Individualised evaluation based on pathophysiology for moyamoya vasculopathy:application in surgical revascularisation

Background Although bypass surgery is an effective treatment for moyamoya vasculopathy(MMV),the incidence of postoperative complications is still high.This study aims to introduce a novel evaluating system based on individualised pathophysiology of MMV,and to assess its clinical significance.Methods This multicentre,prospective study enrolled adult patients with MMV from Huashan Hospital,Fudan University and National Center for Neurological Disorders,China between March 2021 and February 2022.Multimodal neuroimages containing structural and functional information were used to evaluate personalised disease severity and fused to localise the surgical field,avoid invalid regions and propose alternative recipient arteries.The recipient artery was further selected intraoperatively by assessing regional haemodynamic and electrophysiological information.The preanastomosis and postanastomosis data were compared with assist with the postoperative management.Patients who received such tailored revascularisations were included in the novel group and the others were included in the traditional group.The 30-day surgical outcomes and intermediate long-term follow-up were compared.Results Totally 375 patients(145 patients in the novel group and 230 patients in the traditional group)were included.The overall complication rate was significantly lower in the novel group(p˂0.001).In detail,both the rates of postoperative infarction(p=0.009)and hyperperfusion syndrome(p=0.010)were significantly lower.The functional outcomes trended to be more favourable in the novel group,though not significantly(p=0.260).Notably,the proportion of good functional status was higher in the novel group(p=0.009).Interestingly,the preoperative statuses of perfusion and metabolism around the bypass area were significantly correlated with the occurrence of postoperative complications(P˂0.0001).Conclusions This novel evaluating system helps to identify appropriate surgical field and recipient arteries during bypass surgery for MMV to achieve better haemodynamic remodelling and pathophysiological improvement,which results in more favourable clinical outcomes.

Immediate cystectomy or conservative management for T_1 G_3 bladder cancer: A meta-analysis of general survival rate

Objective： The aim of this study was to compare the therapeutic effects of bladder preserving approach transurethral resection （TURBT） with additional intravesicel instillation versus immediate cystectomy in patients with newly diagnosed stage T1G3 bladder cancer. Methods： Clinical data of patients with newly diagnosed T1G3 bladder cancer underwent immediate cystectomy （Group A） or TURBT with additional intravesical instillation （Group B） was collected from online databases. Meta-analysis that recommended by Cochrane Collaboration was done for the data obtained. Publication bias was examined using a funnel plot. Results： Four trails, including 434 patients, were eligible for this study. The general mortality rate of group A （74/149 = 49.7%） and group B （102/285 = 35.8%） was calculated and compared in RevMan 4.2, which showed the difference on general mortality rate between the two groups was not statistical significant, with the pooled RR = 1.23 （95% CI 1.10-1.70, P 〉 0.05）. Conclusion： Compared with TURBT, immediate cystectomy may not reduce the general mortality rate to improve the forward survival rate.