry. We compared the narrowest diameter stenosis (DS), measured by digital subtraction angiography (DSA), with the area stenosis (AS), measured by OCT. We hypothesized that DS is the gold standard for measuring the degree of stenosis.

Methods: Five neuroradiologists evaluated 49 stenosed V4 segments in a blinded protocol. V4 stenosis was measured in millimeters on DSA at its narrowest diameter. OCT was used to estimate the cross-sectional luminal area. We also used automated software to measure DS. Three different angles (anterior, lateral, and oblique views) were used for calculations, and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) methods were used in all measurements. Spearman's R values were calculated. Non-linear regression analysis was performed between the DS and AS, with statistically different correlations.

Results: A high correlation was observed between the WASID and NASCET methods to measure DS with observer measurement and automated software. A good correlation was found between DS measured by observers and AS measured by OCT. Non-linear regression analysis showed that only observer measurement using the oblique view and the WASID method could attain statistically significant differences, but it was weak (r=0.389).

Conclusion: Measurement of the narrowest diameter was not a reliable predictor of the cross-sectional area of V4 stenosis. Larger studies are therefore needed to develop a new evaluation system based on V4 stenosis.
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http://dx.doi.org/10.1136/neurintsurg-2020-016835DOI Listing
November 2020

Influence of first-pass effect on recanalization outcomes in the era of mechanical thrombectomy: a systemic review and meta-analysis.

Neuroradiology 2021 May 21;63(5):795-807. Epub 2020 Oct 21.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Purpose: This systematic review and meta-analysis summarized the current literature to compare the safety and efficacy between first-pass effect (FPE) and multiple-pass effect (MPE) for thrombectomy in treatment of acute ischemic stroke (AIS).

Methods: Major databases were searched for studies which reported clinical outcomes regarding successful or complete recanalization after first pass of mechanical thrombectomy in AIS. The assessment of bias was performed using different scales. I statistic was used to evaluate heterogeneity between reviewers. Subgroup, meta-regression, and sensitivity analyses were conducted to explore the source of heterogeneity. Visualization of funnel plots was used to evaluate publication bias.

Results: A total of 9 studies were eligible for final analysis. For successful recanalization (mTICI 2b-3), favorable outcomes were seen in 49.7% (95% confidence interval (CI): 40.5-58.9%) and 34.7% (95% CI: 26.8-42.7%) of FPE and MPE patients, respectively. Mortality at 3 months was 13.8% (95% CI: 10.8-16.9%) and 26.0% (95% CI: 17.7-34.2%), respectively. For complete recanalization (mTICI 2c-3), proportion of favorable outcomes were 62.7% (95% CI: 51.2-74.2%) and 47.7% (95% CI: 37.4-58.0%) in FPE and MPE; mortality was seen in 11.5% (95% CI: 4.9-18.2%) and 17.0% (95% CI: 5.2-28.7%), respectively. For AIS with successful recanalization, FPE had more favorable outcome (odds ratio (OR): 1.85, 95% CI: 1.48-2.30; p < 0.01; I = 0%) and lower mortality than MPE (OR: 0.58, 95% CI: 0.42-0.79; p = 0.001; I = 61.9%). Similar results were seen in a subgroup analysis of patients with complete recanalization, with FPE having better outcome (OR: 1.79, 95% CI: 1.40-2.28; p < 0.01; I = 0%) and lower mortality risk (OR: 0.61, 95% CI: 0.44-0.86; p = 0.005; I = 0%) compared to MPE.

Conclusion: FPE is associated with better outcomes than MPE after achieving successful or complete recanalization.
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http://dx.doi.org/10.1007/s00234-020-02586-7DOI Listing
May 2021

Validation and comparison of drug eluting stent to bare metal stent for restenosis rates following vertebral artery ostium stenting: A single-center real-world study.

Interv Neuroradiol 2020 Oct 16;26(5):629-636. Epub 2020 Aug 16.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Background And Purpose: While drug-eluting stents (DES) have been widely applicated in coronary stenosis, uncertainty persists concerning the relative performance and clinical benefit in patients undergoing vertebral artery stenting when compared with a bare metal stent (BMS). We sought to compare in-stent restenosis (ISR) rates of DES and BMS in the treatment of vertebral artery ostium (VAO) stenosis.

Materials And Methods: This study analyzed a single-center prospective cohort. Over 1.5-year period (January 2014-June 2015), 137 consecutive patients underwent VAO stenting involving deployment of 76 DES and 74 BMS. Patient demographics, comorbidities, stenosis severity, stent diameters and lengths, periprocedural complications, imaging and duplex ultrasonography follow-up and recurrent symptoms were assessed.

