Analysis on Mandibular Anterior Tooth Intrusion with Clear Aligners / 医用生物力学

国家自然科学基金项目(11932012、81400536),上海申康医院发展中心临床创新三年行动计划(SHDC2020CR3009A),上海交通大学医工(理)交叉基金(JYJC202130)

Histone demethylase JMJD3 downregulation protects against aberrant force-induced osteoarthritis through epigenetic control of NR4A1 / 国际口腔科学杂志·英文版

Osteoarthritis (OA) is a prevalent joint disease with no effective treatment strategies. Aberrant mechanical stimuli was demonstrated to be an essential factor for OA pathogenesis. Although multiple studies have detected potential regulatory mechanisms underlying OA and have concentrated on developing novel treatment strategies, the epigenetic control of OA remains unclear. Histone demethylase JMJD3 has been reported to mediate multiple physiological and pathological processes, including cell differentiation, proliferation, autophagy, and apoptosis. However, the regulation of JMJD3 in aberrant force-related OA and its mediatory effect on disease progression are still unknown. In this work, we confirmed the upregulation of JMJD3 in aberrant force-induced cartilage injury in vitro and in vivo. Functionally, inhibition of JMJD3 by its inhibitor, GSK-J4, or downregulation of JMJD3 by adenovirus infection of sh-JMJD3 could alleviate the aberrant force-induced chondrocyte injury. Mechanistic investigation illustrated that aberrant force induces JMJD3 expression and then demethylates H3K27me3 at the NR4A1 promoter to promote its expression. Further experiments indicated that NR4A1 can regulate chondrocyte apoptosis, cartilage degeneration, extracellular matrix degradation, and inflammatory responses. In vivo, anterior cruciate ligament transection (ACLT) was performed to construct an OA model, and the therapeutic effect of GSK-J4 was validated. More importantly, we adopted a peptide-siRNA nanoplatform to deliver si-JMJD3 into articular cartilage, and the severity of joint degeneration was remarkably mitigated. Taken together, our findings demonstrated that JMJD3 is flow-responsive and epigenetically regulates OA progression. Our work provides evidences for JMJD3 inhibition as an innovative epigenetic therapy approach for joint diseases by utilizing p5RHH-siRNA nanocomplexes.

Clinical value of integrated traditional Chinese and Western medicine based on the concept of enhanced recovery after surgery in the perioperative period of total knee arthroplasty / 中国基层医药

Objective:To investigate the clinical value of integrated traditional Chinese and Western medicine based on the concept of enhanced recovery after surgery (ERAS) in the perioperative period of total knee arthroplasty.Methods:Sixty patients who underwent primary unilateral total knee arthroplasty in Tonglu Hospital of Traditional Chinese Medicine from July 2018 to June 2019 were included in this study. They were randomized as odd numbers to the control group ( n = 30) and even numbers to the observation group ( n = 30). The control group was treated with conventional rehabilitation treatment, while the observation group was subjected to integrated traditional Chinese and Western medicine based on the concept of ERAS in the perioperative period of total knee arthroplasty. The perioperative pain, related complications, hospitalization expenses and length of hospital stay were recorded in each group. The Visual Analogue Scale (VAS) was used to evaluate the degree of pain and range of motion of the knee joint. The Hospital for Special Surgery (HSS) knee score was also measured to evaluate the curative effects. Results:At 3 and 7 days, 2 and 6 weeks after surgery, knee range of motion score was (63.40 ± 2.80) points, (86.20 ± 4.40) points, (90.30 ± 6.48) points, (100.5 ± 3.39) points, respectively, and at 6 weeks after surgery, HSS knee score was (89.40 ± 5.18) points, in the observation group, which were significantly higher those in the control group [(48.50 ± 4.20) points, (55.40 ± 3.58) points, (77.50 ± 4.38) points, (87.60 ± 4.58) points, (70.50 ± 6.44) points, t = 0.029, 0.013, 0.032, 0.039, 0.042, all P < 0.05]. In the observation group, the VAS score in resting state at 6, 12, 24 and 48 hours after surgery were (3.62 ± 0.40) points, (2.41± 0.52) points, (2.05 ± 0.62) points, (1.93 ± 0.28) points respectively, and the VAS score in active state at 24 and 48 hours were (2.15 ± 0.21) points and (1.71 ± 0.39) points, respectively, which were significantly lower than those in the control group [(5.71 ± 0.63) points, (4.60 ± 0.31) points, (3.84 ± 0.22) points, (3.30 ± 0.21) points, (5.50 ± 0.49) points, (4.80 ± 0.21) points, t = 0.040, 0.035, 0.046, 0.042, 0.027, 0.024, all P < 0.05]. The proportions of patients experiencing postoperative urinary retention, mental disorder, or blood transfusion, length of hospital stay, and hospitalization expenses in the observation group were lower or shorter than those in the control group ( χ2 = 0.003, 0.005, 0.017, t = 0.040, 0.048, all P < 0.05). Conclusion:Integrated traditional Chinese and Western medicine based on the concept of ERAS can mitigate postoperative pain, reduce perioperative complications, and promote the recovery of knee joint function, and thereby deserves clinical application.

