Effect of endovascular embolization combined with two-stage stereotacticradiosurgery for the treatment of intracranial arteriovenous malformation / 中国脑血管病杂志

Objective To investigate the safety and effectiveness of endovascular embolization combined with two-stage stereotacticradiosurgery (SRS)for the treatment of intracranial arteriovenous malformation (AVM). Methods From January 2010 to December 2012,the clinical data of 66 patients treated with endovascular embolization combined with two-stage SRS AVM comprehensive therapy at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were analyzed retro-spectively. They were followed up by imaging. The followed-up time was 7 to 96 months. DSA revealed that the complete disappearance of vascular flow void shadow was regarded as a cure. The patients were divided into either a cured group (n = 29)or a not cured group (n = 37)according whether they were cured or not. The effects of different factors,such as AVM rupture or not,the volume size before embolization,and the degree of embolization on the cure rate of AVM with the comprehensive therapy were observed in both groups,and logistic regression was used to analyze the factors affecting the cure rate of comprehensive therapy. Results (1)There were 22 patients (75. 9%)had ruptured AVMs and 7 (24. 1%)had unruptured AVMs in the cured group. The diameters of the aneurysms < 3 cm and ≥3 cm were in 26 (89. 7%)and 3 (10. 3%)cases respectively. Spetzler-Martin (SM)grades of patients were Ⅰ to Ⅲ. In the not cured group,20 patients (54. 1%)had ruptured AVMs and 17 (45. 9%)had unruptured AVMs. The diameters< 3 cm and ≥3 cm were 18 (48. 6%)and 19 patients (51. 4%)respectively. The SM grade in 34 cases were Ⅰ to Ⅲ. (2)During the follow-up period,29 patients (43. 9%)achieved cure on imaging. The modified Rankin scale (mRS)scores in 64 cases (97%)were 0 to 1. Six patients had complications. (3)Multivariate logistic regression analysis showed that the size of AVM (OR,0. 141,95% CI 0. 035 -0. 570,P < 0. 01)and the degree of interventional embolization (OR,2. 414,95% CI 1. 038 -5. 613,P <0. 05)were the influencing factor of the cure rate. Conclusions Vascular interventional embolization in combination with SRS for the treatment of intracranial AVMs was both effective and safe. The diameter of AVM < 3 cm was the beneficial factor of cure rate of comprehensive therapy. The degree of interventional embolization not reaching cure on imaging was a risk factor for the cure rate of comprehensive therapy.

Inter- and intra-observer reproducibility of 3.0 T high-resolution magnetic resonance imaging for evaluating atherosclerotic stenosis in the middle cerebral artery / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the reproducibility of 3.0 T high-resolution magnetic resonance imaging (HR MRI) for evaluation of atherosclerotic stenosis in the middle cerebral artery (MCA).</p><p><b>METHODS</b>From February, 2011 to December, 2013, 66 consecutive patients with MCA-M1 atherosclerotic stenosis (50%-99%) confirmed by digital subtractive angiography (DSA) received examinations with 3.0 T HR MRI for measurement of the vessel area (VA) and lumen area (LA) at the maximum narrow site (VA(narrow) and LA(narrow)) and the reference site (VA(reference) and LA(reference)) as well as the plaque distribution (ventral, dorsal, superior, and inferior). Two independent readers reviewed all the images and one reader reevaluated these images 4 weeks later. The inter- and intra-observer reproducibility was evaluated using the intraclass correlation coefficient (ICC).</p><p><b>RESULTS</b>The measurements of VA(narrow), VA(reference), and LA(reference) using HR MRI showed excellent inter- (ICC=0.801, 0.843, and 0.808, respectively) and intra-observer reproducibility (ICC=0.811, 0.916, and 0.958, respectively), but the measurement of LA(narrow) had only moderate inter- and intra-observer reproducibility (ICC=0.584 and 0.625, respectively). For plaque distribution analysis (ventral, dorsal, superior, and inferior plaques), HR MRI also showed excellent inter- (ICC=0.856, 0.836, 0.791, and 0.905, respectively) and intra-observer reproducibility (ICC=0.876, 0.827, 0.825, and 0.950, respectively).</p><p><b>CONCLUSION</b>HR MRI shows good inter- and intra-observer reproducibility in identifying MCA-M1 atherosclerotic plaque distribution and vessel and lumen measurements, but its reliability for lumen area measurement at the maximum narrowing site needs to be improved.</p>

