Endogenous FGF21 attenuates blood-brain barrier disruption in penumbra after delayed recanalization in MCAO rats through FGFR1/PI3K/Akt pathway / 中南大学学报(医学版)

OBJECTIVES@#Restoration of blood circulation within "time window" is the principal treating goal for treating acute ischemic stroke. Previous studies revealed that delayed recanalization might cause serious ischemia/reperfusion injury. However, plenty of evidences showed delayed recanalization improved neurological outcomes in acute ischemic stroke. This study aims to explore the role of delayed recanalization on blood-brain barrier (BBB) in the penumbra (surrounding ischemic core) and neurological outcomes after middle cerebral artery occlusion (MCAO).@*METHODS@#Recanalization was performed on the 3rd day after MCAO. BBB disruption was tested by Western blotting, Evans blue dye, and immunofluorescence staining. Infarct volume and neurological outcomes were evaluated on the 7th day after MCAO. The expression of fibroblast growth factor 21 (FGF21), fibroblast growth factor receptor 1 (FGFR1), phosphatidylinositol-3-kinase (PI3K), and serine/threonine kinase (Akt) in the penumbra were observed by immunofluorescence staining and/or Western blotting.@*RESULTS@#The extraversion of Evans blue, IgG, and albumin increased surrounding ischemic core after MCAO, but significantly decreased after recanalization. The expression of Claudin-5, Occludin, and zona occludens 1 (ZO-1) decreased surrounding ischemic core after MCAO, but significantly increased after recanalization. Infarct volume reduced and neurological outcomes improved following recanalization (on the 7th day after MCAO). The expressions of Claudin-5, Occludin, and ZO-1 decreased surrounding ischemic core following MCAO, which were up-regulated corresponding to the increases of FGF21, p-FGFR1, PI3K, and p-Akt after recanalization. Intra-cerebroventricular injection of FGFR1 inhibitor SU5402 down-regulated the expression of PI3K, p-Akt, Occludin, Claudin-5, and ZO-1 in the penumbra, which weakened the beneficial effects of recanalization on neurological outcomes after MCAO.@*CONCLUSIONS@#Delayed recanalization on the 3rd day after MCAO increases endogenous FGF21 in the penumbra and activates FGFR1/PI3K/Akt pathway, which attenuates BBB disruption in the penumbra and improves neurobehavior in MCAO rats.

Cytopuncture microbiopsy during transcanalicular endoscopic lacrimal duct recanalization: A novel approach

Objective@#To describe the cytopuncture microbiopsy (CM) technique performed during transcanalicular endoscopic lacrimal duct recanalization (TELDR) in patients with primary acquired nasolacrimal duct obstruction (PANDO) as an alternative to open biopsy, the standard method used in collecting specimen.@*Methods@#This is a noncomparative, interventional case series with histopathologic correlation. Patients diagnosed with complete PANDO who underwent TELDR with balloon dacryoplasty and silicone intubation with CM at University of Santo Tomas Hospital from October 2014 to January 2017 were included.@*Results@#Twenty (20) tissue specimens from the lacrimal sac and nasolacrimal duct were obtained from 18 patients. There were 16 females and 2 males included in the study. Mean age was 57.5 years. All specimens revealed few clusters of benign epithelial cells with few degenerated mononuclear cells and lymphocytes, and singly scattered lymphocytes that are set in fibrinous background. Tissue cytology studies were negative for malignant cells.@*Conclusion@#CM is a minimally invasive procedure that offers an alternative to open biopsy technique that can be done routinely during TELDR.

Risk factors for unfavorable outcomes after recanalization of large vessel occlusion in patients with acute ischemic stroke / 中华全科医师杂志