Research Progress in Effects of Mechanical Factors on Angiogenesis of Vascular Endothelial Cells and the Mechanism / 医用生物力学

The angiogenic capacity of vascular endothelial cells is influenced by multiple mechanical factors. Mechanical factors guide the rearrangement of cytoskeleton, mediate intracellular signal transduction, affect cell migration, orientation and other behaviors, and then regulate their angiogenic capacity. However, different types of mechanical stimulation have different effects on their angiogenic capacity. This article summarizes and discusses the research work and progress of the influence of five mechanical factors （shear force, stretch stress, low-intensity pulsed ultrasound, microgravity, material properties） on vascular endothelial cell angiogenesis, which provides a basis and ideas for in-depth research of vascular biomechanics.

Risk prevention and control of facial esthetic defects during orthodontic treatment / 中华口腔医学杂志

Facial aesthetic defect is obviously different from facial aesthetic standard. Orthodontic treatment may expose or even magnify other facial aesthetic defects while solving patients′ main problems. There are many aesthetic traps in facial bone structure, soft tissue and teeth. Orthodontists should comprehensively recognize patients′ dentofacial aesthetic defects. When solving major problems, we should keep an eye on the changes of minor problems and other uncontrollable factors. Potential risks should be clearly recognized and prevented.

Evaluation on three short-term animal models of alcoholic liver disease / 药学学报

Alcoholic liver disease (ALD) includes a spectrum of disorders ranging from asymptomatic steatosis, alcoholic steatohepatitis (ASH), fibrosis and cirrhosis. According to epidemical statistics, ALD has been ranked as the second major cause of liver diseases in China. Many animal models have been made in the study of potential therapies. However, in most of the models, the pathological changes are not always consistent with those in patients. There are three widely used short-term animal models of ALD:the acute alcoholic liver injury model, Gao-binge steatohepatitis model and CCl4-alcohol diet induced liver fibrosis model. In this study, we evaluated the pathological responses of these models and compared the responses with the clinical parameters. The liver/body weight ratio was increased and liver histological lesions were induced in alcoholic groups in the three models, while the levels of biochemical parameters and inflammatory factors were affected by different type of treatments. In the acute alcoholic model, the mRNA levels of interleukin-6 (IL-6) and C-C motif chemokine receptor-2 (CCL2) were surprisingly decreased, which was consistent with the transcriptome profile in patients (P P IL-6 and CCL2 (P CCL2 was impacted differently at various stages of ALDs, which can be considered as a potential biomarker.

