Establishment of HPLC fingerprints of Zhihuang Tongfeng Decoction and determination of four constituents / 中成药

AIM To establish HPLC fingerprints of Zhihuang Tongfeng Decoction (Phellodendri chinensis Cortex,Anemarrhenae Rhizoma,Plantaginis Semen,etc.) and to determine the contents of four constituents.METHODS The analysis of aqueous extract of this drug was performed on a 30 ℃ thermostatic Wondasil C18 column (4.6 mm ×250 mm,5 μm),with the mobile phase comprising of acetonitrile-0.5％ acetic acid in a gradient elution manner,and the detection wavelength was set at 245 nm.RESULTS There were sixteen common peaks in the HPLC fingerprints of ten batches of samples with the similarities of more than 0.9.Berberine hydrochloride,mangiferin,geniposidic acid and salvianolic acid B showed good linear relationships within the ranges of 0.636 2-3.575 μg (R2 =0.9999),0.338-1.425 μg (R2 =0.9990),0.6452-2.7188 μg (R2 =1) and0.938 8-5.275 μg (R2 =0.999 3),whose average recoveries were 100.56％,98.35％,100.25％ and 102.11％ with the RSDs of 2.41％,1.17％,1.24％ and 2.02％,respectively.CONCLUSION This accurate,reliable and specific method can be used for the quality control of Zhihuang Tongfeng Decoction.

Effect of high glucose-based peritoneal dialysis fluids on NLRP3-IL-1β in human peritoneal mesothelial cells / 北京大学学报(医学版)

Objective:To explore the effect of high glucose-based peritoneal dialysis fluids on NLRP3-IL-1β in human peritoneal mesothelial cells.Methods:HMrSV5 cells (SV40 immortalized human peritoneal mesothelial cell line) were grown in type Ⅰ collagen-coated dishes in DMEM/F12 containing 10％ fetal calf serum (FCS).All experiments on HMrSV5 cells were performed between passages 5 and 10.The cells were divided into 7 groups:control,1.5％ dextrose,2.5％ dextrose,4.25％ dextrose,rotenone,thenoyltrifluoroacetone (TTFA),and antimycin A.Immunoblotting was used to evaluate the expression of IL-1 β.Small interfering RNA (siRNA) targeting NLRP3 was used to downregulate the expression of NLRP3 and Western blot was used to evaluate the expression of IL-1 β in human peritoneal mesothelial cells exposed to 4.25％ dextrose.In the meanwhile,resveratrol (RSV) was used to induce autophagy,3-methyladenine (3-MA) and siRNA against Beclin 1 or ATG5 were used to block autophagy,flow cytometric was used to analyze the respiring (mitotracker deep red),total (mitotracker green) and reactive oxygen species (ROS)-generating mitochondria (mitoSOX);Western blot was used to evaluate the expression of IL-1β.Results:The IL-1β relative expressions were 0,0.175 ±0.082,0.418 ± 0.163,2.357 ±0.288,2.642 ±0.358,3.271 ±0.462,and 0.123 ±0.091,indicating that the cells exposed to high glucose-based peritoneal dialysis fluids and cells treated with mitochondria respiratory chain key enzyme complex Ⅰ,and complex Ⅲ inhibitors increased the IL-1β expression.And we found that NLRP3 knock-down significantly blocked the upregulation of IL-1 β.In addition,the fluorescence intensity of total mitochondria and ROS-generating mitochondria in the following groups:control,negative control,RSV,3-MA,ATG5 siRNA,Beclin1 siRNA were 1.76 ± 0.42,1.83 ± 0.55,1.85 ± 0.62,7.36 ± 0.92,5.35 ± 0.77,5.06 ± 0.62 and 821.68 ± 95.12,868.15 ± 102.82,723.39 ± 92.56,1 660.08 ± 113.65,1 433.01 ± 107.24,1 562.36 ± 112.88 respectively.The increased concentrations of mitochondrial ROS and IL-1β upregulation were confirmed in the inhibition but not the induction of autophagy.We also found that downregulation of ATG5 and Beclin1 sensitized cells for the release of IL-1β induced by MSU (monosodium urate) or nigericin which was the NLRP3 inflammasome activator.RSV treatment attentuated this effect.Conclusion:Long-term application of high glucose-based peritoneal dialysis fluids can trigger the consistent activation of NLRP3-IL-1ββ in peritoneal mesothelial cells.Timely initiation of autophagy may block the NLRP3-IL-1ββ activation and provide a basis for the further development of a potential therapeutic strategy for delay of chronic inflammation and peritoneal fibrosis associated with peritoneal dialysis.

