Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Cerebral Venous Thrombosis : A Meta-Analysis

Objective@#: A role of diffusion-weighted imaging (DWI) in the diagnosis of cerebral venous thrombosis (CVT) is not wellunderstood. This study evaluates the effectiveness of DWI in the diagnosis of CVT. @*Methods@#: Literature search was conducted in electronic databases for the identification of studies which reported the outcomes of patients subjected to DWI for CVT diagnosis. Random-effects meta-analyses were performed to achieve overall estimates of important diagnostic efficiency indices including hyperintense signal rate, the sensitivity and specificity of DWI in diagnosing CVT, and the apparent diffusion coefficient (ADC) of DWI signal areas and surrounding tissue. @*Results@#: Nineteen studies (443 patients with 856 CVTs; age 40 years [95% confidence interval (CI), 33 to 43]; 28% males [95% CI, 18 to 38]; symptom onset to DWI time 4.6 days [95% CI, 2.3 to 6.9]) were included. Hyperintense signals on DWI were detected in 40% (95% CI, 26 to 55) of the cases. The sensitivity of DWI for detecting CVT was 22% (95% CI, 11 to 34) but specificity was 98% (95% CI, 95 to 100). ADC values were quite heterogenous in DWI signal areas. However, generally the ADC values were lower in DWI signal areas than in surrounding normal areas (mean difference−0.33×10-3 mm2/s [95% CI, −0.44 to −0.23]; p<0.00001). @*Conclusion@#: DWI has a low sensitivity in detecting CVT and thus has a high risk of missing many CVT cases. However, because of its high specificity, it may have supporting and exploratory roles in CVT diagnosis.

Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Cerebral Venous Thrombosis : A Meta-Analysis

Objective@#: A role of diffusion-weighted imaging (DWI) in the diagnosis of cerebral venous thrombosis (CVT) is not wellunderstood. This study evaluates the effectiveness of DWI in the diagnosis of CVT. @*Methods@#: Literature search was conducted in electronic databases for the identification of studies which reported the outcomes of patients subjected to DWI for CVT diagnosis. Random-effects meta-analyses were performed to achieve overall estimates of important diagnostic efficiency indices including hyperintense signal rate, the sensitivity and specificity of DWI in diagnosing CVT, and the apparent diffusion coefficient (ADC) of DWI signal areas and surrounding tissue. @*Results@#: Nineteen studies (443 patients with 856 CVTs; age 40 years [95% confidence interval (CI), 33 to 43]; 28% males [95% CI, 18 to 38]; symptom onset to DWI time 4.6 days [95% CI, 2.3 to 6.9]) were included. Hyperintense signals on DWI were detected in 40% (95% CI, 26 to 55) of the cases. The sensitivity of DWI for detecting CVT was 22% (95% CI, 11 to 34) but specificity was 98% (95% CI, 95 to 100). ADC values were quite heterogenous in DWI signal areas. However, generally the ADC values were lower in DWI signal areas than in surrounding normal areas (mean difference−0.33×10-3 mm2/s [95% CI, −0.44 to −0.23]; p<0.00001). @*Conclusion@#: DWI has a low sensitivity in detecting CVT and thus has a high risk of missing many CVT cases. However, because of its high specificity, it may have supporting and exploratory roles in CVT diagnosis.

Etiological analysis of surveillance cases of diarrhea syndrome in Gansu Province from 2009 to 2018 / 中华疾病控制杂志

@#Objective To understand pathogenic distribution and epidemiological characteristics of diarrhea syndrome in Gansu Province． Methods Fecal specimens from diarrhea syndrome surveillance cases at sentinel hospitals in Gansu Province from 2009 to 2018 were collected，and virus nucleic acids were detected by real－time fluorescent chain reaction，and bacteria were detected by isolation culture． Ｒesults 1 547 positive cases were detected from 4 406 stool specimens with the positive rate of 35. 11%． Among the positive samples，1 281 cases were positive for virus with the positive rate of 47. 20%; 287 ca- ses were positive for bacteria with the positive rate of 8. 57%． Top five of pathogenic spectrum were rota- virus ( 46. 04%) ，astrovirus ( 13. 37%) ，norovirus ( 13. 15%) ，Shigella ( 9. 90%) and adenovirus ( 7. 81%) ． In different age groups，statistically significant differences were found in the positive rates of rotavirus，norovirus，astrovirus，Shigella and non typhoid Salmonella ( all P＜0. 05) ． The positive rate of virus was higher from November to March of next year，and the positive rate of bacteria was higher from June to August． The epidemic seasons of pathogens were different，of which rotavirus was dominating in four seasons． Conclusions The pathogenic spectrum of diarrhea is wide relatively in Gansu Province， and viral diarrhea is more common，with obvious seasonal peak． Continuous monitoring should be strengthened to grasp characteristics and epidemic trends of pathogens，and it is helpful to take targeted and seasonal preventive measures in population at high risk．

