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Objective:To investigate whether the fluctuation of blood pressure variability (BPV) before carotid endarterectomy (CEA) is related to postoperative cerebral perfusion changes in patients with carotid artery stenosis.Methods:A prospective observational cohort study was performed. Forty-seven patients with carotid artery stenosis accepted CEA in Department of Neurosurgery, Guangdong Provincial People's Hospital Affiliated to Southern Medical University from January 2019 to December 2022 were chosen. Patients' blood pressure was closely monitored 3 d before surgery (4 times/d) to obtain their BPV (the maximum △, based on the maximum absolute differences between systolic or diastolic blood pressures measured continuously during the observation period). At the same time, the changes of cerebral perfusion 3 d after surgery were monitored (criteria of cerebral hyperperfusion: newly-appeared delirium and hyperactivity after anesthesia resuscitation or intracranial hemorrhage found by imaging examination; criteria of cerebral hypoperfusion: newly-appeared speech and motor function deficits or aggravation of original cerebral ischemia symptoms after anesthesia resuscitation, or new-found cerebral infarction by imaging examination). Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of BPV before CEA in postoperative cerebral perfusion changes.Results:In these 47 patients, 9 patients (19.1%) had postoperative cerebral perfusion changes: 2 had neurological deficits due to postoperative cerebral infarction, and the other 7 had short-term postoperative delirium or focal neurological deficits (returned to normal after appropriate adjustment of blood pressure). Area under the ROC curve (AUC) of BPV before CEA in predicting postoperative cerebral perfusion changes was 0.876 ( P=0.001, 95% CI: 0.775-0.977). These 47 patients were divided into high BPV group ( n=16) and low BPV group ( n=31) according to the optimal index threshold (27.00), and the statistics showed that significant difference in incidence of cerebral perfusion changes after CEA was noted between the 2 groups ( P<0.05); incidence of postoperative cerebral perfusion changes in the high BPV group was 15.5 times higher than that in the low BPV group ( RR=15.500, P<0.001, 95% CI: 2.120-113.320). Conclusion:BPV before CEA in patients with carotid artery stenosis can well predict the occurrence of postoperative cerebral perfusion changes.
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ABSTRACT Introduction There are many drawbacks in sports, one of the main problems being injuries. Objective This work aimed to study the effect of prolonged basketball practice and associated sports injuries on electrophysiological indicators about the functional state of the neuromuscular apparatus in specialized athletes. Methods A study was conducted in which 14 basketball players participated voluntarily: 7 basketball players aged 17 to 23 years with first category sports qualifications, relatively healthy, with a history of knee and ankle injuries, and seven non-athletes with no history of injuries. Psychophysiological and electrophysiological methods were used for the study, designed to diagnose strength and endurance, measure rhythmic dynamics in hand movements, evaluate the mobility of neural processes, and the functional state of the central nervous system and processes in the central nervous system. Results It was established that regular sports training leads to morphological and functional changes in the neuromuscular system. Conclusion Due to repeated injuries, basketball players experience a decrease in the conduction velocity of the electrical pulse in the neural fiber pathway and in the level of reflex excitability in the neuronal motor ensemble of the lumbosacral segments of the spinal cord that innervate the bilateral muscles of the lower limbs; a weakening of the nervous system resistance, mobility of the nervous processes, deterioration of the functional state of the central nervous system and analyzers was noted. Evidence level II; Therapeutic studies - outcomes research.
RESUMO Introdução Há muitos inconvenientes no esporte, sendo um dos principais problemas as lesões. Objetivo O objetivo deste trabalho foi estudar o efeito da prática prolongada do basquetebol e as lesões esportivas associadas sobre os indicadores eletrofisiológicos sobre o estado funcional do aparelho neuromuscular em atletas especializados. Métodos Foi realizado um estudo no qual 14 jogadores de basquetebol participaram voluntariamente: 7 jogadores de basquete de 17 a 23 anos com qualificações esportivas da primeira categoria, relativamente saudáveis, com histórico de lesões no joelho e tornozelo; e 7 não-atletas sem histórico de lesões. Métodos psicofisiológicos e eletrofisiológicos foram utilizados para o estudo, que foram desenvolvidos para diagnosticar a força e resistência, mensurando a dinâmica rítmica nos movimentos das mãos, avaliando a mobilidade dos processos neurais, assim como o estado funcional do sistema nervoso central e os processos nervosos no sistema nervoso central. Resultados Foi estabelecido que o treinamento esportivo regular leva a mudanças morfológicas e funcionais no sistema neuromuscular. Conclusão Devido as repetidas lesões, os jogadores de basquetebol experimentam uma diminuição da velocidade de condução do pulso elétrico no trajeto das fibras neurais e do nível de excitabilidade reflexa no conjunto neuronal motor dos segmentos lombossacrais da medula espinhal que inervam os músculos bilaterais dos membros inferiores. Além disso, notou-se um enfraquecimento da resistência do sistema nervoso, mobilidade dos processos nervosos, deterioração do estado funcional do sistema nervoso central e dos analisadores. Evidência nível II; Estudos terapêuticos - pesquisa de resultados.
