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Objective:To evaluate the safety and efficacy of endovascular interventional treatment of the intracranial vertebrobasilar trunk large aneurysms (VBTLAs) compared with conservative treatment.Methods:This is a prospective multi-center cohort study. From October 2012 to October 2018, a total of 69 patients with intracranial vertebrobasilar trunk large aneurysm (diameter>10 mm) from Henan Province People's Hospital and People's Liberation Army Rocket Medical Center were included in this study. Patients themselves chose either endovascular interventional therapy (interventional group) or conservative treatment (conservative group) after discussion with their doctors. The χ 2 test was used to compare the incidence of deaths, stroke, and all other serious adverse events including other site bleeding, myocardial infarction and others between the two groups. Results:A total of 69 patients were enrolled, of whom 51 patients were enrolled in interventional group, 18 patients underwent endovascular reconstructive therapy, 11 patients underwent deconstructive therapy, and 4 patients underwent conjunction interventional treatments. Eighteen patients were enrolled in conservative group, of whom 11 cases received simple risk factor control, 7 cases received antiplatelet and risk factors control. The proportions of hypertensive patients 94.4% (17/18) and giant aneurysms 50.0% (9/18) in the conservative group were higher than those in the surgery group 64.7% (33/51, χ 2=4.500, P=0.034), 19.6% (10/51, χ 2=4.730, P= 0.030).The incidence of all serious adverse events associated with protocol was 15.7% (8/51) in the interventional group and 44.4% (8/18) in the conservative group [risk ratio (RR) =0.353, 95% confidence intervals (CI): 0.156-0.801], and the difference was significant (χ 2=4.668, P=0.031). The incidence of fatal events associated with protocol was 2.0% (1/51) in the interventional group and 38.9% (7/18) in the conservative group (RR=0.050, 95%CI: 0.007-0.382), and the difference was significant (χ 2=14.281, P<0.001). The incidence of hemorrhage events associated with protocol was 2.0% (1/51) in the interventional group and 22.2% (4/18) in the conservative group (RR=0.088, 95%CI: 0.011-0.738), and the difference was significant (χ 2 =5.391, P=0.020). Follow-up imaging showed that the occlusion rate of aneurysms in 44 patients in the interventional group was 56.8% (25/44) after a median follow-up of 6 months. Imaging follow-up was obtained in 9 patients, whose occlusion rate of aneurysms was 0 and the median follow-up time was 12 months, in the conservative group. The difference was significant(χ 2 =7.534, P=0.006). Conclusion:Compared with conservative treatment, endovascular intervention of the intracranial VBTLAs has lower incidences of serious adverse events and death events.
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Objective:To investigate the impact of severe stenosis or occlusion of intracranial artery in anterior and posterior circulation on cognitive function in patients.Methods:Patients with Alberta stroke program early CT score(ASPECTS) and posterior circulation ASPECTS(pc-ASPECTS) of 10 were selected, and neuropsychological assessments were performed in 30 patients with intracranial artery severe stenosis or occlusion in anterior posterior circulation (anterior circulation group)and 23 patients with intracranial artery severe stenosis or occlusion in posterior circulation(posterior circulation group) and 53 control subjects using MMSE, MoCA and multidimensional psychological assessment system.Results:The scores of time orientation(control group: 5.00(5.00, 10.00), anterior circulation group: 5.00(5.00, 5.00), posterior circulation group: 5.00(5.00, 5.00)), attention (control group: 6.00(5.00, 6.00), anterior circulation group: 5.00(4.00, 6.00), posterior circulation group: 5.00(4.00, 6.00)) and word discrimination test (control group: 70.00(60.00, 82.00), anterior circulation group: 48.00(20.50, 67.50), posterior circulation group: 53.50(33.25, 75.25)) were significantly lower in patients of anterior circulation group and posterior circulation group than those of control group(all P<0.05); The scores of memory(control group: 3.00(2.00, 3.00), anterior circulation group: 2.00(1.00, 3.00), MMSE(control group: 29.00(28.00, 30.00), anterior circulation group: 28.00(26.75, 29.00)) and simple subtraction(control group: 72.00(53.50, 85.50), anterior circulation group: 53.50(37.00, 73.00)) were significantly lower in patients of anterior circulation group than those of control group(all P<0.05); The scores of visuospatial executive function(control group: 4.00(3.00, 5.00), posterior circulation group: 3.00(2.00, 4.00)) and digital sequence reasoning(control group: 74.50(51.50, 83.00), posterior circulation group: 42.00(28.00, 70.00)) were significantly lower in patients of posterior circulation group than those of control group(all P<0.05); The scores of spatial working memory test(control group: 77.50(51.75, 89.00), anterior circulation group: 56.50(34.00, 72.50), posterior circulation group: 31.00(18.50, 58.00))were significantly lower in patients of posterior circulation group than those of the other two groups(all P<0.05). Conclusion:Severe stenosis or occlusion of intracranial arteries in anterior and posterior circulation is associated with cognitive impairment in patients.Vascular lesions in different parts can lead to cognitive impairment in different aspects.