Objective:To analyze risk factors for unfavorable outcomes after recanalization of large vessel occlusion (LVO) in patients with acute ischemic stroke (AIS).Methods:Patients with AIS-LVO who underwent recanalization treatment (including intravenous thrombolysis and endovascular intervention) at the Stroke Unit of Beijing Hospital from August 2018 to January 2022 were consecutively enrolled. According to the modified Rankin Scale (mRS) at 90-day follow-up after recanalization treatment, participants were classified as unfavorable outcomes (mRS>2) and favorable outcomes (mRS≤2). Baseline clinical data of enrolled patients was collected, and step-wise multivariate logistic regression analysis was used to identify independent risk factors for unfavorable outcomes after recanalization in AIS-LVO patients.Results:A total of 212 AIS-LVO patients were enrolled, including 86 females (41.35%), with an average age of 72.9 years. There were 75 patients in the favorable outcome group and 137 patients in the unfavorable outcome group. Compared with the favorable outcome group, the unfavorable outcome group had a higher average age, a higher proportion of females and patients with atrial fibrillation, higher baseline NIHSS, higher systolic blood pressure, and higher blood creatinine and D-dimer levels (all P<0.05). After adjusting for age and atrial fibrillation as confounding factors, multivariate logistic regression analysis showed that female ( OR=2.859, 95% CI: 1.202-6.799, P=0.018), higher baseline NIHSS ( OR=14.417, 95% CI: 6.269-33.158, P<0.001), higher pre-treatment systolic blood pressure ( OR=1.034, 95% CI: 1.015-1.054, P=0.001), higher emergency blood creatinine level ( OR=1.378, 95% CI: 1.105-1.719, P=0.005), and higher D-dimer level ( OR=3.594, 95% CI: 1.290-10.014, P=0.014) were independent risk factors for unfavorable outcomes after recanalization treatment in patients with AIS-LVO. Conclusion:Female, higher NIHSS, higher systolic blood pressure, higher blood creatinine level and D-dimer level are independent risk factors for unfavorable functional outcomes at 90 days after recanalization treatment of large vessel occlusion in patients with acute ischemic stroke.

Establishment of the prediction models of malignant brain edema after vascular recanalization in anterior circulation acute large vascular occlusion stroke / 国际外科学杂志

Objective:Based on Logistic regression and XGBoost algorithm, the prediction model of malignant brain edema (MBE) after vascular recanalization of anterior circulation acute great vessel occlusive stroke (ALVOS) was constructed, and the prediction performance was compared.Methods:A retrospective selection of 382 patients with anterior circulation ALVOS who underwent early endovascular treatment (EVT) in our hospital from March 2014 to June 2020 and successfully recanalized the occluded blood vessel was selected. The patients were divided into the training group ( n=267) and the test group ( n=115) according to the ratio of 7∶3 by the random number table method. According to whether the patients had MBE after successful recanalization of the occluded blood vessels, the training group was divided into the MBE group ( n=41) and non-MBE group ( n=226). The baseline data, treatment and brain computed tomography perfusion(CTP) results of MBE group and non-MBE group in training group and test group were compared respectively, including age, admission score of National Institutes of Health Stroke Scale (NIHSS), grade of cerebral collateral circulation, cerebral blood volume, and so on. Logistic regression model and XGBoost algorithm model were used to screen the predictors of MBE in ALVOS patients with occluded vessels successfully recanalized, and the discrimination and calibration of the two models were compared. The measurement data conforming to the normal distribution were expressed as mean ± standard deviation ( ± s), and the independent sample t test was used for comparison between the two groups. Non-normally distributed measurement data were represented by M ( Q1, Q3), using independent sample Mann-Whitney U test. The chi-square test was used to compare the count data between groups. Results:There was no significant difference in baseline data, treatment status, and cranial computed tomography perfusion (CTP) imaging results of the training group and the test group ( P>0.05). The age, admission systolic blood pressure, admission NIHSS score, proportion of hypertension, proportion of cerebral collateral circulation 0-2, proportion of thrombus removal times> 3 times, time from onset to recanalization, and cerebral blood volume (CBV) of MBE group were (68.95±8.04) years old, (146.71±22.73) mmHg, 17(13, 21) min, 87.80%, 82.93%, 68.29%, (365.64±87.83) min, (32.56±5.73) mL/100 g, obvious higher than the non-MBE group [(60.27±7.13) years old, (137.92±19.58) mmHg, 14(10, 18) points, 73.01%, 60.62%, 2.65%, (307.59±74.05) min, (27.49±5.46) mL/100 g] ( P<0.05). The results of Logistic regression model showed that age, NIHSS on admission, grade of cerebral collateral circulation, times of thrombectomy and time from onset to recanalization were the predictors of MBE after successful recanalization of occluded vessels after EVT in patients with anterior circulation ALVOS ( P<0.05). The top five important feature scores of XGBoost algorithm model were cerebral collateral circulation classification 34, embolectomy times 27, onset to vascular recanalization time 25, admission NIHSS score 22, age 16.In the training set, the area under the curve of the Logistic regression model was 0.816(95% CI: 0.749-0.883), and the Hosmer-Lemeshow test showed that χ2=1.547, P=0.438. The area under the curve of the XGBoost algorithm model was 0.856(95% CI: 0.799-0.913), and the Hosmer-Lemeshow test showed that χ2=1.021, P=0.998. Conclusion:Logistic regression model and XGBoost algorithm model had similar prediction performance for MBE after successful recanalization of occluded vessels after EVT in patients with anterior circulation ALVOS, and collateral circulation classification, number of thrombolysis, time from onset to recanalization, NIHSS score on admission, and age could be used as predictors.

