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BACKGROUND:Currently,there is a lack of large sample studies to analyze the bone metabolism level of patients with femoral head necrosis of different etiologies and stages,which is not conducive to the development of better necrosis-promoting repair strategies. OBJECTIVE:To study the bone metabolism of patients with osteonecrosis of the femoral head with different etiologies and Association Research Circulation Osseous(ARCO)stages. METHODS:A retrospective study was performed on 401 patients diagnosed with osteonecrosis of the femoral head as the trial group,and 81 healthy subjects as the control group.The trial group could be divided into three groups according to different etiologies:steroid-induced osteonecrosis of the femoral head,alcoholic osteonecrosis of the femoral head and traumatic osteonecrosis of the femoral head,and were divided into stages Ⅱ/Ⅲ/Ⅳ according to different ARCO stages.Seven bone metabolism-related indicators of all subjects were collected,including bone metabolism-regulating hormone 25-hydroxyvitamin D and bone conversion markers:N-terminal propeptide of type Ⅰ procollagen,degradation product of type Ⅰ collagen,n-terminal middle molecular fragment of osteocalcin,general biochemical markers of bone metabolism:serum calcium,serum phosphorus,serum alkaline phosphatase.The bone metabolism levels of each group were compared and the independent factors associated with osteonecrosis of the femoral head were determined by binary Logistic regression analysis. RESULTS AND CONCLUSION:Compared with the control group,levels of degradation product of type Ⅰ collagen,N-terminal propeptide of type Ⅰ procollagen,n-terminal middle molecular fragment of osteocalcin,serum phosphorus and alkaline phosphatase in the trial group were significantly increased(all P＜0.05).Based on the presence or absence of the disease,according to binary Logistic regression analysis,degradation product of type Ⅰ collagen,N-terminal propeptide of type Ⅰ procollagen,and n-terminal middle molecular fragment of osteocalcin were independent factors associated with osteonecrosis of the femoral head.The levels of degradation product of type Ⅰ collagen and N-terminal propeptide of type Ⅰ procollagen in three groups of patients with different etiologies were higher than normal reference values.The bone metabolism-regulating hormone 25-hydroxyvitamin D and serum calcium in the alcoholic osteonecrosis of the femoral head group were higher than those in the other two groups(P＜0.05).The level of bone metabolism-regulating hormone 25-hydroxyvitamin D in steroid-induced and traumatic osteonecrosis of the femoral head groups was lower than the normal value.There were no significant differences in seven bone metabolism-related indicators in patients with ARCO stages Ⅱ,Ⅲ and Ⅳ osteonecrosis of the femoral head(all P＞0.05),but degradation product of type Ⅰ collagen and N-terminal propeptide of type Ⅰ procollagen in these three groups were higher than normal reference values.Bone metabolism-regulating hormone 25-hydroxyvitamin D in patients with ARCO stage Ⅱ and ARCO stage Ⅳ was lower than the normal reference value.It is concluded that the bone metabolism level of osteonecrosis of the femoral head patients was abnormal.The degradation product of type Ⅰ collagen and N-terminal propeptide of type Ⅰ procollagen of osteonecrosis of the femoral head patients with different etiologies and ARCO stages were all higher than the normal reference value,and they were in a state of high bone turnover.Degradation product of type Ⅰ collagen,N-terminal propeptide of type Ⅰ procollagen and n-terminal middle molecular fragment of osteocalcin may be risk factors for the pathogenesis of osteonecrosis of the femoral head.
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Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.