Diagnostic value of soluble urokinase-type plasminogen activator receptor in artificial joint infection / 实用医学杂志

Objective To explore the possible application of suPAR in the early diagnosis of periprosthet-ic joint infection(PJI). Methods A total of 53 patients with PJI who underwent total arthroplasty were selected as the PJI group. According to ratio of 1:2 between hospital and community,60 people were selected as the control group. The level of suPAR,CRP,IL-1,IL-6,TNF-α and IL-12 were measured. ROC curves were drawn to calcu-late the AUCs of these indicators. Results The level of serum suPAR in PJI patients was(6.70 ± 0.24)ng/mL, which was significantly higher than that in the control group(1.76 ± 0.11)ng/mL,and the difference was statisti-cally significant(P < 0.05). The level of serum IL-12 in PJI patients was(41.99 ± 4.02)pg/mL,which was signifi-cantly higher than that in the control group(23.57 ± 3.16)pg/mL,and the difference was statistically significant (P < 0.05). There was a positive correlation between suPAR and CRP,IL-6,TNF-α and IL-12,and their correlation coefficientwere 0.752,0.769,0.842,0.760 and 0.767,respectively. In addition,the area under the ROC curve of PJI was 0.888,while the AUC of CRP and IL-6 were 0.763 and 0.833,respectively. Conclusion Serum suPAR has a high diagnostic potential in the diagnosis of PJI and can be used as a potential diagnostic marker for PJI.

Value of pelvic CT sagittal reconstruction for percutaneous insertion of iliosacral screws / 中华骨科杂志

Objective To investigate the value of pelvic CT sagittal reconstruction for percutaneous insertion of iliosacral screws.Methods Data of 32 patients who had been treated for pelvic posterior ring injury from June 2015 to March 2017 were retrospectively analyzed.There were 21 males and 7 females,aged from 21 to 75 years (average,43.2 years).According to Tile classification for pelvic fractures,there were 23 cases of type B (type BI in 4,type B2 in 13 and type B3 in 6),and 9 cases type C (type C1 in 6,type C2 in 2 and type C3 in 1).The pelvic CT three-dimensional reconstruction was performed before operation,and the reconstructed layer of CT sagittal position was overlapped,and preset S1,S2 sacroiliac joint hollow.Insert the screws according to the preset needle point and passage under the perspective of C-arm X-ray machine during the operation.In 32 cases of patients,3 cases of type C1,1 case of type C2 and 1 case of type C3 fractures in sacroiliac joint hollow combined with S1-ilium pedicle screw internal fixation,and the rest of 27 patients were treated by iliosacral screws.The time for each screw placement and the times of X-ray projection were recorded.The position of cannulated screw was observed by CT scan and compared with the preset channel after the operation.Postoperative reduction quality was assessed using Matta radiological criteria and Majeed criteria was used at the final follow-ups to evaluate the pelvic function.Results The operations time was ranged from 40 to 240 min (average,130 min);and the blood loss was ranged from 20 to 150 ml (average,80 ml).Altogether 58 iliosacral screws were inserted in 32 patients.The time for each screw placement was ranged from 5 to 15 min (average,9.5 min);and the number for each screw X-ray projection was ranged from 7 to 15 times (average,10.2 times).Postoperative CT scan and vascular ultrasound showed that all the iliosacral screws did not penetrate the cortical bone or damaged the vascular nerves,and the error of the preset channel was from 0 to 5 mm (average,2.2 mm).All fractures healed successfully,and the healing time was 12 to 18 weeks (average,14.2 weeks).According to Matta radiological criteria,reduction was excellent in 26,good in 3 and fair in 3,with an excellent to good rate of 90.6％ (29/32).The follow-up time for the 32 patients was ranged from 6 to 15 months (average,11.3 months).At the latest follow-ups,Xray and CT examination showed fine fracture union and no loosening or breakage of screws in all.By the Majeed criteria,the pelvic function was excellent in 21 cases,good in 8 cases,fair in 3 cases,with a good to excellent rate of 90.6％ (29/32).Conclusion Preoperative pelvic CT sagittal reconstruction for preset of iliosacral screw insertion point,angle and length can achieve more accurate placement,shorter operative time and less time of X-ray projections.

