Balloon-assisted clipping for giant unruptured intracranial aneurysms of internal carotid artery / 国际脑血管病杂志

Objective To investigate the efficacy and clinical value of balloon-assisted clipping for the treatment of giant unruptured intracranial aneurysms of internal carotid artery. Methods Patients with giant unruptured intracranial aneurysm of intracranial segment of internal carotid artery treated with balloon-assisted clipping in the Department of Neurosurgery, Xiangya Hospital, Central South University from September 2017 to May 2018 were enrolled retrospectively. The proximal internal carotid artery or the aneurysm neck were temporarily blocked by balloon, and then the aneurysm was clipped in the hybrid operating room. Demographic data, preoperative symptoms, aneurysm characteristics, position of balloon placement, intraoperative angiography, complications, and follow-up results were collected. Results A total of 12 patients with giant (diameter >2 cm) unruptured intracranial aneurysm of intracranial segment of internal carotid artery were enrolled. They were all successfully clipped using balloon-assisted clipping in the hybrid operating room. Among them, 1 was located in the ophthalmic segment, 3 in the supraclinoid segment, 4 in the posterior communicating segment, 2 in the anterior choroidal artery segment, and 2 in the bifurcation of the internal carotid artery. The balloons were placed in the proximal end of internal carotid artery in 9 cases and in the neck of aneurysm in 3 cases. Intraoperative angiography showed that 12 aneurysms were completely occluded; 1 had severe stenosis of parent artery, and 1 had mild stenosis. Postoperative complications included cerebral infarction in 1 case, temporary diabetes insipidus in 1 case (returned to normal 1 week after operation), hemiplegia in 1 case, and epilepsy in 1 case. Glasgow Outcome Scale score at discharge showed 5 in 9 cases, 4 in 2 cases, and 3 in 1 case. The patients were followed up for 2.3 to 12 months after operation (median 7.5 months). Reexamination of CT angiography showed no recurrence of aneurysm. Glasgow Outcome Scale score was 5 in 11 cases and 4 in 1 case. Conclusions The use of balloon-assisted clipping technique in the hybrid operating room for the treatment of giant intracranial segmental aneurysms of the internal carotid artery is safe and effective, and has a good long-term outcome.

Early surgical treatment of patients with intracerebral hematoma from ruptured intracranial aneurysms / 国际脑血管病杂志

Objective To investigate the clinical effects and influencing factors of the outcomes of early microsurgical treatment in patients with intracerebral hematoma from ruptured intracranial aneurysm. Methods From 2010 to 2016, patients with intracerebral hematoma from ruptured intracranial aneurysm admitted to the Department of Neurosurgery, Xinyu People's Hospital were enrolled retrospectively. The demographic data, Hunt-Hess grade,Glasgow coma scale(GCS)score,imaging data,and procedure-related complications were collected. Glasgow outcome scale (GOS) score was used to evaluate the outcomes. Four to 5 were defined as good outcome and 1 to 3 were defined as poor outcome. The Hunt-Hess gradesⅡ-Ⅲ were used as the low-grade group and the Ⅳ-Ⅴ grades were used as the high-grade group. The survival rate and quality of life of both groups of patients were compared according to the GOS scores. Results A total of 36 patients were enrolled during the study, including 32 with subarachnoid hemorrhage and intracerebral hematoma and 4 with simple intracerebral hematoma. Hunt-Hess grade was grade Ⅱ in 2 cases, Ⅲ in 18 cases, Ⅳ in 14 cases, and Ⅴ in 2 cases. Distribution of responsible aneurysms:18 patients in middle cerebral artery, 9 in anterior communicating artery, 6 in anterior cerebral artery, 3 in posterior communicating artery, including 4 patients with multiple aneurysms. All patients underwent aneurysm clipping+hematoma removal under the general anesthesia within 36 h after onset,24 of them were treated with decompressive craniectomy. One patient died of severe brain swelling after intraoperative reruptureof the aneurysm,1 died of postoperative massive cerebral infarction, and 1 died of severe pulmonary infection and diabetes after giving up further treatment. Thirty-three survivors were followed up for 1 year, 29 had good outcome(80.5％) and 7 had poor outcome (19.5％). There were significant differences in survival rate and quality of life between the low-grade group and the high-grade group (P=0.001). There were significant differences in the Hunt-Hess grade, baseline GCS score, and proportion of patients receiving decompressive craniectomy between the good outcome group and the poor outcome group.Conclusion The Hunt-Hess grade, baseline GCS score, and decompressive craniectomy were the influencing factors of the outcomes in patients with intracerebral hematoma from ruptured intracranial aneurysm. Removal of hematoma and aneurysm clipping should be performed as early as possible,and decompressive craniectomy should be performed if necessary.