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ObjectiveTo summarize the liver biopsy and clinical features of patients with liver injury of unknown origin， and to investigate the value of ultrasound-guided percutaneous liver biopsy in the diagnosis of liver injury of unknown origin. MethodsA retrospective analysis was performed for the clinical data and ultrasound-guided percutaneous liver biopsy results of 94 patients with liver injury of unknown origin who were admitted to Zhongshan Hospital， Xiamen University， from January 2018 to February 2023. According to the proportion of the patients with different final diagnoses， the patients were divided into autoimmune liver disease （AILD） group， metabolic associated fatty liver disease （MAFLD） group， drug-induced liver injury （DILI） group， alcoholic liver disease （ALD） group， and unknown group. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the Bonferroni analysis or the Dunnett’ T3 test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups； the Fisher’s exact test was used for comparison of categorical data between multiple groups. ResultsAll 94 patients with liver injury of unknown origin underwent ultrasound-guided percutaneous liver biopsy after admission， among whom 90 patients （95.7%） had a confirmed diagnosis based on liver biopsy and clinical features. There were 43 patients （45.7%） with AILD， 21 （22.3%） with MAFLD， 15 （16.0%） with DILI， 6 （6.4%） with ALD， 1 （1.1%） with AILD and MAFLD， 1 （1.1%） with hemochromatosis， 1 （1.1%） with Budd-Chiari syndrome， 1 （1.1%） with congenital hepatic fibrosis， and 1 （1.1%） with idiopathic portal hypertension， while 4 patients （4.3%） still had an unknown etiology after liver biopsy. There were significant differences between the patients with top five diagnoses in age （F=4.457， P<0.05） ， body mass index （BMI） （F=3.245， P<0.05）， aspartate aminotransferase （AST） （H=11.128， P<0.05）， gamma-glutamyl transpeptidase （GGT） （H=24.789， P<0.05）， alkaline phosphatase （ALP） （H=26.013， P<0.05）， IgG （H=19.099， P<0.05）， IgM （H=21.263， P<0.05）， AMA-M2 positive rate （P<0.05）， and ANA positive rate （P<0.05）. Compared with the MAFLD group， the AILD group had significantly higher age， AST， GGT， and ALP and a significantly lower BMI； compared with the MAFLD group and the DILI group， the AILD group had significant increases in IgG and IgM； the AILD group had significant increases in the positive rates of AMA-M2 and ANA compared with the other four groups. ConclusionAILD， MAFLD， and DILI are the most common causes in patients with liver injury of unknown origin. Ultrasound-guided percutaneous liver biopsy plays an important role in determining the cause of liver injury of unknown origin， but it is still needed to make a comprehensive analysis based on clinical history， different types of liver injury， laboratory markers， and imaging data.
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Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.
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Objective:With the development of digital technology, network technology and mobile technology, new media aided-teaching has become a hot topic in medical teaching. However, the studies about the application of new media aided-teaching in training for professional postgraduates of neurosurgery are still less studied.Methods:In this study, 24 Batch 2015-2016 professional postgraduates of neurosurgery from Neurosurgery Department of Affiliated Hospital of Southwest Medical University were divided into the test group and control group, with 12 students in each group. From September 2016 to August 2018, students in the test group were taught with conventional teaching and various new media such as WeChat official accounts, professional video sharing websites and so on. The control group adopted conventional teaching methods. Students' theoretical knowledge, operation ability and clinical research ability were assessed between the two groups. SPSS 22.0 software was used for t test and descriptive statistics on the data.Results:The results of t test analysis showed that the scores of theoretical knowledge and general ability in test group were higher than those in control group, with significant differences ( P < 0.05). Meanwhile, the scores of teaching satisfaction, professional interest, teaching participation, knowledge mastery and scientific research ability in the test group were higher than those in the control group, with significant differences ( P<0.05). Conclusion:Conventional teaching combined with new media aided-teaching is a good new training model for professional postgraduates of neurosurgery, which has improved students' participation and motivation of study and contributed to the training of medical students' comprehensive abilities.
