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Objective:To investigate the efficacy and safety of encephalo-duro-arterio-synangiosis (EDAS) for intracranial atherosclerotic steno-occlusive disease (ICASD).Methods:Patients with symptomatic ICASD received EDAS treatment in the Department of Neurosurgery, the PLA General Hospital from January 2018 to January 2019 were retrospectively included. The baseline information, perioperative complications, primary endpoint events, and changes in modified Rankin Scale (mRS) scores before and after surgery were collected. The primary endpoint event was any stroke/death that occurred within 30 d after enrollment. The secondary endpoint events were any stroke/death, non-stroke bleeding (subdural or epidural bleeding), and clinical functional improvement after 30 d. The clinical functional improvement was defined as a decrease of ≥1 in the mRS score compared to before surgery.Results:A total of 40 patients were included, including 30 males and 10 females, aged 53.9±8.6 years old. The clinical symptoms were mainly limb weakness and dizziness. One case of ischemic stroke and one case of hemorrhagic stroke occurred during the perioperative period. The primary endpoint event incidence was 2.5%. The patients were followed up for 49.75±2.99 months after surgery. One patient died of cerebral hemorrhage 31 months after surgery, and one patient developed acute ischemic stroke 35 months after surgery. The postoperative mRS scores of 34 patients decreased compared to before surgery, and the clinical function improvement rate was 85%. The mRS score increased in 2 cases after surgery compared to before surgery and 4 cases had no change.Conclusion:EDAS can improve the clinical function of patients with symptomatic ICASD and reduce the incidence of long-term stroke.
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Objective To investigate the indications of optic canal decompression in the patients with front-orbital fibrous dysplasia and the methods of intraoperative optic canal localization and decompression. Methods We collected 30 cases of fibrous dysplasia. All patients had sufficient images assessment. Patients with symptoms underwent surgery, including front-orbital cranioplasty and optic canal decompression. The frontotemporal epidural approaches were used. If there was a proptosis, the approach was extended with the removal of superior orbital ridge. Six patients undertook intraoperative CT and MRI fusion navigation, assisting in confirming the trunk, orbital and cranial orifice of optic nerve. During the operation, the optic canals were decompressed by three-bits method, to confirm the position of optic nerve. Results There were 30 cases of optic canal decompression and one case of vision loss. The visual acuity and vision field of the remaining patients improved to varying degrees. The proptosis disappeared or alleviated after the operation. Thirteen cases were reconstructed with normal internal plate, five cases with titanium plate, nine cases without reconstruction, and two cases were paved with proliferative broken bone on the orbital top; one case recurred with exophthalmos again after five years, but the visual acuity did not decline. Conclusion For the patients with front-orbital fibrous dysplasia, active surgical treatment should be taken, optic canal decompression should be chosen for diminution of vision, craniofacial anaplasty and orbital decompression should be performed in patients with facial deformity. The epidural approach is a good option to locate the optic nerve from the orbital orifice or cranial orifice. Combined with the three-bits method, we can achieve safe and meticulous optic nerve decompression.
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Lung cancer is the malignant tumor with the highest incidence and mortality in China, and is prone to brain metastasis in the process of disease development, which seriously affects the quality of life and survival of patients. The treatment methods for brain metastasis of lung cancer include surgery, chemotherapy, whole brain radiotherapy, stereotactic radiosurgery, molecular targeted therapy, immunotherapy, anti-angiogenesis therapy, etc. It's one of the research hotspots to choose reasonable and effective treatment schemes for different patients. This paper reviews the research progress in the treatment of brain metastasis from lung cancer, to provide reference for selecting more reasonable clinical treatment for the patients.
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Glioma is the most common primary malignant brain tumor with high recurrence and mortality rate. It is difficult to cure only relying on surgical resection, and comprehensive treatment options must be adopted. With the development of molecular and immunological research, novel therapy options represented by tumor-treating fields, targeted therapy and immunotherapy for glioma are gradually increasing, and some new progress has been made. This review will present the important achievements in the treatment of glioma in recent years and prospects for the future development.
