ABSTRACT
Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.
Subject(s)
Aged , Humans , Central Nervous System Vascular Malformations , Therapeutics , Embolization, Therapeutic , Methods , Paraplegia , DiagnosisABSTRACT
Objective: To construct subtractive cDNA libraries of differentially expressed genes associated with chronic optic nerve injury in cats. Methods: Fifteen adult cats were randomly divided into 3 groups (n=5): control group, 4-w compression group and 8-w compression group. The chronic optic nerve injury was produced by an inflatable balloon implanted under the optic chiasm. The total RNA was prepared from optic nerves of each group by TRIzol method. Double-stranded cDNA was produced by SMART PCR cDNA synthesis protocol. Suppression subtractive hybridization (SSH) was used to isolate the cDNA fragments of differentially expressed genes in the optic nerves after 4-w and 8-w compression. The cDNA fragments were directly inserted into T/A cloning vector to establish the subtractive library,followed by amplification of the libraries through E. coli transformation with calcium chloride and screening of blue and white clones. Three hundred positive bacterial clones were randomly picked in each library and identified by colony PCR. Results: Analysis of the white clones by PCR showed that 80% clones contained 200-800 bp inserts in each library. Conclusion: Four subtractive cDNA libraries of differentially expressed genes associated with chronic optic nerve injury have been successfully constructed by SSH and T/A cloning techniques,which lays a solid foundation for screening and cloning specific differentially expressed genes associated with chronic optic nerve injury.
ABSTRACT
Objective: To clone, identify and analyze subtractive cDNA libraries of differentially expressed genes associated with chronic optic nerve compression in cats. Methods: The constructed cDNA libraries were amplified by E. coli transformation with calcium chloride and were subjected to blue and white screening. Three hundred positive bacterial clones were randomly chosen from each library and were identified by colony PCR. The positive clones were sequenced to screen for the differentially expressed genes. The identified sequences were then analyzed for homology using Blast program against the DNA database bank of Japanese through internet. Real-time PCR was performed to verify the expression of the 4 differential clones. Results: One thousand positive clones were identified by PCR and 674 ESTs were obtained by seqeuncing, with length ranging from 200 to 800bp. Results from Blast analysis revealed 14, 20, 23 and 19 homolog genes in 4-w forward, 4-w reverse, 8-w forward and 8-w reverse subtractive libraries, respectively. These genes fell into several functional groups, such as energy and metabolism, ion transport, gene transcription, signal transduction, cellular injury and repair, and MHC molecules. Result of real-time PCR verified that the 4 clones were differentially expressed. Conclusion: The constructed subtractive cDNA libraries lay an experimental basis for further identification and study of the differentially expressed genes related to chronic optic nerve injury.
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Objective: To examine the pathologcial changes of glial cells after chronic optic nerve compression, so as to discuss the interaction between the glial cells and neurons. Methods: Thirty adult cats were randomly divided into 6 groups (n= 5), namely, control group, sham operation group, 1-week compression group, 2-week compression group, 4-week compression group, and 8-week compression group. The chronic optic nerve injury model was produced by an inflatable balloon implanted under the optic chiasm in the latter 4 groups. All the animals were sacrificed and perfused; the optic nerves were removed and the cellular responses of the nerves were observed by electronic microscopy; and the expression of glial fibrillary acidic protein (GFAP), myelin basic protein (MBP), carbonic anhydrase II (CA II) and ED-1 was exmined at various time points by immunohistochemical staining. Results: Under the electron microscopy, the normal optic nerves had integrated myelin structure, clearly and closely arranged neural plate. The optic nerve presented slight demyelination 2 weeks after compression; myelin laminalle dissociating and glial cell degenerating occurred 4 weeks after compression; and the demyelination became more obvious and the most myelin became thiner 8 weeks after compression. No obvious immunohistochemistral changes were found in the optic nerves during the first two weeks of compression. The MBP staining was disturbed and lost at 4 weeks after compression, which became more obvious 8 weeks after compression. The CA II staining in the compressed region was irregular and lost at 4 weeks, which was more obvious at 8 weeks; the staining in non-compressed region was normal. The intensity of GFAP staining was reduced in the compressed region and increased at proximal portion of the nerve at 4 weeks, which became more significant at 8 weeks. The ED-1 positive cells were found in the normal nerve with low density. The positive cells increased around the compressed region at 4 weeks and became more significant at 8 weeks. Conclusion: Glial cell degeneration and death occur in the compressive region afte chronic compression of optic nerve. The proximal portion of the compressed nerve has astrocyte proliferation and microglia activation, indicating that functional change of glial cells may contribute to chronic optic nerve injury.
ABSTRACT
<p><b>OBJECTIVE</b>To study the effect of standard large trauma craniotomy (SLTC) on outcomes of patients with severe traumatic brain injury (TBI) (GCS<=8).</p><p><b>METHODS</b>230 patients with severe TBI were randomly divided into two groups. 115 patients underwent SLTC (10 cm x 12 cm) as an SLTC group, and other 115 patients underwent temporo-parietal or fronto-temporal craniotomy (6 cm x 8 cm) according to the position of hematomas as a routine craniotomy (RC) group. Other treatments were identical in two groups. According to Glasgow outcome scale (GOS), the prognosis of the patients was evaluated and the complications were compared between two groups.</p><p><b>RESULTS</b>27 patients got good outcome and moderate disability (23.5%), 40 severe disability and vegetative survival (34.8%), and 48 died (41.7%) in SLTC group. 21 patients got good outcome and moderate disability (18.3%), 28 severe disability and vegetative survival (24.3%), and 66 died (57.4%) in RC group. The incidence of incision hernia was lower in SLTC group than in RC group. However, the incidence of operative encephalocele, traumatic epilepsy and intracranial infection were not different in two groups.</p><p><b>CONCLUSIONS</b>Standard large trauma craniotomy significantly reduces the mortality of patients with severe TBI without serious complications, but does not improve the life quality of the patients.</p>