Epidemiological Features of Nontraumatic Spontaneous Subarachnoid Hemorrhage in China: A Nationwide Hospital-based Multicenter Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Nontraumatic spontaneous subarachnoid hemorrhage (SAH) is associated with a high mortality. This study was conducted to investigate the epidemiological features of nontraumatic spontaneous SAH in China.</p><p><b>METHODS</b>From January 2006 to December 2008, the clinical data of patients with nontraumatic SAH from 32 major neurosurgical centers of China were evaluated. Emergent digital subtraction angiography (DSA) was performed for the diagnosis of SAH sources in the acute stage of SAH (≤3 days). The results and complications of emergent DSA were analyzed. Repeated DSA or computed tomography angiography (CTA) was suggested 2 weeks later if initial angiographic result was negative.</p><p><b>RESULTS</b>A total of 2562 patients were enrolled, including 81.4% of aneurysmal SAH and 18.6% of nonaneurysmal SAH. The total complication rate of emergent DSA was 3.9% without any mortality. Among the patients with aneurysmal SAH, 321 cases (15.4%) had multiple aneurysms, and a total of 2435 aneurysms were detected. The aneurysms mostly originated from the anterior communicating artery (30.1%), posterior communicating artery (28.7%), and middle cerebral artery (15.9%). Among the nonaneurysmal SAH cases, 76.5% (n = 365) had negative initial DSA, including 62 cases with peri-mesencephalic nonaneurysmal SAH (PNSAH). Repeated DSA or CTA was performed in 252 patients with negative initial DSA, including 45 PNSAH cases. Among them, the repeated angiographic results remained negative in 45 PNSAH cases, but 28 (13.5%) intracranial aneurysms were detected in the remaining 207 cases. In addition, brain arteriovenous malformation (AVM, 7.5%), Moyamoya disease (7.3%), stenosis or sclerosis of the cerebral artery (2.7%), and dural arteriovenous fistula or carotid cavernous fistula (2.3%) were the major causes of nonaneurysmal SAH.</p><p><b>CONCLUSIONS</b>DSA can be performed safely for pathological diagnosis in the acute stage of SAH. Ruptured intracranial aneurysms, AVM, and Moyamoya disease are the major causes of SAH detected by emergent DSA in China.</p>

Histopathological classification and location of consecutively operated meningiomas at a single institution in China from 2001 to 2010 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of large series. This study was a retrospective analysis of the characteristics of meningioma cases consecutively operated on at a single institution in China from 2001 to 2010.</p><p><b>METHODS</b>This study investigated the demographic background of 7084 meningioma cases, and the subtypes and locations of the tumors. Sex and age distributions were analyzed, and the pathological subtypes were classified according to the World Health Organization (WHO) classification. The location of the meningiomas was also categorized.</p><p><b>RESULTS</b>The female:male ratio of the 7084 cases was 2.34:1. The mean age was 51.4 years (range, 11 months-86 years). The mean age of cases of WHO grade I meningioma was significantly older than that of grade II or III meningiomas (P < 0.001, Fisher's Least Significant Digit test). There was a significantly higher female:male ratio in WHO grade I meningiomas than in grade II or grade III meningiomas (2.57, 1.03 and 0.76, respectively; P < 0.001, χ(2) test). Meningothelial (n = 2061) and fibrous meningiomas (n = 3556) were the most common subtypes, comprising 79.3% of all meningiomas. All meningioma cases were classified into 23 locations in this study, with the cerebral convexity the most common site (38.33%, n = 2722). Cases with uncommon locations such as extra-cranial and sylvian fissure meningiomas were also present in this series.</p><p><b>CONCLUSIONS</b>Female predominance was found for benign meningiomas, while malignant subtypes showed male predominance. The mean age of patients with WHO grade I meningiomas was older than that of patients with higher-grade tumors. Meningothelial and fibrous meningiomas were the most common subtypes. The cerebral convexity was the most common meningioma location.</p>