Development and validation of a dynamic nomogram predicting futile recanalization after thrombectomy in acute ischemic stroke / 中华神经科杂志

Objective:To establish and verify a dynamic web-based nomogram for predicting futile recanalization after thrombectomy in acute ischemic stroke.Methods:Three hundred and four acute ischemic stroke patients admitted to the Second Affiliated Hospital of Soochow University from May 2017 to April 2021 were retrospectively enrolled. All these patients underwent mechanical thrombectomy and obtained successful recanalization. The eligible patients were randomly divided into training group ( n=216) and test group ( n=88) by 7∶3. The nomogram was established and internally validated with the data of the training group, and externally validated with the data of the test group. For the training group, multivariate Logistic regression analysis was performed by including all variables with P<0.05 in univariate analysis, and the independent predictors of futile recanalization were screened out to construct a nomogram. In the training group and the test group, the performance of the nomogram was verified by C-index, calibration chart and decision curve analysis respectively. Results:No significant difference was detected between the training group and the test group in futile recanalization [134/216 (62.0%) vs 56/88 (63.6%), χ 2=0.07, P=0.794]. Multivariate Logistic regression analysis showed that age ( OR=1.04,95% CI 1.00-1.08, P=0.033), National Institutes of Health Stroke Scale (NIHSS) score on admission ( OR=1.11,95% CI 1.04-1.19, P=0.001), neutrophil to lymphocyte ratio ( OR=1.19,95% CI 1.07-1.32, P=0.001), glycated hemoglobins ( OR=2.02,95% CI 1.34-3.05, P<0.001), poor collateral status ( OR=10.87,95% CI 4.08-29.01, P<0.001), postoperative high density ( OR=11.38,95% CI 4.56-28.40, P<0.001) were independent risk factors for futile recanalization. The C-index of this nomogram in the training group and the test group was 0.92 (95% CI 0.877-0.954, P<0.001) and 0.93 (95% CI 0.87-0.98, P<0.001), respectively. Conclusion:This web-based nomogram, including age, NIHSS score on admission, neutrophil to lymphocyte ratio, glycated hemoglobin, poor collateral status and postoperative high density, predicted individual probability of futile recanalization after mechanical thrombectomy with good discrimination and clinical utility.

Analysis of risk factors of Budd-Chiari syndrome associated with hepatocellular carcinoma in patients who underwent endovascular recanalization / 中华肝胆外科杂志

Objective:To study the risk factors of Budd-Chiari syndrome (BCS) associated with hepatocellular carcinoma in patients who underwent endovascular recanalization.Methods:The data of 340 patients with BCS who underwent endovascular recanalization at the Affiliated Hospital of Xuzhou Medical University between January 2015 and June 2021 were retrospectively collected. Using propensity score matching, a total of 57 patients (40 males and 17 females) were enrolled into this study, with the age of (50.4±8.7) years. Patients were divided into the hepatocellular carcinoma group ( n=19) and the control group ( n=38) according to whether occurrence of hepatocellular carcinoma after cardovascular recanalization. Preoperative indicators including gender, age, BCS type, and model for end-stage liver disease (MELD) score, and postoperative indicators including alpha fetoprotein, intrahepatic nodule formation, vascular restenosis, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were compared between the two groups after propensity score matching. Multivariate logistic regression analysis was used to analyze the risk factors of BCS associated with after endovascular recanalization in these patients. Results:There were no significant differences in gender, age, BCS type, MELD score and other preoperative data between the two groups (all P>0.05). The proportions of patients with postoperative alpha fetoprotein>9.0 μg/L, AST>40 U/L, ALT>50 U/L, intrahepatic nodules and vascular restenosis after endovascular treatment in the hepatocellular carcinoma group were significantly higher than those in the control group (all P<0.05). Multivariate analysis showed postoperative alpha fetoprotein >9.0 μg/L ( OR=46.778, 95% CI: 3.310-661.140), AST>40 U/L ( OR=36.307, 95% CI: 1.317-1 001.009), intrahepatic nodule formation ( OR=66.254, 95% CI: 4.225-1 038.974) and vascular restenosis ( OR=16.276, 95% CI: 1.712-154.773) to have an increased risk of being associated with hepatocellular carcinoma in these BCS patients (all P<0.05). Conclusion:Postoperative alpha fetoprotein>9.0 μg/L, AST>40 U/L, intrahepatic nodule formation and vascular restenosis were independent risk factors of BCS associated with hepatocellular carcinoma in patients who underwent endovascular recanalization.

