Short-term follow-up for unruptured wide-necked intracranial aneurysms treated with Pipeline embolization device / 中国脑血管病杂志

Objective To evaluate the short-term effect of Pipeline embolization device (PED)for the treatment of unruptured wide-necked intracranial aneurysms. Methods From October 2015 to September 2016,15 consecutive patients with unruptured wide-necked intracranial aneurysm (aneurysm neck and aneurysm body ratio ≥0. 5)treated with PED at the Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University were enrolled retrospectively. Their clinical and imaging data were analyzed. Kamran scale was used to evaluate the embolization rate of aneurysms and the changes of the parent arteries. DSA examination was performed again at 6 -12 months after operation. Results Fifteen PED were implanted in 15 patients with unruptured wide-necked intracranial aneurysms,including 13ophthalmic artery aneurysms,1 posterior communicating artery aneurysm,and 1 cavernous sinus aneurysm. The technical success rate was 100% . Immediately after PED implantation,Karman rating of 15 cases were aneurysm grade 2 embolization,parent artery grade A (grade 2a). DSA examination was performed again at 6 - 12 months after operation showed that 14 patients were aneurysm grade 4,parent artery was grade A (grade 4a). One patient (ophthalmic artery aneurysm)underwent the second DSA examinations at 6 and 12 months after operation showed that the residual development of aneurysms. The aneurysm embolization was grade 3, and the parent artery was grade A (grade 3a). No branch artery occlusion was observed. Non of them had neurological deficit. The modified Rankin scale score was 0 in all 15 patients. Conclusion The use of PED in the treatment of unruptured wide-necked intracranial aneurysms has a higher occlusion rate. Its long-term effect still needs further follow-up.

A Meta-analysis of effect comparison between interventional embolization and surgical clipping in treatment of ruptured intracranial aneurysms / 重庆医学

Objective To compare the efficacies between interventional embolization and surgical clipping in treatment of ruptured intracranial aneurysms to provide an evidence‐based basis for selecting the clinical treatment scheme .Methods The related randomized controlled trail(RCT) literatures on the effects of interventional embolization and surgical clipping were retrieved from the databases of Pubmed ,Cochrane ,Medline and Embase .The screening was independently performed by two researchers according to the including and excluding criterion .The occurrence rate of adverse reactions ,postoperative 1‐year mortality rate ,re‐bleeding rate ,occurrence rate of vasospasm and ischemic cerebral infarction served as the measurement indicators .The data were extracted and performed the meta analysis by the RevMan5 .3 software .Results Sixteen RCT literatures were included for conducting analy‐sis ,involving 7 373 patients ,in which 3 092 cases adopted interventional embolization and 4 281 cases adopted surgical clipping .The occurrence rate of adverse events(OR=1 .25 ,95% CI ,1 .12-1 .40 ;P<0 .000 1) and re‐bleeding rate(OR=0 .43 ,95% CI ,0 .28 -0 .66 ;P=0 .000 1) in the interventional embolization group were lower than those in the surgical clipping group ;however ,there were no statistical differences between the interventional embolization group and surgical clipping group in the postoperative 1‐year mortality rate(OR=1 .13 ,95% CI ,0 .92-1 .39 ;P=0 .23) ,incidence rate of vasospasm (OR=1 .41 ,95% CI ,0 .99-2 .02 ;P=0 .06) and incidence rate of ischemic cerebral infarction(OR=0 .66 ,95% CI ,0 .42 -1 .05 ;P=0 .08) .Conclusion The current clinical re‐search evidences indicate that using the interventional embolization in treating ruptured intracranial aneurysms can obviously reduce the occurrence rate of adverse events than the surgical clipping ,but increases the re‐bleeding rate .The postoperative 1‐year mortali‐ty rate ,incidence rate of vasospasm and incidence rate of ischemic cerebral infarction have no obvious difference between these two kinds of operation .

Clinical pathway for the safety in patients with intracranial aneurysms during the perioperative period / 实用医学杂志

Objective To explore the effect of clinical pathway on the safety in patient with intracranial aneurysms during the perioperative period. Methods A total of 68 patients with intracranial aneurysms who had been hospitalized and treated from July to December 2012 were assigned to a study group and received clinical pathway. And then they were compared with 56 patients who had been treated from January to June (control group). The patients in control group received routine medical care. Then all the patients were evaluated in preoperative waiting duration, incidence of postoperative complications, health education compliance rate, and the Glasgow outcome scale (GOS) at discharge. Results Both the incidence rate of cerebral vasospasm and hydrocephalus and the health education compliance rate were improved in the study group (P<0.05), so was the GOS at discharge and 6 months after discharge (P<0.05). Conclusions The clinical pathway management plays a role in guarantee of the safety in patient during the perioperative phase and in the acceleration of postoperative rehabilitation.

Clinical and anatomy research external fixation combined with limited cut restoration gram needle internal fixation for distal radial fractures / 中国基层医药