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Background@#and Purpose Brainstem gliomas (BSGs) in adults are rare brain tumors with dismal outcomes. The aim of this study was to determine the clinical and genetic features in a series of BSGs and their association with the prognosis. @*Methods@#Fifty patients who underwent a stereotactic biopsy between January 2016 and April 2018 at a single institution were collected. Data on clinicopathological characteristics were analyzed and factors associated with patient survival were identified using a Cox regression model. @*Results@#The median age at diagnosis was 55.5 years, and 62% of the patients were male. Glioblastoma (44%) accounted for the largest proportion of BSGs, and oligodendroglioma (2 of 50) was rarely encountered. The IDH mutation (6 of 44) occurred infrequently in astrocytomas, and IDH-mutant tumors harbored both ATRX loss and MGMT promoter methylation at a relatively low level. Wild-type IDH astrocytomas were identified as having high rates of 1p/19q codeletion (5 of 38) and loss of heterozygosity 1p (8 of 38) or 19q (8 of 38) only. In diffuse midline glioma H3K27M mutant, MGMT promoter methylation occurred in three of four cases. Patients were offered radiotherapy and/or concurrent/adjuvant temozolomide chemotherapy, and their median survival time was 13 months. Multivariate analysis revealed that a low tumor grade, absence of tumor enhancement, duration of symptoms ≥3 months, Karnofsky performance status ≥70, and ATRX loss conferred a survival advantage. @*Conclusions@#Adult BSGs showed different molecular genetic characteristics, but also resembled supratentorial gliomas in their clinical features associated with oncological outcomes.
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Background@#and Purpose Brainstem gliomas (BSGs) in adults are rare brain tumors with dismal outcomes. The aim of this study was to determine the clinical and genetic features in a series of BSGs and their association with the prognosis. @*Methods@#Fifty patients who underwent a stereotactic biopsy between January 2016 and April 2018 at a single institution were collected. Data on clinicopathological characteristics were analyzed and factors associated with patient survival were identified using a Cox regression model. @*Results@#The median age at diagnosis was 55.5 years, and 62% of the patients were male. Glioblastoma (44%) accounted for the largest proportion of BSGs, and oligodendroglioma (2 of 50) was rarely encountered. The IDH mutation (6 of 44) occurred infrequently in astrocytomas, and IDH-mutant tumors harbored both ATRX loss and MGMT promoter methylation at a relatively low level. Wild-type IDH astrocytomas were identified as having high rates of 1p/19q codeletion (5 of 38) and loss of heterozygosity 1p (8 of 38) or 19q (8 of 38) only. In diffuse midline glioma H3K27M mutant, MGMT promoter methylation occurred in three of four cases. Patients were offered radiotherapy and/or concurrent/adjuvant temozolomide chemotherapy, and their median survival time was 13 months. Multivariate analysis revealed that a low tumor grade, absence of tumor enhancement, duration of symptoms ≥3 months, Karnofsky performance status ≥70, and ATRX loss conferred a survival advantage. @*Conclusions@#Adult BSGs showed different molecular genetic characteristics, but also resembled supratentorial gliomas in their clinical features associated with oncological outcomes.
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Objective:To explore the mechanism of complement 5a (C5a) in the pathogenesis of sepsis.Methods:SPF male C57BL/6J mice were selected and divided into sham operation group (Sham group), cecal ligation and puncture (CLP) group and CLP+anti-C5A monoclonal antibody intervention group (CLP+anti-C5a group) according to random number table with 20 mice in each group. A CLP model was reproduced to induce sepsis, and those in the Sham group only underwent laparotomy without ligation and perforation. In the CLP+anti-C5a group, 0.15 mg of anti-C5a monoclonal antibody was injected intraperitoneally immediately after CLP, and in the Sham group and CLP group were given equal amount of normal saline. The cumulative survival rate was analyzed by Kaplan-Meier method. Serum levels of tumor necrosis factor-α (TNF-α), interleukins (IL-12, IL-4), and interferon-γ (IFN-γ) were