Characteristics of high-resolution magnetic resonance vessel wall imaging of cervicocerebral artery dissection and the influential factors of vascular recanalization / 中南大学学报(医学版)

OBJECTIVES@#Cervicocerebral artery dissection (CAD) is one of the important causes for ischemic stroke in young and middle-aged people. CAD is dangerous and untimely diagnosis and treatment are likely to result in severe disability. Early diagnosis and timely intervention can greatly improve the prognosis of patients. This study was to investigate the imaging features of CAD on high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) and to analyze the influential factors of vascular recanalization.@*METHODS@#A total of 19 CAD patients with both baseline HRMR-VWI and follow-up data of vascular imaging in the period from April 2017 to December 2019 in Department of Radiology, Xiangya Hospital, Central South University were retrospectively analyzed. The diseased vessels were divided into a recovery group and a unrecovered group. After treatment, diseased vessels with no residual arterial dissection and no residual stenosis in the lumen were included in the recovery group. Diseased vessels with stenosis, occlusion or residual dissection were included in the unrecovered group. Diseased vessels were divided into a ischemic stroke group and a non-ischemic stroke group according to the presence or absence of ischemic stroke in the area supplied by the diseased vessels. Differences in clinical data and HRMR-VWI imaging findings were compared between the groups.@*RESULTS@#A total of 26 vessels were involved, including 14 (53.8%) internal carotid artery extracranial segment, 8 (30.8%) vertebral artery extracranial segment, 3 (11.5%) vertebral artery intracranial segment, and 1 (3.9%) basilar artery. Ischemic stroke occurred in 16 diseased vascular supply areas. Intramural hematoma was all observed in the baseline HMR-VWI of the affected vessels. There were 18 vessels (69.2%) in the recovery group and 8 vessels (30.8%) in the unrecovered group. Compared with the vessels in the recovery group, the vessels in the unrecovered group were mostly found in the intracranial segment (@*CONCLUSIONS@#Intramural hematoma is a common imaging manifestation of CAD and can be shown clearly and accurately on HRMR-VWI. Recanalization rate of CAD is high, and the recanalization of CAD in intracranial segment is slower than that of CAD in extracranial segment, which can prolong the review time.

Clinical study of factors affecting outcome of tubal recanalization using microsurgical techniques: a retrospective study

Background: In India, many couples complete their families by the age of 25 to 30 years and opt for tubal sterilization as a method of family planning in spite of availability of other spacing methods. Due to unforeseen circumstances, 10 % of them regret their decision and about 1% want to restore their fertility due to various reasons like loss of only child, loss of male child, desire to have more children, loss of children in natural calamities, remarriage and other socioeconomic factors. The objective of the present study was to analyze various factors which are involved in pregnancy rate in tubal recanalization.Methods: 31 women undergoing microsurgical tubal recanalization by mini laparotomy in RRMCH, Bengaluru during a study period of 2 year from 2014 -2016 were followed up for a period of 2 years by telephonic conversation.Results: An overall 67.7 % pregnancy rate was achieved with microsurgery technique.Conclusions: The important factors determining the success of operation were age of the patient, method of previous ligation and the remaining length of tube after recanalization. The microsurgical technique should be available at specialized centres to improve the success of family planning services and also this could be the hope for hopeless.

