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Background: Alzheimer's disease (AD) leads to progressive neuronal loss and cognitive and behavioral decline in the aging population. Matrix metalloproteinases (MMPs) and associated tissue inhibitors of metalloproteinases (TIMPs) are involved in remodeling the extracellular matrix. Amyloid beta-42 interrupts the integrity of the neurovascular unit and induces a toxic reaction affecting neurons., Objective: This study investigated the relationships among genetic variants of the MMP-2, MMP-9, TIMP-1, and TIMP-2 genes and AD., Methods: Two hundred and thirteen probable AD patients and 315 control participants of the Taiwan population were recruited for primary investigations, and we used the data of 763 participants from the Taiwan Biobank (TWB), as controls, for validation. Multivariable logistic regression was performed with adjustments for age, sex, hypertension, diabetes mellitus (DM), and alcohol consumption. The associations between the genotypes and allele frequencies and the SNP-associated AD hereditary models were analyzed using the SNPassoc package for R. We performed a permutation test with 1,000 replicates for the empirical estimates., Results: A total of 213 probable AD patients and 315 control participants were recruited. The frequency of the A alleles in rs7503726 (G > A) in TIMP-2 was lower in the AD patients (p < 0.01). The frequencies of the TIMP-2 rs7503726 G/A and A/A genotypes were also significantly lower in the AD patients (p = 0.02) than in the controls and TWB. The TIMP-2 rs7503726 AA genotype was associated with a protective effect of AD in additive and recessive hereditary models (OR = 0.54, 95% CI: 0.32 - 0.92, p = 0.02; OR = 0.68, 95% CI: 0.50 - 0.92, p = 0.01, respectively)., Conclusion: The TIMP-2 rs7503726 AA genotype was inversely correlated with AD susceptibility, and the presence of minor alleles of rs7503726 (A allele) have protective effects against AD., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) encode essential alcohol-metabolizing enzymes. While alcohol use is associated with spontaneously deep intracerebral haemorrhage (SDICH), particularly in males, the activities and genetic variants of ADH and ALDH may affect SDICH development. This case-control study was conducted to identify the interaction of alcohol use and SDICH with five single-nucleotide polymorphisms (SNPs): ADH1B rs1229984, ADH1C rs2241894, ALDH2 rs671, ALDH2 rs886205, and ALDH2 rs4648328. We enrolled 208 patients with SDICH and 244 healthy controls in a Taiwanese population. ALDH2 rs671 was significantly associated with SDICH in the dominant (P < 0.001) and additive models (P = 0.007). ALDH2 rs4648328 was borderline significantly associated with SDICH in the recessive (P = 0.024) or additive models (P = 0.030). In alcohol-using patients, the ALDH2 rs671 GG genotype was associated with SDICH risk compared to the GA+AA genotype (P = 0.010). ADH1B rs1229984, ADH1C rs2241894, and ALDH2 rs886205 did not demonstrate association with SDICH. Thus, the ALDH2 rs671 GG genotype is a risk factor for SDICH. Because the genetic distributions of ALDH2 rs671 exhibited strong ethnic heterogeneity, further studies in different populations are needed to validate these findings.

Objective: Spontaneous subarachnoid hemorrhage (SAH) is a catastrophic disease with a high mortality. Although it is associated with poor prognosis in older patients, the socioeconomic consequences in younger patients with stroke may be more severe. We aimed to focus on the demographics and short-term outcomes of SAH in a population younger than 50 years., Methods: We retrospectively enrolled 1689 patients with a primary diagnosis of SAH from 1993 to 2010. We identified intergroup differences in clinical variables between the patients aged 18-49 years (n = 531) and those aged ≥50 years (n = 1158)., Results: The patients with SAH included 688 men and 1001 women (an overall male/female ratio of 1:1.45), of whom 31.4% were aged 18-49 years. Men comprised 53.5% of the younger patients and 34.9% of the older patients (P < 0.01). The post-SAH sequela of hemiplegia was more common in the younger patients (P < 0.01), whereas the incidences of in-hospital mortality in the younger and older groups were 25.4% and 32.4%, respectively (P < 0.01)., Conclusions: Adults younger than 50 years account for a significant portion of the population with SAH. There is a male predominance in this age group, probably related to early and substantial risk exposure. Although younger age imparts a higher probability of survival, it is also accompanied by a greater incidence of resultant sequelae. A better understanding of the age-related variability of SAH will assist in guidance for public health and adjustment of clinical management., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: Decompressive craniectomy (DC) for traumatic brain injury (TBI) can be used in 2 completely different situations: primary and secondary DC. Although intracranial pressure (ICP) monitoring has proved to be helpful in guiding therapy for head injuries, its role after primary DC is not well analyzed. The aim of this study was to elucidate the relationship between ICP monitoring and outcomes in patients undergoing primary DC for TBI., Methods: We enrolled 187 head-injured patients undergoing primary DC in this retrospective study. The patients were subdivided into 2 groups based on whether postoperative ICP was monitored (n = 34) or not (n = 153). We identified the intergroup differences in clinical parameters and prognosis. Unfavorable and favorable neurologic outcomes were defined by Glasgow Outcome Scale scores of 1-3 and 4-5, respectively., Results: The rate of ICP monitoring was 18.2% for our head-injured patients after primary DC. There was no difference in preoperative Glasgow Coma Score, pupil reactivity, features of computed tomography images, or other demographic variables between patients with or without ICP monitoring. The mortality at