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Objective To quantitatively analyze the correlation between stenosis ratio and cerebral perfusion in patients with solely symptomatic M1 stenosis of middle cerebral artery.Methods All the patients with solely symptomatic M1 stenosis of middle cerebral artery were selected to this study from consecutive 203 patients with elective stenting of symptomatic intracranial artery stenosis.Brain CT, CT perfusion (CTP) and DSA examinations were performed in all cases.The CTP parameters of mean transit time (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) were measured in regions of interest (ROIs) including bilateral frontal lobe, anterior watershed, opercula of the insula (including parsopercluaris and part of insula), temporal lobe, posterior watershed and occipital lobe.Compared with the unaffected side as control, the change of CTP and their relative CTP parameters in these ROIs at affected side were analyzed.Based on DSA data, the ratio of M1 stenosis was measured manually and blindly, the source of collateral branch of compensative artery was estimated and the blood flow was graded.Correlation between the ratio of M1 stenosis and the CTP parameters including the absolute and the relative values was investigated.Results Twenty patients were selected into this study; their average M1 stenosis ration of the affected side was 70.5% ± 10.6% (53% to 91%).Compared with the unaffected side, MTT and CBF were no significant change but CBV increased in the affected frontal lobe; MTT prolonged, CBF was normal and CBV increased in the affected anterior watershed and opercula of the insula; MTT prolonged, CBF and CBV had no significant difference in the affected temporal lobe; MTT prolonged, CBF decreased and CBV had no significant difference in the affected posterior watershed; MTT, CBF and CBV were normal in occipital lobe.Tissue perfusion gradually decreased from the front to the backward in all the M1 stenosis affected cerebral regions and the posterior watershed area was the only region at hemodynamic failure stage.Leptomeningeal vessels of the anterior cerebral artery were the major sources of compensative arteries shown in the DSA in all cases.The ratio of M1 stenosis was positively correlated (r =0.66, P =0.002) with the rCBV in posterior watershed and there is no significant correlation between the ratio and any other CTP parameters in any regions.Conclusions Associated with distribution of collateral compensative artery,tissue perfusion showed obvious spatial distribution at different level in different cerebral region.M1 stenosis ratio is positively correlated with rCBV in hemodynamic failure regions, and there is no correlation with tissue perfusion in hemodynamic compromise regions.