Results: Technical success was achieved in all patients. Mean VAO stenosis at presentation were 82.4 ± 7.2% in the DES group and 83.3 ± 7.5% in the BMS group and were reduced to 12.5 ± 4.5% and 11.3 ± 4.0%. Mean stent diameter was 3.53 ± 0.40 mm in DES and 5.05 ± 0.40 mm in BMS (p < 0.0001). Mean follow-up was 12.3 months for DES and 11.7 months for BMS. The use of DES was associated with significant lower ISR rates compared with BMS (18.4% vs. 31.1%; OR = 2.628, p = 0.021). Recurrent symptoms rates were similar in DES vs. BMS (2.6% vs 2.7%, p = 0.680). Stent type and stent diameter were independent risk factors for ISR (P = 0.026).

Conclusion: Our results suggest superior efficacy of deploying DES for the treatment of VAO stenosis with lower ISR rates as compared to BMS, but do not support significant differences in periprocedural risk and recurrent symptoms rate.
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http://dx.doi.org/10.1177/1591019920949371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645189PMC
October 2020

ResNet-Locust-BN Network-Based Automatic Identification of East Asian Migratory Locust Species and Instars from RGB Images.

Insects 2020 Jul 22;11(8). Epub 2020 Jul 22.

Key Laboratory of Agricultural Land Quality (Beijing) Ministry of Land and Resources, China Agricultural University, Beijing 100083, China.

Locusts are agricultural pests found in many parts of the world. Developing efficient and accurate locust information acquisition techniques helps in understanding the relation between locust distribution density and structural changes in locust communities. It also helps in understanding the hydrothermal and vegetation growth conditions that affect locusts in their habitats in various parts of the world as well as in providing rapid and accurate warnings on locust plague outbreak. This study is a preliminary attempt to explore whether the batch normalization-based convolutional neural network (CNN) model can be applied used to perform automatic classification of East Asian migratory locust (AM locust), (rice locusts), and cotton locusts. In this paper, we present a way of applying the CNN technique to identify species and instars of locusts using the proposed ResNet-Locust-BN model. This model is based on the ResNet architecture and involves introduction of a BatchNorm function before each convolution layer to improve the network's stability, convergence speed, and classification accuracy. Subsequently, locust image data collected in the field were used as input to train the model. By performing comparison experiments of the activation function, initial learning rate, and batch size, we selected ReLU as the preferred activation function. The initial learning rate and batch size were set to 0.1 and 32, respectively. Experiments performed to evaluate the accuracy of the proposed ResNet-Locust-BN model show that the model can effectively distinguish AM locust from rice locusts (93.60% accuracy) and cotton locusts (97.80% accuracy). The model also performed well in identifying the growth status information of AM locusts (third-instar (77.20% accuracy), fifth-instar (88.40% accuracy), and adult (93.80% accuracy)) with an overall accuracy of 90.16%. This is higher than the accuracy scores obtained by using other typical models: AlexNet (73.68%), GoogLeNet (69.12%), ResNet 18 (67.60%), ResNet 50 (80.84%), and VggNet (81.70%). Further, the model has good robustness and fast convergence rate.
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http://dx.doi.org/10.3390/insects11080458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469226PMC
July 2020

Clinical outcomes of radiation-induced carotid stenosis: A systematic review and meta-analysis.

J Stroke Cerebrovasc Dis 2020 Aug 5;29(8):104929. Epub 2020 Jun 5.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. Electronic address:

Objectives: Clinical outcomes of radiation-induced carotid stenosis are still unclear. Therefore, a systematic review and meta-analysis is needed to evaluate the short- and long-term outcomes after interventions to treat radiation-induced carotid stenosis.

Methods: PubMed, EMBASE, the Cochrane Library and Web of Science were searched from 1 January 2000 for relevant RCTs and observational studies which reported outcomes after carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) for carotid stenosis induced by radiation. Risk of bias were assessed through different scales according to study design. I statistic were used to evaluate the heterogeneity, and meta-regression were performed to investigate the source of heterogeneity. Visual inspection of funnel plots was used to judge publication bias.

