RESUMO
Objective:To evaluate the necessity, safety and efficacy of endovascular treatment for cerebral infarction caused by middle cerebral artery (MCA) stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.Methods:The clinical and surgical data of patients with MCA atherosclerotic disease who underwent endovascular treatment in the First Affiliated Hospital of Zhengzhou University from January 2014 to October 2021 were retrospectively analyzed. A total of 6 patients with cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery were selected. The preoperative and postoperative clinical imaging characteristics, perioperative complications and follow-up of these 6 patients were summarized and evaluated.Results:After the endovascular treatment, the imaging of the lenticulostriate artery in all the 6 patients was clearer than that before the operation, and the number of main trunks of the lenticulostriate artery shown by imaging in 2 patients was more than that before operation. The computer tomography perfusion of 6 patients after the endovascular treatment showed that perfusion in the supply area of the lenticulostriate artery was significantly improved compared with pre-operation. No stroke, transient ischemic attack (TIA) and death occurred during the perioperative period. The time of clinical follow-up was 360 (322, 495) days, and there were no stroke, TIA or death occurring in the corresponding artery. All the 6 patients underwent imaging follow-up, of which 3 patients underwent digital subtraction angiography and 3 underwent CT angiography. The lumen of the target vessels showed patency in all patients.Conclusions:With rigorous imaging evaluation, endovascular treatment may be safe and effective for cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.
RESUMO
Objective:To observe the level of mindfulness and coping style in patients with acute cerebral infarction (ACI) after interventional therapy, and analyze the intermediary effect of benefit finding between them, so as to provide a theorectical basis of implement mindfulness intervention in clinical practice.Methods:The 130 patients with ACI after interventional treatment in the First Affiliated Hospital of Zhengzhou University from October 2019 to October 2021 were included in this cross-sectional survey study. The general data questionnaire, Five-factor Mindfulness Scale (FFMQ), Benefit Finding Rating Scale (BFS), and Simple Coping Style Questionnaire (SCSQ) were used to analyze the relationship between benefit finding, mindfulness level and coping style, and the intermediary effect of benefit finding between them.Results:The total FFMQ score of 130 ACI patients after interventional therapy was (123.34 ± 5.14) points. The BFS score, positive coping score and negative coping score were (49.73 ± 3.41), (20.35 ± 2.25), (13.18 ± 1.45) points, respectively. The level of mindfulness and benefit were positively correlated with positive coping ( r=0.687, 0.737, both P<0.05). The level of mindfulness and benefit were negatively correlated with negative coping( r=-0.654, -0.779, both P<0.05). It was found that mindfulness level played a partial intermediatory effect on positive coping and negative coping in ACI patients after interventional therapy, with contribution rates of 49.71% and 64.58%, respectively. Conclusions:Benefit finding plays a partial intermediary effect on the level of mindfulness and coping style of patients with ACI after interventional therapy.
RESUMO
The NLRP3 inflammasome's core and most specific protein, NLRP3, has a variety of functions in inflammation-driven diseases. Costunolide (COS) is the major active ingredient of the traditional Chinese medicinal herb Saussurea lappa and has anti-inflammatory activity, but the principal mechanism and molecular target of COS remain unclear. Here, we show that COS covalently binds to cysteine 598 in NACHT domain of NLRP3, altering the ATPase activity and assembly of NLRP3 inflammasome. We declare COS's great anti-inflammasome efficacy in macrophages and disease models of gouty arthritis and ulcerative colitis via inhibiting NLRP3 inflammasome activation. We also reveal that the α-methylene-γ-butyrolactone motif in sesquiterpene lactone is the certain active group in inhibiting NLRP3 activation. Taken together, NLRP3 is identified as a direct target of COS for its anti-inflammasome activity. COS, especially the α-methylene-γ-butyrolactone motif in COS structure, might be used to design and produce novel NLRP3 inhibitors as a lead compound.