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Objective To investigate the effect ofbiglycan (BGN) on neural apoptosis in mice with early brain injury (EBI) after subarachnoid hemorrhage (SAH).Methods SAH models were induced by endovascular perforation in young male C57BL/6J mice.(1) Totally,48 mice were randomly divided into sham-operated group,SAH 6 h group,SAH 12 h group,SAH 24 h group,SAH 48 h group,and SAH 72 h group (n=8);the BGN protein and mRNA expressions were detected by Western blotting and real-time quantitative PCR (qRT-PCR).(2) Totally,16 mice were randomly divided into sham-operated group and SAH 48 h group (n=8);immunofluorescent double staining was conducted to explore the BGN expression in the neurons of brain tissues.(3) Totally,24 mice were randomly divided into sham-operated group,sham+control lentivirus group,and sham+BGN lentivirus group (n=8);BGN lentiviral vector and control lentivirus were administered intracerebroventricularly 7 d before sham-operation;qRT-PCR was performed to explore the BGN mRNA expression.(4) Totally,48 mice were randomly divided into sham-operated group,SAH+control lentivirus group,and SAH+BGN lentivirus group (n=16);BGN lentiviral vector and control lentivirus were administered intracerebroventricularly 7 d before SAH;neurological scores were detected by modified Garcia scale and beam balance tests;TUNEL was used to detect the neuronal apoptosis,and Western blotting was performed to explore the expressions of nuclear transcription factor kappa B (NF-κB) and phosphorylated-(p-) NF-κB.Results (1) Mice in the SAH 48 h group had the highest BGN protein and mRNA expressions,which showed statistical differences as compared with the sham-operated group (P＜0.05).(2) A majority of BGN expressions were detected in the neurons 48 h after SAH.(3) The sham+BGN lentivirus group had statistically lower BGN mRNA expression than the sham+control lentivirus group (P＜0.05).(4) As compared with those in the SAH+control lentivirus group,both scores of modified Garcia scale and beam balance tests were significantly higher in SAH+BGN lentivirus group (6.125±1.246 vs.13.000±1.309;1.125±1.126 vs.2.875±0.835),and neural apoptosis ratio and ratio of p-NF-κB/NF-κB were significantly lower in the SAH+BGN lentivirus group (51.950％±11.166％ vs.31.938％±7.705％;1.161±0.156 vs.0.886±0.142,P＜0.05).Conclusion Inhibition of BGN can effectively reduce neuronal apoptosis in mice with EBI after SAH,and attenuate neurological deficits.
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Objective:To evaluate a new imaging sign, named" bilateral water sign" (BWS), which can evaluate the neurovascular compression of primary trigeminal neuralgia (TN).Methods:A prospective study was conducted on 85 primary TN patients admitted to our hospital from March 2017 to March 2019. All patients accepted magnetic resonance 3D-T2W-DRIVEN sequence examination and multiplanar reconstruction (MPR) for post-processing. The sequential nerve (low signal)-cerebrospinal fluid (high signal)-vessel (low signal)-cerebrospinal fluid (high signal)-nerve (low signal) signs on the recombination plane were named as "BWS". The sensitivity, specificity, positive predictive value and negative predictive value of BWS in evaluating the neurovascular compression were calculated respectively, by combining with intraoperative situation of microvascular decompression (MVD).Results:In 85 TN patients, 46 patients (54.12%) had BWS. The sensitivity was 57.14%, the specificity was 75.00%, the positive predictive value was 95.65% and the negative predictive value was 15.38%. There was a statistically significant difference in the degree of neurovascular compression between patients with and without BWS ( P<0.05); and degree of neurovascular compression was severer in patients with BWS. Conclusion:BWS can evaluate the relation of neurovascular compression in TN patients and suggest the degree of neurovascular compression.
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Objective To investigate the effect of long non-coding RNA F19 (lncRNA F19) on secondary brain injury following traumatic brain injury (TBI) in mice. Methods (1) A total of 96 C57BL/6J male wild-type mice were divided into sham group, sham+control lentivirus group, sham+F19 lentivirus group, TBI group, TBI+control lentivirus group and TBI+F19 lentivirus group according to the random number table. Each group consisted of two subgroups of 1 day and 3 days after TBI, with eight mice per subgroup. The expression and silence efficiency of lncRNA F19 were detected. ( 2 ) A total of 96 C57BL/6J male wild-type mice were divided into sham group, TBI+control lentivirus group and TBI + F19 lentivirus group