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Objective:To investigate the clinical manifestations and pathogenic gene mutation sites of familial cavernous hemangioma by a pedigree study of this disease.Methods:A family of cerebral cavernous hemangioma who was admitted to the Department of Neurology of the First Affiliated Hospital of Henan University of Science and Technology in April 2019 was diagnosed as cerebral cavernous hemangioma type 1 based on clinical manifestations and head magnetic resonance imaging (MRI), diffusion weighted imaging and susceptibility weighted imaging screening. According to Zabramski classification criteria, the family′s clinical data were collected and genes were sequenced.Results:A 58-year-old female proband had dizziness and headache as the main symptoms, her daughter and son had no clinical symptoms, and her granddaughter had clinical manifestations of cerebral hemorrhage and seizures. The proband and her family members showed multiple cavernous hemangioma on cranial MRI,and the p.L436fs mutation in the KRIT1 gene of familial cerebral cavernous malformation type 1 was confirmed through genetic examination, which was consistent with the Zabramski typing results based on head MRI. The mutation site of the familial spongiform malformation type 1 pathogenic gene was found to be p.L436fs in KRIT1 gene, which has not been reported in familial cerebral cavernous hemangioma type 1 until now.Conclusion:A new p.L436fs mutation of KRIT1 gene was found in familial cerebral cavernous malformation type 1, which expands understanding of the clinical manifestations and pathogenic gene mutation sites of familial cavernous hemangioma.
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Objective:To evaluate the effectiveness of exogenous melatonin in preventing delirium in critically ill patients.Methods:The computer searched Pubmed, Medline, Embase, Web of Science, the Cochrane Library and other English databases for randomized controlled trials on the efficacy of exogenous melatonin in the prevention of delirium in critically ill patients. The retrieval time was from the establishment of the database to March 2021. Two researchers independently screened the literature, extracted data and evaluated the quality according to the inclusion and exclusion criteria. Revman 5.3 software was used for meta-analysis.Results:A total of 10 randomized controlled trials and 1 224 critically ill patients were included. The results of meta-analysis showed that there were no significant differences in the incidence of delirium during hospitalization (relative risk [ RR] 0.72, 95% confidence interval [ CI] 0.47-1.09; Z=1.57, P=0.12), ICU hospitalization time (mean difference [ MD] -0.36, 95% CI -1.01-0.28; Z=1.11, P=0.27), mechanical ventilation time ( MD -49.42, 95% CI -126.63-27.80; Z=1.25, P=0.21) and mortality ( RR 0.74, 95% CI 0.42-1.30; Z=1.05, P=0.29) between the experimental group and the control group. Conclusion:Exogenous melatonin can not prevent the occurrence of delirium in critically ill patients, nor can it shorten the hospitalization time and mechanical ventilation time in intensive care unit and reduce the mortality.
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Objective To study the effect of transcranial ultrasound (US) on arterial recanalization in acute ischemic stroke patients.Methods Patients with acute middle cerebral artery (MCA) main stem occlusion after 6 h were randomized into a target group receiving low-frequency,pulse-wave mode,transcranial US for 30 min or a control group.All were treated with intravenous urokinase for thrombolysis.Transcranial doppler sonography (TCD) was used to document vascular occlusion and confirm recanalization at 2 h and 24 h after treatment,and the patients were evaluated using the National Institutes of Health Stroke Scale ( NIHSS).Results Recanilization (complete or partial) after 2 hours was significantly higher in the US group (44.4％) compared with the control group ( 10.5％ ).Recanalization had occurred in 50％ of the US group 24 hours after treatment compared with 15.7％ of the controls.At 2 h after treatment,33.3％ of the US group and 5.5％ of the controls had improved at least 4 points on the NIHSS assessment.After 24 hours the figures were 44.4％ and 10.5％.After 3 months,11 subjects from US group (61.1％ ) had a modified Rankin score ≤2 compared with 4 subjects (21％) from the control group.Conclusions In acute ischemic stroke,transcranial US has positive effects on recanalization and neural function.