Effect of Zaoren Anshen Priscription combined with escitalopram in treatment of coronary heart disease with anxiety disorder and its mechanism on neurotransmitters / 中草药

Objective: To study the effect of self-made Zaoren Anshen Priscription combind with escitalopram in treatment of coronary heart disease with anxiety disorder and its effect on neurotransmitters, and discussion on the mechanism of drug prescription. Methods: A total of 120 cases of CHD with anxiety disorder in Zhumadian Central Hospital from April 2016 to March 2018 were randomly divided into the control group and the experimental group for 60 cases in each group. The two groups were given conventional treatment for coronary heart disease, including Aspirin Enteric-coated Tablets, Metoprolol Succinate Tablets, isosorbide mononitrate, and atorvastatin. The control group was given escitalopram, while the experimental group was treated with Zaoren Anshen Priscription on the basis of the control group. Four weeks as a one course of treatment, three courses in a row. Before and after treatment, the HAMA score, TCM syndrome score, and angina pectoris score were evaluated, and evaluated the effect of coronary heart disease and anxiety, and the serum levels of 5-HT, MPO, NE, NPY were measured. Results :After treatment, the effective rate of coronary heart disease and anxiety in the experimental group was 91.67%, 93.33%, higher than 78.33% and 80% in the control group (P < 0.05); The HAMA score, TCM syndrome score, and angina score in the experimental group were lower than those in the control group (P < 0.05); The 5-HT, NE and NPY in the test group were higher, while MPO was lower than that in the control group (P < 0.05). Conclusion: The treatment of coronary heart disease and anxiety can improve the symptoms of coronary heart disease and anxiety, and improve the curative effect, and was adjusting the level of 5-HT, NE, NPY, and MPO to play the therapeutic effect.

Clinical Outcome of (131)I Therapy in Differentiated Thyroid Cancer with Preablative Thyroglobulin below 10 ng/ml / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical outcome of (131)I therapy in differentiated thyroid cancer (DTC) with preablative stimulated thyroglobulin (ps-Tg) below 10 ng/ml and the value of ps-Tg for predicting clinical outcome.</p><p><b>METHODS</b>Totally 167 DTC patients with ps-Tg below 10 ng/ml were included and divided into three groups [excellent response (ER, n=131), acceptable response (AR, n=34), and incomplete response (IR, n=2)] according to the response to initial (131)I therapy. One-way analysis of variance, χ(2) test, and Kruskal-Wallis test were used to evaluate the statistical differences of clinicopathological features, recurrence risk, and ps-Tg value among the three groups. The ps-Tg value between ER group and non-ER group were compared by Mann-Whitney rank-sum test. The ROC curve and optimal cut-off point were analyzed to evaluate the clinical value of ps-Tg for predicting disease-free status.</p><p><b>RESULTS</b>There was significant difference in ps-Tg level (H=14.305, P=0.001) among three groups but not in age (F=0.831, P=0.755), sex (χ(2)=0.178, P=0.915), cervical lymph node metastases (χ(2)=1.475, P=0.478), TNM stage (H=1.063, P=0.588), and recurrence risk (H=2.947, P=0.229). The median level of ps-Tg in ER group was 2.20 ng/ml (1.10, 4.40), which was significantly lower than 4.40 ng/ml (2.70, 5.90) of non-ER groups (U=1424.50, P=0.000). Area under the ROC curve was 0.717. The cut-off value of ps-Tg was 2.35 ng/ml,with a sensitivity of 83.33%, specificity of 53.43%, and negative predictive value of 92.11%.</p><p><b>CONCLUSION</b>The serum ps-Tg value is a sensitive marker for predicting the disease-free status in DTC patients with ps-Tg below 10 ng/ml.</p>