according to the random number table. Each group consisted of two subgroups of 1 day and 3 days after TBI, with 16 mice per subgroup. The effect of lncRNA F19 on neuronal apoptosis after TBI was recorded. The mice TBI model was established using the controlled cortical damage method (CCI). The lncRNA F19 lentivirus or control lentivirus were administrated by intracerebroventricular injection 5 days before injury. The expressions of lncRNA F19 ( 2 -ΔΔct ) were detected by real-time quantitative PCR ( qRT-PCR ) at 1 day and 3 days after injury. The Toll-like receptor 4 (TLR4), B lymphocyte tumor-2 (Bcl-2) and Bcl-2 related protein (Bax) expressions were detected by Western blot. The TUNEL was used to detect apoptosis around the traumatic lesions. Results From the first day after injury, both in the sham operation and TBI groups, the control lentivirus had no effect on the level of lncRAN F19 (P >0. 05). One day after injury, compared with sham +control lentivirus group, the levels of lncRNA F19 in sham + F19 lentivirus group were significantly decreased (0. 07 ± 0. 07:0. 93 ± 0. 17);compared with TBI+control lentivirus group, levels of lncRNA F19 in TBI+F19 lentivirus group were significantly decreased (2. 91 ± 1. 18:0. 52 ± 0. 32) (P<0. 05). There were significantly lower protein levels of TLR4 (0. 51 ± 0. 13:0. 66 ± 0. 15), Bax (0. 45 ± 0. 06:0. 67 ± 0. 16), lower TUNEL-positive neurons ratio [(23. 55 ± 6. 85)％ : (31. 58 ± 7. 52)％], but higher protein levels of Bcl-2 (0. 76 ± 0. 16:0. 47 ± 0. 12) in TBI+F19 lentivirus group compared with the TBI+ control lentivirus group (P <0.05). Three days after injury, compared with sham + control lentivirus group, levels of lncRNA F19 in sham+F19 lentivirus group were significantly decreased (0. 11 ± 0. 09:0. 96 ± 0. 09); compared with TBI+control lentivirus group, levels of lncRNA F19 in TBI+F19 lentivirus group were significantly decreased (0. 54 ± 0. 24:3. 39 ± 0. 90) (P <0. 05). There were significantly lower protein levels of TLR4 (0. 60 ± 0. 20):(0. 85 ± 0. 09)], lower Bax (0. 60 ± 0. 12:0. 88 ±0. 21), lower TUNEL-positive neurons ratio [(29. 10 ± 7. 37)％ :(39. 22 ± 10. 64)％], but higher protein levels of Bcl-2 (0. 66 ± 0. 12:0. 35 ± 0. 16) in TBI+F19 lentivirus group compared with the TBI+control lentivirus group (P<0. 05). Conclusion Inhibition of lncRNA F19 can significantly reduce the TLR4-induced neuronal apoptosis in cortex after TBI in mice and alleviate reduce the secondary brain injury.
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Objective To investigate the clinical effect of percutaneous hollow screw combined with tension band internal fixation for comminuted patellar fracture after arthroscopic reduction.Methods 105 patients with comminuted patellar fracture in our hospital from April 2013 to September 2017 were selected and divided into observation group (n =53) and control group (n =52) according to different treatment schemes.The control group was treated with conventional open reduction and Kirschner wire combined with tension band internal fixation,while the observation group was treated with arthroscopic assisted reduction and percutaneous cannulated screw combined with wire tension band internal fixation.The operation status and postoperative fracture healing time of the two groups were compared.One-year follow-up was performed after operation.The incidence of complications,the excellent and good rate of operation,and the preoperative and postoperative pain scores (VAS) and knee were compared.Hospital for special surgery knee score (HSS),Activity of Daily Life Scale (ADL),quality of life score (the Mos 36-item Short Form Health Survey,SF-36) were compared.Results The observation group had fewer fluoroscopy times during operation,shorter incision length and shorter healing time after operation than the control group (P ＜ 0.05);the incidence of complications in the observation group was 3.85％,lower than 20.00％ in the control group,and the excellent and good rate of operation was 96.15％,higher than 82.00％ in the control group (P ＜ 0.05);the VAS scores of the two groups were lower than those of the control group one year after operation,and the scores of HSS,ADL and SF-36 were lower than those of the control group.The preoperative improvement was higher in the observation group than in the control group (P ＜ 0.05).Conclusions Arthroscopic reduction combined with percutaneous hollow screw and tension band internal fixation for patellar comminuted fracture can reduce surgical trauma and accelerate the rehabilitation of patients.It can reduce the incidence of complications,relieve pain,improve knee function,daily living ability and quality of life,and the effect is remarkable.