Establishment of HPLC fingerprints of Zhihuang Tongfeng Decoction and determination of four constituents / 中成药

AIM To establish HPLC fingerprints of Zhihuang Tongfeng Decoction (Phellodendri chinensis Cortex,Anemarrhenae Rhizoma,Plantaginis Semen,etc.) and to determine the contents of four constituents.METHODS The analysis of aqueous extract of this drug was performed on a 30 ℃ thermostatic Wondasil C18 column (4.6 mm ×250 mm,5 μm),with the mobile phase comprising of acetonitrile-0.5％ acetic acid in a gradient elution manner,and the detection wavelength was set at 245 nm.RESULTS There were sixteen common peaks in the HPLC fingerprints of ten batches of samples with the similarities of more than 0.9.Berberine hydrochloride,mangiferin,geniposidic acid and salvianolic acid B showed good linear relationships within the ranges of 0.636 2-3.575 μg (R2 =0.9999),0.338-1.425 μg (R2 =0.9990),0.6452-2.7188 μg (R2 =1) and0.938 8-5.275 μg (R2 =0.999 3),whose average recoveries were 100.56％,98.35％,100.25％ and 102.11％ with the RSDs of 2.41％,1.17％,1.24％ and 2.02％,respectively.CONCLUSION This accurate,reliable and specific method can be used for the quality control of Zhihuang Tongfeng Decoction.

Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique.</p><p><b>METHODS</b>We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated.</p><p><b>RESULTS</b>All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months), 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia.</p><p><b>CONCLUSIONS</b>The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.</p>

Endovascular treatment of a giant internal carotid artery bifurcation aneurysm with drainage into cavernous sinus / 中华医学杂志(英文版)

This report documents the treatment of a giant aneurysm of the internal carotid artery bifurcation with a fistula to the cavernous sinus, which appeared following closed head trauma. A 39-year-old man suffered from a blunt head trauma in an automobile accident. Two weeks after the trauma, progressive chemosis of left eye was presented. Four months after the trauma, digital subtraction angiography showed an internal carotid artery bifurcation aneurysm, with drainage into the cavernous sinus. The lesion was successfully obliterated with preservation of the parent artery by using coils in conjunction with Onyx. Follow-up angiography obtained 3 months postoperatively revealed persistent obliteration of the aneurysm and fistula as well as patency of the parent artery. Endovascular treatment involving the use of coils combined with Onyx appears to be a feasible and effective option for treatment of this hard-to-treat lesion.

Application of endovascular embolization for brain arteriovenous malformation / 中国医学科学院学报

Endovascular embolization has increasingly been applied for brain arteriovenous malformation (BAVM). With our better understanding of BAVM and the continuous improvement of micro-catheter technology and embolic materials, the therapeutic effectiveness has constantly increased. This paper reviews recent advances in research on BAVM and the application of endovascular embolization.

Statistical study on correlation between cerebral arteriovenous malformation and hemodynamic aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>to explore the characteristic factors of arteriovenous malformation (AVM) which have statistically significant correlation with hemodynamic aneurysms.</p><p><b>METHODS</b>from August 1999 to July 2009, the clinical and imaging indices of 363 consecutive patients with AVM were retrospectively reviewed and entirely statistically analyzed. There were 229 male patients and 137 female patients, the mean age at the time of presentation was 28 ± 13 years. By using SPSS 16.0 medical statistic software, the correlation were analyzed between hemodynamic aneurysms and 13 characteristic factors associated with AVM through the methods of unit-factor and multi-factor analysis. Finally, the risk of the correlative factors filtered were evaluated.</p><p><b>RESULTS</b>the crosstabs analysis of unit-factor strongly suggested that the following factors, including age, location (supertentorium, subtentorium), size, number of main feeding arteries, number of drainage veins, ectasis of drainage veins, contralateral supply, and supply by both anterior and posterior circulation, were correlated with hemodynamic aneurysms. And the results of regression analysis of multi-factors indicated the following factors, including age, number of main feeding arteries, and contralateral supply, were positively correlated with hemodynamic aneurysms and the number of drainage veins were negatively correlated with hemodynamic aneurysms.</p><p><b>CONCLUSION</b>the factors including age, number of main feeding arteries, number of drainage veins and contralateral supply, are highly correlated with hemodynamic aneurysms.</p>

Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer: technical aspects / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endovascular therapy plays an important role in the treatment of brain arteriovenous malformations (BAVMs). Ethylene vinyl alcohol copolymer (Onyx) is a novel liquid embolic material. This study aimed to summarize our experience of using Onyx for embolization of BAVMs with the focus on embolization technique.</p><p><b>METHODS</b>From September 2003 to November 2007, 115 patients (43 women and 72 men, with a mean age of 29 years) with BAVMs were endovascularly treated with Onyx in our department. The following features of all AVMs were evaluated prior to treatment: type of nidus and shunt, draining veins, and feeding arteries. A total of 196 endovascular procedures were performed.</p><p><b>RESULTS</b>The course of endovascular treatment was completed in 88 patients. Additional sessions were planned in 27 patients. Of the 88 patients, total occlusion was obtained in 23 patients (26.1%), near-total (> 80% of the original volume) occlusion was obtained in 35 patients (39.8%) and partial occlusion (< 80% of the original volume) was obtained in 30 patients (34.1%) using embolization as the sole therapeutic technique. Mean volume reduction was 72% (range 30% - 100%) in 115 patients. Thirty four patients (38.6%, 34/88) underwent radiosurgical treatment. Additional embolization sessions were planned in 27 patients. Complications occurred in 19 patients (16.5%, 19/115), leading to death in one patient (mortality 0.9%) and permanent disabling in 3 patients (morbidity 2.6%).</p><p><b>CONCLUSIONS</b>Onyx was shown to be feasible and safe for embolization of BAVMs. Proper use of the Onyx injection technique largely improved the endovascular treatment of BAVMs. Large AVMs can be adequately reduced in size through the use of additional treatment.</p>

Transvenous embolization with a combination of detachable coils and Onyx for a complicated cavernous dural arteriovenous fistula / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Treatment of cavernous dural arteriovenous fistulas (DAVF) is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach.</p><p><b>METHODS</b>From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins.</p><p><b>RESULTS</b>Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external carotid artery were embolized, and transient facial palsy was appeared after operation. The fistula was fully embolized with Onyx via the inferior petrosal sinus after two months with no complications. One bilateral cavernous sinus DAVF was embolized with Onyx via the inferior petrosal sinus by two operations, and transient abducens nerve palsy occurred after embolization.</p><p><b>CONCLUSIONS</b>Because Onyx may be injected via a transvenous approach and the microcatheter is easily withdrawn, cavernous sinus via transvenous catheterization and embolization is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulas, especially those for which operations via transarterial approaches have failed, or spontaneous cavernous dural arteriovenous fistulas.</p>

Endovascular treatment of wide-necked intracranial aneurysms using of "remodeling technique" with the HyperForm balloon / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the "remodeling technique" with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result.</p><p><b>METHODS</b>From June 2004 to September 2006, forty-two patients (20 men, 22 women) with wide-necked or large neck/fundus ratio aneurysms were treated by using the "remodeling technique" with the HyperForm balloon.</p><p><b>RESULTS</b>Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases (80.9%), subtotal in 4 (9.5%) and incomplete in 2 (4.8%). One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months.</p><p><b>CONCLUSIONS</b>The "remodeling technique" with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms-located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurysms when the standard remodeling technique might have failed.</p>

Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.</p><p><b>METHODS</b>From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.</p><p><b>RESULTS</b>All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.</p><p><b>CONCLUSIONS</b>Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.</p>

Transvenous occlusion of carotid cavernous fistula / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the treatment of carotid cavernous fistula with the transvenous approaches.</p><p><b>METHODS</b>Seventeen patients (14 males and 3 males) with carotid cavernous fistula (CCF) were retrospectively analyzed.</p><p><b>RESULTS</b>Totally 18 cavernous sinus of 17 patients were occluded. Nine operations were performed via inferior petrosal sinus approaches and 6 via the facial vein. One patient (bilateral fistula) received both two approaches. The fistula were completely occluded immediately after the procedures in 12 patients. Small shunts remained in four of other patients (2 pterygoid drainage and 2 inferior petrosal sinus, respectively). Facial vein catheterization failed because of vein vasospasm in one patient; his symptoms relieved 5 days later and angiography showed the CCF disappeared another 2 days later.</p><p><b>CONCLUSION</b>Transvenous embolization of CCF is effective, safe, and easy to perform.</p>