Results: A total of 26 studies with 1002 patients were included. CEA was performed in 364 patients and CAS in 638 patients. The overall estimated rate of short-term stroke was 0.19% (95% CI: 0-0.90%), and the rate of long-term stroke was 2.68 % (95% CI: 1.19-4.57%). The rate of cranial nerve injury in CEA group was significantly higher than that in CAS group [risk ratio (RR): 6.03, 95% CI: 1.63-22.22, P = .007]. The univariate regression analysis showed that the risk of stroke in CAS group were significantly higher than CEA group in both short- and long-term [incidence rate ratio (IRR): 3.62, 95% CI: 1.21-10.85, P = 0.22; IRR: 2.95, 95% CI: 1.02-8.59, P = .046, respectively].

Conclusions: This systematic review provided the worldwide profile of outcome of treatment for radiation-induced carotid stenosis, and also found that CEA can yield better results for these patients than CAS. Nonetheless, as large-scale studies have not yet been conducted, and there is a definite need for further studies in the future.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104929DOI Listing
August 2020

Treatment strategies for asymptomatic carotid artery stenosis in the era of lipid-lowering drugs: protocol for a systematic review and network meta-analysis.

BMJ Open 2020 07 5;10(7):e035094. Epub 2020 Jul 5.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

Introduction: Carotid endarterectomy (CEA), carotid artery stenting (CAS) and best medical therapy (BMT) are the major treatments used for significant asymptomatic carotid artery stenosis (ACAS, ≥50%). However, the widespread use of lipid-lowering drugs in this century has improved BMT outcomes. This study aims to compare the treatment efficacy of current BMT, CEA+BMT and CAS+BMT in patients with significant ACAS.

Methods And Analysis: This protocol was designed based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Publication time for studies will be set from 1 January 2000 to 1 June 2020. We will search three databases: PubMed, EMBASE and The Cochrane Library. Suitable randomised controlled studies will be screened. The primary outcomes will include short-term and long-term mortality, stroke and myocardial infarction. OR and HR for dichotomous data and time-to-event data with 95% CIs will be calculated. Treatment effects among different therapies will be ranked according to the surface under the cumulative ranking curve and mean rank. A comprehensive evaluation of the risk of bias, heterogeneity and transitivity will be performed before data synthesis. Consistency and evidence quality will also be assessed.

Ethics And Dissemination: There will be no need for ethics approval as this systematic review is a summary and analysis of existing literature. Final results may be presented in international conferences or a peer-reviewed journal.

Prospero Registration Number: CRD42019138942.
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http://dx.doi.org/10.1136/bmjopen-2019-035094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337893PMC
July 2020

Thirty-day outcomes of carotid endarterectomy in the elderly: A 17-year single-center study.

J Clin Neurosci 2020 Aug 1;78:86-90. Epub 2020 Jul 1.

Interventional Radiology Diagnosis and Treatment Center, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address:

Introduction: Carotid endarterectomy (CEA) has been supported as a durable procedure for treating patients with carotid artery stenosis by many randomized controlled trials (RCTs). The aim of this study was to evaluate the 30-day outcomes and risk factors for CEA in elderly patients with a retrospective single-center study.

Methods: Our study sample consisted of patients from 2001 to 2017 CEA-targeted Xuanwu Hospital, Capital Medical University data set. The primary outcome was 30-day postoperative incidence of major adverse clinical events (MACEs; death, myocardial infarction (MI) and ipsilateral stroke). Univariable and multivariable analyses were performed to identify high-risk patients and procedural characteristics associated with MACEs.

Results: A total of 348 elderly patients undergoing CEA for carotid artery stenosis were identified and analyzed. The incidence of postoperative MACEs was 4.6% (16 cases, included 1 death, 14 S, and 1 MI respectively) for elderly patients. Univariate analysis indicated symptomatic lesion (81.3% vs 55.7%, p = 0.044), diabetes mellitus (56.3% vs 26.8%, p = 0.011) and DBP (85.56 ± 11.26 mmHg vs 76.53 ± 9.51 mmHg, p < 0.001) were statistically significant with MACEs. On multivariable analysis, independent predictors of MACEs included diabetes mellitus (DM) (OR = 2.882; 95% CI = 1.005-8.266; P = 0.049) and higher diastolic blood pressure (DBP) (OR = 1.079; 95% CI = 1.025-1.136; P = 0.004). Symptomatic lesion was not an independent risk factor (OR = 2.805; 95% CI = 0.759-10.361; P = 0.122).