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Objective To explore the role of phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway in early brain injury after subarachnoid hemorrhage (SAH) and its possible mechanism in rats. Methods Ninety healthy male SD rats were randomly divided into 5 groups (n=18) according to the random number table, namely sham-operated group, SAH group, vehicle control group, SAH+PI3K/Akt pathway agonist group (group A), and SAH+PI3K/Akt pathway inhibitor group (group I, n=18). Rat SAH models of the later 4 groups were established by intravascular puncture; rats in the vehicle control group, group A, and group I were given 10μL dimethyl sulfoxide (DMSO), insulin-like growth factor (IGF-1, 1μg/10 μL), and Ly294002 (25μg/10μL) solution, respectively, before model making. After 24 h of intravascular puncture, modified Garcia nerve function scale was used to evaluate the motor function, dry-wet weight method was used to detect the water content of the brain tissues, and immunofluorescence staining was employed to observe the β-amyloid precursor protein (β-APP)/ βtubulin III positive expressions in the subcortical white matter, and Western blotting was employed to detect theβ-APP, and total (t)-and phosphorylated (p)-PI3K and Akt protein expressions in the brain tissues; one month after modeling, HE staining was used to observe the changes of cell structure after cerebral edema. Results As compared with the sham-operated group, SAH model group had significantly lower modified Garcia nerve function scale scores, significantly increased brain water content, significantly larger number ofβ-APP/βtubulin III positive cells, statistically increasedβ-APP protein expression, and significantly increased t-PI3K, and t-Akt protein expressions (P<0.05). As compared with the SAH model group, group A had significantly higher modified Garcia nerve function scale scores, significantly decreased brain water content, significantly smaller number of β-APP/ βtubulin III positive cells, statistically decreasedβ-APP protein expression, and significantly increased p-PI3K and p-Akt protein expressions (P<0.05). As compared with group A, group I had significantly lower modified Garcia nerve function scale scores, significantly increased brain water content, significantly larger number ofβ-APP/βtubulin III positive cells, statistically increasedβ-APP protein expression, and significantly decreased p-PI3K and p-Akt protein expressions (P<0.05). HE staining showed serious morphological damage. Conclusion PI3K/Akt signaling pathway plays an important role in early brain injury after SAH in rats;early stimulation of PI3K/Akt signaling pathway activation can alleviate early brain injury after SAH, and the mechanism may be related to regulation of axonal injury in white matter after SAH.
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Objective To investigate the safety and efficacy of LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase.Methods From May 2014 to August 2017,the clinical and imaging data of 56 patients with ruptured wide-necked intracranial aneurysm treated with LVIS stents for acute phase assisted embolization at the Department of Neurosurgery,the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.All patients were treated with LVIS stent combined with coil embolization.Immediate postoperative angiography,six months after procedure,and follow-up imaging were evaluated by Raymond grade (RS grade).The clinical follow-up results were evaluated by the modified Rankin Scale (mRS) score.Results LVIS stent combined with coil embolization was performed in 56 patients with 60 aneurysms in this group.The success rate of stent release was 100％.Immediate angiography after procedure showed that the complete embolization rate of aneurysms was 80.0％ (48/60),the near complete embolization rate was 13.3 ％ (8/60),and the incomplete embolization rate was 6.7％ (4/60).Postoperative follow-up angiography at 6 monthrevealed that the complete embolization rate of aneurysms was 87.8％ (36/41),nearly complete embolization rate was 7.3％ (3/41),incomplete embolization rate was 4.9％ (2/41).Postoperative follow-up angiography at 12 months revealed that the complete embolization rate of aneurysms was 83.0％ (39/47),and near complete embolization rate was 12.8％ (6/47),and incomplete embolization rate was 4.3％ (2/47).Of the 56 patients,49 were followed up clinically and 7 were lost to follow up.The average follow-up time was 13 ± 4 months.The clinical follow-up showed that the good prognosis (mRS score 0-2) rate was 87.8％ (43/49).Intraoperative complications occurred in 7 cases,5 were intraoperative parent artery thrombosis and 2 were intraoperative aneurysm rupture.Conclusions LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase has good efficacy and safety.Its long-term efficacy remains to be confirmed by long-term follow-up.