Increased expression of osteopontin in brain arteriovenous malformations / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The precise mechanisms responsible for the development and growth of intracranial arteriovenous malformations (AVMs) remain unclear. Osteopontin (OPN) is a phosphorylated glycoprotein with diverse functions. This study aimed to analyze the expression of OPN in human brain AVMs.</p><p><b>METHODS</b>The AVM nidus was surgically obtained from patients with AVM, whereas control brain artery specimens were surgically obtained from patients with epilepsy. Reverse transcription-polymerase chain reaction (RT-PCR) was used to examine the expression of OPN mRNA in biopsy specimens. OPN protein expression was localized by immunohistochemistry. The statistical differences between different groups were assessed by two-way analysis of variance (ANOVA).</p><p><b>RESULTS</b>We analyzed 36 brain AVM specimens and 8 control brain artery specimens. Eleven patients with brain AVM received embolization treatment, and five underwent gamma knife radiotherapy before resection. Nineteen patients with brain AVM had a history of hemorrhage from AVMs. The expression of OPN mRNA was significantly higher in AVMs than that in the control specimens (25.76 ± 2.71 vs. 21.46 ± 2.01, P < 0.01). There was no statistically significant difference in the extent of OPN mRNA expression between the AVM group with and that without history of hemorrhage (26.13 ± 2.45 vs. 25.34 ± 2.99) or gamma knife radiotherapy (24.39 ± 2.10 vs. 24.53 ± 1.85). However, the difference between the AVM group with and that without embolization treatment history was statistically significant (24.39 ± 2.10 vs. 28.80 ± 1.13, P < 0.01). In the group with gamma knife radiotherapy history, OPN expression was found in arteries with early-stage radio-effect.</p><p><b>CONCLUSIONS</b>OPN may contribute to the vascular instability of brain AVMs. It may play an important role in the pathophysiological process related to embolization treatment.</p>

Superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis in treating moyamoya disease: surgical techniques, indications and midterm follow-up results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgical interventions for moyamoya disease include direct and indirect revascularizations. This study aimed to evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass combined with an indirect revascularization procedure, encephalo-duro-myo-synangiosis, in the treatment of moyamoya disease.</p><p><b>METHODS</b>From October 2005 to November 2009, we performed this combined revascularization procedure in 111 patients with different types and stages of moyamoya disease. The superficial temporal artery, middle meningeal artery and the deep temporal artery were evaluated for individualized surgical planning in these cases. The integrity of the deep temporal artery and the middle meningeal artery network, and the pre-existing spontaneous anastomoses of the distal branches of the external carotid artery with the cortical arteries were well preserved. The mean follow-up time was 72.5 months, all clinical and radiological data were retrospectively reviewed.</p><p><b>RESULTS</b>A total of 198 stomas were performed in 122 hemispheres, all remaining patent until the last follow-up. The encephalo-duro-myo-synangiosis resulted in extensive anastomoses of the deep temporal artery (100%), the middle meningeal artery (90.9%), and the sphenopalatine artery (39.8%) with the cortical arteries, respectively. The superficial temporal artery, deep temporal artery, and the middle meningeal artery were significantly thickened in 88 patients as determined by digital subtraction angiography at follow-up. The relative cerebral blood flow increased significantly within one week after the operation. At 6 months post the operation, the relative cerebral blood flow was further increased by 15.5% from the gradual formation of anastomoses as a result of indirect revascularization. Transient ischemic attacks were effectively reduced or totally arrested. The neurological deficits significantly improved in 37 patients, with the National Institutes of Health Stroke Scale scores lowered by 2-8. There was no rehemorrhage in hemorrhagic moyamoya disease patients.</p><p><b>CONCLUSION</b>This study showed that the superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis can achieve good therapeutic effect in the treatment of moyamoya disease.</p>

Diagnostic value of contrast-enhanced intraoperative Doppler sonography for cerebral arteriovenous malformations compared with angiography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intraoperative Doppler sonography has been used in the neurosurgical operating room for the localization and description of cerebral arteriovenous malformations (AVMs). This study aimed to investigate the clinical value of contrast-enhanced intraoperative Doppler sonography, including its ability to assess the location and identify of feeding arteries in patients with AVMs and to compare this method with angiography.</p><p><b>METHODS</b>Twenty-three patients with cerebral AVMs who were diagnosed using angiography, were examined with contrast-enhanced intraoperative Doppler sonography. As an echo-enhancing agent, Sulphur Hexafluoride Microbubbles for Injection ("SonoVue") was administered intravenously in all patients. Sonogram results were reviewed and correlated with angiographic findings. For statistical analysis, the Wilcoxon signed-rank test was applied.</p><p><b>RESULTS</b>Angiography identified 20 AVM lesions in the anterior or middle fossa and 3 in the posterior fossa. Contrast-enhanced intraoperative Doppler was somewhat less sensitive for only detecting 21/23 (91.3%) of the AVM lesions. Additionally, contrast-enhanced intraoperative Doppler slightly underestimated AVM size compared with angiographic findings but showed feeding arteries with sufficient acoustic properties. In 15 patients, angiography revealed a coincidental blood supply from another intracranial vessel, which was missed by contrast-enhanced intraoperative Doppler sonography.</p><p><b>CONCLUSIONS</b>In a limited group of patients with AVMs, contrast-enhanced intraoperative Doppler sonography was a less sensitive but useful and simple method for the detection of AVMs in contrast to angiography. No specific untoward effects were attributed to the use of "SonoVue" as a contrast-enhancing substance.</p>