Study on ganoderma acid in the treatment of rats essential hypertension / 中华老年医学杂志

Objective To investigate the effect and mechanism of ganoderma acid in therapy of the rat essential hypertension.Methods 30 male spontaneously hypertensive rat (SHR) were divided randomly into three groups:control group (CG),ganoderma acid group (Gan) and captoril (Cap) as positive control group.SHR were fed with distilled water (10 ml/kg) in control group,ganoderma acid (0.6 g/kg ) in Gan group,catopril (0.03 g/kg) in Cap group.After 8-weeks therapy,5 ml blood was extracted,rats in every group were sacrificed to get the aorta.The mRNA expression of superoxide dismutase (SOD),nitric oxide synthase (NOS) and high density lipoprotein (HDL) were detected by RT-PCR and the apoptosis of endothelial cells were measured by flowcytometry.Results After the 8 weeks therapy,as compared with the CG group,blood pressure of SHR in Gan group became stable[(112.6±3.2) mm Hg](P＜0.01).The expression of SOD,NOS and HDL showed obviously upregulated,and apoptosis of endothelial cell decreased significantly (P＜0.01).NO contents increased,and MDA,ET-1 decreased (P＜0.01).The contents of LDL decreased and HDL increased (P＜0.01).Conclusions Ganoderma acid may improve the function of endothelial cell and decrease the blood pressure by promoting the mRNA expression and activity of SOD,cleaning the radical ions and inhibiting the apoptosis of the endothelial cell.

Risk factors of early rebleeding after endovascular embolization of ruptured intracranial aneurysms / 介入放射学杂志

Objective To discuss the clinical characteristics and risk factors related to the early rebleeding after endovascular embolization of ruptured intracranial aneurysms, to reduce its occurrence and to provide the theoretical basis for the clinical selection of therapeutic methods. Methods During the period of July 2002-Oct. 2007 in the Department of Neurosurgery of Changhai Hospital, patients with DSA-proved ruptured intracranial aneurysms were treated with pereutaneous endovascular embolization. The clinical data and imaging findings of the patients who had occurred early rebleeding after interventional therapy (study group) were retrospectively analyzed. The patients who had not occurred early rebleeding after interventional therapy during the same period were randomly selected and served as the control group. The number of patients in control group was 7.5 times of that in study group. The suspected risk factors were statistically analyzed by using univariate and multivariate methods, the results were compared between two groups. Results Of 881 patients with raptured intracranial aneurysms treated by endovascular interventional embolization, 17 (1.93%) occurred rebleeding in the early time, among them 12 (1.36%) died. The reality or falsity of the aneurysms, the ruptured times of the aneurysms before treatment, the obvious intracranial vascular spasms seen on DSA during the procedure and the degree of embolization were the four main independent risk factors related to the early rebleeding. The probability equation of the early rebleeding of ruptured intracranial aneurysms afterendovascular embolization was calculated.Conclusion Although the incidence of early rebleeding in patients after endovascular embolization of ruptured intracranial aneurysms is low, the outcome, if it occurs, is poor with high mortality. Preoperative prevention measures directed against the risk factors, embolizing the ruptured intracranial aneurysm as completely as possible and prompt postoperative cerebral angiography are all very important for reducing the incidence of the early rebleeding. And active and effective dealing with the rebleeding can definitely improve the prognosis.