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Objective To explore the altered expression of circular RNA (circRNA) and mRNA in the mouse cortex in the early phase of subarachnoid hemorrhage (SAH) and possible biological functions of the circRNA in early brain injury (EBI).Methods A total of 18 C57BL/6J male mice were randomly divided into a sham and a SAH group (n=9).SAH models were prepared by endovascular perforation.Total RNAs of brain samples were extracted to construct the cDNA library 24 h after operation.RNA-sequencing (RNA-seq) was carried out by HiSeqTM 2500 User Guide and followed by RT-qPCR for confirmation.Reads were aligned to the mouse transcriptome to obtain expression profiles ofcircRNA and mRNA.Bioinformatic study included GO analysis,KEGG pathway analysis and forecast of targeted miRNA of circRNA.Results A total of 26 circRNA (6 up-regulated and 20 down-regulated) and 804 mRNA (396 up-regulated and 408 down-regulated) were significantly changed.These altered mRNA were mainly related to regulation of neuronal synaptic plasticity,inflammatory and immune response.Bioinformatics showed that some significantly altered circRNA contained binding sites for many miRNA.The RT-qPCR analysis of 4 randomly selected circRNA (circFoxj3,circSetbp1,circArpp21 and circ2010111 I01Rik) confirmed the accuracy of RNA-seq.Conclusions SAH alters the expression of circRNA in mouse cortex and the differentially expressed circRNA may be involved in regulation of EBI following SAH,promising a potential therapeutic target for the diagnosis,treatment and prognosis of SAH.
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Polypeptide fragment of rabies virus glycoprotein(RVG)has become one of the most popular polypeptides in drug delivery field,because of its advantages of neurotropiam,penetration of blood-brain barrier and biosafety.Polypeptide fragment of RVG can directly deliver proteins and nucleic acids into brain.Additionally,when polypeptide fragment of RVG couples with drug-loading polymers,nanoparticles or liposomes,it can mediate the latters into brain.The application of the RVG polypeptide fragment provides a safe and effective approach for the treatment of brain diseases with biomolecules,such as chemicals,proteins.plasmids,siRNA,miRNA.
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Objective To investigate the effect ofolipoprotein E (ApoE) mimetic peptide on neural apoptosis and autophagy and their mechanisms in mice after traumatic brain injury (TBI).Methods A total of 40 health adult male C57BL/6J mice were randomly divided into sham-operated group,TBI+normal saline (NS) group,TBI+COG1410 (1 mg) group and TBI+COG1410 (2 mg) group (n=10).The TBI models of moderate mice were constructed by controlled cortex impact (CCI) devices in the later three groups and mice in the sham-operated group were performed bone window operning only.Thirty min after model making,COG1410 treatment was given by intravenous injection of COGl410 via the tail vein at a dose of 1 mg/kg.d or 2 mg/kg.d.Mice in sham-operated group and TBI+NS group were injected with equal sterile NS instead.Neurological functions were tested 3 d after TBI by rolling-bar test and modified neurological severity scale (mNSS).Neural apoptosis was analyzed by TUNEL and autophagy protein LC3 expression in the neurons of cortex around the lesion focus was detected by immunofluorescence.Western blotting was employed to detect the expressions of apoptosis-related proteins (Bax,Bcl-2 and Caspase-3) and autophagy proteins (Beclin-1,LC3-Ⅰ and LC3-Ⅱ),and changes of Akt,mTOR,phosphorylated-(p-) Akt,p-mTOR levels.Results As compared with those in the sham-operated group,significantly shortened rotarod latency,significantly increased mNSS scores,significantly increased Bax and Caspase-3 protein expressions,significantly decreased Bcl-2,significantly increased Beclin-1 and LC3-Ⅱ protein expressions and number of TUNEL postive neurons,and statistically increased p-Akt and p-mTOR levels in the TBI+NS group were noted (P＜0.05).As compared with those in the TBI+NS group,significantly increased rotarod latency,significantly decreased mNSS scores,significantly decreased Bax and Caspase-3 protein expressions,significantly increased Bcl-2,significantly decreased Beclin-1 and LC3-Ⅱ protein expressions and number of TUNEL postive neurons,and statistically increased p-Akt and p-mTOR levels in the TBI+COG1410 (1 mg) group and TBI+COG 1410 (2 mg) group were noted (P＜0.05).As compared with those in the TBI+COG 1410 (1 mg) group,significantly increased rotarod latency,significantly decreased mNSS scores,significantly decreased Bax and Caspase-3 protein expressions,significantly increased Bcl-2 expression,significantly decreased Beclin-1 and LC3-Ⅱ protein expressions and number of TUNEL postive neurons,and statistically increased p-Akt and p-mTOR levels in the TBI+COG1410 (2 mg) group were noted (P＜0.05).Conclusion ApoE peptide is effective in reducing the excessive neuronal apoptosis and neurological dysfunctions caused by excessive neuronal autophagy after TBI,which is associated with the modulation of Akt/mTOR related pathway.