MRI analysis of the effect on mandibular retrusion with anterior disc displacement treated by using Herbst appliance / 中华口腔医学杂志

Objective@#To investgate the effect of Herbst appliance on the growth and remodeling of the temporomandibular joint (TMJ) in class Ⅱ patients with mandibular retrusion by using MRI.@*Methods@#Between December 2010 and October 2014, 12 class Ⅱ patients (11-16 years old) with mandibular retrusion were chosen. The patients were divided into two groups. The control group included 7 patients (14 joints) with normal disc condyle relationship and the anterior disc displacement (ADD) group included 5 patients (10 joints) with anterior disc displacement. The MRI images of TMJ were measured, including condylar height, joint space index and disc position ratio, before and after the treatment.@*Results@#The condylar height of the patients in the control group was significantly increased (P<0.001) after treatment, and no significant difference in joint space index (P=0.821) and disc position ratio (P=0.146) was found. The joint space index of the patients ([-14.70±8.82]% and [4.90±11.35]%) in ADD group changed significantly (P<0.001) after treatment, and no significant difference in condylar height (P=0.294) and disc position ratio (P=0.120) was found.@*Conclusions@#The normal disc condyle relationship was beneficial to the reconstruction of the condylar process, and the increase of the condylar height. The condyle moved forward in patients with anterior disc displacement after treatment.

Relationship between the mandibular hypoplasia and temporomandibular joint internal derangement in adolescents with skeletal class Ⅱ malocclusion / 中华口腔医学杂志

Mandibular hypoplasia is very common clinically. Studies have reported that temporomandibular joint internal derangement (TMJID) might manifest as mandibular retrusion, and whether there is a direct correlation between them remains controversial in academia. On the other hand, for adolescent patients with skeletal class Ⅱ malocclusion, the growth of mandible could be motivated by orthopedic force, and then the mandibular retrusion corrected. However, if TMJID is the direct cause of mandibular retrusion, orthopedic treatment will not have a significant effect on it. Base on literature review and analysis as well as our own research, this article will review the distribution of structural abnormalities of the temporomandibular joint in adolescents with mandibular hypoplasia and its association with skeletal class Ⅱ malocclusion, as well as the effect of TMJID on the treatment of skeletal class Ⅱ malocclusion in adolescents.

Application of sEST+EPBD in patients with mild or moderate biliary pancreatitis / 中国内镜杂志

Objective To explore the clinical value of sEST+EPBD applied in patients with mild-to-moderate biliary pancreatitis. Methods We selected out 60 cases mild or moderate biliary pancreatitis from January, 2013 to December, 2015, and randomly divided these cases into control group, EST group and sEST + EPBD group. We compared serological indexes, postoperative inflammation index, concurrent operation, hospitalization and follow-up indicators of these three groups. Results The levels of serum amylase, CRP and PCT were no statistical significance in three groups (P > 0.05). Total lengths of hospital stay and recurrence of pancreatitis in EST groups and sEST + EPBD group were significantly shorter than in control group (P < 0.05), and the total cost of hospitalization in sEST + EPBD group was obviously lower than in control group (P < 0.05). The level of postoperative serum amylase in sEST + EPBD group was obviously higher than in EST group, and the total length of hospital stay, cost and operative complications in sEST+EPBD group was significantly lower than that in EST group (P < 0.05); However, within one year, recurrences of pancreatitis and rates of cholecystectomy were no significant differences in these two groups. Conclusion sEST+EPBD is an effective and safe treatment in mild or moderate biliary pancreatitis, and can reduce the length of hospital stay and cost, operative complications, and assist the implementation of interval laparoscopic cholecystectomy.