Conclusions: According to our single-center experience, CEA could be safely performed in elderly patients. Risk factors identified for MACEs in this special group patients were DM and higher DBP.
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http://dx.doi.org/10.1016/j.jocn.2020.06.007DOI Listing
August 2020

Analysis of risk factors for gallbladder polyp formation - A retrospective study based on serial ultrasounds.

Eur J Gastroenterol Hepatol 2020 09;32(9):1154-1159

Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing.

Aim: To evaluate gallbladder polyp (GBP) formation related risk factors based on serial ultrasounds (US).

Methods: Risk factors related GBP formation were retrospectively investigated among participants, who had US reexamination and interval >180 days in 5 years. After groups were divided based on US, we compared final data and initial data in GBP new incidence group. Then compared the data in GBP new incidence group and GBP(-) group.

Results: Overall 20 447 participants were recruited, including 18 243 in GBP (-) group and 2204 in GBP group. The mean diameters of polyps were 0.455 ± 0.198 mm in initial and 0.420 ± 0.180 mm in final examination. GBP new incidence group included 797 participants. Percentage of GBP new incidence participants was higher than GBP resolved (36.16% vs. 11.71%). Participants in middle age were more likely have GBP size increase or new incidence, and participants in old age (≥60 years old) were with GBP size decrease or resolved. In GBP new incidence group, participants in final US showed higher FBG, higher LDL, lower HDL, higher ALT and higher AST than initial US. Compared with GBP (-) group and, same risk factors, in addition with age, were shown in GBP new incidence group, Logistic regression analysis show that higher LDL, lower HDL and higher AST were risk factors for GBP formation.

Conclusion: Participants in middle age were more likely to have GBP new incidence. Higher LDL, lower HDL and higher AST were independently risk factors for GBP formation.
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http://dx.doi.org/10.1097/MEG.0000000000001814DOI Listing
September 2020

Changes in MMP-2, MMP-9, inflammation, blood coagulation and intestinal mucosal permeability in patients with active ulcerative colitis.

Exp Ther Med 2020 Jul 30;20(1):269-274. Epub 2020 Apr 30.

Department of Gastroenterology, Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning 110032, P.R. China.

Changes in matrix metalloproteinase (MMP)-2, MMP-9, inflammation, blood coagulation factors and intestinal mucosal permeability in patients with active ulcerative colitis (UC) were investigated. A total of 50 active UC patients treated in our hospital from January 2016 to December 2018 were selected as the UC group, whereas 50 normal subjects receiving physical examination were selected as the control group. Venous blood was drawn to detect the content of early predictors, C-reactive protein (CRP), follistatin-like protein 1 (FSTL1) and D-dimer in serum. The disease activity index (DAI) score was recorded in both groups, the levels of MMP-2 and MMP-9 were determined, and the inflammatory factors interleukin (IL)-1, IL-6 and tumor necrosis factor (TNF)-α were also detected. Moreover, the blood coagulation factors, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen level were detected, the content of lactulose (L) and mannitol (M) in the urine after oral administration of L and M test liquid was determined via high-performance liquid chromatography in both groups, and the L/M ratio was calculated. In UC group, the content of CRP, FSTL1 and D-dimer was significantly higher than that in the control group (P<0.05). The DAI score was significantly higher (P<0.05), the content of MMP-2 and MMP-9 was remarkably raised (P<0.05), the platelet count, PT, APTT and fibrinogen level were all obviously increased (P<0.05), and the L/M ratio was notably lower (P<0.05) in the UC group than in the control group. In patients with active UC, MMP-2, MMP-9 and inflammatory factors were significantly increased, and there were changes in the blood coagulation factors and intestinal mucosal permeability, which further promote the occurrence and development of UC.
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http://dx.doi.org/10.3892/etm.2020.8710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282134PMC
July 2020

Risk factors for silent new ischemic cerebral lesions following carotid artery stenting.

Neuroradiology 2020 Sep 4;62(9):1177-1184. Epub 2020 May 4.

Interventional Radiology Diagnosis and Treatment Center, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Purpose: Silent new ischemic cerebral lesions (sNICL) detected by diffusion-weighted imaging (DWI) are common after carotid artery stenting (CAS). As part of the Revascularization of Extracranial Carotid Artery Stenosis (RECAS) study, this work aimed to determine predictors of sNICL detected by DWI following CAS.

Methods: A total of 694 patients eligible for the RECAS study treated in Xuanwu Hospital, Capital Medical University, with complete imaging data were included in this retrospective study. The patients were asymptomatic after CAS, and those with stroke, transient ischemic attack (TIA), or death were excluded. The RECAS protocol specified that DWI was completed 1-7 days before the procedure and within 3 days after CAS. Several parameters were assessed for associations with sNICL occurrence after CAS in univariate analysis. Finally, multivariate analysis was performed to determine risk factors for sNICL.