Endovascular recanalization of the symptomatic non-acute occlusion of large intracranial artery of circulation: preliminary study / 中华放射学杂志

Objective To investigate the feasibility,safety and efficacy of endovascular recanalization of the symptomatic occlusion of large intracranial artery in anterior circulation.Methods From October 2015 to December 2017,13 patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation were enrolled into this study and underwent endovascular recanalization.The initial procedural results,including the rate of successful recanalization and perioprocedural complications,and angiographic and clinical follow-up results were collected.The functional outcome was evaluated at discharge and 90 days.Results Recanalization was successful in 11 out of 13 patients.Perioperative complications occurred in 8 cases,including distal embolization in 7 cases (3 with symptom and 4 without),in which intracerebral hemorrhage associated with embolectomy was found in 1 case;and distal embolization concomitant with artery dissection in 1 case.At discharge,the symptoms of 10 out of 11 patients with successful recanalization were improved and 1 was unchanged;one of 2 patients with recanalization failure was aggravated and 1 was unchanged.After the procedure,1 patient with successful recanalization,but complicated with intracerebral hemorrhage associated with embolectomy was lost at follow-up,thus angiographic follow-up was available in the remaining 10 patients.Of the 10 patients,1 patient developed in-stent restenosis at 12 months and 9 patients had no hemodynamic stenosis/reocclusion.The clinical follow-up was available in 12 patients.No recurrence of TIA or stroke was found in 9 cases with successful recanalization except for 1 case who developed in-stent stenosis and suffered from TIA.At the follow-up of 90 days,l0 patients with successful recanalization showed good function (mRS∶0-2),2 patients with recanalization failure were deteriorated.Conclusions In strictly selected patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation,endovascular recanalization was feasible and safe,which may improve patients' symptoms in a short term and reduce the recurrence rate of stroke,but its definite efficacy needs to be confirmed by studies with larger sample and longer follow-up.

Value of fibrinogen to albumin ratio on predicting spontaneous recanalization of infarct-related artery in patients with acute ST-segment elevation myocardial infarction / 中华心血管病杂志

Objective@#To investigate the value of fibrinogen to albumin ratio (FAR) at admission on predicting spontaneous recanalization of infarct-related artery (IRA) in patients with acute ST-segment elevation myocardial infarction (STEMI).@*Methods@#Clinical data from 255 acute STEMI patients ((61.1±11.2) years old, 189 males) who underwent emergency coronary angiography within 12 hours in our hospital from December 2015 to April 2018 were retrospectively analyzed. The acute STEMI patients were divided into non-spontaneous recanalization group (thrombolysis in myocardial infarction (TIMI) flow grade 0-1, 203 cases) and spontaneous recanalization group (TIMI flow grade 2-3, 52 cases). Multivariate logistic regression analysis was used to evaluate related factors of IRA spontaneous recanalization. The receiver operating characteristic (ROC) curve was used to evaluate the value of FAR in predicting spontaneous coronary recanalization.@*Results@#There was no significant difference in age,gender, hypertension, diabetes, smoking,systolic blood pressure,diastolic blood pressure,heart rate, duration of chest pain, type of infarction, infarct-related artery, door-to-balloon time, and drug used before admission between non-spontaneous recanalization group and spontaneous recanalization group (all P>0.05). The FAR and high-sensitivity C-reactive protein levels were significantly lower in the spontaneous recanalization group than in the non-spontaneous recanalization group (8.20±1.85 vs. 11.02±2.75, P<0.001; (6.87±3.36) g/L vs. (8.51±3.72) g/L, P=0.004). Multivariate logistic regression analysis showed that FAR (OR=0.492, 95%CI 0.354-0.686, P<0.001), serum uric acid (OR=0.994, 95%CI 0.989-0.999, P=0.018) and high-sensitivity C-reactive protein (OR=0.774, 95%CI 0.614-0.975, P=0.030) were independent negative correlation with spontaneous recanalization of infarct-related artery in patients with acute STEMI. The ROC curve showed that the area under the curve of FAR predicting spontaneous recanalization of infarct-related artery in patients with acute STEMI was 0.807 (95%CI 0.630-0.758, P<0.001), and the diagnostic threshold was 9.26, the sensitivity was 76.9%, the specificity was 75.9%.@*Conclusion@#The level of admission FAR has certain predictive value for spontaneous recanalization of infarct-related arteries in patients with acute STEMI.