Risk factors in carotid angioplasty and stenting for extracranial carotid stenosis of elderly patients / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the risk factors and safety of carotid angioplasty and stenting(CAS) for extracranial carotid stenosis in elderly patients and summarize CAS on the indication of elderly patients and the prevention of complications.</p><p><b>METHODS</b>The population characteristics, clinical features and vascular data of 60 elderly patients (≥ 75 years) treated between June 2001 and December 2010 were retrospectively analyzed. There were 57 male and 3 female. The median age of the patients was 78.8 years (range, 75 - 93 years ). The mean case history was 2.5 months with a range of 1 to 6 months. To summarize the prognosis of CAS according to the reduction of stenosis, NIHSS score, the incidence of early postoperative, 30 days adverse events and the follow-up status. Using χ(2) test as the statistical method.</p><p><b>RESULTS</b>The mean stenosis was reduced from 81% ± 17% preoperative to 18% ± 9% postoperative. NIHSS score was reduced from preoperative 22 ± 8 to postoperative 10 ± 4. The average follow-up period was 1.5 years (range from 3 months to 3 years), and the results showed no procedure-related death occurred. Ipsilateral stroke occurred in 1 case (1.7%) and restenosis (≥ 50%) occurred in 2 patients (3.3%). Diabetes (χ(2) = 23.96, P < 0.01)and cardiac insufficiency (χ(2) = 6.446, P < 0.05)had a respectively significant impact on the incidence of early postoperative complications.</p><p><b>CONCLUSIONS</b>CAS can be effective in restoring carotid artery stenosis of elderly patients and preventing the occurrence of stroke. The elderly, diabetes, cardiac insufficiency are more likely to increase the postoperative risk of adverse events.</p>

Risk factors for infection with extended-spectrum beta-lactamase-producing strains in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the risk factors for infection with extended-spectrum beta-lactamase (ESBL) producing strains in children.</p><p><b>METHODS</b>The clinical data of 242 pediatric in-patients with lower respiratory tract infections from February 2009 to January 2011 were retrospectively analyzed. The risk factors of ESBL-producing strain infections were investigated using univariate analysis and multivariate logistic regression analysis.</p><p><b>RESULTS</b>Univariate analysis showed that six factors were related with ESBL-producing strain infections: repeated sucking of phlegm (OR: 2.279, P<0.01), tracheal intubation(OR: 3.101, P<0.01), administration of the third generation cephalosporin for more than three days (OR: 3.628, P<0.01), admission to the pediatric intensive care unit (PICU) (OR: 2.378, P<0.01), indwelling of nasogastric tube (OR: 2.460, P<0.01), prophylactic use of antibiotics (OR: 1.747, P<0.05). Multivariate logistic regression showed that the application of the third-generation cephalosporin for more than three days (OR: 5.672, P<0.01), repeated sucking of phlegm (OR: 3.917, P<0.01), tracheal intubation (OR: 3.717, P<0.01), indwelling of nasogastric tube (OR: 2.961, P<0.01), and admission to PICU (OR: 3.237, P<0.01) were the independent risk factors for the infections.</p><p><b>CONCLUSIONS</b>The infections of ESBL-producing strains are caused by many factors, among which the application of the third-generation cephalosporin for more than three days, invasive operations, and admission to PICU are the independent risk factors.</p>

Evaluation of carotid angiography and stenting for patients with contralateral carotid occlusion / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the efficiency and safety of carotid angioplasty stenting (CAS) in patients with contralateral carotid artery occlusion.</p><p><b>METHODS</b>From January 2001 to January 2010, 56 carotid artery stenosis patients with contralateral carotid artery occlusion were performed CAS and the feature and results of these cases were analyzed retrospectively. All the cases were confirmed to be carotid artery stenosis with contralateral carotid artery occlusion by digital subtraction angiography (DSA). The diameter stenosis rate was 72% ± 15%. CAS were performed with distal protection device in 56 cases.</p><p><b>RESULTS</b>The technique success rate of CAS were 100% in all the 56 patients with contralateral carotid artery occlusion and post-procedure stenosis rate descended to 13% ± 8%, and the symptoms of cerebral ischemia were all improved. Only 1 case occurred remote hemorrhage in the position of previous cerebral infarction in the side of CAS after the procedure, and recovered with light neurological deficit after the craniotomy to remove the hematoma. No ischemic complications or death occurred. During the following up of 6 months to 3 years, no cerebral ischemic symptoms reoccurred. The rechecking results of color Doppler of 47 cases and DSA of 2 cases showed no restenosis in-stent.</p><p><b>CONCLUSIONS</b>CAS is safe and effective for the patients with contralateral carotid artery occlusion. Critical election of the case, operation of skilled doctors and scrupulous post procedure general management can decrease the rate of complication.</p>

