Only overlapping stents therapy for intracranial vertebral artery dissection aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, safety, clinical, and angiographic follow-up of only overlapping stents therapy for intracranial vertebral artery dissection aneurysms (VADA).</p><p><b>METHODS</b>Eight consecutive patients (6 men, 2 women; mean age 46.8 years ranging from 34 to 62 years) with intracranial VADA admitted to Department of Neurology, Chinese People's Liberation Army General Hospital from June 2008 to June 2014 were retrospectively reviewed. All patients were diagnosed intracranial VADA by MRI or digital subtraction angiography (DSA). All patients were treated by only overlapping stents therapy under general anesthesia. In the endovascular treatment process 2 to 3 Solitaire, Neuroform or Wingspan self-expandable stents were overlapping implanted in the segment of the aneurysms. All patients received routine antiplatelet therapy before and after endovascular treatment.</p><p><b>RESULTS</b>The operative procedures were succeeded in all patients. Eight patients were implanted 18 stents (2 patients, 3 stents; 6 patients, 2 stents). The stents were located accurately and implanted smoothly, none perioperative complications occurred. All patients lived and worked normally and had no recurrent symptoms on follow-up of 6 to 48 months. All patients performed DSA reexamination on follow-up. The aneurysm blocked in 2 patients, the size lessened in 2 patients, and the size had no change in 3 patients.</p><p><b>CONCLUSIONS</b>Only overlapping stents therapy for treating intracranial VADA is feasible and has good operation safety. Preliminary follow-up results show that it can reduce the probability of thrombosis or hemorrhage and can improve the patients' life quality.</p>

Transient Receptor Potential Ankyrin 1 Channel in Neuropathic Pain (review) / 中国康复理论与实践

Transient receptor potential ankyrin 1 (TRPA1) is a family member of the transient receptor potential (TRPs). It is primarily localized to a subpopulation of primary sensory neurons, such as trigeminus, vagus and dorsal root ganglia. Neuropathic pain is often caused by peripheral nerve injury, diabetes and chemotherapeutics. A large of oxidative/nitrative stress products are produced during neuropathic pain, which cause acute nociception, allodynia, and hyperalgesia. TRPA1 antagonists may be beneficial in the treatment of neuropathic pain. Here, the role of TRPA1 in neuropathic pain is summarized.

Clinical value of CereTom mobile CT scanner for patients in neurological ICU / 医疗卫生装备

Objective To explore the clinical value of cranial CT for the patients in neurological ICU by analyzing the application of mobile CT scanner CereTom in some hospital.Methods Retrospective analysis was carried out for the patients being hospitalized and undergoing cranial CT examination in some hospital from March 2012 to August 2014.Results Totally 261 patients and 325 times of examination were involved in, and two ones failed in the examination, with the success rate of 99.23%. There were 218 patients (83.52%) had the examination completed in one time and 43 ones (16.48%) in several times. It's proved that bedside CT could be applied clinically with high successful rate. The mean time of bedside CT examination was (18.3±3.8)min, significantly less that then of common examination.Conclusion Mobile CT may decrease moving-related risk of the patient and the time, manpower consumed for examination, and thus is worth popularizing clinically.

Microarray analysis of gene expression after electrical stimulation of the dura mater surrounding the superior sagittal sinus in conscious adult rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The molecular and cellular origins of migraine headache are among the most complex problems in contemporary neurology. Up to now the pathogenesis of migraine still remains unclearly defined. The objective of this study was to explore new factors that may be related to the mechanism of migraine.</p><p><b>METHODS</b>The present study performed a comprehensive analysis of gene expression in the trigeminal nucleus caudalis induced by electrical stimulation of dura mater surrounding the superior sagittal sinus in conscious rats using microarray analysis followed by quantitative real-time reverse-transcribed polymerase chain reaction (qRT-PCR) verification. Student's two sample t-test was employed when two groups were compared. A P value <0.05 was considered to be statistically significant.</p><p><b>RESULTS</b>Comparing the placebo and the electrical stimulation groups, 40 genes were determined to be significantly differentially expressed. These significantly differentially expressed genes were involved in many pathways, including transporter activity, tryptophan metabolism, G protein signaling, kinase activity, actin binding, signal transducer activity, anion transport, protein folding, enzyme inhibitor activity, coenzyme metabolism, binding, ion transport, cell adhesion, metal ion transport, oxidoreductase activity, mitochondrion function, and others. Most of the genes were involved in more than 2 pathways. Of particular interest is the up-regulation of Phactr3 and Akap5 and the down-regulation of Kdr.</p><p><b>CONCLUSION</b>These findings may provide important clues for a better understanding of the molecular mechanism of migraine.</p>