Clinical outcomes of concurrent three-dimensional conformal radiotherapy and chemotherapy for limited-stage small cell lung cancer / 中华放射肿瘤学杂志

Objective To evaluate therapeutic effects and complications of concurrent three-dimensional conformal radiotherapy (3DCRT) and chemotherapy in patients with limited-stage small cell lung cancer (LSCLC).Methods From June 2000 to August 2005, 93 histologically proved LSCLC patients were randomized into two groups:3DCRT group (n =46) and conventional group (n =47).In both groups, patients received one cycle chemotherapy, followed by concurrent chemoradiotherapy and then received consolidate chemotherapy.Chemotherapy was four to six cycles of PE regimen.Conventional irradiation field was setup in conventional group, while in 3 DCRT group clinical target volume (CTV) only involved visible tumor and adjacent lymphatic region.Radiotherapy was delivered at 2 Gy per fraction, 5 fractions per week to a median total dose of 60 -64 Gy.Those who achieved a complete response were treated with prophylactic cranial irradiation (PCI) with 30 Gy in 10 fractions.Results The follow-up rate was 100% in both groups.The number of patients completed 1-, 2-and 3-year follow-up were 36, 34 and 16 in 3DCRT group, 14, 7 and 8 in conventional group, respectively.The complete and overall response rate were 52% and 89% in 3DCRT group, while 47% and 85% in conventional group, respectively.The 1-, 2-and 3-year survival rates were 78%, 35% and 15% in 3DCRT group, 72%, 30% and 17% in conventional group, respectively.The median survival time was 23.2 and 22.8 months, respectively.There was no statistical difference in short-term (Χ~2 = 0.34 ,P = O.759) and long-term outcomes (Χ~2 = 0.18 ,P = 0.92).In 3DCRT group, the incidence of grade 1 +2 acute radiation pneumonitis and esophagitis, grade 1 +2 and grade 3 chronic radiation pneumonitis were lower than those in conventional group.There was no grade 3 or 4 acute radiation pneumonitis or esophagitis, or grade 4 chronic radiation pneumonitis in both groups.There was no difference in grade 1 + 2, grade 3 or grade 4 acute myelo-suppression between the two groups.Conclusions In the treatment of LSCLC, concurrent 3DCRT and chemotherapy can achieve satisfactory short-term and long-term outcomes with acceptable complications.

Early cerebral ischemic lesions ly after stenting for symptomatic intracranial artery stenosis: a clinical study / 介入放射学杂志

Objective To analyze the clinical manifestations of early cerebral ischemic lesions after stenting with WingSpan system for symptomatic intracranial artery stenosis, and to evaluate the early effects and safety of the stenting therapy. Methods Twenty-nine consecutive patients with symptomatic intracranial stenosis underwent diffusion weighted imaging (DWI) before and after stenting (within 72 hours). The clinical data, including patients' general condition, stenting procedures and newly-developed cerebral ischemic lesions, were recorded. Neurological defect was estimated with NIHSS, the safety and early outcome of stenting were evaluated. Results The degree of stenosis was reduced from a mean baseline of (72.3 ± 10.7)% to (31.9 ± 13.6)% immediately after stenting. The technical success rate was 100%. The total eomplicatiom nate was 17.2%. And among them, z were symptomatic (6.9%). Sixty-three ischemic lesions were demonstrated on DWI in 13 patients (44.8%). Among them, 11 (84.6%) were asymptomatic. Fifty-five newly-developed lesions on DWI (87.3%) were located in the region of stented vessels and 3.2% were situated in the region of branch vessels of stented artery. Conclusion DWI is of great value in assessing the safety of intracranial stenting procedures. The treatment of symptomatic intracranial artery stenosis by using WingSpan system is safe and effective. Newly-developed ischemic lesions can be well detected on DWI and should receive physician's attention, although most ischemic lesions are asymptomatic. Long-term outcome of this treatment needs to be further observed.