measured 24, 48 and 72 hours after operation by enzyme linked immunosorbent assay (ELISA). Immunohistochemical staining was used to observe the expression of C5a receptor (C5aR) in lung and kidney tissues 48 hours after operation. The proportions of dendritic cell (DC), regulatory T cell (Treg) and helper T cell 17 (Th17) in splenic mononuclear cells 48 hours after operation were analyzed by flow cytometry.Results:The 7-day cumulative survival rate of mice in the CLP group was significantly lower than that in the Sham group (30.00% vs. 100.00%; Log-Rank test: χ 2 = 47.470, P < 0.001), and the peripheral blood inflammatory mediators TNF-α, IL-12 and IL-4 were increased 24 hours after operation, followed by a significant decreasing at 48 hours, and then gradually increased at 72 hours. IFN-γ gradually increased 24 hours after operation and lasted for 72 hours. Immunohistochemistry showed that a large number of C5aR was expressed in pulmonary and renal endothelial cells 48 hours after operation in the CLP group. Compared with the Sham group, the proportion of DC [(1.80±0.30)% vs. (6.90±1.20)%, P < 0.05] and Treg [(0.38±0.02)% vs. (4.00±0.50)%, P < 0.05] in splenic mononuclear cells was down-regulated in the CLP group, the proportion of Th17 was up-regulated [(0.83±0.08)% vs. (0.32±0.03)%, P < 0.05], and disorder of immune function was found. After anti-C5A monoclonal antibody intervention, the 7-day cumulative survival rate increased significantly compared with the CLP group (54.54% vs. 30.00%; Log-Rank test: χ 2 = 28.090, P < 0.001); TNF-α, IL-12 and IFN-γ were further increased, while IL-4 was significantly decreased; the expression of C5aR in lung and kidney tissues were significantly decreased, and the expression of mature DC cells [(5.10±1.20)% vs. (1.80±0.30)%, P < 0.05] and Treg [(2.58±0.05)% vs. (0.38±0.02)%, P < 0.05] in spleen were significantly increased compared with the CLP group, and Th17 was significantly decreased [(0.54±0.05)% vs. (0.83±0.08)%, P < 0.05]. Conclusion:It is preliminarily concluded that anti-C5A monoclonal antibody may improve the prognosis of sepsis by improving the polarization of mature DC and T cells in the spleen, and C5a plays an important role in the immune regulation of sepsis cells.
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Traumatic brain injury (TBI) is a major cause of death and disability in naval warfare. Due to the unique physiochemical properties of seawater, immersion in it exacerbates TBI and induces severe neural damage and complications. However, the characteristics and underlying mechanisms of seawater-immersed TBI remain unclear. Mitochondrial dysfunction is a major cause of TBI-associated brain damage because it leads to oxidative stress, decrease in energy production, and apoptosis. Thus, the present study aimed to further elucidate the current understanding of the pathology of seawater-immersed TBI, particularly the role of mitochondrial dysfunction, using a well-defined rat model of fluid percussion injury and a stretch injury model comprising cultured neurons. The biochemical and pathological markers of brain-related and neuronal injuries were evaluated. Histological analysis suggested that seawater immersion enhanced brain tissue injury and induced a significant increase in apoptosis in rats with TBI. Additionally, lactate dehydrogenase release occurred earlier and at higher levels in stretched neurons at 24 h after seawater immersion, which was consistent with more severe morphological changes and enhanced apoptosis. Furthermore, seawater immersion induced more rapid decreases in mitochondrial membrane potential, adenosine triphosphate (ATP) content, and H+-ATPase activity in the cortices of TBI rats. In addition, the immunochemical results revealed that seawater immersion further attenuated mitochondrial function in neurons exposed to stretch injury. The increases in neuronal damage and apoptosis triggered by seawater immersion were positively correlated with mitochondrial dysfunction in both in vivo and in vitro models. Thus, the present findings strengthen the current understanding of seawater-immersed TBI. Moreover, because seawater immersion aggravates mitochondrial dysfunction and contributes to post-traumatic neuronal cell death, it is important to consider mitochondria as a therapeutic target for seawater-immersed TBI.