Hypoglossal canal dural arteriovenous fistulas treated with transvenous embolization:report of two cases and literature review / 浙江大学学报·医学版

Two cases of hypoglossal canal dural arteriovenous fistulas (HCDAVF) were reported. The clinical manifestation, radiological features, treatment and prognosis were reviewed. Both cases presented chemosis and pulsatile tinnitus. 3D-time-of-flight (TOF) magnetic resonance angiography (MRA) demonstrated abnormal high signal in hypoglossal canal. Cerebral digital subtraction angiography (DSA) showed that these HCDAVFs were supplied by multiple intracranial and extracranial arteries, and fistulas were located in hypoglossal canal. Fistulas were blocked by coils and Onyx-18 through transvenous approach, and the angiography after the embolism showed complete occlusion of fistula. No adverse events after treatment and no recurrence during the follow up were observed.

A preliminary study on the disappearance time of influenza virus antigen / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the antigen clearance time, time to symptom disappearance, and the association between them using immunofluorescence assay for dynamic monitoring of influenza virus antigen in children with influenza.</p><p><b>METHODS</b>A total of 1 063 children suspected of influenza who visited the Hunan People's Hospital from March to April, 2016 were enrolled. The influenza A/B virus antigen detection kit (immunofluorescence assay) was used for influenza virus antigen detection. The children with positive results were given oseltamivir as the antiviral therapy and were asked to re-examine influenza virus antigen at 5, 5-7, and 7 days after onset.</p><p><b>RESULTS</b>Of all children suspected of influenza, 560 (52.68%) had an influenza virus infection. A total of 215 children with influenza virus infection were followed up. The clearance rate of influenza virus antigen was 9.8% (21 cases) within 5 days after onset. The cumulative clearance rate of influenza virus antigen was 32.1% (69 cases) within 5-7 days, and 98.1% (211 cases) within 7-10 days after onset. Among these children, 6 children (2.8%) achieved the improvement in clinical symptoms within 3 days after onset. The cumulative rate of symptom improvement was 84.7% (182 cases) within 3-5 days after onset, and 100% achieved the improvement after 5 days of onset.</p><p><b>CONCLUSIONS</b>The time to improvement in symptoms after treatment is earlier than antigen clearance time. Almost all of the children achieve influenza virus antigen clearance 7-10 days after onset. Therefore, it is relatively safe for children to go back to school within 7-10 days after onset when symptoms disappear.</p>

Construction and function identification of luciferase reporter gene vectors containing SNPs in NFKBIA gene 3'UTR / 药学学报

This study aims to investigate the function of two SNPs (rs8904C > T and rs696G > A) in 3' untranslated region (3'UTR) of NFKBIA gene by constructing luciferase reporter gene. A patient's genomic DNA with rs8904 CC and rs696 GA genotype was used as the PCR template. Full-length 3'UTR of NFKBIA gene was amplified by different primers. After sequencing validation, these fragments were inserted to the luciferase reporter vector, pGL3-promoter to construct recombinant plasmids containing four kinds of haplotypes, pGL3-rs8904C/rs696G, pGL3-rs8904C/rs696A, pGL3-rs8904T/rs696G and pGL3-rs8904T/rs696A. Then these plasmids were transfected into LS174T cells and the luciferase activity was detected. Compared with pGL3- vector transfected cells (negative control), the luciferase activity of the four kinds of recombinant plasmids was significantly decreased (P A, the luciferase activity of the recombinant plasmids containing A allele (pGL3-rs8904C/rs696A and pGL3-rs8904T/rs696A) was about 45.1% (P P T, there were no significant differences in the luciferase activity between the recombinant plasmids containing T allele and those with C allele. Together, the luciferase reporter gene vectors containing SNPs in NFKBIA gene 3'UTR were constructed successfully and rs696G > A could decrease the luciferase activity while rs8904C > T didn't have much effect on the luciferase activity.