Results: The rate of post-procedural sNICL in CAS was 51.3% (356/694 patients with sNICL). All patients underwent stenting with embolic protection devices. Univariate analysis showed that diabetes mellitus (P = 0.008), ipsilateral calcified plaques (P = 0.036), ipsilateral ulcerated plaques (P = 0.026), pre-dilatation (P = 0.003), and open-cell stent use (P < 0.001) were significantly associated with sNICL occurrence in CAS. Multivariate analysis revealed that diabetes mellitus (P = 0.006), ipsilateral calcified plaques (P = 0.024), ipsilateral ulcerated plaques (P = 0.021), and open-cell stent use (P < 0.001) were independent risk factors for sNICL.

Conclusions: Patients with diabetes, calcified or ulcerated plaques who undergo CAS with open-cell stent application, are at high risk of sNICL. Large-scale prospective randomized controlled trials are needed to confirm these findings.
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http://dx.doi.org/10.1007/s00234-020-02447-3DOI Listing
September 2020

Extracranial-intracranial bypass surgery for occlusive atherosclerotic disease of the anterior cerebral circulation: protocol for a systematic review and meta-analysis.

Syst Rev 2020 04 2;9(1):70. Epub 2020 Apr 2.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China.

Background: Occlusive atherosclerotic disease of the anterior cerebral circulation is one of the most common causes of anterior circulation ischemia and stroke. Treatment options include medical therapies (including antiplatelet use, blood pressure control, lipid reduction, and lifestyle modification) and extracranial-intracranial bypass surgery (such as superficial temporal artery-middle cerebral artery bypass). However, the optimal treatment remains unclear. The objective of this study will be to compare the efficacy of and extracranial-intracranial bypass surgery with that of other medical therapy in adult patients with occlusive atherosclerotic disease of the anterior cerebral circulation.

Methods: This is the study protocol for a systematic review. We will search MEDLINE, EMBASE, Web of Science, and the Cochrane Library (from January 1980 onwards). We will include randomized controlled trials, quasi-experimental studies (non-randomized, interrupted time series), and observational studies (e.g., cohort studies and case-control studies), examining the efficacy of extracranial-intracranial bypass surgery compared to other treatments for adult patients with occlusive atherosclerotic disease of anterior cerebral circulation. Two team members will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The primary outcome will include stroke or death. The secondary outcomes will include intracranial hemorrhage, transient ischemic attack, and myocardial infarction. The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., study design, geographical location, or risk of bias).

Discussion: This review will evaluate the evidence on the efficacy of extracranial-intracranial bypass surgery for adult patients with occlusive atherosclerotic disease of the anterior cerebral circulation. We anticipate that our findings will be of interest to patients, their families, caregivers, healthcare professionals, and in making optimal treatment selection. Implications for future clinical and epidemiological research will be discussed.

Systematic Review Registration: PROSPERO CRD42018105513.
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http://dx.doi.org/10.1186/s13643-020-01325-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118989PMC
April 2020

Thirty-Day Outcome of Carotid Artery Stenting in Elderly Patients: A Single-Center Experience.

World Neurosurg 2020 06 26;138:e311-e316. Epub 2020 Feb 26.

Interventional Radiology Diagnosis and Treatment Center, Department of Neurosurgery, Capital Medical University, Beijing, China. Electronic address:

Background: The safety of carotid artery stenting (CAS) in elderly patients is controversial. The aims of this study were to evaluate 30-day outcomes after CAS in elderly patients (≥70 years old) and to investigate risk factors for postoperative incidence of major adverse clinical events (MACE) to improve CAS safety based on clinical evidence in this specific subgroup of patients.

Methods: The data set included patients who underwent CAS between 2001 and 2017 at Xuanwu Hospital, Capital Medical University. The primary outcome variable was 30-day postoperative incidence of the following MACE: death, myocardial infarction, and ipsilateral stroke. Univariate and multivariate analyses were performed to identify high-risk patients and procedural characteristics associated with MACE.