Subject(s)
Apoptosis/physiology , Brain Injuries, Traumatic , Immersion/adverse effects , Mitochondria/pathology , Neurons/physiology , Seawater , Animals , Brain Injuries, Traumatic/pathology , Brain Injuries, Traumatic/physiopathology , Brain Injuries, Traumatic/psychology , Cells, Cultured , Disease Models, Animal , Disease Progression , Female , Immersion/physiopathology , Male , Membrane Potential, Mitochondrial/physiology , Mice , Neurons/pathology , Pregnancy , Rats , Rats, Sprague-Dawley , Reactive Oxygen Species/metabolism , Seawater/adverse effectsABSTRACT
Objective:To investigate the early changes of serum biomarkers in rats with mild blast-induced traumatic brain injury (bTBI) in cabin.Methods:Explosion source in the simulated cabin was detonated by initiator. The bTBI rat models caused by explosion shock wave in cabin were established. A total of 24 adult male Sprague-Dawley rats were divided into normal control group ( n=6) and bTBI group ( n=18), according to the random number table. Rats in bTBI group were subdivided at 3, 24, and 72 h post-blast, with 6 rats at each time point. Shock wave pressure at the rat head was measured during the explosion. At 3, 24, and 72 h post-blast, the general condition of rats was observed. Rat blood was collected by cardiac puncture. Then brains were taken completely and quickly for pathological observation. HE staining was used to observe the changes of neurons in hippocampal CA1 area. The collected serum was tested for levels of biomarkers, including interleukin- 6 (IL-6), neuron specific enolase(NSE), S100-β, alpha Ⅱ-spectrin breakdown product-145 (SBDP-145) and Tau. Results:The maximum peak value of the shock wave pressure curve at the rat head was (818.2±33.3)kPa, and the duration was about 1 000 μs. After the explosion, the activity of the rats decreased significantly, the hair was dull, and the appetite decreased. General observation showed that the brain tissue was obviously swollen, the blood vessels on the brain surface were thickened, and there was a little patchy bleeding, but no obvious brain contusion was seen. HE staining showed that some neurons in the hippocampus CA1 area had apoptosis or necrosis. At 3, 24, and 72 hours post-blast, the levels of IL-6 were (155.3±10.7)pg/ml, (171.3±25.3)pg/ml and (155.6±18.2)pg/ml, all of which were significantly higher than that in normal control group [(116.3±7.3)pg/ml]( P<0.05); the levels of NSE were (12.0±1.0)ng/ml, (11.0±1.0)ng/ml and (11.0±1.2)ng/ml, all of which were significantly higher than that in normal control group [(8.1±0.5)ng/ml]( P<0.05); the levels of S100-β were (71.9±10.7)pg/ml, (58.0±11.5)pg/ml and (56.5±12.2)pg/ml, all of which were significantly higher than that in normal control group [(35.2±2.5)pg/ml] ( P<0.05); the levels of SBDP-145 were (29.4±2.8)ng/ml, (24.5±4.8)ng/ml and (20.7±2.1)ng/ml, and only the level at 3 h post-blast was significantly higher than that in normal control group [(20.9±1.2)ng/ml]( P<0.05); the levels of Tau were (141.4±11.7)pg/ml, (189.5±28.2)pg/ml and (179.1±32.5)pg/ml, all of which were significantly higher than that in normal control group [(97.8±5.9)pg/ml]( P<0.05). Conclusion:The serum levels of IL-6, NSE, S100-β, SBDP-145 and Tau in mild bTBI rats increase in various degrees at early time, which provides a theoretical basis for use of serum markers in the early diagnosis of mild bTBI.
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Qingnaopian has been used in traditional Chinese medicine for treating central nervous system (CNS) injury and inflammatory diseases. The aim of this study was to investigate the effects of Qingnaopian in concussion mice. C57BL/6 mice were used to establish the mild Traumatic Brain Injury (mTBI)/ concussion using the weight-drop techniques. Animal behavioral experiments righting reflex response and locomotor activity were assessed. The expression of pro inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-1 and Glial fibrillary acidic protein (GFAP) were assessed by enzyme-linked immunosorbent assay (ELISA) and Western blot method, respectively. SPSS 19.0 software was used for statistical analysis. The results showed that righting reflex time and locomotor activity were higher in model group compared with those in control group. Qingnaopian treated mice had lower pro inflammatory cytokines, such as IL-1, IL-6 and TNF-α with alleviated GFAP. In short, Qingnaopian treatment improved GFAP induced by blow to head and inflammatory cytokines in concussion mice.
