Zuoxu Fan

Schizophrenia and the risk of cardiovascular diseases: A meta-analysis of thirteen cohort studies

BACKGROUND Numerous studies have investigated the relationship between schizophrenia and the incidence of cardiovascular disease (CVD), but their results were not entirely consistent. Our study aimed to elucidate the association between schizophrenia and the risk of CVD by a meta-analysis of cohort studies. METHODS PubMed, the Cochrane Library, and EMBASE databases were searched to identify relevant studies that met the prespecified inclusion criteria. We also reviewed reference lists from the retrieved articles. Relative risks (RRs) and 95% confidence intervals (CIs) were extracted and pooled using the fixed-effect or random-effects models. RESULTS Thirteen studies involving 3,549,950 participants, with outcomes of CVD reported for 422,698, were included in the meta-analysis. The follow-up period ranged from 1.6 to 36.0 years. The meta-analysis found that the pooled RRs for schizophrenia compared with the reference group were 1.53 (95% CI: 1.27-1.86) for the incidence of CVD, 1.20 (95% CI: 0.93-1.53) for coronary heart disease (CHD), 1.71 (95% CI: 1.19-2.46) for stroke, and 1.81 (95% CI: 1.42-2.29) for congestive heart failure (CHF). Sensitivity analysis after the exclusion of a single cohort or using the unadjusted RRs yielded similar results to the primary overall estimations. No evidence of publication bias was observed. CONCLUSIONS Schizophrenia is associated with increased incidence of CVD, stroke and CHF, and might also increase the risk of CHD. Greater attention should be paid to schizophrenia patients to prevent the occurrence of CVD and to decrease the risk of cardiac morbidity.

Dissociation of vasospasm-related morbidity and outcomes in patients with aneurysmal subarachnoid hemorrhage treated with clazosentan: a meta-analysis of randomized controlled trials

OBJECT Clazosentan therapy after aneurysmal subarachnoid hemorrhage (SAH) has been found to be effective in reducing the incidence of vasospasm in randomized controlled trials. However, while vasospasm-related morbidity, including delayed ischemic neurological deficits (DINDs) and delayed cerebral infarctions, was consistently decreased, statistical significance was not demonstrated and outcomes were not affected by clazosentan treatment. The objective of this meta-analysis was to determine whether clazosentan treatment after aneurysmal SAH significantly reduced the incidence of DINDs and delayed cerebral infarctions and improved outcomes. METHODS All randomized controlled trials investigating the effect of clazosentan were retrieved via searches with sensitive and specific terms. Six variables were abstracted after the assessment of the methodological quality of the trials. Analyses were performed following the method guidelines of the Cochrane Back Review Group. RESULTS Four randomized, placebo-controlled trials met eligibility criteria, enrolling a total of 2181 patients. The meta-analysis demonstrated a significant decrease in the incidence of DINDs (relative risk [RR] 0.76 [95% CI 0.62-0.92]) and delayed cerebral infarction (RR 0.79 [95% CI 0.63-1.00]) in patients treated with clazosentan after aneurysmal SAH. However, this treatment regimen was not shown to outcomes including functional outcomes measured by Glasgow Outcome Scale-Extended (RR 1.12 [95% CI 0.96-1.30]) or mortality (RR 1.02 [95%CI 0.70-1.49]). Adverse events, including pulmonary complications, anemia, and hypotension, were all significantly increased in patients who received clazosentan therapy. CONCLUSIONS The results of the present meta-analysis show that treatment with clazosentan after aneurysmal SAH significantly reduced the incidence of the vasospasm-related DINDs and delayed cerebral infarctions, but did not improve poor neurological outcomes in patients with aneurysmal SAH. Further study is required to elucidate the dissociation between vasospasm-related morbidity and outcomes.

Buyang Huanwu decoction increases angiopoietin-1 expression and promotes angiogenesis and functional outcome after focal cerebral ischemia *

Buyang Huanwu decoction (BYHWD), a traditional Chinese herbal prescription, has been widely used clinically to treat stroke in China for hundreds of years; however, the mechanisms of this drug for stroke treatment are still unclear. This study aims to observe the cerebral angiogenesis effects of BYHWD on chronic brain injury after focal cerebral ischemia in rats and to explore its possible mechanisms. The ischemia was induced by occlusion of the right middle cerebral artery for 90 min. BYHWD (12.5 and 25.0 g/(kg·d), equivalent to the dry weight of the raw materials) was orally administered twice a day beginning 2 h after surgery. BYHWD significantly attenuated the neurological dysfunction, infarct volume, and brain atrophy after ischemia. There was a significant increase in the microvessel density, as assessed by immunofluorescence CD31, and a significant increase in angiopoietin-1 (Ang-1) in the penumbra areas of the rats was shown by immunohistochemical staining and Western blotting. The results indicate that the neurorestorative effects of BYHWD are associated with angiogenesis and the enhancement of the expressions of Ang-1 on chronic brain injury after focal cerebral ischemia.

The relationship between risk factors and prognostic factors in patients with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage.