RESUMEN Introducción Existen muchos inconvenientes en el deporte, siendo uno de los principales problemas las lesiones. Objetivo El objetivo de este trabajo fue estudiar el efecto de la práctica prolongada del baloncesto y las lesiones deportivas asociadas sobre los indicadores electrofisiológicos del estado funcional del aparato neuromuscular en atletas especializados. Métodos Se realizó un estudio en el que participaron voluntariamente 14 jugadores de baloncesto: 7 jugadores de baloncesto de entre 17 y 23 años con titulación deportiva de primera categoría, relativamente sanos, con antecedentes de lesiones de rodilla y tobillo; y 7 no deportistas sin antecedentes de lesiones. Para el estudio se utilizaron métodos psicofisiológicos y electrofisiológicos, destinados a diagnosticar la fuerza y la resistencia, midiendo la dinámica rítmica en los movimientos de la mano, evaluando la movilidad de los procesos neurales, así como el estado funcional del sistema nervioso central y los procesos nerviosos en el sistema nervioso central. Resultados Se estableció que el entrenamiento deportivo regular produce cambios morfológicos y funcionales en el sistema neuromuscular. Conclusión Debido a las lesiones repetidas, los jugadores de baloncesto experimentan una disminución de la velocidad de conducción del impulso eléctrico en el trayecto de las fibras neuronales y del nivel de excitabilidad refleja en el conjunto neuronal motor de los segmentos lumbosacros de la médula espinal que inervan los músculos bilaterales de las extremidades inferiores. Además, se observó un debilitamiento de la resistencia del sistema nervioso, la movilidad de los procesos nerviosos, el deterioro del estado funcional del sistema nervioso central y de los analizadores. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados.
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Objective To preliminarly investigate the application value of Pipeline embolization device ( PED ) in the endovascular interventional treatment of complex intracranial aneurysms. Methods From July 2015 to October 2016, the clinical data of 10 consecutive patients with complex intracranial aneurysm treated with PED at the Department of Neurosurgery, Guangdong General Hospital were enrolled retrospectively. Their surgical modalities,complications,and imaging findings were analyzed. Results Of the 10 patients,7 were females and 3 were males,their age was 32-68 years ( mean age 54 ± 12 years) . There were 8 patients with internal carotid artery aneurysm,1 with middle cerebral artery aneurysm,and 1 with vertebrobasilar artery aneurysm;there were 2 patients with ruptured aneurysm and 8 with unruptured aneurysm;there were 5 patients with saccular aneurysm ( 2 with wide-necked aneu-rysm) ,3 with fusiform aneurysm,2 with dissecting aneurysm;there were 2 patients with medium aneurysm ( diameter>5-15 mm) ,2 with large aneurysm ( diameter>15-25 mm) ,6 with giant aneurysm ( diameter>25 mm) ,and there were 2 patients with recurrent aneurysm. They were all single aneurysms. Three patients were treated with PED in combination with coil embolization,and 7 patients were treated with PED implantation alone. Nine patients were treated with one PED and 1 was treated with 3 PEDs. The immediate postoperative angiography revealed that the contrast agents in the aneurysm cavities were obviously stranded. One patient died after procedure and 1 had quadriplegia after procedure,and the remaining 8 patients had no PED-related complications. The modified Rankin scale score was 0 in 8 cases,5 in 1 case,and 6 in 1 case on the first post-operative day. They were followed up for 14 to 28 months. Conclusions The different types of intracranial aneurysms treated with PED implantation is relatively safe and effective,but there are also some risks of dis-ability and death. Strictly selecting the indications and developing the individualized treatment strategies are needed.