Results: A total of 1029 elderly patients who underwent CAS for carotid artery stenosis were identified and analyzed. The incidence of postoperative MACE was 3.01% (n = 31 cases [5 deaths, 24 strokes, and 2 myocardial infarctions]). After multivariate analysis, independent predictors of MACE included a family history of stroke (odds ratio [OR] = 3.817; 95% confidence interval [CI], 1.227-11.876; P = 0.021), symptomatic status (OR = 2.650; 95% CI, 1.210-5.806; P = 0.015), and modified Rankin Scale score ≥3 (OR = 4.594; 95% CI, 1.708-12.352; P = 0.003). Hyperlipidemia was not an independent risk factor (OR = 1.597; 95% CI, 0.745-3.425; P = 0.229).

Conclusions: At our center, CAS was safely performed in elderly patients. A family history of stroke, symptomatic status, and modified Rankin Scale score ≥3 indicating a neurologic deficit increased the risk of 30-day postoperative MACE.
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http://dx.doi.org/10.1016/j.wneu.2020.02.093DOI Listing
June 2020

Risk factors for new ischaemic cerebral lesions after carotid artery stenting: protocol for a systematic review and meta-analysis.

BMJ Open 2019 08 24;9(8):e030025. Epub 2019 Aug 24.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

Introduction: New ischaemic cerebral lesions (NICL) detected by diffusion-weighted imaging MRI are common after carotid artery stenting (CAS), with an occurrence rate ranging from 18% to 57%. Many studies reported occurrence of NICL could increase risk of future cerebrovascular events and cognitive impairment. However, controversies about determinants for occurrence of NICL after CAS exist among studies, and one risk factor embodied in an article may not be in another. Aim of this study is to introduce a protocol for a systematic review and meta-analysis to identify risk factors associated with occurrence of NICL after CAS.

Methods And Analysis: All relevant literature referring to risk factors for occurrence of NICL after CAS will be searched on the major databases, such as PubMed, Embase, Web of Science and the Cochrane Library until 31 December 2018. Literature, which must be randomised controlled trials, case-control studies or cohort studies, will be included in accordance with the prespecified eligibility criteria. The risk of bias will be assessed using the Cochrane Collaboration criteria and the quality of evidence will be assessed with the corresponding scale. Data will be extracted with a form prepared before and analysed using RevMan V.5.3 analyses software. Heterogeneity will be assessed using I statistic. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Ethics And Dissemination: There is no need for ethical approval because primary data will not be attained. The systematic review will be presented at international conferences and published in peer-reviewed journals.

Prospero Registration Number: CRD42019121129.
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http://dx.doi.org/10.1136/bmjopen-2019-030025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719763PMC
August 2019

Risk factors of gallbladder polyps formation in East Asian population: A meta-analysis and systematic review.

Asian J Surg 2020 Jan 17;43(1):52-59. Epub 2019 May 17.

Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

To perform Meta-analysis to identify risk factors associated with gallbladder polyps (GBP) formation in east Asian population. Three English electronic bibliographic databases includes PubMed, Embase and Medline, with reviewed researches from 1986 to 2017. All possible risk factors of GBP formation were recorded. Meta-analyses were performed by Review Manager Software. Pooled odds ratios (OR) or the mean difference (MD) were used to determine risk factors. Sixteen studies and 227021 people were recruited, including 17261 people with GBP and 209760 without GBP. For categorical variables evaluated by OR test., risk factors of GBP formation were male gender (OR, 1.63; 95%CI, 1.42-1.87) and positive HBsAg. GBP formation were not correlated with age <50 years old, hypertension, DM, BMI ≥ 25kg/m, smoking, drinking, HDL decrease, TC increase, TG increase, fatty liver and GBS. For continuous variables evaluated by MD test, risk factors of GBP formation were DBP (MD, 1.08; 95%CI, 0.15-2.02), mean BMI (MD,0.19; 95%CI,0.02-0.35), waist circumference (MD,1.780; 95%CI, 0.17,3.40), mean LDL (MD,0.89; 95%CI,0.03-1.75), mean HDL (MD,-1.87; 95%CI,-3.21 to -0.52). GBP formation were not correlated with mean age, SBP, mean TC, mean TG, ASL and ALT. In conclusion, risk factors of gallbladder polyp formation included male gender, higher BMI, higher waist circumference, higher DBP, higher LDL, lower HDL and positive HBsAg in east Asian population. GBP formation was not correlated with age, hypertension, DM, smoking, drinking, fatty liver, GBS, TC, TG, SBP, ASL and ALT. The mechanism of Dyslipidemias causing GBP needs deeper study in future.
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http://dx.doi.org/10.1016/j.asjsur.2019.03.015DOI Listing
January 2020
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