Preliminary analysis of right heart contrast echocardiography in healthy volunteers / 中华医学超声杂志（电子版）

Objective To explore the incidence of the right to left shunt (RLS) originated from patent foramen ovale (PFO) and/or pulmonary (PFO-RLS and/or P-RLS). Methods The transoesophageal echocardiography (TEE) and contrast transthoracic echocardiography (cTTE) were performed in 42 consecutive healthy adults. An agitated saline solution was used as contrast agent. According to the time that microbubbles (MB) occurred in the left atrium within or beyond the ifrst 3 cardiac cycles after contrast appearance in the right atrium, the RLS was identiifed as PFO-RLS or P-RLS. The RLS were semi-quantitated and graded in a three-level categorization according to the number of MB appearanced in the left atrium in every single frame image:level 1 indicated ≤10 MB, namely mild RLS;level 2 indicated 11-30 MB, namely moderate RLS and level 3 indicated>30 MB, namely severe RLS. The reseach mainly focused on:(1) How many PFO and PFO-RLS existed in healthy adults? What was the size of PFO in healthy adults ? (2) Was there any P-RLS could be detected in healthy adults and what was the incidence of P-RLS ? (3) Was there any relationship between the RLS and Valsalva maneuver ? (4) The semi-quantitation and grading of the RLS originated from different sources. Results In 42 healthy adults, 13 cases (13/42, 30%) were diagnosed as PFO by TEE. The width of PFO was (1.46±0.18) mm (1-3 mm) and the length of PFO was (7.23±1.09) mm (4-14 mm). In 42 healthy adults, 30 cases (30/42, 71%) were diagnosed as RLS by cTTE. In 4 cases, the RLS were originated both from PFO and pulmanory, so ifnally there were 12 PFO-RLS (12/42, 29%) and 22 P-RLS (22/42, 52%). Most of PFO-RLS occurred during Valsalva maneuver, especially at the end of Valsalva maneuver, except 1 case in which PFO-RLS occurred at rest condition. Most of P-RLS occurred during rest condition (14) and few occurred after Valsalva maneuver (8). The incidence of PFO-RLS was lower than that of P-RLS. The difference between the two incidences was signiifcant (χ2=4.941, P=0.026). The diagnose for PFO was consistent in 11 cases between TEE and cTTE. But 2 cases were only diagnosed as PFO by TEE and 1 case were only diagnosed as PFO-RLS by cTTE. The semi-quantiifcation grading of RLS was signiifcant different between PFO-RLS and P-RLS (Z=-3.901, P=0.000). In 12 PFO-RLS, there were 6 cases in level 2 and 6 cases in level 3. In 22 P-RLS, there were 11 cases in level 1, 10 cases in level 2 and 1 case in level 3. Conclusions In healthy adults, PFO with a small amount RLS is common and its incidence is about a quarter. The detecting of PFO-RLS must be supplemented by a valsalva maneuve. In healthy adults, the P-RLS is also common and its semi-quantiifcation grading is lower than that of the PFO-RLS. The incidence, detecting inlfuence factor and the clinical signiifcant of the P-RLS are still not very clear and need more study.

The effects of flunarizine hydrochloride on plasma calcitonin gene-related peptide and substance P levels after cortical spreading depression in rats / 中国神经精神疾病杂志

Objective To explore the effects of flunarizine hydrochloride on plasma calcitonin gene-related pep-tide and substance P levels after CSD in a rat migraine model of cortical spreading depression (CSD). Methods Thirty adult rats were randomly and evenly divided into three groups:control Group, CSD group and flunarizine group. The CSD waves were evoked by application of potassium chloride on brain surface with filter paper. Funarizine hydrochloride was intravenously administered to rats five minutes prior to application of potassium chloride. The plasma levels of CGRP and SP were measured by using radioimmunity assay. Statistical analyses were performed using two-sample t test and analy-sis of variance. Results CSD waves were absent in control group whereas CSD waves were induced in CSD and flunari-zine groups. The latency of the first CSD wave was longer in flunarizine group (167.90 ± 25.18 s) than in CSD group (130.90 ± 13.30 s) (P<0.01). The number of CSD waves was smaller in flunarizine group (4.50 ± 1.84) than in CSD group (8.50 ± 2.07) (P<0.01). The amplitude of CSD waves was lower in flunarizine group (11.40 ± 4.12 mv) than in CSD group (24.40±3.57 mv) (P<0.01). The levels of CGRP and SP in both CSD group (CGRP, 32.95±11.61 pg/mL;SP, 27.80±7.51 pg/mL) and flunarizine group (CGRP, 25.13 ± 5.67 pg/mL; SP, 19.45 ± 6.10 pg/mL) were higher than in control group (CGRP, 14.44 ± 6.39 pg/mL; SP, 12.36 ± 4.22 pg/mL) (P<0.01). The levels of CGRP and SP in flunarizine group (CGRP, 25.13±5.67 pg/mL;SP, 19.45±6.10 pg/mL) were lower than those in CSD group (CGRP, 32.95±11.61 pg/mL;SP, 27.80± 7.51 pg/mL) (P<0.05). Conclusions Flunarizine hydrochloride can inhibit CSD and reduce the plama levels of CGRP and SP in the rat model of CSD.