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Objective To explore the ultrasound characteristics of carotid atherosclerosis in acute stroke patients with early neurological deterioration (END). Methods END was defined as a increase by at least two points in the National Institutes of Health Stroke Scale between admission and day 7. Among 128 patients with acute stroke in whom carotid ultrasound examinations were performed within 24 hours after admission, 38 patients with END and 40risk-matched patients without END were included in the END group and the non-END group,respectively. The ultrasound characteristics of carotid atherosclerosis were compared in both groups. Results Plaque score (16.7 ±4.4 mm vs. 13.3 ±3.5 mm, t=2.673, P=0.009),intima-media cross-sectional area (26. 4 ± 8. 5 mm2 vs. 20. 5 ± 6. 8 mm2, t = 3. 394, P =0. 001), arterial stiffness index (28. 94 ±4. 29 vs. 21. 22 ±5. 85, t = 6. 618, P =0. 000), and the rates of unstable plaque (66. 7% υs. 43. 3%, χ2=9. 164, P =0. 003), eccentric plaque (62. 8% vs. 45. 6%, χ2=5. 008, P =0. 025), stenosis ≥50% (71. 1% vs. 37. 5%, χ2=8. 828, P =0. 003), and negative remodeling (28. 9% vs. 7. 5%, χ2=6.087, P =0.014) in the END group were significantly higher than those in the non-END group, while the distensibility coefficient ([14. 74 ±8. 66]×10-6/P υs. [19. 16 ±9.35] × 10-6/Pa, t =2. 163, P=0. 034)and compliance coefficient ([0.49 ±0. 13] × 10-4 mm2/Pa υs. [0. 58 ±0. 11] × 10-4 mm2/Pa,t =3.307, P =0. 001) were significantly lower than those in the non-END group. Conclusions The ultrasound characteristics such as plaque score, intima-media cross-sectional area, arterial stiffness index, unstable plaque, eccentric plaque, stenosis ≥ 50%, negative remodeling,distensibility and compliance may be useful to predict END in patients with acute stroke.
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Objective To explore the effect of the complex containing neuron stem cells(NSCs)and endothelial progenitor cells(EPCs)after being transplanted to ischemia and reperfusion rat model on the differentiation of neural stem cells to neuron and synapse formation.MethodsTotally 300 SD adult male rats were randomly divided into sham operation group,middle cerebral artery occlusion(MACO)model group,MACO+NSCs group,MACO+EPCs group,and MACO+complex group,and every group were further divided into 6 subgroups according to time points 1,3,7,14,30 and 60 d after operation,NSCs were isolated from the hippocampus of neonatal SD rats born in 24 h and identified with Nestin staining.EPCs were obtained from the artery blood of SD rats and verified with immunocytochemical stainings of CD31 and CD34 after culture.NSCs and EPCs were cultured together to produce the complex with aid of laminin.Then normal saline,the NSCs,EPCs,or complex(2?1010/L)were transplanted into the ischemia penumbra of corresponding model rat brain,sham control or MACO rats.The differentiation of NSCs,the expression of P38,synapsin-I,mRNA of connexin 43 were observed with double label immunofluorescence technique,immunohistochemical method,RT-PCR and Western blot analysis in ischemic penumbra.ResultsCompared with other groups,there were more double Brdu and neural special enolase positive cells in MACO+complex group with the increased expression of P38.RT-PCR and Western blot analysis indicated that MACO+complex group had significantly higher expressions of synapsin-I at mRNA and protein levels in ischemic penumbra,and so did the mRNA expression of connexin 43.ConclusionThe transplantation of the complex of NSCs and EPCs improves the NSCs differentiation to neuron,synapse formation and reconstruction of neural network.
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Objective To investigate the effect of endothelial progenitor cells (EPCs) which complexed with neuron stem cells (NSCs) after transplanted into ischemia and reperfusion (I/R) rat model on the proliferation and apoptosis of the NSCs and vasal construction. Methods Totally 150 SD adult male rats were randomly and equally divided into 5 groups, sham-operation group, I/R group, I/R+NSCs group, I/R+EPCs group, and I/R+NSCs+EPCs group. The rats were further divided into 5 subgroups according to the time points of 3, 7, 14, 30 and 60 d after transplantation. I/R rat model was established by reversiblyligating middle cerebral artery occlusion. NSCs were derived from the hippocampus of SD rats born in 24 h and identified with Nestin staining. EPCs were obtained from the artery blood of SD rats and verified with immunocytochemical stainings of CD31, CD34 and KDR after culture. The complex of NSCs and EPCs was produced with aid of laminin. Then the complex were transplanted into the ischemia penumbra of corresponding model rat brain. The proliferation and apoptosis of NSCs, and the fomation of new vessels were observed through immunohistochemistry and double-labeled immunofluorescence staining. Results The proliferation of NSCs was increased, apoptosis cells were decreased and the new vessels were raised in the complex transplantation when compared with single NSCs or EPCs transplantation groups. Conclusion The complex of NSCs and EPCs transplantation improves the proliferation of NSCs, suppresses cell apoptosis and promotes the formation of new vessels.