ObjectiveTo explore the anatomy and clinical significance of fixation combined with limited outside cut restoration gram needle internal fixation for distal radial fractures. MethodsBased on the anatomical observation and measurement of the forearm and hand. Found out the distal radial fractures fixed bracket screws and gram needle safety area and the needle into the body, and made reasonable angle respectively, to formulate standardized orientation, and applied to clinical procedures, and the clinical cases were followed up. The clinical curative effect was observed. ResultsThe place for the fixed bracket screws of the second metacarpal was the nail parts of radial dorsal partial ends. The proximal fracture for external fixation stents bolt into the nail near abductor muscle and manipulation long in the thumb short extensormuscles. Its feet side for stabbing abductor muscle and refers to a long stretch of radial side for tendon, radial side wrist short stretch muscles. The farthest distance between the lister nodule was (63.69 ±3.00) mm,nearest distance between the lister nodule was(123.64 ±5.00)mm. Gram needle do limited internal fixation security clearance for thumb long stretch tendon and refers to stretch tendons,radial side wrist length stretch tendons, thumb short extensor tendons, stretch retinaculum and this gap proximal distance lister nodule for ( 33. 52 ± 4.20) mm, remote distance lister nodule for( 8.81 ± 0. 88) mm. In clinical applications, wrist imaging recovery, function of ratings had no significant difference ( P ＞ 0.05). But the postoperative complications of the two sets of patients had statistically significant difference ( P ＜ 0. 05 ). ConclusionAccording to the anatomy of distal radial fractures,from the results of our research applied in fixation distal radial fractures in the operation,it had the advantages of simple operation,reset good,fixed firmly,and small trauma. It was worth of used widely in clinical.

Effect of autologous bone marrow cell transplantation on angiogenesis in focal cerebral ischemia in rats / 中国组织工程研究

BACKGROUND: Bone marrow cell transplantation is a simple and effective treatment to promote angiogenesis. The neovascularization and reestablishment of blood circulation is crucial to the repair of injured but still living neurons as well as to the survival and differentiation of the implanted tissues and cells. However,it is not clearly known whether autologous bone marrow cells implantation could promote neovascularization and facilitate reestablishment of circulation in ischemic regions of the brain.OBJECTIVE: To investigate the effect of autologous bone marrow cell transplantation via the carotid artery on angiogenesis in the ischemic regions of the brain.DESIGN: A randomized controlled experiment based on experimental animals.SETTING: Department of neurosurgery and institute of urinary surgery in a university hospital.MATERIALS: The experiment was conducted in the Laboratory of the Department of Neurosurgery,Second Affiliated Hospital,and the Institute of Urinary Surgery,Jiangxi Medical College during the period from September 2002 to April 2003,using 10 specific pathogen-free male SD rats weighing 250 - 300 g.INTERVENTIONS: Rat models of focal cerebral ischemia model were established and randomized equally into two groups. The rats in the transplantation group were injected with autologous bone marrow cells via the carotid artery and those in the control group normal saline injection. The angiogenesis in the ischemic regions of the brain was observed with immunohistochemical staining for microvessel counting.MAIN OUTCOME MEASURES: The density of microvessels. Immunohistochemical staining for F8.RESULTS: Greater density of the microvessels was found in the ischemic regions after bone marrow cell transplantation than in the control group[(159. 15 ±40.4)/mm2 vs(81.70 ± 32. 18)/mm2,P ＜ 0. 05] . Numerous endothelial cells were found scattered in the ischemic cortex of the transplantation group,but scarcely in the control group.CONCLUSION: Autologous bone marrow cell transplantation via the carotid artery can promote angiogenesis in the ischemic regions of the brain.

Requirements of human brain-derived neural stem cells for different storage, isolation and cultivation / 中国组织工程研究

BACKGROUND: Due to a new finding in the in vitro proliferation and differentiation of neural stem cells, neural stem cells are regarded as optimal materials for repairing and replacing the injured neural tissues. But how to enhance the proliferation of neural stem cells and how to induce neural stem cells to differentiate into certain phenotypes remain objects for discussing.OBJECTIVE: To investigate the frozen/nonfrozen storage techniques in isolation and cultivation of neural stem cells isolated from human brain and to discuss the conditions suitable for their differentiation.DESIGN: A single sample based on cells.SETTING: Urinology Institute of Jiangxi Medical University and Neurosurgery Department of Second Hospital Affiliated to Jiangxi Medical College.MATERIALS: From December 2003 to June 2004, this study was conducted at the Urinology Institute of Jiangxi Medical College. Brain tissues removed from sixteen-week-old embryos were studied.METHODS: After being digested with trypsin, cells were separated from the brains of embryos. They were cultured in the serum-free media, stimulated by basic fibroblast growth factor and epidermal growth factor and were induced to differentiate using serum. Immunofluorescent cytochemical staining technique was adopted to detect the expressions of the Nestin and the neuron-specific enolase(the marker for mature neural cells) in these cells. The influence of basic fibroblast growth factor, epidermal growth factor and serum on the proliferation and differentiation of the neural stem cells were investigated.MAIN OUTCOME MEASURES: The main outcome measurements in this tification of the Nestin and the neuron-specific enolase in these cells.bryo brain successfully. The embryo brain cells in primary culture were clear and round. After 3 days some cells aggregated to form neurospheres and some others suspended. Two weeks later, the neurospheres enlarged and a part of cells in it expanded into folds with strong reflection and proliferation. The continuous cultured cells inherited these characteristics and kept the morphological properties. The clones were cultured in the medium with serum. Twenty-four hours later, most of the cells were attached to the bottom of the plates. Cells were dissociated from the neurospheres and became irregular. Forty-eight hours later, most of the cells differentiated into many scattered patches of astrocytes with various shapes and neurites and many isolated neural stem cells were continuously cultured in vitro and they expressed Nestin, the marker of neural stem cells. After being cultured in medium with serum for 48 hours, the differentiated cells mainly expressed freeze-thaw cells were alive. Their living status had no significant difference compared to that of the fresh isolated cells.CONCLUSION: Serum-free culture medium, together with basic fibroblast growth factor and epidermal growth factor, enables the in vitro culture, proliferation and purification of the neural stem cells. The feasibility of the method is confirmed. Meanwhile, the comparison between the cultures of freeze-thaw cells and fresh isolated cells indicated that frozen storage can be used as a way to preserve the human embryo brain cells, which will be available for study after thaw.