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Objective To explore the risk factors of recurrence of chronic subdural hematoma (CSDH) after drilling and drainage,and to explore the cumulative risk of various risk factors in recurrence.Methods A retrospective analysis of 257 patients with CSDH,admitted to and accepted complete drainage in our hospital from January 2010 to December 2015,was performed;234 patients were without recurrence and 23 patients with recurrence.The risk factors of relapse,including age,hypertension,diabetes,hematoma characteristics,preoperative hematoma thickness,preoperative median deviation,hematoma thickness at discharge,midline deviation at discharge and hematoma density,were analyzed.Logistic regression analysis was performed to conform the independent risk factors and cumulative risk of multiple possible risk factors.Results Univariate analysis showed that age,hypertension,diabetes mellitus,preoperative hematoma thickness,preoperative median deviation,hematoma thickness at discharge,midline deviation at discharge and hematoma density were significantly different between the patients without recurrence and patients with recurrence (P＜0.05).Age,diabetes mellitus,preoperative hematoma thickness,and midline shift at discharge were independent risk factors for postoperative drilling recurrence.The cumulative effect of risk factors was that patients with two independent risk factors had a relapse risk of one 4.22-9.50-fold in patients with or without recurrence-independent risk factors,with a risk of recurrence of up to 38.0-fold in patients with three or four independent risk factors.Conclusions The risk factors of recurrence of chronic subdural hematoma after bile duct drainage are age,diabetes mellitus,preoperative hematoma thickness ≥20 mm and midline deviation ≥ 5 mm at discharge.When more independent risk factors are combined,fold increase of cumulative risk of recurrence is noted.
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With the efforts of several generations, modern medicine has been from experience medicine and evidence-based medicine to the precise medicine. The precision medicine has also become a common goal for global clinical workers. However, traumatic brain injury involves a wide range and various types of injuries. The extent of the brain damage caused by trauma is complex. There is still a big gap between current medicine and precise medicine in the treatment of traumatic brain injury. Therefore, to achieve accurate, punctual, sharing and individualized precision medicine of traumatic brain injury, we must follow the objective routines of traumatic brain injury, and constantly improve the monitoring and treatment means of traumatic brain injury, and constantly improve the clinical research with globalization, multi-center, large data and prospection.
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Objective To investigate the clinical value of noninvasive monitoring technique in intracranial hemorrhage and secondary brain edema after operation for traumatic brain injury (TBI).Methods A retrospective case-series analysis was done on 196 TBI patients (128 males and 68 females,aged 18-60 years old,median age 36.5 years old) admitted from January 2014 to December 2015 and treated surgically with simultaneous implantation of intracranial pressure (ICP) probe.There were 89 patients with Glasgow coma score (GCS) 6-8 points and 107 with GCS 9-12 points.The values of ICP were recorded.The changes of cerebral electrical impedance (CEI) were monitored in all patients through the BORN-BE noninvasive monitor.Results The disturbance factor of the BORN-BE noninvasive monitor in brain edema in the cerebral stage exhibited a strongly positive correlation with ICP (R =0.954,R2 =0.910,P ＜ 0.05).All the rebleeding occurred within 24 hours after operation in the study.The disturbance factor showed a significant reduction in the bleeding side,which exhibited a strongly negative correlation with the volume of cerebral hemorrhage (R =-0.982,R2 =0.964,P ＜ 0.05).Conclusion After operation for TBI,the ICE changes from dynamic noninvasive monitor can reflect the severity of brain edema digitally,indicating that the postoperative rebleeding and its volume may play an important role in selection of optimal treatment.
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Objective To investigate the clinical features, treatments and prognoses of pediatric intracranial aneurysms. Methods The clinical and follow-up data of 16 consecutive patients with pediatric intracranial aneurysms (≤16 years), admitted to our hospital from January 2003 to December 2014, were analyzed retrospectively. Results Pediatric intracranial aneurysms in this study accounted for 0.78%of all intracranial aneurysms. Of the 16 children, 14 were male, 2 were female. There were 12 anterior circulation aneurysms and 5 posterior circulation aneurysms; there were 4 large aneurysms (diameter 11-25 mm) and 2 giant aneurysms (diameter≥25 mm);there were 14 complex aneurysms. At a mean follow-up duration of 16.8 months, no death was noted. Of the 12 patients received microsurgical therapy, 10 patients had favorable outcomes (modified Rankin scale [mRS] 0-1) and 2 patients had some sequelae: different degrees of disability (mRS 2-4). Of the 4 patients received endovascular therapy, 3 patients had favorable outcomes (mRS 0-1) and one patient had hemiparesis (mRS 2). Conclusions Pediatric intracranial aneurysms are different from adult intracranial aneurysms. The treatment effects and prognosis are relatively well when we select individualized treatment mode according to the clinical features of pediatric intracranial aneurysms.