Enhancing erythromycin precursor 6-dEB production by using synthetic small regulatory RNAs in Escherichia coli / 生物工程学报

Although heterologous biosynthesis of polyketide erythromycin has been successfully achieved in Escherichia coli, the titer remains at a very low level (-10 mg/L). In this study, based on genome-scale metabolic model of E. coli, in silico method flux distribution comparison analysis was used to discover novel potential targets for heterologous 6-dEB biosynthesis. Synthetic small regulatory RNAs (sRNAs) was used to experimentally test 12 down-regulated targets. The results showed that repression of each of these target genes e.g. lsrC and ackA led to significantly improve heterologous 6-dEB biosynthesis. Using co-repression of lsrC and ackA, 6-dEB titer was improved by 59.9% in shake-flask with a maximum yield of 22.8 mg/L. This study indicates that combined flux distribution comparison analysis and synthetic small regulatory RNAs is an effective strategy to improve 6-dEB production in E. coli.

Engineering MEP pathway in Escherichia coli for amorphadiene production and optimizing the bioprocess through glucose feeding control / 生物工程学报

The pathway of 2-methyl-D-erythritol-4-phosphate (MEP) is the exclusive isoprenoid precursor biosynthetic pathway in Escherichia coli, with a higher theoretical yield than mevalonate (MVA) pathway. However, due to lack of information about the regulation of MEP pathway, only engineering MEP pathway in E. coli achieved limited improvement of heterologous isoprenoid production. We used exogenous MEP pathway genes to improve MEP pathway in E. coli and optimized the glucose feeding to release the potential of MEP pathway. The results demonstrate that co-expression of dxs2 from Streptomyces avermitilis and idi from Bacillus subtilis can increase amorphadiene production with 12.2-fold compared with the wild-type strain in shake flask fermentation. Then we established a high-cell density fermentation process for the engineered strain, and found that the phase from 24 to 72 h is important for product biosynthesis. The optimization of glucose feeding rate during 24 to 72 h significantly improved product accumulation, which was improved from 2.5 to 4.85 g/L, within the same process time. Considering the attenuation of strain metabolism after 72 h, this study further modulated the glucose feeding rate during exponential phase to control strain growth and the amorphadiene yield eventually reached to 6.1 g/L. These results provided useful information to develop engineered E. coli for isoprenoid production through MEP pathway engineering.

Design and construction of artificial biological systems for complex natural products biosynthesis / 生物工程学报

Natural products (NPs) are important drug pools for human disease prevention and treatment. The great advances in synthetic biology have greatly revolutionized the strategies of NPs development and production. This review entitled with design and construction of artificial biological systems for complex NPs biosynthesis, mainly introduced the progresses in artificial design of synthetic biological parts, naturally mining novel synthetic parts of NPs, the assembly & adaption of the artificial biological modules & systems.

Design and Application of Second Order Dynamic Drug Storeroom Inventory Warning System / 中国药房

OBJECTIVE: To standardize and simplify the drug receving and preparing model. METHODS: Reasonable pharamcy inventory parameters were set up based on our experience; second order drug storeroom dynamic inventory system was designed and applied, and the indexes of drug storeroom inventory and workload of the new and the old models were reported and analyzed. RESULTS: The new warning system provided an optimal inventory, and in which the incidences of overstock or stock shortage, the frequency of daily drug receving, drug kinds and the time used with checking stock and filling receipt were all significantly less than in the traditional model. CONCLUSION: Due to the second order drug storeroom dynamic inventory warning system, the drug receiving was more scientific, the drug stock amount was reduced and the drug receiving time was saved, and the mangament level of hospital drug storeroom inventory was enhanced.