RESUMO
Objective To explore the value of three dimensional sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE)magnetic resonance for postoperative follow-up of intracranial artery stent. Methods The clinical and imaging data of 19 patients with intracranial atherosclerotic stenosis after stent implantation were collected retrospectively from April 2017 to April 2018 in the Department of Neurology, First Affiliated Hospital of Zhengzhou University. 3D-SPACE sequence magnetic resonance examination was performed within 3 days after digital substraction angiography (DSA). Double-blind readings of DSA and MRI images were performed by two physicians, and the degree of lumen stenosis in the stent was measured by the WASID study method. The intra-group correlation coefficient was used to evaluate the consistency of the DSA and 3D-SPACE sequence measurements between the two physicians.The sensitivity, specificity, positive predictive value, and negative predictive value of 3D-SPACE sequence measurement results were evaluated using DSA as the gold standard. Paired sample t test was used to compare the difference in the degree of stenosis between the 3D-SPACE sequence and the DSA. Results Good inter-observer agreement was noted between the two physicians. The ICC value of DSA was 0.903 (P<0.01), and the ICC value of the 3D-SPACE sequence was 0.875 (P<0.01). With DSA as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of the 3D-SPACE sequence in the diagnosis of stent stenosis were 100.0％, 80.0％, 81.8％, and 100.0％, respectively. The average stenosis degree in the stent measured by DSA was (51.7 ±19.2)％, and the 3D-SPACE sequence was (55.5 ± 18.9)％. The difference was not statistically significant (t=1.675, P=0.111). Conclusions 3D-SPACE sequence magnetic resonance imaging can be used as a non-invasive imaging method for follow-up after intracranial stenting.
RESUMO
Objective To evaluate the safety and efficacy of the use of Enterprise stent in the treatment of symptomatic intracranial atherosclerotic stenosis (sICAS) . Methods The clinical data of 27 patients with sICAS, who were treated with Enterprise stent implantation at First Affiliated Hospital of Zhengzhou University, China, during the period from January 2012 to December 2017, were retrospectively collected. The patient's basic parameters, characteristics of target lesions, technical success rate, perioperative safety and follow-up results were analyzed. Results A total of 27 patients (28 lesions in total) were enrolled in this study, and a total of 28 Enterprise stents were implanted. The preoperative mean stenosis degree of lesions was (75.7 ±6.7) ％, the postoperative residual stenosis degree was (23.2 ±16.6) ％. The technical success rate was 100％. Postoperative complication of perforating branch events occurred in 2 patients. No severe complications such as hemorrhage, artery dissection, in-stent thrombosis, hyper-perfusion syndrome, or cardiovascular events occurred. All patients were followed up for (10.8±9.1) months, and 3 instent restenosis lesions (≥50％) were detected although the patients had no target lesion-related symptoms, the incidence of in-stent restenosis was 10.7％. No newly-developed stroke caused by responsible blood vessel, bleeding events or death occurred. Conclusion For the treatment of sICAS, balloon dilatation followed by Enterprise stent implantation is technically feasible, and clinically safe and effective. The incidence of perioperative complications is low and the follow-up results are satisfactory. Further randomized controlled trials are still needed before its long-term efficacy is clarified.
RESUMO
Cellular therapy in acute ischemic stroke (AIS) is a research hotspot in the field of neu-roscience in recent years. Compared with other cells,bone marrow mononuclear cells (BMMNCs) are one of the most attractive therapeutic cells because BMMNCs can be rapidly isolated from bone marrow,are enriched with stem cells and permit autologous applications. Numerous basic researches showed that BMMNCs trans-plantation can decrease infarct volume and promote neurological outcomes in animal stroke model,indicating BMMNCs transplantation may has therapeutic values in acute ischemic stroke,and the transformation from basic research to clinical applications is on the key phase. In this paper,the progress of BMMNCs transplan-tation is reviewed in acute ischemic stroke on the aspects of BMMNCs component,methods of purification, route of transplantation,therapeutic mechanisms and problems from basic research to clinical application.
RESUMO
Objective To analyze the etiology of cerebral ischemic complications occurring in perioperative period of interventional therapy for intracranial aneurysms,and to discuss its prevention and treatment.Methods From January 2011 to March 2015,a total of 1106 patients with intracranial aneurysms underwent interventional therapy at the First Affiliated Hospital of Zhengzhou University,China.Among the 1106 patients,48 patients developed cerebral ischemic complications;their clinical data and the imaging materials were retrospectively analyzed.The factors associated with complications,the effective therapeutic scheme and the clinical preventive methods were discussed.Three months after the treatment,the recovery of neurological function was assessed with modified Rankin Scale (mRS).Results The causes of ischemic complications were,in order of decreasing frequency,cerebral vasospasm/unable elimination of microemboli (n=19),thrombus (n=16),impaired blood flow of adjacent perforating or distal vascular branches caused by embolization (n=6),intra-procedural hypotension (n=4) and cerebral edema (n=3).Combined treatments,including integrated anticoagulation,anti-platelet aggregation,anti-vasospasm,medication of elevating blood pressure,endovascular intervention,etc.were adopted.The patients were followed up for 3 months.Thirty-four patients (70.8％) obtained a mRS of ≤2 (no serious sequelae),and mRS＞2 (poor prognosis) was seen in 14 patients (29.2％).Conclusion The etiology of cerebral ischemia occurring during interventional treatment of intracranial aneurysms is complicated.It is necessary to take useful measures such as individualized anticoagulation,anti-platelet aggregation,anti-vasospasm,etc.during perioperative period of interventional therapy.The procedure-related complications can be effectively treated with interventional therapy and reliably prevented by careful and skilled surgical manipulation.