Occluded sinus for complex posterior fossa dural arteriovenous fistula / 中国脑血管病杂志

Objective: To evaluate the pathophysiology and therapeutic effect of venous sinuse embolization via Jugular vein for treatment of posterior fossa venous sinus dural arteriovenous fistula (DAVF). Methods: 10 patients with posterior fossa DAVF were diagnosed by angiography, all patients underwent endovascular embolization and cranial venous thrombosis under direct vision to dispose the segment with concentrated fistular feeders in ipsilateral sigmoid and transverse sinus after partial embolization via arterial approach. Results: Circled digit oneThe venous sinus occlusion procedure were successfully finished in 10 cases. Postoperative DSA examination showed that the fistula disappeared entirely in six patients, with more than 80% reduction in four patients. Residual fistulas have no obvious tendence of drainage to cortical veins. Circled digit twoThe murmur was disappeared and intracranial hypertension were relieved in all patients. DSA examination confirmed all the feeders were disappeared in 4 cases with craniotomy. 4 cases had followed-up and no recurrence was found. There was partial recurrence of fistula in 1 of 6 cases who underwent coil embolization and a second embolization was performed. Among five patients of declining of vision, 3 cases had different degrees of recovery after 6-12 months, 2 cases had no obviousy recovery. Five cases with edema of the optic disc were recovered. 3 patients had preoperative CSF pressure higher than 300 mm H2O, the postoperative CSF pressure reduced to 240, 230 and 200 mm H2O. Conclusion: Posterior fossa DAVF is a complicated condition, and transarterial embolization is difficult to achieve good result. The direct cerebral venous sinus occlusion and embolization via femoral vein may have curative effect to cure the posterior fossa DAVF.

Dynamic observation of cerebral vasoreactivity after carotid angioplasty and stenting / 中华神经医学杂志

Objective To explore the changes and influencing factors of cerebral vasoreactivity (CVR) in patients after carotid angioplasty and stenting (CAS). Methods Thirty-seven patients performed CAS, admitted to our hospital from July 2008 to September 2009, were finished the follow-up and chosen in our study; the breath-holding index (BHI) of the bilateral middle cerebral artery was measured using transcranial Doppler combined with breath holding test before thc operation, and 1 d and 3-10 months after the operation. Repeated measures design analysis of variance was employed to detect the BHI changes before and after the stenting; multiple regression was employed to analyze the influencing factors of BHI. Results BHI values after stenting were significantly higher than those before stenting on the stenotic side (P＜0.05). The follow-up BHI values were negatively correlated with those of tandem stenoses (β=-0.016, P=0.002) and positively correlated with the postoperative BHI values (β=1.030, P=0.000). Conclusion CAS can immediately improve CVR on the ipsilateral side and make it close to normalization gradually. Tandem stenoses are the independent risk factors of CVR.

Influencing factors of kinking of extracranial internal carotid artery in patients with transient ischemic attack / 中华神经医学杂志

Objective To investigate the influencing factors of kinking of extracranial internal carotid artery (EICA) in patients with transient ischemic attack. Methods Three hundred and thirty-four patients with ischemic cerebrovascular disease performed digital subtraction angiography (DSA) were chosen; they were divided into 2 groups according to vascular morphology through DSA detection: kinking group (angulation smaller than 90°, n=110) and non-kinking group (angulation larger than 90°, n=224). According to the age, the patients were divided into youth group (18-45 years old),middle age group (46-64 years old) and elderly group (older than 65 years old). The influencing factors which may be related to the kinking of EICA, including gender, age, height and stenosis degree, and the risk factors for cerebrovascular diseases were statistically analyzed. Results Univariate analysis found that the kinking group and non-kinking group on the ratio of age, gender, height, and histories of hypertension, smoking and drinking were significantly different (P＜0.05). Multiple logistic regression analysis showed that the kinking of EICA was obviously correlated to the history of hypertension (OR=2.546, 95% CI: 1.376-4.712, P=0.003) and age (taking youth group as reference group, middle age group:OR=2.610, 95% CI: 1.056-6.452, P=0.038, elderly group: OR=2.929, 95% CI: 1.159-7.401, P=0.023).Conclusion The history of hypertension and age are identified as independent predictors for kinking of EICA in patients with ischemic cerebrovascular diseases.