Hybrid recanalization for occluded internal carotied artery followed by mechanical thrombectomy for distal artery: A case report and literature review / 中国脑血管病杂志

The clinical characteristics of a patient who received hybrid racanalizaion for chronic occlusion of right internal carotid artery was retrospectively analyzed in this report The advantages of hybrid operation for such lesion was discussed and reviewed. This patient was a 59 years old man, who suffered from numbness and weakness at right extremities accompanied with clumsy response. DSA revealed ulcerative plaque in the left internal carotid artery and occlusion of the right internal carotid artery. The hybrid operation to racanalize the occluded right internal carotid artery was performed. Firsdy, right carotid endarlerectomy was perfomed. Intraoperative DSA confirmed right internal carotid artery was recanalized, but the ipsilatcral M2 segment became invisible. It was occluded by a detached embolus which was retrieved by a stent to recover the patency of the artery. This case suggested that hybrid recanalization of occluded internal carotid artery could make use of merits of both endarterectomy and interventional techniques, thus increasing the opportunity of recanalization. Besides, control radiological imaging can be performed at any time during operation to better assure patients' safety.

Vascular ultrasound assessment of internal carotid artery dissection and vertebral artery dissection and the difference analysis of lumen recanalization / 中国脑血管病杂志

Objectives To diagnose and test cervical artery dissection (CAD) during the follow-up by color Doppler flow imaging (CDFI) and to analyze and compare the differences of internal carotid artery dissection ( ICAD) and stenosis degree of vertebral artery dissection ( VAD) , and lumen recanalization. Methods From January 2016 to December 2018 , a total of 136 consecutive patients (160 dissecting vessels) with CAD of intramural hematoma type diagnosed by CDFI and confirmed by high-resolution MRI and/or CT angiography in Xuanwu Hospital .Capital Medical University were enrolled retrospectively. They were divided into ICAD group (n =66, with 75 ICADs) and VAD group (n =70,with 85 VADs).The gender, age,risk factors,cerebral ischemic symptoms, and CDFI manifestations were compared in the patients between the two groups. They were followed up at 3,6, and 12 months after onset. The patients with CAD were reexamined, and the difference of recanalization rate between the two groups was compared. Results There was a statistically significant difference in the mean age and proportion of hypertension between the ICAD group and the VAD group (both P 0. 05); there was significant difference in the degree of vascular stenosis (P 0. 05) between the VAG group and the ICAD group. Conclusions ICAD was different from VAD in the degree of lumen stenosis and the rate of lumen recanalization at different follow-up time. CDFI had good test and follow-up re-examination values for CAD.

Spontaneous recanalization of chronic internal carotid artery occlusion: A case report / 中国脑血管病杂志

Spontaneous recanalization after chronic occlusion of internal carotid artery (ICA) is a rare phenomenon, and its mechanism is not clear. This article reports a case of chronic occlusion of the extracranial segment of the right ICA. The right ICA occlusion was confirmed by the DSA and one year later, DSA showed the recanalization of occlusion ICA with tandem stenosis of the origin and the proximal petrosal segment. Carotid artery stenting was successfully performed, and postoperative angiography showed that the right ICA was patent and the stenosis was obviously improved. Therefore, drug therapy could be continued when artery lumen was completely normal or slightly narrow after spontaneous recanalization of chronic internal carotid artery occlusion;carotid endarterectomy or carotid artery stenting may be considered for tandem stenosis or severe stenosis with high risk of ischemic events.

Clinical indications for recanalization following tubal sterilization / 中国实用妇科与产科杂志

For women planning pregnancy after tubalsterilization,they have to choose tubal recanalization or vitro fertilization(IVF).The important factors fordetermining the successful pregnancy after recanali-zation are the age of patient,the remaining length oftube,the type of sterilization initially performed and thetechnique of tubal recanalization.For women 40 years whoare with electrocoagulation as the method of steriliza-tion,they are suitable for IVF.Nevertheless,for the restones,there is no evidence showing which strategy islikely to be more effective.