Subject(s)
Brain Concussion/drug therapy , Drugs, Chinese Herbal/pharmacology , Encephalitis/drug therapy , Glial Fibrillary Acidic Protein/metabolism , Animals , Brain/drug effects , Brain/metabolism , Brain/pathology , Brain Concussion/complications , Coumaric Acids/analysis , Cytokines/cerebrospinal fluid , Drugs, Chinese Herbal/chemistry , Encephalitis/cerebrospinal fluid , Encephalitis/metabolism , Locomotion/drug effects , Male , Mice, Inbred C57BL , Reflex, Righting/drug effectsABSTRACT
OBJECTIVE: Hemorrhage in the basal ganglia is a common type of intracerebral hemorrhage and has high mortality and poor prognosis. In our study, we aimed to evaluate surgical outcomes and functional recovery after evacuation of hematoma using either craniotomy or endoscopy. METHODS: We analyzed retrospective data from 58 patients with basal ganglia hemorrhage who were treated with hematoma evacuation using either craniotomy or endoscopy. Magnetic resonance imaging and a navigation system were used for calculating hematoma volume and for navigation during surgery. Clinical information and surgical outcomes were recorded. At 6-month follow-up, the recovery of neurologic function and the results of the Aphasia Battery of Chinese test were assessed. RESULTS: The endoscopy group showed lower intraoperative blood loss (75.36 ± 45.56 vs. 462.67 ± 120.08 mL, P < 0.001), shorter operation time (1.59 ± 0.30 vs. 4.17 ± 0.86 hours, P < 0.001), and a higher hematoma clearance rate (0.93% ± 0.05% vs. 0.88% ± 0.13%, P = 0.04) than the craniotomy group, respectively. No significant differences in mortality were identified, but a trend toward lower mortality in the endoscopy group was apparent (7.14% in the endoscopy group vs. 16.67% in the craniotomy group, P = 0.43). Assessment of neurologic recovery indicated significant differences in the modified Rankin Scale grades between the 2 groups (χ2 = 4.381, P = 0.036). Listening comprehension and speaking ability were also better in the endoscopy group than the craniotomy group (χ2 = 4.693, P = 0.03). CONCLUSIONS: Evacuation by endoscopy had better surgical outcomes, recovery of neurologic function, and aphasia recovery than evacuation by craniotomy. It appears that endoscopy is the surgical treatment of choice for middle-aged and elderly patients with a basal ganglia hemorrhage volume of >35 mL.
Subject(s)
Basal Ganglia Hemorrhage/surgery , Basal Ganglia/surgery , Craniotomy/methods , Neuroendoscopy/methods , Recovery of Function/physiology , Aged , Basal Ganglia/diagnostic imaging , Basal Ganglia Hemorrhage/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To investigate the effect of nimodipine combined with cerebrospinal fluid replacement on hemoglobin concentration,Toll-like receptor 4 (TLR4) expression level and cerebral vasospasm (CVS) in patients with CVS after aneurysmal subarachnoid hemorrhage (aSAH).Methods One hundred and twenty patients with CVS after aSAH admitted to the Department of Neurosurgery,the Sixth Medical Center of PLA General Hospital from May 2013 to May 2015 were selected.They were randomly divided into control group and observation group (n =60 in each group).The control group received conventional treatment and nimodipine infusion after embolization of the aneurysms,and the observation group underwent cerebrospinal fluid replacement by lumbar puncture on this basis.The clinical efficacy,Glasgow Coma Scale (GCS) scores,hemoglobin concentration and TLR4 expression levels before and after treatment,and adverse reactions were compared between the two groups.Results One month after treatment,the improvement rate of vasospasm in the observation group was significantly higher than that in the control group (86.7％ vs.60.0％;x2 =9.590,P =0.002).Three months after the treatment,the good rate of clirnical outcome (the modified Rankin Scale score 0-2) was significantly higher than that of the control group (88.3％ vs.58.3％;x2 =13.807,P＜0.001).Before treatment,there were no significant differences in hemoglobin concentration and TLR4 expression levels between the two groups;after treatment,the hemoglobin concentration and TLR4 expression levels of both groups were significantly reduced (P ＜0.05).Compared with the control group,the hemoglobin concentration (119.9 ± 19.8 g/L vs.137.6 ± 17.8 g/L;t =3.270,P =0.001) and TLR4 expression level (2.5 ± 1.2 vs.4.5 ± 1.5;t =8.060,P ＜0.001) in the observation group decreased more