Neuronal apoptosis and caspase 3 gene expression of in vitro cultured rat hippocampal neurons of epilepsy models / 中国组织工程研究

BACKGROUND: The attack of temporal epilepsy is associated with the loss and death of hippocampal neurons, in which the specific pattern and mechanism of the loss of hippocampal neurons are still unclear, and it is hard to make sure the inevitable association of the epileptic discharge with activation of cysteine-containing ASPartate-specific protease (caspase 3)and neuronal apoptosis, of hippocampal neurons.OBJECTIVE: To observe the neuronal apoptosis and caspase 3 gene expression of in vitro cultured rat hippocampal neurons of epilepsy models.DESIGN: An open experiment.SETTINGS: Department of Neurosurgery, Changhai Hospital, the Second Military Medical University of Chinese PLA; Department of Neurosurgery,Changzheng Hospital, the University.MATERIALS: The experiments were carried out in the Neurosurgery Laboratory of the Second Military Medical University of Chinese PLA from June 2002 to June 2003. Ten male or female SD rats with 24 hours after birth were used. The Caspase 3 flow detection kit was purchased from American BD Company, and polymerase chain reaction (PCR) primers were synthetized by Shanghai Haojia Company.METHODS: ① The SD rats within 24 hours after birth were killed by cutting down the head to remove the brain, then bilateral hippocampi were taken out, and hippocanpal neuron models of epileptic discharge were established. The discharge of the models was recorded with whole cell patch clamp technique. The neurons cultured for 8 days and treated with Mg-free medium were taken as epileptic discharge model group, and those cultured for 8 days but not treated with Mg-free medium were taken as the blank control group, and the changes of potentials were recorded. ② The fulllength cDNA of caspase 3 was cloned with reverse transcription-polymerase chain reaction (RT-PCR), and then it was labeled. The expression of caspase 3 gene and neuronal apoptosis were detected with in situ hybridization and flow cytometry.MAIN OUTCOME MEASURES: ① Results of cDNA cloning of caspase 3; ② Results of Caspase 3 in situ hybridization; ③ Results of apoptosis.RESULTS: ① The products amplified by RT-PCR showed DNA segment lanes of about 800 bp after treated with 12 g/L agarose gel electrophoresis (Figure 1), which was concordant with the predicted value. The detection of DNA sequence showed that the length of the obtained cloning open-reading frame was 843 bp. ② The hybridization showed that in the blank control group, the positively stained hippocampal neurons were less than 10%, the neurites were well-stacked, and formed extensive synaptic association; In the epileptic discharge model group, the positively stained neurons were obviously increased at 3 hours after the Mg-free treatment, and there were many strongly and positively stained neurons at 12 hours, all these neurons kept the neurites, which became little. ③ The flow cytometry showed that at 6 hours after the Mg-free treatment, the apoptotic cells began to increase obviously, the numbers of apoptotic cells in certain times were not the same.CONCLUSION: Epileptic discharge can trigger the caspase 3 gene expression, by which neuronal apoptosis is induced.

Recanalization of occlusive extracranial internal carotid artery dissection through medication of anticoagulant and antiplatelet agents:report of two cases with literature review / 介入放射学杂志

Objective To determine the effectiveness and safety of antiplatelet and anticoagulant agents in the treatment of extracranial internal carotid artery dissection (eICAD). Methods Antiplatelet and anticoagulant agents were adopted to treat two cases of eICAD in our hospital. The clinical data were retrospectively analyzed and the medical literatures concerning eICAD, which were obtained from Pubmed database, were reviewed. Results Most researches advocated the empirical use of antiplatelet and anticoagulant agents in eICAD. About 30% of occluded eICAD could be reopened in 8 days and about 60% - 80% in 3 months after the onset of the disease. During the period of treatment, the rate of ischemic stroke recurrence, disability or death was 8.3%-14.3% in anticoagulant group, while it was 7% - 23.7% in antiplatelet group. Conclusion Antiplatelet agents can be used in patients with eICAD who are contraindicated to anticoagulants. Anticoagulants should be used as early as possible in patients who are not contraindicated to anticoagulants.