Antioxidant activity of natural and cultured Cordyceps sp / 中国中药杂志

<p><b>OBJECTIVE</b>Investigating the antioxidant activities of water and ethanol extracts of natural Cordyceps sinensis and Cordyceps militaris and their fermentation preparations.</p><p><b>METHOD</b>The samples were tested through 6 assays: inhibition ability of linoleic acid oxidation; scavenging activity of DPPH, hydrogen peroxide, hydroxyl radical and superoxide anion; and metal chelating activity.</p><p><b>RESULT</b>Samples showed different antioxidant ability, and there was not an extract that exhibited high activity in all assays; however, water extract of natural C. militaris could be regarded as the most powerful antioxidant among 8 samples. It had high activity in inhibition of linoleic acid oxidation, chelating metal ions, and scavenging DPPH and hydroxyl radical. The research also indicated that the contents of phenolic compounds in water and ethanol extracts of natural and cultured Cordyceps sp. had huge difference.</p><p><b>CONCLUSION</b>Natural Cordyceps sp. and its fermentation preparations could be used as potential natural antioxidants. The fermented process affected the antioxidant ability of cultured Cordyceps sp., and the antioxidant activity of both natural and cultured Cordyceps sp. did not significantly related with the quantity of phenolics.</p>

Risk factors for intracranial aneurysm in a Chinese ethnic population / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intracranial aneurysm (IAN) is a protruding bubble or a sac on a brain artery that balloons out over time, which may lead to spontaneous subarachnoid hemorrhage (SAH), ultimately disability and mortality. Current research indicates that the disease is due to multiple causes, including environmental factors and various congenital abnormalities of blood vessels. Apart from congenital predisposition, various high-risk factors such as sex, age, hypertension, and atherosclerosis are involved in the formation of intracranial aneurysms. The aim of this study was to investigate the risk factors associated with the formation of sporadic intracranial aneurysms in Chinese Han ethnic patients.</p><p><b>METHODS</b>A total of 251 patients with intracranial aneurysm and 338 patients with other cerebral diseases (control group) were enrolled in this study. Single factor and logistic regression model were used to analyze the association of intracranial aneurysms with age; sex; cigarette smoking; alcohol or cocaine consumption; history of hypertension, coronary artery disease, diabetes mellitus and inherited connective tissue disease; and the levels of fasting blood glucose and blood fat. The data expressed as mean +/- standard deviation were processed with the statistical software SPSS13. Quantitative and qualitative data were analyzed by the independent-sample t test, and the chi-square test respectively. Logistic regression method was used to analyze the multiple factors.</p><p><b>RESULTS</b>In the 251 patients, 163 (64.94%) were at age of 40 to 60 years. Sex (OR, 1.41; 95% CI, 1.01 - 1.96), cigarette smoking (OR, 1.81; 95% CI, 1.06 - 3.10), hypertension (OR, 2.32; 95% CI, 1.30 - 4.16) and fasting blood glucose were significantly associated with intracranial aneurysm (P < 0.05). Intracranial aneurysm was correlated with alcohol consumption, coronary artery disease, and the level of blood lipids (P > 0.05). Using logistic regression analysis, we identified female sex and advanced age as significant risk factors for sporadic intracranial aneurysms.</p><p><b>CONCLUSIONS</b>Sporadic intracranial aneurysms mostly occur in people aged 40 to 60 years. Feminine, cigarette smoking, and hypertension are independent risk factors for the disease, and the gender is the most significant factor. Advanced age can increase the effect of these risk factors.</p>

Early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate clinical strategy and effect of early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm.</p><p><b>METHODS</b>Seventy-five patients presenting with anterior circulating aneurysmal subarachnoid hemorrhage (SAH) underwent early-mid-phase (within 3 days or 3-10 days) microsurgical clipping at Huashan Hospital between January 2001 and August 2004. Glasgow outcome scale (GOS) was conducted to evaluate patients' outcomes.</p><p><b>RESULTS</b>Of 81 intracranial aneurysms, 77 lesions were clipped successfully, and 4 were wrapped. Good outcome was achieved in 53 cases, mild disability in 9 cases, severe disability in 7 cases, persistent vegetative state in 3 cases, and 3 patients (4%) died after surgery. The difference of GOS was statistically significant between patients in Hunt and Hess Grade I-III and Grade IV-V. However, there was no significant difference between early surgery and metaphase surgery.</p><p><b>CONCLUSIONS</b>Early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm is considered the feasible opinion.</p>