RESUMO
Objective To evaluate the clinical safety and efficacy of LVIS stent (a low profile knitting designed self-expandable stent) in assisting endovascular embolization for intracranial saccular aneurysms.Methods A total of 127 patients with intracranial saccular aneurysm,who were admitted to authors' hospital during the period from April 2014 to June 2016 to receive LVIS stent-assisted endovascular embolization,were retrospectively analyzed.The safety of the operation,the immediate postoperative outcomes,the recurrence rate,and the clinical and radiographic follow-up results were analyzed.Results A total of 130 LVIS stents were successfully implanted in the 127 patients with intracranial saccular aneurysm,implantation failure was seen in one patient,the technical success rate was 99.2％.During or after the endovascular embolization process in-stent thrombosis was observed in 7 patients (7/127,5.5％).Neither perioperative bleeding nor death occurred.Immediately after the operation,complete occlusion of the aneurysm was obtained in 112 aneurysms (88.1％) and neck remnant was observed in 15 aneurysms (11.9％).The patients were followed up for a mean period of 8 months.Follow-up angiography was performed in 37 patients,which showed that complete occlusion of the aneurysm was obtained in 33 patients (89.1％),and visualization of the aneurysm was seen in 4 patients (10.9％),including 3 patients who had aneurysm visualization immediately after embolization and one patient who had aneurysm recurrence.No death occurred.Conclusion The use of LVIS stent to assist endovascular embolization for intracranial saccular aneurysms is safe and effective,although its long-term effect needs further observation.
RESUMO
Objective To investigate the clinical significance of circumferential aneurysmal wall enhancement (CAWE)in high-resolution magnetic resonance imaging. Methods The imaging and clinical data of 41 patients with intracranial aneurysm underwent gadolinium-enhanced 3. 0 T HR-MRI from October 2014 to July 2015 were analyzed retrospectively. Two experienced neurovascular radiologists read the vascular neuroimagings independently and determined whether the intracranial aneurysm walls of the patents had CAWE. Twenty-five patients had unstable intracranial aneurysms and 16 had stable intracranial aneurysms. The consistency of the diagnostic results of the 2 radiologists was evaluated by the Kappa test. The CAWE,number,location,size and the imaging features of intracranial aneurysms,as well as gender,age, smoking history,drinking history,hypertension and diabetes of clinical risk factors of the patients in both groups were compared. The comparison between groups was conducted by using the chi-square test. Results A total of 47 intracranial aneurysms were detected in 41 patients,including 29 unstable intracranial aneurysms (a unstable aneurysm group)and 18 stable intracranial aneurysms (a stable aneurysm group). The consistency of CAWE results diagnosed by 2 experienced neurovascular radiologists was better (κ =0. 828;95%CI 0. 668 -0. 989). CAWE of the unstable intracranial aneurysms was significantly more than those of the stable intracranial aneurysms. There was significant difference (75. 9%[22 / 29]vs. 33. 33%[6 / 18];χ2 = 8. 341,P = 0. 004). The age of the patients with unstable intracranial aneurysm was younger than 60 years;it was more than those with stable intracranial aneurysm. There was significant difference (68%[17/ 25]vs. 31. 25%[5/ 16];χ2 = 5. 299,P = 0. 021),while there were no significant differences in the imaging features,including the number,location,size,as well as the clinical risk factors,including gender, smoking history,drinking history,hypertension,and diabetes between the 2 groups (P > 0. 05). Conclusion CAWE is significantly more common in unstable intracranial aneurysms. It can differentiate the symptomatic,morphological changes of ruptured intracranial aneurysms between the stable intracranial aneurysms.