Influencing factors of diagnostic time in adult Moyamoya disease / 中华神经医学杂志

Objective To investigate the influencing factors of diagnostic time in adult moyamoya disease (MMD) and provide evidence for its early diagnosis. Methods The clinical data of 65 consecutive patients, admitted to our hopspital from August 2008 to December 2009, were retrospectively analyzed. Logistic regression nalysis was employed to confirm the relevant factors of diagnostic time. Results The 65 patients with early diagnosis and late diagnosis were 41 (63.1%) and 24 (36.9%), respectively. The percentage of patients firstly visiting a hospital with the third grade, patients with high education and high income, and patients having initial hemorrhage of the early diagnosis group was significantly higher than that in those of late diagnosis group (P<0.05). Through a logistic regression analysis, the grade of initial hospital, the level of education, initial symptom and economic level were significantly associated with the early diagnosis, and the patients having initial hemorrhage and firstly visiting a hospital with higher grade were diagnosed earlier (OR=3.401, 95%CI 1.301-8.892, P=0.013;OR=26.351, 95%CI 4.953-140.193, P=0.000). Conclusion Patients with MMD having initial hemorrhage and firstly visiting a hospital with the third grade can be early diagnosed.

Embolization combined with endovascular stenting for treatment of intracranial pseudoaneurysms / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of embolization combined with endovascular stenting in the for treatment of intracranial pseudoaneurysms.</p><p><b>METHODS</b>Seventeen patients with intracranial pseudoaneurysms received endovascular treatment with coil placement, NBCA glue embolization and endovascular stenting, and the therapeutic effect was evaluated according to the findings in immediate postoperative and follow-up angiography.</p><p><b>RESULTS</b>Fatal aneurysm rupture occurred in 1 case during embolization, and the surgical procedures were carried out smoothly in the remaining 16 cases. The aneurysm cavity dense coil packing ratio was 50% in coil embolization group and 42.9% in stent-assisted coil embolization group. In the follow-up for 3 months to 2 years, 2 patients in coil embolization group experienced pseudoaneurysm recurrence and were managed successfully with additional embolization with coils and stent. Aneurysms were not found postoperatively in stent-assisted coil embolization group.</p><p><b>CONCLUSION</b>Embolization combined with endovascular stenting is a safe and effective treatment of intracranial pseudoaneurysms with minimized risk of recurrence.</p>

The recognition and endovascular treatment of subclavian steal syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate and evaluate the effectiveness and safety of the percutaneous transluminal angioplasty (PTA) and stent placement (SP) in the treatment of left subclavian steal syndrome (SSS).</p><p><b>METHODS</b>From January 2007 to December 2009, 32 patients with left SSS were selected and the digital subtracted angiography (DSA) were used to evaluate before PTA and SP. Anticoagulation and antiplatelet therapy before and after interventional treatment were taken. Then the therapeutic effect was evaluated after the procedure immediately, in the third month and the sixth month post-operatively by transcranial doppler sonography (TCD).</p><p><b>RESULTS</b>DSA was used to evaluate therapeutic effect after PTA and SP, the stenosis degree in average lumens diameter of the patients descended from 87.5% to 15.0%. The stenosis of subclavian steal artery was obviously improved and the contraflow of vertebral artery was disappeared without the stent's recovery and displacement by TCD. The mean systolic blood pressure difference between left and right upper limb was obvious lower than that before therapy [51.6 mmHg (1 mmHg = 0.133 kPa) vs 10 mmHg after 3 months]. No embolism and death was found.</p><p><b>CONCLUSIONS</b>PTA and SP are effective in the treatment of SSS. Anticoagulation and antiplatelet therapy after interventional treatment has a good therapeutic effect. TCD is a cheap, sensitive and non-invasive method for evaluating SSS.</p>

Clinical study on endovascular treatment for symptomatic atherosclerotic stenosis of basilar artery / 中华外科杂志