Effects of rizatriptan on cortical spreading depression and c-Fos expression within periaqueductal grey / 中华神经科杂志

Objective To determine whether rizatriptan has an effect on cortical spreading depression (CSD) and c-Fos expression within periaqueductal grey (PAG) induced by CSD in rats. Methods The experimental SD rats were randomly divided into group A injected with KCl, group B KCl plus rizatriptan and group C NaCL The number and amplitude of CSD were recorded after KCl or NaCl injection. C-Fos positive neurons of different layer were identified by the immunohistochemical technique 2 hours after the first injection of KCl or NaCl. Results There was no CSD in group C. The number of CSD in group A ( 10.70±3.23 ) was significantly more than that in group B (6.10±2.56, t = - 3.528, P < 0.01 ). The amplitude of CSD in group A ( 17.33 (95% CI 11.45--23.11 ) mV) was significantly greater than that in group B (11.82 (95%CI 9.24--14.70) mV, Z= -4.360, P< 0.01). There were more cFos-like immnoreactive neurons in every layer in group A than in group C (P < 0.01 ) and in group B (P < 0.05 ). Conclusion Rizatriptan has an inhibitory effect on CSD, which might induce the headache through exciting the neurons in PAG.

Analysis on Relationship between Leukoaraiosis and Carotid Atheromatous / 中国康复理论与实践

@#Objective To investigate the relationship between the leukoaraiosis(LA) and atheromatous.Methods 86 LA patients(as the observation group) and 84 non-leukoaraiosis patients(as the control group) were given examinations of carotid color doppler ultrasonography and magnetic resonance angiography(MRA).The imaging data of two groups were analyzed contrastively.Results In the observation group,the detectable rate of carotid atheromatous plaques was 86.05%,the rates of medium and serious stenosis were 52.70% and 24.32%;the detectable rate of intracalvarium artery atheromatous plaques were 75.58%,the rates of medium and serious stenosis were 46.15% and 29.23%.By analysis of statistics,there was a significant difference between the two groups(P<0.01).Conclusion Carotid and intracalvarium artery atheromatous plaques are closely correlation with LA,and may signify the genesis,development and severity of LA.

Involvement of Sympathetic Nerve System in Vascular Headache / 中国康复理论与实践

@#Objective To investigate the involvement of sympathetic nerve system in the transmission of nociceptive information related to vascular headache. Methods Fos expression in the midbrain periaqueductal grey (PAG) induced by electrical stimulation of dural matter near the superior sagittal sinus (SSS) of the rat was determined before and after the extirpation of the superior cervical ganglion (SCG) using standard avidin-biotin immunohistochemistry. Results Fos immunoreactive positive neurons were detected in the ventrolateral PAG, and were bilateral symmetry. Fos expression was (133.3±12.5) in SCG extirpated group, and higher than that in sham-operated group (76.0±11.3). Conclusion The sympathetic system may be involved in the transmission of nociceptive information through PAG, associated with vascular headache such as migraine.

Diagnosis and therapy of trigeminal autonomic cephalalgias / 中国实用内科杂志

This paper introduces the classification of trigeminal autonomic cephalalgias (TAC) and their clinical manifestation,diagnostic criteria and therapy of main type.TAC share the clinical features of headache and prominent cranial parasympathetic autonomic features.The most effective therapy for acute cluster headache is oxygen inhalation and Sumatriptan subcutaneous injection.Ergotamine is the first choice drug for the preventive treatment of episodic cluster headache and Verapamil coupled with Lithium salt is preventive treatment for chronic cluster headache.Indomethacin is specific treatment for paroxysmal hemicrania.Lamotrigine,Topiramate and Gabapentin are all useful to SUNCT.