significantly.Multivariate logistic regression analysis showed that hypertension (odds ratio [OR] 5.19,95％ confidence interval [CI] 2.31-6.71),hyperlipidemia (OR 2.70,95％ CI 1.93-4.86),previous history of stroke or transient ischemic attack (OR 6.29,95％ CI 3.23-7.32),smoking (OR 4.80,95％ CI 2.18-6.19),and the TLR4 expression level before treatment (OR 3.28,95％ CI 2.87-6.93) were independently correlated with the lack of improvement in CVS,and cerebrospinal fluid replacement was independently correlated with CVS improvement (OR 0.40,95％ CI 0.14-0.89).There was no significant difference in the incidence of adverse reactions such as blood pressure drop,obstructive hydrocephalus and gastrointestinal hemorrhage betw een the observation group and the control group,but the incidence of delayed CVS (13.3％ vs.36.7％;x2 =7.510,P =0.006) and secondary cerebral infarction (8.3％ vs.31.7％;x2 =8.800,P =0.003) in the observation group were significantly lower than those of the observation group.Conclusion Nimodipine infusion combined with cerebrospinal fluid replacement by lumbar puncture affected the hemoglobin concentration and TLR4 expression levels,improved the CVS improvement rate,and significantly improved the clinical outcome in patients with CVS after aSAH.
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Objective@#To investigate the effect of nimodipine combined with cerebrospinal fluid replacement on hemoglobin concentration, Toll-like receptor 4 (TLR4) expression level and cerebral vasospasm (CVS) in patients with CVS after aneurysmal subarachnoid hemorrhage (aSAH).@*Methods@#One hundred and twenty patients with CVS after aSAH admitted to the Department of Neurosurgery, the Sixth Medical Center of PLA General Hospital from May 2013 to May 2015 were selected. They were randomly divided into control group and observation group (n=60 in each group). The control group received conventional treatment and nimodipine infusion after embolization of the aneurysms, and the observation group underwent cerebrospinal fluid replacement by lumbar puncture on this basis. The clinical efficacy, Glasgow Coma Scale (GCS) scores, hemoglobin concentration and TLR4 expression levels before and after treatment, and adverse reactions were compared between the two groups.@*Results@#One month after treatment, the improvement rate of vasospasm in the observation group was significantly higher than that in the control group (86.7% vs. 60.0%; χ2=9.590, P=0.002). Three months after the treatment, the good rate of clinical outcome (the modified Rankin Scale score 0-2) was significantly higher than that of the control group (88.3% vs. 58.3%; χ2 =13.807, P<0.001). Before treatment, there were no significant differences in hemoglobin concentration and TLR4 expression levels between the two groups; after treatment, the hemoglobin concentration and TLR4 expression levels of both groups were significantly reduced (P<0.05). Compared with the control group, the hemoglobin concentration (119.9±19.8 g/L vs. 137.6±17.8 g/L; t=3.270, P=0.001) and TLR4 expression level (2.5±1.2 vs. 4.5±1.5; t=8.060, P<0.001) in the observation group decreased more significantly. Multivariate logistic regression analysis showed that hypertension (odds ratio [OR] 5.19, 95% confidence interval [CI] 2.31-6.71), hyperlipidemia (OR 2.70, 95% CI 1.93-4.86), previous history of stroke or transient ischemic attack (OR 6.29, 95% CI 3.23-7.32), smoking (OR 4.80, 95% CI 2.18-6.19), and the TLR4 expression level before treatment (OR 3.28, 95% CI 2.87-6.93) were independently correlated with the lack of improvement in CVS, and cerebrospinal fluid replacement was independently correlated with CVS improvement (OR 0.40, 95% CI 0.14-0.89). There was no significant difference in the incidence of adverse reactions such as blood pressure drop, obstructive hydrocephalus and gastrointestinal hemorrhage between the observation group and the control group, but the incidence of delayed CVS (13.3% vs. 36.7%; χ2=7.510, P=0.006) and secondary cerebral infarction (8.3% vs. 31.7%; χ2=8.800, P=0.003) in the observation group were significantly lower than those of the observation group.@*Conclusion@#Nimodipine infusion combined with cerebrospinal fluid replacement by lumbar puncture affected the hemoglobin concentration and TLR4 expression levels, improved the CVS improvement rate, and significantly improved the clinical outcome in patients with CVS after aSAH.