RESUMO
Objective To investigate the safety and feasibility of multiple overlapping stents combined with coils in treating intracranial fusiform aneurysms, and to evaluate its therapeutic efficacy. Methods During the period from Aug. 2012 to Aug. 2013, three patients with intracranial fusiform aneurysm were admitted to authors’ hospital. The diagnosis was confirmed by CT angiography and whole cerebral angiography. Multiple overlapping stents combined with coils was carried out in all the three patients. All the patients were followed up and the clinical results were analyzed. Results Multiple overlapping stents combined with coils was successfully accomplished in all the three patients. Greater part of the aneurysmal cavity was occluded, and immediately after the procedure obvious blood whirling in the aneurysmal sac was seen. A total of 7 stents and 17 coils were used in treating the three patients. No aneurysm rupture or thrombosis occurred. The patients were followed up for 3 - 8 months. In one case the headache disappeared in 8 months, no dysneuria was detected, and angiography showed that the aneurysmal sac disappeared and the parent artery was patent. In another patient the headache disappeared in 3 months, and the angiography showed that the aneurysmal cavity had slight visualization and the parent artery was patent. The remaining patient was asymptomatic at 3-month follow-up. Conclusion For the treatment of intracranial fusiform aneurysms, multiple overlapping stents combined with coils is clinically feasible and safe with excellent short-term efficacy although its long-term results need to be further studied. (J Intervent Radiol, 2014, 23: 277-280).
RESUMO
Objective To evaluate the incidence,potential hazards and effective countermeasure for perforator stroke (PS) resulting from stent angioplasty of symptomatic intracranial artery stenosis.Methods Peri-operation PS complications of 258 patients receiving Gateway balloon-Wingspan stenting for severe symptomatic intracranial stenosis were analyzed.The incidence,clinical course,and prognosis of PS resulting from stenting were recorded.Special attention was given to the anatomical features,clinical manifestation and video materials of patients with PS.x2 test was used for statistics.Results Two hundred and fifty-five patients received stent angioplasty successfully and 7 patients had PS ( incidence rate 2.7％ ).The patients with basilar artery stenosis had a higher incidence of PS resulting from intracranial stenting (6.1％,4/66) than patients with middle cerebral artery stenosis (2.5％,3/118) (x2 =2.320,P =0.025 ).The potential hazards for PS included preoperative perforator stroke adjacent to the stenotic segment and prominent dissection during operation.Six patients presented symptoms after awake from general anaesthesia and one had symptoms 3 hours after stenting.One deteriorated gradually and the others reached the maximum deficit almost at once.At the follow-up of 3 months,3 patients were disabled and scored one,two,two by mRS respectively.Conclusion The incidence of PS resulting from intracranial stenting was low and the prognosis was not disastrous.Stenosis at basilar artery and preoperative perforator stroke adjacent to the stenotic segment were potential risk factors for PS complication.Proper maneuver of angioplasty may decrease the incidence of PS and improve the prognosis.
RESUMO
Background and purpose: Sorafenib hepatocellular carcinoma assessment randomized protocol (SHARP) and sorafenib in patients in Asia-Pacific region with hepatocellular carcinoma (ORIENTAL) had indicated that multi-kinase inhibitor sorafenib could prolong overall survival (OS) and time to progression (TTP) as well as improve progress free survival (PFS) in patients with advanced stage hepatocellular carcinoma. Drug-related adverse events in the course of treatment restricted its clinical application to a certain degree. This study was aimed to summerize the adverse events as well as the management of sorafenib in our clinic. Methods: Twenty-five cases clinically diagnosed as advanced hepatocellular carcinoma were enrolled from January 2008 to October 2009. All the patients who received sorafenib treatment met inclusion criteria as followed: (1) Progression of disease after trans-hepatic arterial chemoembolization therapy; (2) Extensive portal vein cancerous thrombus formation; (3) Portal zone or retroperitoneal lymph node metastasis or multiple remote metastasis, such as lung or bone; (4) Diffused poor blood supply to tumor; (5) Inform consent was obtained. All adverse events with different grade were observed during the beginning 12 weeks, and clinical treatment were carried out relatively. Results: Total of 25 cases were enrolled. Nine patients died of the disease, 3 of them died during the first 12 weeks, 3 patients abandoned sorafenib treatment, among them 2 died before the finish of 12 weeks treatment and 1 patient discontinued 5 months after the sorafenib treatment. Twenty cases finally assigned. Number of patients encountered drug-related adverse events were: HFSR (hand-foot-skin-reaction) 4(4/20), diarrhea 4(4/20), alopecia 5(5/20), rasb 4(4/20), fatigue 8(8/20), leukopenia and Thrombocytopenia 4(4/20), elevated blood pressure 1(1/20) and abdominal pain 1(1/20). After clinical management, 20 patients' sorafenib treatment were eventually not affected by adverse events. Conclusion: Sorafenib was well-tolerated and is a safe option of treatment for patients with advanced hepatocellular carcinoma.