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Objective To explore the electrocardiogram (ECG) characteristics and prognoses of patients with severe acute spontaneous subarachnoid hemorrhage (SAH) complicated by cerebrocardiac syndrome (CCS).Methods The ECG characteristics and clinical data of 80 patients with severe SAH admitted to our hospital from January 2012 to December 2015 were retrospectively analyzed.The myocardial enzymes,serum troponin T and ECG changes in patients of Hunt-Hess grading Ⅳ and Ⅴ were compared.Results ECG abnormalities at the first time were noted in 76 patients,accounting for 95%.Wave changes (more than two kinds) were noted in 63 patients.ST-T changes were noted in 68 patients,T wave changes in 45,QT interval prolongation in 30,cardiac arrhythmia in 26,conduction block in 11,and abnormal Q wave in 9.The occurrence rates of Q-T interval prolongation,cardiac arrhythmia,conduction block,abnormal Q wave and Glasgow outcome scale (GOS) scores between patients of Hunt-Hess grading Ⅳ and Ⅴ were significantly different (P<0.05).The myocardial enzyme levels were normal and serum troponin T level slightly increased in patients of Hunt-Hess grading Ⅴ within 2 h of admission.Conclusion ST and T waves changes are the common electrocardiogram manifestations of acute severe SAH patients with CCS;CCS is the important prognostic factors of acute severe SAH patients.
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Objective To compare the effect of Solitaire AB and Enterprise stent-assisted endovascular embolization of intracranial wide-necked aneurysms. Methods The clinical data 218 patients with intracranial aneurysm treated with Solitaire AB stent or Enterprise stent in Guangdong General Hospital from January 2012 to December 2014 were analyzed retrospectively. Seventy patients were treated with Solitaire AB stents and 148 were treated with Enterprise stents. They were followed up after procedure (2 months to 2 years). The Raymond grade and the modified Rankin scale (mRS)scores were used to compare the efficacy of the 2 kinds of stents. Results There were no significant differences in patients before procedure in the Hunt-Hess grade (Z = 1. 550,P = 0. 121),Fisher grade (Z =1. 537,P =0. 124),aneurysm size (Z =0. 192,P =0. 848),and position (χ2 = 0. 337,P = 0. 736)between the 2 stent groups,while there were no significant differences in patients after procedure in the instant Raymond grade (Z = 0. 682,P = 0. 495), follow-up Raymond grade (Z = 0. 206,P =0. 837),and mRS score (P =0. 662)between the 2 stent groups. Further multivariate Logistic regression analysis showed that the stent type (Solitaire AB stent or Enterprise stent),Raymond grade follow-up grade (OR,0. 029 ,95% CI 0. 126 - 0. 199,P = 0. 661 ),and postoperative mRS score (OR,2. 000,95% CI 0. 204 - 19. 603,P = 0. 552)had no influence on the prognosis. Conclusions In the assisted embolization of intracranial wide-necked aneurysms using the Solitaire AB and Enterprise stents,the effects of both stents are good in the assisted embolization of intracranial wide-necked aneurysms.
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Objective To compare the effect of thin-sliced enhanced CT scanning and 3D-DSA data sources in the 3 D printing data reconstruction of intracranial arteriovenous malformation (AVM ). Methods Five patients with AVM were selected prospectively,3 were Spetzler-Martin grade II and 2 were grade III. Two of them used 256-slice spiral CT thin slice enhanced scanning. Three used the 3D-DSA rotating imaging,and the DICOM raw data of the examination results were extracted. Digital processing was performed by using the Mimics software,and the 3 D printing was performed according to the ratio of 1∶1 obtaining the solid model and the effects were compared. Results Using the data source 3 D printing of 256 slice spiral CT thin-slice enhanced scan could obtained skull and blood vessel image information and could reveal the smallest diameter of 0. 9 mm vessel,however,the fine branch structures of the vessel were difficult to distinguish. The 3D printing based on 3D-DSA data,although the digital subtraction did not have the skull data information,the vascular branches showed more abundant. It could reveal the smallest diameter of 0. 9 mm vessel. Conclusions Using the CT thin-slice enhanced scan or 3D-DSA data source can obtain reconstruction images of AVM nidus,and 3D-DSA shows that the better effect for spatial structure of AVM nidus. It is helpful to the design of preoperative treatment scheme and the development of corresponding auxiliary tools.