Cerebral revascularization in treatment of intractable aneurysms / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the effectiveness of cerebral revascularization in the treatment of intractable aneurysms and to discuss the indications, surgical techniques, and the outcome of the revascularization.</p><p><b>METHODS</b>During the recent 4-year period, 9 radical artery grafts were performed in patients with intractable or giant internal carotid artery (ICA) aneurysms. The indications for cerebral revascularization included parent vessel occlusion during the treatment of the intractable aneurysms with poor collateral circulation or the young patients. Modified techniques were taken to use the main trunk of superficial temporal artery (STA) as donor, while M3 branches near the bifurcation of the M2 segment of the middle cerebral artery (MCA) were chosen as the recipient arteries. STA-Radial artery (RA)-MCA bypass was followed by parent vessel occlusion via chronic cervical ICA ligation or balloon occlusion.</p><p><b>RESULTS</b>Postoperative angiography demonstrated the patency of the grafts in eight cases. The procedure of the parent vessels occlusion was uneventful in these patients. Follow-up showed the patients were in excellent conditions after successful treatment of aneurysms. Significantly delayed filling of the graft was revealed in one patient, who could not tolerate balloon occlusion test and occlusion of parent artery failed.</p><p><b>CONCLUSIONS</b>Extracranial-to-intracranial bypass followed by parent vessel occlusion is a safe and effective method to treat intractable ICA aneurysms. Radical artery as graft can offer high-flow revascularization with less complications. Combined surgical and endovascular treatment might be the future direction for the treatment of the difficult aneurysms.</p>

Diagnosis and treatment of tentorial dural arteriovenous fistulae / 中华外科杂志

<p><b>OBJECTIVE</b>Tentorial dural arteriovenous fistulae are uncommon but life-threatened lesions. We present our experience of 5 cases with tentorial dural arteriovenous fistulae, review the relevant literature and present the rationale of our current management strategy.</p><p><b>METHODS</b>The data of five patients with tentorial DAVF treated in Huashan Hospital between June 2002 and May 2003 were reviewed retrospectively, including their ill history, neuroimagings, operation records and follow-up data.</p><p><b>RESULTS</b>There were 3 females and 2 males with age from 25 to 52 years (average, 42.6 years). Clinical manifestations were acute subarachnoid hemorrhage in 2 cases, progressing neurological deficits in 3 cases. MRI and DSA were major diagnostic and follow-up modalities. Borden classification type II was in 1 case, type III in 4 cases. According to DAVF location, tentorial marginal type were in 3 cases, tentorial lateral type 1 case, tentorial medial type 1 case. Two patients had transarterial embolization preoperatively. All patients underwent craniotomy with the coagulation of the nidus and tentorium, disconnection of leptomeningeal venous drainage. The surgical approaches were via trans-anterior-petrous approach in 3 cases, transpterional subdural approach 1 case, transoccipital and transtentorial approach 1 case. All patients had clinical improvement, there was no surgical mortality and morbidity. Postoperative DSA confirmed obliteration of DAVF in 3 cases, MRI demonstrated the thrombosis of venous aneurysm and the disappearance of previous brainstem edema, partial thrombosis of venous aneurysm in 1 case. Follow-up study ranging from 1 to 2 year showed no recurrence and all patients resume their full activities.</p><p><b>CONCLUSIONS</b>Tentorial DAVF is an aggressive vascular lesion, causing subarachnoid hemorrhage and progressive neurological deficits. Prompt diagnosis and definite treatment for tentorial DAVF are mandatory. Obliteration of the nidus and/or leptomeningeal venous drainage should be the goal of treatment. Microsurgical procedures with/without endovascular intervention are the best choice of treatment.</p>

Effect of Addition Nucleotides on Heparinase Production by Flavobacterium heparinum / 微生物学通报

The effect of addition nucleotides on heparinase production by Flavobacterium heparinum was reseached. The result indicated that addition of nucleotides cause different effects on heparinase production depend on its addi ng mode, single kind of nucleotide would restrain, but multiplex promote. The s trongest promotion happened when the propotion of nucleotides was consistent wit h the nucleic acids of heparinase mRNA. HPLC result confined the entrance of nu cleoides to the bactera cell. And it also suggested the synthesis metabolic of nucleic acids in F.heparinum was imbalance, there always be higher lever of purin nucleoides. L-Asp was added to medium culture to enhance pyridine nucle oides thynesis in order to improve the enzyme production ,which has been affecte d by the imbalance of nucleoides.