Umbilical vein recanalization with one stage stent placement as modified Meso-rex bypass for portal vein cavernous transformation / 中国实用外科杂志

OBJECTIVE:To study the effect of modified meso-rex surgery combined with umbilical vein recanalization and primary stent implantation in the treatment of portal vein portal vein cavernous transformation.METHODS:A retrospective study was conducted in Beijing Tsinghua Changgung Hospital. A patient underwent classic or thotopic total liver transplantation for more than 9 years, admitted in February 2018 was selected.Her main portal vein occlusion and portal vein cavernous transformation were followed by portal hypertension, esophageal and gastric varices, and gastrointestinal bleeding. Surgical treatment of Meso-rex bypass were performed. During operation, hyperplasia of the left liver was noted. After wedge resection of part of the left liver parenchyma, the stump of ligamentum teres hepatis was exposed. Left portal vein was difficult to be dissected and exposed. After the umbilical vein was recanalized to the left branch of the portal vein, vascular anastomosis and stent implantation were completed. Postoperative anticoagulant therapy was given,and the blood flow was monitored.RESULTS:The shunt procedure was successful. The bypass patent, and blood flow was unobstructed 1-year post-operation. No gastrointestinal bleeding occurred ever.CONCLUSION:Meso-rex bypass combined with umbilical vein recanalization and primary stent implantation can be used to treat patients with portal vein cavernous transformation whose left portal vein is patent but difficult to be exposed.The long-term effect is worth expecting and more cases are needed for further verification.

Does Clot Burden Score on Baseline T2*-MRI Impact Clinical Outcome in Acute Ischemic Stroke Treated with Mechanical Thrombectomy? / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: A long clot, defined by a low (0-6) clot burden score (CBS) assessed by T2*-MR sequence, is associated with worse clinical outcome after intravenous thrombolysis (IVT) for acute ischemic stroke than is a small clot (CBS, 7-10). The added benefit of mechanical thrombectomy (MT) might be higher in patients with long clot. The aim of this pre-specified post hoc analysis of the THRombectomie des Artères CErebrales (THRACE) trial was to assess the association between T2*-CBS, successful recanalization and clinical outcome. METHODS: Of 414 patients randomized in the THRACE trial, 281 patients were included in this analysis. Associations between T2*-CBS and clinical outcome on the modified Rankin Scale (mRS) at 3 months were tested. RESULTS: High T2*-CBS, i.e., small clot, was associated with a shift toward better outcome on the mRS; proportional odds ratio (POR) per point CBS was 1.19 (95% confidence interval [CI], 1.05 to 1.34) in the whole population, 1.34 (95% CI, 1.13 to 1.59) in IVT group, and 1.04 (95% CI, 0.87 to 1.23) in IVTMT group. After adjustment for baseline prognostic variables, the effect of the full scale T2*-CBS was not statistically significant in the whole population and for the IVTMT group but remains significant for the IVT group (POR, 1.32; 95% CI, 1.11 to 1.58). CONCLUSIONS: A small clot, as assessed using T2*-CBS, is associated with improved outcome and may be used as a prognostic marker. Despite the worst outcome with long clot, the relative benefit of MT over IVT seemed to increase with low T2*-CBS and longer clot.

Recuperación de la fertilidad en una paciente estéril,mediante microcirugía de trompa uterina, y la aproximación al ovario contralateral / Fertility recovery in a sterile patient, by means of uterine tube microsurgery, and the approach to the contralateral ovary

Para que ocurra un embarazo exitoso, se requiere la integridad del tracto genital femenino, destacando como elementos importantes las trompas uterinas (TU) que transportan gametos y al óvulo fecundado a la cavidad uterina. La enfermedad de las TU por varias causas, como el embarazo ectópico, constituyen un 20% de causas de infertilidad. Gracias al desarrollo de técnicas de reproducción asistida (TRA) como la fecundación in vitro (FIV), en un alto porcentaje de pacientes que tienen un daño permanente y severo en estas estructuras, la cirugía para reparar o recanalizar las trompas uterinas ha sido desplazada por esta técnica de reproducción asistida. La reanastomosis tubárica tiene una tasa de éxito y de embarazos naturales después de la cirugía del 9% en mujeres con enfermedad tubárica severa al 69% en casos de enfermedad tubárica leve. Se presenta el caso de una paciente joven diagnosticada de infertilidad postquirúrgica por antecedentes de dos embarazos ectópicos accidentados previos que afectaron ambas trompas uterinas y ooforectomía izquierda; luego de realizado el procedimiento microquirúrgico, recuperó la posibilidad de ser madre.