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Objective To explore the effects of Caspase-3 and Glypicante1 (Gpc1) altered expressions on the proliferation of glioma cells and its mechanism.Methods Fifty-two glioma specimens and 13 normal cerebral tissues were collected in our hospital from October 2011 to October 2014;the protein expressions of Caspase-3 and Gpc1 in these tissues were detected with immunohistochemistry.The peDNA3.1/Gpc 1 high expression plasmids were constructed;human glioma A172 cell lines were routinely cultured in vitro;the signal path changes of Hedgehog (H-h) in the A172 cells after being transfected with 0.5,1,2 and 4 μg peDNA3.1/Gpc1 high expression plasmids were detected by Luciferase luciferase reporter gene kit.Gpc 1-1694 interference plasmids were transfected into the A172 cells to silence the Gpc1 expression and these A172 cells were given 8 iμg/mL Blasticidin (experimental group) for 24 h;normal A172 cells were given the same volume of solvent (control group);altered expressions of G-pc 1 were detected by immumohistochemical staining and proliferation activity of the cells were observed by MTT assay 24,48,72 and 96 h after transfection.Results The expressions of Caspase-3 and Gpc1 in the glioma specimens were significantly higher than those in the normal brain tissues (P<0.05);in the glioma specimens,positive correlation between Caspase-3 and Gpc1 was noted (r=0.486,P=0.000).As compared with the control group,increased fluorescence intensity was observed in the 0.5,1,2 and 4 μg peDNA3.1/Gpc1 high expression plasmids groups (P<0.05);immumohistochemical staining showed that CyclinD1 expression in the Hh pathway of in the peDNA 3.1/Gpc1 high expression plasmids groups was significantly lower than that in the control group;MTT assay showed that the proliferation activity of the A172 cells in the peDNA3.1/Gpc1 high expression plasmids groups at 24,48,72 and 96 h after transfection was significantly lower than that in the control group (P<0.05).Conclusion Caspase-3 and Gpc1 play important roles in regulating the proliferation of glioma cells,which might be related to Hedgehog signaling pathway.
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Objectives Tostudytheexpressionchangesofproproteinconvertase1(PC1)incerebral cortex nerve cells and its substrate neuropeptide Y (NPY)after focal cerebral ischemia in mice and to investigatetheeffectofPC1inneuronalischemicinjury.Methods Twenty-fourmaleC57micewere randomly allocated into a sham-operation group,an ischemia-reperfusion 4-or 24-hour group with computer (n=8 in each group). A rat model of middle cerebral artery occlusion was induced by the intraluminal suture method. Western blot and real-time quantitative nucleic acid amplification were used to detect the expression changes of PC1,NPY,and mRNA in mouse cortical neurons. Results (1)Compared with the sham operation group,the expression of PC1 mRNA of ischemic cortex brain tissue at ischemic side in the ischemia-reperfusion 4-hour group increased 2. 66 ± 0. 24 and in the ischemia-reperfusion 24-hour group expressed 2. 07 ± 0. 23 (all P0. 05 ). (2 )Compared with the sham operation group,the preproNPY mRNA and protein level increased significantly after reperfusion in the ischemia-reperfusion 4-hour group (P < 0. 05 ),the mRNA expressed 2. 31 ± 0. 27,and the increase of precursor protein level continued until 24 hours. Conclusion TheexpressionofprecursorPC1increasedaftercerebralischemia-reperfusioninmice, thus affecting the processing activity of PC1 ,and resulting in NPY protein,an active substrate of PC1 accumulated with the form of precursors,which may be one of the underlying mechanisms of neuronal ischemic injury.
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Objective To investigate the efficacy, technical tip, safety and complication prevention of combining Neuroform stents and Guglielmi detachable coils for treating acute ruptured giant intracranial aneurysms. Methods Among 10 cases who were diagnosed with giant intracranial aneurysms,Neuroform stents were released for supporting the neck of aneurysms, then micro-catheters were inserted into aneurysms through lumina of stents and coils were implanted. Results All the operations were completed successfully. There was no complication in these cases. The aneurysms were packed totally in 9 cases and partly in 1 case.Eight postoperative cases were followed up by 6 to 17 months. Neither bleeding nor thrombus was found, and all the patients recovered well. Conclusion Combining Neuroform stents and Guglielmi detachable coils for treating acute ruptured giant intracranial aneurysms is a safe and effective method.
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Objective To observe the effect of contortrostafin on human glioma xengoraft model and explore its mechanism.Method Animal models were established on BALB/c nude mice with subcutaneously transplanted neoplasma of U87 glioma.The nude mice bearing withU87 slioma were devided randomly into two groups,which were treated without drugs or with doses of 40 μg/d.The dimension of xenografts was measured and the living state of nude mice with U87 glioma was observed.The protein expression of microvesel density(MVD),bFGF in each paraff in imbedded xenograft of nude mice bearing with U87 glioma were detected by immunohistochemistry staining.Result Contortrostafin inhibited the growth of xenografts in nude mice with U87 glioma(P<0.05),and the tumor volume was reduced by 50%.Meanwhile the control group highly expressed bFGF at the level of protein,coupling with increase of MVD.Compared with the dissolvent control group,contortrostatin treated group showed lower expression of bFGF,(P<0.01)and more decrease in MVD(P<0.01).Conclusion Contortrostatin diffusa has significant inhibitive effect on human glioma xenograft.