ObjectiveWe investigated the predictors and outcomes of aneurysmal subarachnoid hemorrhage in patients with shunt-dependent hydrocephalus and make a preliminary inquiry into the relationship between the two. MethodsA consecutive cohort of 202 patients was evaluated, which included 40 shunt-dependent hydrocephalus patients. The basic characteristics on admission, complications of hemorrhage, management before onset of chronic hydrocephalus, and outcomes of shunting were established. The Glasgow Outcome Scale score was used to evaluate the recovery of patients with a ventriculoperitoneal (V-P) shunt. Furthermore, relevant statistical analyses were presented to identify the significance of risk factors and prognostic factors associated with shunt-dependent hydrocephalus. ResultsFrom among 202 patients, 40 (19.8%) developed shunt-dependent hydrocephalus, and 26 (65.0%) of these 40 improved after undergoing a V-P shunt. In the univariate analysis, age, preexisting hypertension, Glasgow Coma Scale score, Hunt-Hess grade, modified Fisher grade, posterior circulation, rebleeding, acute hydrocephalus, intraventricular hemorrhage, vasospasm, nosocomial meningitis, neurosurgical clipping, decompressive craniectomy, external ventricular drainage (EVD), and duration of EVD were significantly related to shunt-dependent hydrocephalus; moreover, age, preexisting hypertension, posterior circulation, acute hydrocephalus, intraventricular hemorrhage, and decompressive craniectomy were independent predictors. Similarly, age, Hunt-Hess grade, Glasgow Coma Scale score, nosocomial meningitis, and duration of EVD could be the prognosticators of a V-P shunt. ConclusionsPatients who were older, with worse mental function status on admission, nosocomial meningitis, and longer duration of EVD, are susceptible to shunt-dependent hydrocephalus because of ruptured intracranial aneurysm and also have unfavorable outcomes after a V-P shunt. Timely and appropriate treatment can benefit such patients in recovery.

Clinical and Radiological Outcomes After Treatment of Unruptured Paraophthalmic Internal Carotid Artery Aneurysms: a Comparative and Pooled Analysis of Single-Center Experiences

OBJECTIVE Unruptured paraophthalmic aneurysms present unique challenges, and the ideal management remains unknown. METHODS We performed a pooled analysis of single-center experiences to compare the risks and effectiveness involving patients with unruptured paraophthalmic aneurysms treated with clipping, coiling alone, stent-assisted coiling, and flow-diversion. The MEDLINE database was searched and thirty-three series (including our institutional experience) were included. RESULTS Clipping caused more intracranial hemorrhage (ICH) and neurologic complications (NCs) than coiling alone (ICH: odds ratio [OR] = 3.058, P = 0.013; NC: OR = 5.809, P < 0.001), stent-assisted coiling (ICH: P = 0.018; NC: OR = 7.367, P < 0.001), and flow-diversion (ICH: P = 0.006; NC: OR = 16.954, P < 0.001). Clipping also caused more unfavorable visual outcomes than both coiling alone (OR = 3.037, P = 0.001) and stent-assisted coiling (OR = 6.055, P = 0.005). Clipping resulted in a lower reoperation rate than coiling alone in large/giant aneurysm group, which approached statistical significance (OR = 0.133, P = 0.057). Clipping, stent-assisted coiling, and flow-diversion all showed higher occlusion rates compared with coiling alone (OR [clipping vs. coiling alone] = 2.852, P ≤ 0.001; OR [coiling alone vs. stent-assisted coiling] = 0.302, P = 0.003; OR [coiling alone vs. flow-diversion] = 0.400, P = 0.013). Flow-diversion showed comparative complication rate, clinical outcomes, and angiographic result compared with stent-assisted coiling. No significant differences were found among all 4 treatment modalities on mortality and poor outcome. CONCLUSIONS Endovascular therapies have benefits over surgical clipping in terms of fewer intracranial hemorrhage complications, fewer NCs, and lower unfavorable visual outcome rate. Flow diversion showed comparative safety and effectiveness to stent-assisted coiling, and they both achieved better radiologic results than coiling alone. Further validation by randomized cohort studies is still needed to provide robust evidence.

Smoking and risk of meningioma: A meta-analysis

OBJECTIVE The relationship between smoking and the development of meningioma has been investigated in several epidemiological studies. However, the results of these studies are inconsistent. We conducted a meta-analysis in order to identify any potential association. METHODS PubMed, the Cochrane Library, and EMBASE databases were searched to identify relevant articles that investigated the risk of meningioma following cigarette smoking. Two researchers evaluated study eligibility and extracted the data independently, and disagreements were resolved by discussion. The variables used to estimate the pooled risk of smoking in meningioma development were the multivariate-adjusted risk estimates presented in the literature. RESULTS Seven case-control and two cohort studies were included in this meta-analysis. The pooled estimated risks associated with ever smoking for meningioma were 1.02 (95% confidence interval (CI): 0.85-1.21) in the case-control studies, 0.93 (95% CI: 0.83-1.04) in the cohort studies and 0.95 (95% CI: 0.87-1.05, P = 0.32) in all studies when the cohort and case-control data were combined. Subgroup analyses suggested that the risk estimates were 1.49 (95% CI: 1.06-2.09, P = 0.02), 0.86 (95% CI: 0.65-1.13), 0.79 (95% CI: 0.50-1.25) and 0.84 (95% CI: 0.69-1.03) for men, women, current and past smoking respectively. Sensitivity analyses restricted to studies with different adjustments for confounders yielded similar results. No evidence of publication bias was observed. CONCLUSION Our meta-analysis suggests that there is no association between ever smoking and the risk of meningioma. However, a small but significant risk elevation is present among men smokers.