Experience in Teaching Practical Anatomy of Central Nervous System for Postgraduate Students / 中华医学教育探索杂志

With the rapid development of neurosurgery,requirement for neuroanatomy is increasing in clinical practice.The authors made a primary exploration on how to teach focal neuroanatomy for neurosurgical postgraduate students.The idea of asking the students to draw focal anatomy was suggested by the author with the purpose of making them learn it positively.Software workstation and clinical neuroradiological work-ups such as MRI and DSA were also applied and evaluated.The authors proposed all these procedures be helpful for comprehending neuroanatomy.

Clinical evaluation of microwire assisted coiling for distal intracranial wide-necked aneurysms / 介入放射学杂志

Objective To evaluate endovascular treatment for distal intracranial wide necked aneurysms with microwire assisted coiling technique. Methods Twenty five patients with ruptured small wide necked aneurysms were treated with this procedure including 12 aneurysms located in anterior communicating artery, 12 in bifurcation of middle cerebral artery and 1 in PICA. Microcatheters were firstly introduced into the aneurismal sacs. We remodelled the microwire in line with parent artery and advanced it across the aneurismal neck. The aneurysms were then packed with guglielmi detachable coil through microcatheter. Results Technical success was achieved in all cases with no associated complications. The aneurysms were totally occluded with patency of parent artery and the patients recovered uneventfully. The follow up of 16 cases, showed no recanalization of aneurysms. Conclusions Microwire assisted coiling is a novel alternative for endovascular treatment of distal, small wide necked aneurysm with satisfactory safety and economical efficacy.

Interventional treatment for intracranial vertebral arterial dissection / 介入放射学杂志

Objective To summarize experiences in diagnosis and interventional management for intracranial vertebral arterial dissection. Methods Clinical symptoms and imaging results were analysed in 23 cases of intracranial vertebral dissection, and corresponding interventional managements were reviewed. Results Clinical symptoms consisted of spontaneous SAH and vertebrobasilar insufficiency. DSA usually showed "pearl and string" sign. Interventional management included stent assisted coiling of the dissection, embolization of the affected artery with GDC and to learn the details of the stenotic ICA and draw up and appropriate operation plan.Conclusions Direct energetic intervention should be undertaken promptly for intracranial dissection.

Embolization of intracranial aneurysm using Guglielmi detachable coils / 中华放射学杂志

Objective To investigate the indication, preoperative evaluation, technical tip, prevention and treatment of complications, effect, and clinical use of the embolization of intracranial aneurysms by using GDCs. Methods From July 1998 to February 2000,93 patients with 118 intracranial aneurysms were embolized using GDCs, including 84 ruptured aneurysms (Hunt-Hess grade, Ⅰ 18 cases, Ⅱ 29 cases, Ⅲ 25 cases, Ⅳ 10 cases, Ⅴ 2 cases). 72 patients were treated at emergency, and 48 patients had CTA examination preoperatively. The operations were completed under the DSA monitoring. Continuous lumbar subarachnoid drainage was instituted and standard 3H treatment was given postoperatively. Results Total occlusion was achieved in 104 aneurysms(88 14%), over 90% in 11aneurysms(9.32%), less than 90% in 3 aneurysms(2 54%), with 3 patients (3/93, 3 23%) died in the cohort. One case rebleeded after 1.5 months and was cured by surgical clipping, 2 patients experienced enlargement of the aneurysmal neck and were reembolized. Following-up was performed from 2 to 22 months, 1 had severe disability, 7 had mild neurological deficit symptoms. Conclusion The results of short-term follow-up suggested that embolization of intracranial aneurysms with GDCs be microtraumatic, safe, effective, and reliable. Partial packing may result in continuous enlargement, rupture, and bleeding, while tight coil packing in aneurysms was reliable. The ruptured aneurysms need emergency embolization, and postoperative continuous lumbar subarachnoid drainage can enhance curative effect significantly.