<p><b>OBJECTIVE</b>To study the feasibility, safety and validity of percutaneous angioplasty and stenting (PTAS) for symptomatic atherosclerotic stenosis of basilar artery.</p><p><b>METHODS</b>The results of treatment and follow-up of 40 cases with symptomatic atherosclerotic stenosis of basilar artery performed PTAS from August 2003 to December 2009 were studied retrospectively, who had either recurrent transient ischemic attacks (TIAs) or obvious ischemic symptoms and resistant to medical therapy.</p><p><b>RESULTS</b>PTAS were successfully performed in all the 40 cases and the post-operative average residual stenosis descended to 14% ± 11% from pre-operative 82% ± 14%. After operation the patients were administrated with antiplatelet drugs. After procedure the clinic symptoms and signs of ischemia were improved obviously in 38 cases and deteriorated in 2 cases whose CT scanning showed that the range of infarction in brain stem enlarged. The symptoms improved after treatment but 2 patients had neurological deficit. No hemorrhagic complications occurred in the group. During the follow-up for 2 months to 7 years, transcranial doppler ultrasonography in 26 cases demonstrated the blood flow was faster than normal in 2 cases, and digital subtraction angiography (DSA) in 6 cases showed restenosis in-stent in 1 case. The second stent was implanted because of the symptomatic restenosis. In another case the follow-up DSA showed occlusion of basilar artery in-stent but there was no ischemia of post circulation because the generation of anastomoses.</p><p><b>CONCLUSIONS</b>PTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic atherosclerotic stenosis of basilar artery. Further study in large number of patients is needed for long-term outcome.</p>

Reconstructive endovascular treatment for symptomatic giant and fusiform aneurysm of vertebrobasilar artery with self-expandable stents / 中华外科杂志

<p><b>OBJECTIVE</b>To reconstruct and affix symptomatic giant and fusiform aneurysms of vertebrobasilar artery by using self-expandable stents in 5 cases with an average volume 5.5 mm × 5.0 mm × 60.0 mm.</p><p><b>METHODS</b>The clinical data of 5 patients who were suffered from giant and fusiform aneurysms of vertebrobasilar artery between October 2007 and October 2009 were retrospectively analyzed. Under instructing of digital subtraction angiography (DSA) images deployed the LEO and Neuroform stents for reconstructing and affixing the deferent 5 giant fusiform aneurysms of vertebrobasilar artery. And assisted embolized with 3 Orbit coils for a ruptured aneurysm to stop bleeding at the same time.</p><p><b>RESULTS</b>The operative procedures were succeeded in all five cases. The damaged signs and symptoms of posterior group of cranial nerves disappeared in 3 cases by following 3 to 26 months. Trigeminal neuralgia in one case was markedly improved but a hemiparesis. One case with subarachnoid hemorrhage (SAH) showed no relapse evidence. Follow up DSA images in 3 cases demonstrated one case with a more rule modality in the part of aneurysm affixed by stent and proximal part of aneurysm in which no covering by stent revealed a mild to expand after 26 months review. And the images of postoperative DSA following 1 month and 4 months in another 2 cases displayed the imaging enlargement of part of the original aneurysm body shrink and shape the rules than the previous view.</p><p><b>CONCLUSIONS</b>The treatment of symptomatic huge fusiform vertebrobasilar aneurysms by using self-expandable stents is feasible, aneurysm growth is under control, short-term effects are positive.</p>

Cause and treatment for intracranial hemorrhage during the perioperative period of carotid artery stenting / 中华外科杂志

<p><b>OBJECTIVES</b>To discuss the possible cause of intracranial hemorrhage and treatment after carotid artery stenting (CAS) in patients with carotid artery stenosis.</p><p><b>METHODS</b>From January 2003 to August 2009, 403 patients with carotid artery stenosis that were performed CAS, intracranial hemorrhage occurred in 5 cases after the procedure. We analyzed the feature of these cases and perioperative management retrospectively to summarize the possible cause of intracranial hemorrhage and preventive measure.</p><p><b>RESULTS</b>Cerebral hemorrhage were found 30 min after CAS in 2 cases, 5 days in 2 cases and 3 days in 1 case. One patient was treated conservatively whose hemorrhage was about 2 ml, one was performed draining of ventricle and the other three cases were all performed craniotomy to remove the hematoma and to depress. The position of hemorrhage were all in the side of carotid artery stenosis, and in 2 cases of them the hemorrhage were at the region of previous cerebral infarction. One patient was cured conservatively, the one who was performed draining of ventricle died. Among the other three cases performed craniotomy, one recovered with light neurological deficit and two died of multiple organ failure.</p><p><b>CONCLUSION</b>Intracranial hemorrhage is the most serious complication of CAS of carotid artery, and general measure should be taken to prevent it from occurring.</p>

Factors associated with cerebral microbleeds in patients with ischemic stroke / 中华神经医学杂志