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<p><b>OBJECTIVE</b>To investigate the influence of najanalgesin on glutamate-glial transporter 1(GLT-1) in spinal cord of rats after L5 spinal nerve ligation and transection (SNL), and explore the spinal analgesic mechanism of najanalgesin.</p><p><b>METHOD</b>One hundred male SD rats were randomly divided into 6 groups: sham(A), SNL(B), SNL + najanalgesin(C), SNL + saline (D), SNL + najanalgesin + liposome (E), SNL + najanalgesin + liposome + GLT-1 As-ODNs(F) and treated with intrathecal injections of 10 p.L saline (A and D), 40 ng X kg(-1) najanalgesin (C, E and F), qd, respectively. Besides intrathecal administration of najanalgesin the rats were intrathecally injected with 10 microL of GLT-1 antisense oligodeoxynucleotides (As-ODNs) (F) and 10 micdroL of liposome(E) once daily on day 3. The L4-L6 segments of the spinal cord were isolated in 1, 4 and 7 d(A,B,C and D), 7 d(E and F) after surgery. The mRNA and protein of GLT-1 were determined.</p><p><b>RESULT</b>The SNL model has successfully been set up. Compared to sham group, the expression of GLT-1 mRNA and protein level in group B and D both increased firstly and decreased later, the expression of GLT-1 in group C was significantly increased and kept stable, which were also higher when compared to group D in day 7th. Compared to SNL + najanalgesin group, after intrathecal injection of GLT-1 As-ODNs the GLT-1, expression of GLT-1 in F group significantly decreased. While intrathecal administration of liposome had no significant effect on the spinal GLT-1 expression.</p><p><b>CONCLUSION</b>Najanalgesin could increase the mRNA and protein expression of GLT-1 in spinal cord, which may be one of its spinal mechanisms of analgesia.</p>
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Animals , Male , Rats , Elapid Venoms , Pharmacology , Elapidae , Excitatory Amino Acid Transporter 2 , Genetics , Metabolism , Gene Expression Regulation , Neuralgia , Genetics , Metabolism , RNA, Messenger , Genetics , Metabolism , Rats, Sprague-Dawley , Spinal Cord , MetabolismABSTRACT
Objective To compare the difference of ultrasound and digital subtraction anginography (DSA) in diagnosing carotid atheriosclerosis. Methods A total of 340 patients of ischemic cerebrovascular disease with carotid atheriosclerosis were examined with ultrasound and DSA. They were divided into cerebral infarction group (n=235) and transient ischemic attack (TIA, n=105), and also were divided into the young-aged group (n=54), middle-aged group (n=137) and old-aged group (n=149) by age. Results Both of the ultrasound and DSA found that the incidence of carotid artery stenosis in cerebral infarction was higher than that in TIA (P<0.05);the incidence that of carotid artery stenosis in old-aged group were higher than that in middle-aged and young-aged group (P<0.05), and in middle-aged group was higher than that in young-aged group. Taking DSA as standard, the accordance rate of ultrasound in diagnosing stenosis, clot and both of them were 89.39%, 80.85%, 87.15%, respectively. Conclusion Carotid artery ultrasound has high sensitivity in diagnosis of carotid atheriosclerosis. Either carotid artery ultrasound or DSA has advantages. With combination of two methods, there will be an important significance in the diagnosis, clinical treatment, assess before operation and follow-up after operation in patients with carotid atheriosclerosis.
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Objective To investigate short-term hemodynamic changes in selected patients with middle cerebral artery(MCA) stenting by transcranial Doppler sonography(TCD).Methods Stenting was given to 29 cases (31 MCAs) of patients with moderate and severe MCA stenosis if they had recurred symptoms during the standard antiplatelet therapy.TCD was applied to assess the hemodynamic changes in the stenosis segment and stenotic distal segment before stenting, 1 h and 3 d after stenting. Results Angiography showed that the rate of post-procedure residual stenoses of MCA were less than 20%.Compared with the pre-stentinng peak systolic velocity [PSV, (273±77)cm/s], the post-stenting PSV significantly decreased,which was (162±38) cm/s (P＜0.01) at 1 hour and (168±45)cm/s ( P＜0.01)at 3 days, respectively.Three cases (3 MCA) experienced recurrent stenosis-like spectra at stenosis segments 3 d after stenting and brain CT showed that 2 out of 3 cases suffered intracranial hemorrhage,which was potentially induced by hyperperfusion; PSV doubled in the stenotic distal segment in at least 28.6% patients.There was no statistic difference between pre- and post-stenting in the contralateral MCA (P＞0.05).Conclusions Stenting can dramatically improve the hemodynamic compromise of stenosis segments and their distal segments in selected patients with symptomatic MCA stenosis, however, potential hyperperfusion risk might he taken into consideration after MCA stenting.