Application of MOOC teaching model in continuing medical education of oral and maxillofacial surgery / 中华医学教育探索杂志

Continuing medical education refers to the completion of basic medical education for inservice education,which is to guarantee the sustainable development of physicians in clinical and scientific research ability,and is the essential means to safeguard and improve the level of medical treatment.Traditional continuing medical education is given priority to the form of regularly organize workshops,so it has some limitations to oral and maxillofacial surgery.MOOC teaching is a kind of large-scale open new online teaching mode.This study provides an overview of the MOOC development,characteristics and development situation in the medical teaching.The necessity and feasibility of MOOC based teaching protocol in oral and maxillofacial surgery continuing medical education has been discussed.And curriculum transformation,construction of education model and possible challenges have also been analyzed and discussed in this paper.

The change of FOXO1 expression during alveolar bone remodeling induced by orthodontic force / 医用生物力学

Objective To study the remodeling of alveolar bone and change in expression of forkhead box O1 (FOXO1) during orthodontic tooth movement (OTM) in rat, so as to preliminarily investigate the role of FOXO1 in alveolar bone remodeling induced by orthodontic force. Methods The rat OTM models were established and the left maxillary 1st molars were moved with force of 50 g. The rats were executed on the 1st, 3rd and 7th day of OTM, respectively. HE staining and immunohistochemical staining were used to observe the remodeling of alveolar bone in the inter-radicular region of the 1st molars and expression of FOXO1 at different time points during OTM. Results The 1st molars were constantly moved mesially under orthodontic force. There were more osteoclasts in the alveolar bone of OTM group than that in non-OTM group, and the osteoclasts on the 3rd day of OTM showed the highest activity. The number of active osteoblasts gradually increased in the inter-radicular region of alveolar bone under orthodontic force, with the enhanced osteoblast activity. Expression of FOXO1 in OTM group was elevated compared with non-OTM group. Most osteoblasts in alveolar bone during OTM were FOXO1 positive, and the expression of FOXO1 was gradually increased with the number of osteoblasts increasing. Conclusions Orthodontic force induces bone remodeling of alveolar bone in the inter-radicular region during OTM, and the change in FOXO1 expression may be related to alveolar bone remodeling during OTM.

Construction and function identification of luciferase reporter gene vectors containing SNPs in NFKBIA gene 3'UTR / 药学学报

This study aims to investigate the function of two SNPs (rs8904C > T and rs696G >A) in 3' untranslated region (3'UTR) of NFKBIA gene by constructing luciferase reporter gene. A patient's genomic DNA with rs8904 CC and rs696 GA genotype was used as the PCR template. Full-length 3'UTR of NFKBIA gene was amplified by different primers. After sequencing validation, these fragments were inserted to the luciferase reporter vector, pGL3-promoter to construct recombinant plasmids containing four kinds of haplotypes, pGL3-rs8904C/rs696G, pGL3-rs8904C/rs696A, pGL3-rs8904T/rs696G and pGL3-rs8904T/rs696A. Then these plasmids were transfected into LS174T cells and the luciferase activity was detected. Compared with pGL3-vector transfected cells (negative control), the luciferase activity of the four kinds of recombinant plasmids was significantly decreased (P < 0.001). For rs696G > A, the luciferase activity of the recombinant plasmids containing A allele (pGL3-rs8904C/rs696A and pGL3-rs8904T/rs696A) was about 45.1% (P < 0.05) and 56.1% (P < 0.001) lower than those containing G allele (pGL3-rs8904C/rs696G and pGL3-rs8904T/rs696G), respectively. For rs8904C > T, there were no significant differences in the luciferase activity between the recombinant plasmids containing T allele and those with C allele. Together, the luciferase reporter gene vectors containing SNPs in NFKBIA gene 3'UTR were constructed successfully and rs696G > A could decrease the luciferase activity while rs8904C >T didn't have much effect on the luciferase activity.