Objective To investigate the clinical and neuroimaging features of cerebral microbleeds(CMBs)in patients with ischemic stroke. Methods MRI,including gradient-echo T2~*-weighted MRI,was performed in 85 patients with acute ischemic stroke.Their clinical information and imaging characteristics were analyzed. Results One hundred and twenty-four CMBs were noted in 26 patients(30.6%)with the number of CMBs ranged from 1 to 16 per patient.CMBs were more frequently presentcd in the cortical-subcortical region and thalamus-basal ganglia than in the cerebellum and brain stem legions.Some CMBs in the brain stem had related neurological symptoms and signs.CMBs,the age of the patient,the number of lacunar infarcts and the white matter changes were correlative(r=0.243,P=0.025;r=0.337,P=0.025;r=0.438,P=0.000).CMBs could be well demonstrated in the gradient-echo T2~*-weighted MRI and some larger ones could be demonstrated in the apin-echo T2~*-weighted MRI and DWI. Conclusion CMBs are the sighs for microangiopathy in the brain with advanced age,mutiple lacunar infartion and leukoaraiosis as its main prognosis factors.

Effects of montelukast on atherosclerosis and monocyte chemoattractant protein-1 expression in ahypercholesterolemic rabbit model / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the effects of montelukast on atherosclerosis and monocyte chemoattractant protein-1 expression in a hypercholesterolemic rabbit model.</p><p><b>METHODS</b>Thirty four male New Zealand white rabbits were randomized into four groups including normal control group (n = 6), placebo group (n = 8), atorvastatin group (1.5 mgxkg(-1)xd(-1), beginning at 8(th) weeks for 4 weeks, n = 10) and montelukast group (1 mgxkg(-1)xd(-1), beginning at 8(th) weeks for 4 weeks, n = 10). Rabbits except those in normal control group were fed a high cholesterol diet for 12 weeks. Serum lipids were measured at 0, 8 and 12 weeks after intervention. The intima/media ratio, percentages of macrophages or smooth muscle cells in intima and the expression of MCP-1 mRNA were examined.</p><p><b>RESULTS</b>Atherosclerosis was evidenced in placebo group and atorvastatin or montelukast treatment significantly reduced neointima (0.32 +/- 0.12 and 0.34 +/- 0.10 vs. 1.12 +/- 0.36, P < 0.05) and macrophage content [(9.8 +/- 4.6)% and (11.2 +/- 3.7)% vs. (34.6 +/- 8.8)%, P < 0.05], increased SMC content [(18.6 +/- 6.9)% and (19.2 +/- 8.6)% vs. (5.2 +/- 2.3)%, P < 0.05] and inhibited expression of MCP-1 mRNA (0.42 +/- 0.08 and 0.40 +/- 0.06 vs. 2.36 +/- 0.48, P < 0.01). Montelukast had similar anti-atherogenetic effects as atorvastatin but had no influence on plasma lipids.</p><p><b>CONCLUSIONS</b>Montelukast could attenuate atherosclerosis in this hypercholesterolemic rabbit model which might be attributed to its anti-inflammatory effects.</p>

Carotid angioplasty and stenting for stenosis of extracranial carotid artery / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the operation method and prevention from complications of extracranial carotid stenosis.</p><p><b>METHODS</b>Three cases of carotid angioplasty and stenting for 271 patients with extracranial carotid stenosis were performed from October 2001 to June 2008. Before the operation, take Clopidogrel for 75 mg/d, Aspirin Delayed-Release Capsules for 100 200 mg/d, Simvastatin for 40 mg 1/night, for 5 - 10 d. Then treat continuous vein infusion Heparin 50 mg/d for 2 d. After the operation, continue antiplatelet and reduce blood fat therapy.</p><p><b>RESULTS</b>All 300 carotid stenting were successfully accomplished. DSA showed that the diameter of stenosed segment of carotid artery was markedly enlarged, and all clinical ischemia signs were improved remarkably. Seven cases suffered from complications in one week after operation and one died. Following up 3 - 24 months in 226 patients, restenosis were found in 5 cases, among which 45 patients were evaluated at follow-up by means of ultrasonic examination for 36 months or so, no restenosis was found. No ischemic attack occurred at follow-up.</p><p><b>CONCLUSIONS</b>The satisfactory effect and safety are achieved in the therapy of carotid stenosis by carotid angioplasty and stenting. Correct intraoperative treatment and skilled techniques are the key points of success.</p>