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Objective To assess the feasibility and clinical value of high-resolution magnetic resonance imaging (HRMRI) in patients with symptomatic severe intracranial stenosis (SSIS).Methods HRMRl wasperformed with a 3.0 T MR scanner on 5 patients with symptomatic middle cerebral(n=3) or basilar (n=2) arterial stenosis of≥70% confirmed bv DSA.Image diagnosis Was made on the basis of HRMRI findings of vessel wall at the stenotic segment by 2 neuroradiologists blinded t0 patient's status.Results Three of the five patients were diagnosed to have advanced intracranial atherosclerosis based on the presence of a complex eccentric atherosclerotic plaque containing a large lipid-rich necrotic core with a heterogeneous post-contrast enhancement and with signs of ruptured fibrous cap.Two other patients were likely to suffer from non-atherosclerotic lesion.HRMRI revealed an iso-signal septum in the arterial lumen attaching to the slighfly thickened arterial wall that was iso-signal with a homogeneous post-contrast enhancement in one patient and an obviously concentrically thickened arterial wall with hypo-intense signal on T1 WI and slightly high signal on T2 WI and PDWI and without any post-contrast enhancement in the remaining patient.Conclusions In vivo HRMRI in patients with SSIS is technically feasible.It provides detailed information of intracranial arterial wall at the stenotic segment.
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Aim To find out the relationship between muscarinic receptor and reactive oxygen species (ROS) and the probable differences between the four muscarinic receptor subtypes. Methods We transfected the plasmid encoding muscarinic receptor (including subtypes: M_1, M_2, M_3 and M_4) into PC12 cells. Then PC12 cells were exposed to hydrogen peroxide (H_2O_2), carbachol and other inhibitors such as atropine, LY294002 and PD98059. Results The results showed that activation of muscarinic receptor by carbachol protected PC12-M_1, PC12-M_2,PC12-M_3 and PC12-M_4 cells from apoptosis induced by H_2O_2. There was no statistical difference in the protective effect between these four muscarinic receptor subtypes. By using the inhibitors, we found that atropine and LY294002 blocked the protective effect of activation of muscarinic receptor on apoptosis induced by H_2O_2. Conclusion Activation of muscarinic receptor retarded the apoptosis induced by H_2O_2. There was no difference between the four muscarinic receptor subtypes. The protective effect was mainly mediated by the activation of muscarinic receptor and phosphatidylinositol-3 kinase (PI3K).
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RNA interference is an evolutionarily conserved surveillance mechanism that responds to double-stranded RNA by sequence-specific silencing of homologous genes. It can block and regulate gene expression. Over the past few years, RNAi has already begun to revolutionize experimental biology in organisms ranging from unicellular protozoans to mammals. In neuroscience, we are only begining to know the mechanistic complexity of this process and its biological ramifications.
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Objective To evaluated the safety and complications of endovasdcular stenting for symptomatic carotid stenosis with surgical high risk.Methods A series of 11 vessels in 9 patients at surgical high risk were treated by endovascular stenting. The complications during the procedures and postoperative periods were analyzed within one to five months. Results All of the operations were successfully performed without any serious complications. During the follow up period (averaging 6 months), there were no complications of TIAs, stokes and restenoses.Conclusions The study suggests that endovascular stenting may be safe and effective for patients at surgical high risk, but further more study is needed.
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Purpose:To study the clinical value of percutaneous placement of biliary stents tbr treatment of malignant biliary obstruction.Materials and methods:A total of 58 stents were placed pereutaneously in 53 patients for palliative of malignant biliary obstruction. Results:The success rate of stent implantation was 98.1%(52/53).The difference between post-and pre-operation in the serum total bilirubin level of 52 patients was 182?67 ? mol/L,P
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AIM: To observe the expression of neuronal Aryl hydrocarbon receptor nuclear translocator 2 (ARNT2) involved in neuronal apoptosis evoked by low K + and to investigate the relationship between ARNT2 and neuronal apoptosis. METHODS: After neuron apoptosis model was established, the changes of mRNA and protein of ARNT2 during apoptosis were investigated by RT-PCR and Western blotting, respectively. Immunofluorescence was analyzed by confocal microscopy to probe the subcellular localization of ARNT2. RESULTS: Induced by low K +, the expression of ARNT2 mRNA was up-regulated obviously at the point of 30 min, and peaks at the point of 1 h. This up-regulated expression lasted for 12 h, and the variation of ARNT2 protein was similar to that of mRNA. The results of immunofluorescence analyzed by confocal microscopy showed that the localization of ARNT2 protein was in the nucleus. CONCLUSION: ARNT2 locate in nuclei of normal cerebellar granule neurons of rat. During the process of apoptosis evoked by low K +, both mRNA and protein of ARNT2 are overexpressed.