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Objective To investigate the effect of Galangin on migration and invasion in gliomas and explore the possible mechanism.Methods (1) After treating the glioma lines U87 and U251 with 0,10,20 and 40 μmol/L galangin for 24 h,CCK-8 was performed to detect the cell viability;wound healing assay and Transwell assay were used to detect the cell migration and invasion,respectively;protein expression of transforming growth factor (TGF) β was detected by Western blotting.(2) The second experiment was divided into control group,20 μmol/L galangin treatment group,TGFβ over-expression group and 20 μmol/L galangin+TGFβ over-expression group;the cells in the control group and 20 μmol/L galangin treatment group were transfected with empty-vector plasmids;cells in the TGFβ over-expression group and 20 μmol/L galangin+TGFβ over-expression group were transfected with TGFβ plasmids,and 24 h after the transfection,the cells in the 20 μmol/L galangin treatment group and 20 μ mol/L galangin+TGFβ over-expression group were added 20 μmol/L galangin;24 h after that,wound healing assay and Transwell assay were used to detect the cell migration and invasion,respectively;TGF β protein expression was detected by Western blotting.Results (1) As compared with cells from the 0,10 and 20 μmol/L galangin group,the cells from 40 μmol/L galangin group had significantly lower cell viability (P＜0.05).Cells from the 0,10 and 20 μmol/L galangin group had significantly decreased wound healing percentage,significantly decreased cell number reaching to the lower chamber,and statistically decreased TGFβ protein expression in sequence (P＜0.05).(2) U87 and U251 cells from the TGFβ over-expression group,control group,20 μmol/L galangin+TGFβ over-expression group and 20 μmoll/L galangin treatment group had successively decreased wound healing percentage,decreased cell number reaching to the lower chamber,and decreased TGFβ protein expression (U87 cells:1.63±0.21,1.00±0.00,0.78±0.05 and 0.43±0.08;U251 cells:1.98±0.20,1.00± 0.00,0.86±0.06 and 0.29±0.04),with significant differences (P＜0.05).Conclusion Galangin inhibits the glioma migration and invasion through TGFbβ down-regulation.
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Background:Drug-induced liver injury( DILI)is a kind of commonly seen diseases,in which typical clinical manifestations are lacking and misdiagnosis and missed diagnosis are frequently occurred. Aims:To investigate the clinical characteristics of patients with DILI. Methods:Clinical data of patients with DILI at Zhongshan Hospital,Xiamen University from January 2014 to December 2015 were collected. Clinical characteristics were retrospectively analyzed and the relationship between clinical characteristics and prognosis was investigated. Results:A total of 51 patients with DILI were enrolled,the ratio of male to female was 1∶ 1. 32,the average age at diagnosis was(50. 6 ± 17. 9)years old,the highest proportion(43. 1% )of patients were aged 60 and older. Hepatocellular damage was the main type of liver injury (84. 3% ). Chinese herbs,cardiovascular drugs,hormone and endocrine drugs were the most common drugs causing DILI, which accounted for 51. 0% ,19. 6% and 9. 8% ,respectively. Concomitant diseases of DILI covered many systems. The clinical manifestation of DILI was atypical,and the laboratory examination also lacked specificity. The positivity rate of autoimmune antibody was 5. 9% . Most patients had good prognosis,and the cure rate and improvement rate were 21. 6%and 66. 7% ,respectively. The mortality rate was 5. 9% with the cause of death being liver failure. Levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin,prothrombin time(PT) and international normalized ratio( INR) at admission were correlated significantly with prognosis( P ﹤ 0. 05 ). Conclusions:DILI commonly occurs in elderly population,and inappropriate use of Chinese herbs maybe the important cause. The clinical manifestation of DILI is not typical,and most patients have good prognosis. Levels of ALT,AST, TBIL,albumin,PT and INR at admission are correlated significantly with prognosis.