For a successful pregnancy to occur, the integrity of the female genital tract is required, highlighting as important elements the uterine tubes (TU) that transport gametes and the fertilized egg into the uterine cavity. The disease of TU due to several causes, such as ectopic preg- nancy, constitute 20% of infertility causes. Thanks to the development of assisted reproduction techniques (ART) such as in vitro fertilization (IVF), in a high percentage of patients who have permanent and severe damage to these structures, surgery to repair or recanalize the uterine tubes has been displaced by This assisted reproduction technique. Tubal reanastomosis has a success rate and natural pregnancies after surgery of 9% in women with severe tubal disease at 69% in cases of mild tubal disease. We present the case of a young patient diagnosed with post-surgical infertility due to a history of two previous injured ectopic pregnancies that affec- ted both uterine tubes and left oophorectomy; After performing the micro-surgical procedure, he recovered the possibility of being a mother.

Safety and efficacy of nanoknife ablation for unresectable hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To evaluate the safety and curative effect of nanoknife ablation in the treatment of unresectable hilar cholangiocarcinoma.Methods 15 patients with unresectable hilar cholangiocarcinoma received nanoknife ablation treatment from March 2016 to May 2017.The clinical variables of the patients before and after operation were analyzed.Results The operations in all the patients carred out successfully.Cardiac arrhythmia occurred in some patients during the operation accidentally.The level of CA19-9 increased significantly on postoperative day 1,3 and then gradually decreased in 13 patients;one patient had no significant change of CA19-9,and the data for another patient was always in the normal range.The liver function of all patients gradually improved after operation,and the level of total bilirubin,AST and ALT showed a downward trend.The myocardial enzyme in all the patients increased on postoperative day 1,then returned to normal within the following 5 days.Postoperative complications included atrial fibrillation (1 case),upper gastrointestinal bleeding (1 case).The recanalization rates of the bile duct at 2 weeks,1 month,and 2 months after surgery were 66.6％,86.6％,and 93.3％,respectively.Conclusion Nanoknife ablation has superior safety,noteworthy efficacy and less complications in the treatment of the unresectable hilar cholangiocarcinoma in the short term.

Preliminary experience of endovascular revascularization for chronic long segment internal carotid artery occlusion / 中华放射学杂志

Objective To explore the feasibility,safety and effect of endovascular revascularization for chronic long segment internal carotid artery occlusion. Methods The cases of chronic long segment internal carotid artery occlusion who were treated by endovascular revascularization in our center from May 2015 to April 2017 were reviewed. Eleven cases met the inclusion criteria:the duration of the occlusion was more than three weeks and the segment of the occlusion was beyond the petrosal segment of internal carotid arteries from the initial segment. All of the cases had the related symptoms and had declining cerebral perfusion. The analysis index included:baseline information,radiological information,perioperative results, clinical follow-up and imaging follow-up. The imaging follow-up index were the re-stenosis or re-occlusion of the revascularized artery. Results The occlusion was recanalized successfully in 9 of 11 patients,the two procedures were abandoned after repeated attempts and the guide wire could not reach the true lumen when navigating in the cavernous segment. Six cases of the nine successfully recanalized cases accepted perfusion-weighted imaging scan. Cerebral perfusion of all the cases were improved. Thrombus shifting was observed in one case and occluded a subbranch,mechanical thrombectomy was performed successfully,the case was recovered well without sequela. No symptomatic stroke or death was happened in the perioperative period. All of the nine cases who successfully recanalized acquired clinical follow-up,median follow-up time was ten months(4—28 months). No ischemic stroke and death happened after the procedures. Seven of nine cases improved in the clinical symptoms. Five cases accepted the imaging follow-up. The meantime was six months. No re-occlusion was happened. Conclusions Endovascular revascularization for chronic long segment internal carotid artery occlusion is feasible,safe,and short-term effective. More clinical research is needed to verify the long-term effect.

Overcoming bottlenecks in stroke treatment to comprehensively improve the efficiency of emergent treatment / 第二军医大学学报

To overcome the bottlenecks of treatment for stroke and comprehensively improve the treatment efficiency, we need to do three jobs: public health education, entering hospital in time, and specialized stroke treatment. Lack of public knowledge about stroke is the most important bottleneck restricting the treatment of stroke in China. Public health education is the foundation of treatment for stroke. Another bottleneck is whether the patients can enter a capable hospital in time. Optimizing the referral system, establishing a regional stroke network, and applying modern referral tools and information network can help the patients entering the target hospital in time. Specialized treatment of stroke refers to the quick access to professional treatment for stroke, which requires to avoid delay in hospital; and the effective strategy is to build and optimize the green channel for stroke treatment.