Endovascular treatment of cerebral arteriovenous malformations with Onyx embolization / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In the past 5 years, new treatment materials and techniques offering a different concept in endovascular treatment have been described for cerebral arteriovenous malformations (CAVMs). The aim of this study was to assess the endovascular treatment of CAVMs by using a liquid embolic material, Onyx (Micro Therapeutics. Inc., Irvine, CA, USA).</p><p><b>METHODS</b>From September 2003 to September 2004, Onyx was used to treat 22 patients with CAVMs. Ten AVMS were located in functional areas, 8 in deep cerebral areas, and 4 in the cerebellar hemisphere. The size of CAVMs was about 3 cm in diameter in 5 patients, 3-6 cm in 11, and more than 6 cm in 6.</p><p><b>RESULTS</b>In the 22 patients, Onyx embolization was successful. Nidus occlusion was complete in 3 patients, > 90% in 8, > 80% and < 90% in 6, and > 50% and < 80% in 5. Complications included transient neurological deficits in 2 patients, and adherence of microcatheter to the site of injection in 2.</p><p><b>CONCLUSIONS</b>Being non-adhesiveness, Onyx is a safe and satisfactory embolic material in the treatment of CAVMs. But its long-term efficacy awaits further follow-up.</p>

Application of Neuroform stent in the treatment of intracranial aneurysm / 中国医学科学院学报

<p><b>OBJECTIVE</b>To introduce the application of Neuroform stent in the treatment of intracranianl wide neck aneurysm.</p><p><b>METHODS</b>Eight patients (9 aneurysms), including 3 males and 5 females, aged from 41 to 74, were treated. Among the 9 aneurysms, there were 3 wide-neck aneurysms in internal carotid artery (ICA), 4 vertebral aneurysms (in 3 cases), and 2 basilar tip giant aneurysms. Heparinization were given for all procedures after femoral artery Seldinger's puncture. Stents were released through 3 m Transcend 0.014 guide wires, which were posited in the aneurysm-carry arteries first, or, through a 205 cm Transcend 0.014 guiding wire. Further coiling was selected for some cases. After the treatment 24 h heparinization were maintained. For coiling cases, aspirin (300 (mg/d) and ticlopiding (250 mg/d) were given at first 6 weeks, and aspirin (300 mg/d) was given following 6 months. For stent alone cases, only 1 month aspirin (300 mg/d) was given.</p><p><b>RESULTS</b>In one ICA aneurysm, the stent moved to the bifurcation of ICA while a coil was pushed into the aneurysm lumen, and the ICA spasmed. Partial occlusion achieved in the aneurysm. The patient died due to bleeding of the aneurysm 20 h after anticoagulation treatment with heparin. One dissection aneurysm and 2 fusiform aneurysms (in bilateral vertebral arterys of one patient) were treated with stents only. The dissection aneurysm was completely occluded after 3 months. In 1 basilar artery (BA) tip giant aneurysm, the distal part of BA spasmed immediately after stenting. Complete occlusion was achieved with coils 4 months later. Another BA tip aneurysm was partially occluded after the stent was deployed. The other 3 aneurysms were completely embolized with the protection of the Neuroform stents. There is no further DSA follow-up of the cases.</p><p><b>CONCLUSIONS</b>The Neuroform stent is easy to pass through the tortuous vessels. Combine with coils, it may be used in the treatment of wide neck aneurysms. However, it has the risk of migration because of the softness.</p>

Embolization of intracranial aneurysms with new mechanically detachable coils / 中国医学科学院学报

<p><b>OBJECTIVE</b>To primarily embolize intracranial aneurysms with new-developed mechanically detachable coils, which is called Detachable Coil System (DCS).</p><p><b>METHODS</b>Five intracranial aneurysms were embolized with DCS, in which 2 were giant aneurysms. DCS with J coils were initially used to make baskets in giant aneurysms, and then other kinds of coils were utilized to pact the aneurysmal cavity. Whereas, spiral coils were mostly used in smaller aneurysms. Coils of DCS were detached by rotating the delivering wire after the coils were satisfactorily positioned in aneurysms.</p><p><b>RESULTS</b>Two of the 5 cases were totally occluded with DCS. Two was sub-totally embolized. Pushing, withdrawal, and adjusting of DCS were safe and efficient. Detachment of DCS was fast. In one case of wide-necked giant aneurysm, coils could not stay inside the aneurysm, which was treated by occlusion of the parent artery.</p><p><b>CONCLUSIONS</b>DCS is a new addition to the interventional radiologist's armamentarium. Detachment is faster. J coils are suitable for giant aneurysms for its unique way of coiling. But more evaluation depends on accumulation of the clinical usage.</p>