Regulation of HDAC1 expression and activity in haploid human tumor cells / Recommendation for radiological follow-up and evaluation of chances of growth of unruptured intracranial aneurysms based on the experience of the National Hospital for Neurology and Neurosurgery- Department of Neurosurgery (Queen Square, London)

Leitlinien für das Management von unrupturierten intrakraniellen Aneurysmen (UIAs) und zuverlässige Marker, die das Rupturrisiko vorhersagen, sind noch ausständig. Patienten, denen von einer sofortigen chirurgischen oder endovaskulären Behandlung abgeraten wird, unterziehen sich mehreren Kontrolluntersuchungen, um Wachstum zu detektieren, da eine Größenzunahme des Aneurysmas stark mit dessen Ruptur assoziiert ist. Die optimale Strategie für das konservative Follow-up bleibt jedoch umstritten. 1112 zunächst unbehandelte UIAs wurden von 792 Patienten hinsichtlich Wachstum und Ruptur analysiert. Die Aneurysmen dieses Patientenkollektivs wurden zwischen 20012 und 2018 am National Hospital for Neurology and Neurosurgery (Queen Square/London, University College London Hospitals) entweder neu diagnostiziert oder im Rahmen einer Verlaufskontrolle beobachtet. Personen mit UIAs, die in externen Krankenhäusern entdeckt und innerhalb dieses Zeitraums in unserem Zentrum nachuntersucht wurden, sind ebenfalls eingeschlossen worden. Deren radiologische Befunde waren auch verfügbar. Die Wahrscheinlichkeit des Wachstums pro Aneurysma betrug 1,19% im Jahr und das Risiko einer Ruptur bei wachsenden Aneurysmen betrug jährlich 1,37% pro Aneurysma, verglichen mit 0,06% bei nicht wachsenden Aneurysmen. Dieser Unterschied war statistisch signifikant (p=0,011; OR=22,23, 95% CI [3,11; 158,93]). Nahezu 95% des Wachstums trat innerhalb von 8 Jahren nach der Diagnosestellung auf, wobei 5% der Größenzunahme unentdeckt blieb. Das rechtfertigt eine weitere Überwachung auch nach 8 Jahren konservativen Follow-ups, was in der derzeitigen klinischen Praxis nicht gemacht wird. Wachstum intrakranieller Aneurysmen (IAs) und deren Ruptur sind signifikant assoziiert. Bei diagnostizierter Größenzunahme wird eine Behandlung dringend empfohlen. Die klinische Praxis sollte überdacht werden, da Aneurysmen auch nach 8 Jahren stabilen Verhaltens immer noch wachsen können.Guidelines for the management of unruptured intracranial aneurysms (UIAs) and reliable markers indicating rupture risk are ambiguous. Patients who are advised against immediate surgical or endovascular treatment undergo several surveillance scans to monitor for growth because an increase in size is strongly associated with aneurysm rupture. The optimal strategy for the conservative management, however, remains controversial. 792 patients with 1112 initially untreated UIAs presenting or followed-up in the National Hospital for Neurology and Neurosurgery at Queen Square/ London (University College London Hospitals) between 20012- 2018 were analysed regarding growth and rupture. Persons with UIAs diagnosed in external hospitals and followed-up within this time period in our centre were also included, with access to their radiology reports. Chance of growth per aneurysm year yielded 1.19% and annual risk of rupture per aneurysm for growing aneurysms was 1.37% compared to 0.06% for non-growing aneurysms. This difference was statistically significant (p=0.011; OR=22.23, 95% CI [3.11; 158,93]). Almost 95% of growth occurred within 8 years after diagnosis, leaving 5% of eventual increase in size undetected. This justifies continuous surveillance even after 8 years of follow-up, unlike current clinical practice. Intracranial aneurysm (IA) growth and rupture are significantly associated. Treatment is strongly advised if increase in size is diagnosed. Clinical practice should be reconsidered because aneurysm growth is still evident even after 8 years of stable appearance.Arbeit an der Bibliothek noch nicht eingelangt - Daten nicht geprüftMedizinische Universität Wien, Diplomarb., 2020(VLID)493115

Risk of Aneurysm Rupture (ROAR) study: protocol for a long-term, longitudinal, UK multicentre study of unruptured intracranial aneurysms

Introduction Unruptured intracranial aneurysms (UIA) are common in the adult population, but only a relatively small proportion will rupture. It is therefore essential to have accurate estimates of rupture risk to target treatment towards those who stand to benefit and avoid exposing patients to the risks of unnecessary treatment. The best available UIA natural history data are the PHASES study. However, this has never been validated and given the known heterogeneity in the populations, methods and biases of the constituent studies, there is a need to do so. There are also many potential predictors not considered in PHASES that require evaluation, and the estimated rupture risk is largely based on short-term follow-up (mostly 1 year). The aims of this study are to: (1) test the accuracy of PHASES in a UK population, (2) evaluate additional predictors of rupture and (3) assess long-term UIA rupture rates.Methods and analysis The Risk of Aneurysm Rupture study is a longitudinal multicentre study that will identify patients with known UIA seen in neurosurgery units. Patients will have baseline demographics and aneurysm characteristics collected by their neurosurgery unit and then a single aggregated national cohort will be linked to databases of hospital admissions and deaths to identify all patients who may have subsequently suffered a subarachnoid haemorrhage. All matched admissions and deaths will be checked against medical records to confirm the diagnosis of aneurysmal subarachnoid haemorrhage. The target sample size is 20 000 patients. The primary outcome will be aneurysm rupture resulting in hospital admission or death. Cox regression models will be built to test each of the study’s aims.Ethics and dissemination Ethical approval has been given by South Central Hampshire A Research Ethics Committee (21SC0064) and Confidentiality Advisory Group support (21CAG0033) provided under Section 251 of the NHS Act 2006. The results will be disseminated in peer-reviewed journals.Trial registration number ISRCTN17658526