Changes in FoxO1 expression of MC3T3-E1 cells during continuous tensile stress induced osteogenic differentiation / 医用生物力学

Objective To study the effect of continuous tensile stress on expression of Forkhead box protein O1 (FoxO1) in MC3T3-E1 cells in vitro during osteogenic differentiation, and explore the role of FoxO1 in the mechanism of continuous tensile stress induced-osteogenic differentiation. Methods MC3T3-E1 cells were seeded and applied with tensile stress at the frequency of 1 Hz and amplitude of 10% by FX-4000TTM mechanical loading system. MC3T3-E1 cells were divided into control, 1 h, 4 h, 6 h, 12 h, 24 h, 48 h, 72 h group, respectively, according to the time subjected to the tensile stress. Alkaline phosphatase (ALP) staining, real-time PCR, Western blotting and immunofluorescence were applied to detect the effects of continuous tensile stress on osteogenesis ability of MC3T3-E1 cells, mRNA and protein expression of FoxO1, and allocation of FoxO1 in MC3T3-E1 cells. Results (1) Continuous tensile stress could promote the osteogenic differentiation of MC3T3-E1 cells. Compared with the control group, the mRNA expression of ALP increased significantly at 24 h, 48 h, and the mRNA expression level of osteocalcin (OCN) reached the peak value at 72 h, which was significantly higher than that in the control group. The mRNA expression of runt-related transcription factor-2 (Runx2) significantly increased at 4 h as compared to the control group, and Runx2 protein level changed accordingly. The ALP staining results of the stress group and control group were significantly different. (2) Continuous tensile stress could increase mRNA and protein expression of FoxO1. The mRNA expression of FoxO1 markedly increased at 24 h, and its protein expression significantly elevated at 12 h. (3) FoxO1 was expressed in the nucleus and cytoplasm at 6 h, and then significantly increased in the cytoplasmat at 24 h. Conclusions 10% continuous tensile stress can stimulate the osteogenic differentiation of MC3T3-E1 cells, up-regulate the mRNA and protein expression of FoxO1 and change the allocation of FoxO1 in MC3T3-E1 cells. The investigation on the change rules of FoxO1 expression and allocation under mechanical stimulation will provide the experimental basis for studying the role of FoxO1 in mechanical stimulation.

A3-A3 side-to-side anastomosis combined with endovascular intervention in recurrent complex anterior artery aneurysm: a case report and literature review / 浙江大学学报·医学版

A 28-year-old female patient was admitted to the Second Affiliated Hospital, Zhejiang University School of Medicine, with sudden headache and vomiting for 1 day. CT scan conducted at emergency revealed subarachnoid hemorrhage, whereas digital subtraction angiography demonstrated a wide-neck aneurysm located at A1 segment of the left anterior cerebral artery. The aneurysm was totally coiled using stent assistance, which, however, was recanalized at 3 month follow-up. This patient was then subjected to aneurysm and parent artery occlusion after bypass of the bilateral A3 segments, who recovered well and discharged without ischemic complications.

The role of lumbar drainage in symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage / 中华急诊医学杂志

Objective To investigate the risk factors of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage and evaluate the effect of lumbar drainage of cerebrospinal fluid on vasospasm.Methods In this retrospective controlled-cohort study, 175 patients with aneurysmal subarachnoid hemorrhage met our study criteria between January 2012 and December 2013.By multi-factor regression analysis, gender, age, Hunt-Hess grade, modified Fisher grade and lumbar drainage were analyzed.The outcomes were assessed by the presence or absence of symptomatic cerebral vasospasm and vasospasm-related infarction, and the mean days of hospital stay and score of Glasgow Outcome Scale at 1-month follow-up.Results Several factors affected the prognosis of subarachnoid hemorrhage.Lumbar drainage was a protective factor of symptomatic cerebral vasospasm (OR =0.243, 95％ CI: 0.119-0.497) and vasospasm-related infarction (OR =0.305, 95％ CI: 0.154-0.604).The patients with lumbar drainage had higher score of Glasgow Outcome Scale (P ＜ 0.05).But the patients with lumbar drainage had longer hospital stay (P ＜ 0.05).Conclusions Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage markedly reduced the risk of symptomatic cerebral vasospasm and improved outcome.