discharge was 14.7% for patients with ICP monitoring and 32.7% for patients without, which showed a statistically significant difference (P = 0.037). The neurologic outcomes did not differ between the patient groups at discharge or the end of follow-up., Conclusions: Our data suggest that ICP monitoring after primary DC for head-injured patients significantly decreases in-hospital mortality and should be implemented in neurocritical care to ensure the highest chances of surviving TBI., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Surgical treatment of spinal ependymomas requires careful consideration of the relative risks of neurological worsening from surgery. Our aim was to determine the risk factors of neurological deterioration after surgery for spinal ependymomas., Material and Methods: This 20-year study included 17 patients (seven men and 10 women; 44.65±13.62 years) with histologically confirmed spinal ependymomas. The basic features were reviewed and the functional status was assessed by using the modified McCormick classification. We subdivided the patient population into two groups according to whether neurological deterioration occurred after primary tumor resection (N=5) or not (N=12), and compared their clinical characteristics., Results: The average duration of presenting symptoms in the 17 patients was 23.53±21.45 months. Three (17.6%) patients underwent subtotal or partial resection and 14 (82.4%) patients underwent gross total resection. The incidence of neurological deterioration after primary resection of spinal ependymomas was 29.4%. There were five (100%) and two (16.7%) male patients in the neurological-deterioration and no-deterioration groups, respectively (p=0.003). The duration of presenting symptoms was 24 months or over in all the patients with neurological deterioration and five of the 12 patients with improved or stabilized function (p=0.044)., Conclusion: The risk associated with surgical resection of spinal ependymomas should not be overlooked because of the significant incidence of neurological deterioration. The male gender and long-standing symptom (≥24 months) are risk factors of postoperative neurological worsening. Early diagnosis and surgery are therefore critical for successful treatment of spinal ependymomas., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: Decompressive craniectomy (DC) is a life-saving measure for traumatic brain injury (TBI). However, survivors may remain in a vegetative or minimally conscious state and require tracheostomy to facilitate airway management. In this cross-sectional analytical study, we investigated the predictors for tracheostomy requirement and influence of tracheostomy timing on outcomes in craniectomised survivors after TBI., Methods: We enrolled 160 patients undergoing DC and surviving >7 days after TBI in this 3-year retrospective study. The patients were subdivided into 2 groups based on whether tracheostomy was (N=38) or was not (N=122) performed. We identified intergroup differences in early clinical parameters. Multivariable logistic regression was used to adjust for independent predictors of the need for tracheostomy. Early tracheostomy was defined as the performance of the procedure within the first 10 days after DC. Intensive care unit (ICU) stay, hospital stay, mortality, and Glasgow outcome scale (GOS) were analysed according to the timing of the tracheostomy procedure., Results: After TBI, 24% of craniectomised survivors required tracheostomy. In the multivariate logistic regression mode, the significant factors related to the need for tracheostomy were age (odds ratio=1.041; p=0.002), the Glasgow coma score (GCS) at admission (odds ratio=0.733; p=0.005), and normal status of basal cisterns (odds ratio=0.000; p=0.008). The ICU stay was shorter for patients with early tracheostomy than for those undergoing late tracheostomy (p=0.004). The timing of tracheostomy had no influence on the hospital stay, mortality, or GOS., Conclusion: Age and admission GCS were independent predictors of the need for tracheostomy in craniectomised survivors after TBI. If tracheostomy is necessary, an earlier procedure may assist in patient care., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The purpose of this 2-year retrospective study is to compare the outcomes of patients with either surgical clipping or endovascular coiling treatment for ruptured anterior circulation cerebral aneurysms. We enrolled 100 patients with spontaneous subarachnoid hemorrhage resulting from ruptured anterior circulation cerebral aneurysms. We reviewed the demographic information, operative details, and image examinations including computed tomography (CT), digital subtraction angiography, and magnetic resonance imaging of brains. The patients were subdivided into two groups on the basis of treatment modalities: surgical clipping (N = 44) or endovascular coiling (N = 56). The modified Rankin's scale (mRS) was used as an outcome measures. Unfavorable outcome was defined by a mRS score of 1-3. The mean age of 100 patients, comprising 35 men and 65 women, was 57.48 ± 12.68 years. The follow-up period was 18.91 ± 13.05 months in average. The differences between the clipping and coiling groups in terms of admission Glasgow Coma Scale, Hunt and Hess grade, World Federation of Neurosurgical Societies grade, and Fisher's grade by CT scans were not statistically significant. There was no intergroup difference in the following results: symptomatic or radiographic vasospasm, post-treat rebleeding, and recurrence of aneurysms. Although the incidences of unfavorable outcome at the end of follow-up were 32.0% and 27.0% in the clipping and coiling group respectively, it revealed no significant difference (p = 0.202). In dealing with the patients with ruptured anterior circulation cerebral aneurysms, our results provide helpful information when discussing projected outcome before surgical or endovascular treatment., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)