RESUMO
Objective To present our single-center experience in treating traumatic direct carotidcavemous fistulas (TDCCFs)by using detachable balloon,coil and Willis covered stent via arterial route.Methods During the last five years,transarterial endovascular treatment by using detachable balloon,coil and Willis covered stent was performed in fifty-one consecutive patients of traumatic direct carotid-cavernous fistulas.with a total of 54 TDCCFs.The detachable balloon was the material of first choice,while Willis covered stents and coils were regarded as the back-up materials.A clinical and angiographic follow-up for 348 months (mean 20.8 months) was conducted to evaluate the arterial patency and the stability of embolization.The clinical data were retrospectively analyzed.Results By using the detachable balloon alone via transarterial route.85%TDCCFs were successfully treated with good preservation of ICA.A total of 98% TDCCFs in this study were successfully treated by using detachable balloon,coil and/or Willis coveted stent,the fistulas became occluded,and ICAs were preserved except one patient.Forty TDCCFs were treated with detachable balloons alone,two TDCCFs with the Willis covered stent alone,and one DCCF with coils alone.Eight TDCCFs were treated with detachable balloons together with Willis covered stent.Of these eight TDCCFs,two were treated with a single session,three were treated with detachable halloons in combination with coils,and one had to receive Willis covered stent.Second and third times of endovascular treatment were needed in 12 TDCCFs.The TDCCF-rel(at)ed symptoms were gradually relived or improved within 1 day to 6 months after treatment,except for five patients who suffered from ipsilateral moderate visual loss or cranial nerve deficit.No perioperative complications.such as vessel rupture,distal embolization or new neurologic deficits,occurred.During the follow-up period lasting for six months,neither delayed neurologic or vascular complications nor recurrence of the lesions developed.Conclusion Via the transarterial route,using detachable balloon to occlude the fistula and at the same time to preserve ICA remains the optimal treatment for TDCCFs.When the standard treatment fails.various coils and the Willis covered stents can be used as an effective alternative or remedial tool in the treatment of TDCCFs,which can preserve ICA.Willis covered stent deployment seems to be an effective,safe,feasible and economical endovasculal treatment for TDCCF,but more clinical studies are needed before we can further clarify its specifications and indications.
RESUMO
Objective To study the apoptosis of endothelial cells and the relation between it and the expression of P53 protein after focal cerebral ischemia reperfusion in rats.Methods The apoptosis of endothelial cell 2,6,12 h and 1,2,3,7,14,21 d after cerebral ischemic reperfusion were observed using an in situ end labeling method,and the expression of P53 protein was detected by immunohistochemical staining methods.Results Apoptotic endothelial cells in ischemic penumbra were observed 2h after cerebral ischemic reperfusion, they peaked at 12~24 h, and decreased gradually.There was no remarkable difference between it and the sham operative group at 21 d.The P53 protein began to express 6h after cerebral ischemic reperfusion, it peaked at 1~2 d, and then declined gradually to controlled level at 7d. The expression peak time of P53 was 24 h later than that of cell apoptosis.Conclusion Apoptosis was a pattern of endothelial cell death after reperfusion of MCAO. P53 protein played an important role in the process of apoptosis of endothelial cells.
RESUMO
ObjectiveTo investigate effects of exhaustive swimming on erythrocyte membrane composition. MethodThe components of rat erythrocyte membrane like sialic acid,phospholipid cholesterol ,ratio of cholesterol/phospholipid , -SH and MDA were measured afterexhaustive swimming. ResultThe components of erythrocyte membrane such as sialic acid,phospholipid and-SH decreased significantly while MDA,cholesterol/phospholipid ratio increased after exhaustive swimming,no significant change of cholesterol content was ob-served. ConclusionIt suggested that exhaustive swimming caused significant changes in composition of erythrocyte membrane impairing thedeformability and normal function of erythrocyte.