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Tinnitus is a subjective symptom of phantom sound in the ear or brain without sound or electrical stimulation in the environment. The mechanism of tinnitus is complicated and mostly unclear. Recent studies suggested that the abnormal peripheral auditory input lead to neuroplasticity changes in central nervous system followed by tinnitus. More research concerned on the tinnitus central mechanism. A rapid development of functional magnetic resonance imaging (fMRI) technique made it more widely used in tinnitus central mechanism research. fMRI brought new findings but also presented some shortages in technology and cognition in tinnitus study. This article summarized the outcomes of fMRI research on tinnitus in recent years, exploring its existing problems and application prospects.
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Objective@#To evaluate the clinical value and outcomes of technical improvement of hybrid operatical clipping for large paraclinoid internal carotid artery aneurysms.@*Methods@#A review was conducted on 18 cases of large paraclinoid internal carotid artery aneurysm which were clipped by balloon non-fluoroscopic occlusion of the parent artery via a micro-bone window frontolateral approach in hybrid operating room at Neurosurgery Department of Tianjin Medical University General Hospital from June 2014 to December 2017. There were 8 males and 10 females with age of (63±4) years. There were 6 cases of unruptured aneurysm and 12 cases of ruptured aneurysm of subarachnoid hemorrhage (6 cases of grade Ⅱ, 4 cases of grade Ⅲ and 2 cases of grade Ⅳ in Hunt-Hess classification). Frontolateral approach incision (average length of about 5 cm) and bone window about 3 cm×3 cm were performed. No incision of the neck was needed to expose the internal carotid artery for temporary occlusion. In the operation, the balloon was slowly pushed to the preset position of the internal carotid artery under non-fluoroscopy. The balloon was expanded to block the blood flow of internal carotid artery. Then aneurysm was clipped. The balloon was loosened and retraced to the guiding catheter after clipping. The clipping condition was examined by cerebral angiography. If there was residual aneurysm neck or stenosis of the parent artery, the balloon was pushed under non-fluoroscopy again to temporary occlusion and the clip was adjusted until the aneurysm neck was clamped satisfactorily.@*Results@#Eighteen aneurysms were successfully clipped in hybrid operating room. Fourteen aneurysms showed complete occlusion of the aneurysm neck and no stenosis of the parent artery. Four cases showed residual aneurysm neck after clipping by intraoperative angiography, then aneurysms were clipped satisfy by adjusting the aneurysm clip. The patients were followed up for 3 months to 1 year. Ten patients recovered well (modifed Rankin score (mRS): 0), and 3 patients had no obvious disability (mRS: 1). Two patients with Hunt-Hess grade Ⅲ were slightly disabled (mRS: 2). 1 patients with Hunt-Hess grade Ⅲ were moderately disabled (mRS: 3). 1 patients with Hunt-Hess grade Ⅳ were severely disabled (mRS: 4). One elderly patients with Hunt-Hess grade Ⅳ were seriously disabled (mRS: 5).@*Conclusions@#Application of balloon non-fluoroscopic occlusion clipping for large paraclinoid internal carotid artery aneurysm via a micro-bone window frontolateral approach is safe, effective and minimally invasive.
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Objective To investigate the advantages of virtual endoscopy (VE) reconstruction technique for interventional therapy under the guidance of rotational digital subtraction angiography (DAS).Methods Patients with intracranial aneurysm received interventional therapy under the guidance of DSA were selected.The reconstruction of images with the volume rendering (VR) and the VE techniques were used to measure aneurysmal necks.The diameters and image clarity of the aneurysmal necks measured by the 2 techniques were compared.Results A total of 62 patients were included.Their mean age was 59.8 ± 2.6 years.In twenty-seven patients who were unable to clearly reveal and measure the diameters of aneurysm necks on the VR image,they could clearly reveal and accurately measure after VE reconstruction,and there was a significant difference between the measured values of the VR image and the VE image (2.47± 1.25 mmvs.3.14± 1.16 mm;t=2.042,P=0.046).However,there was no significant difference in the measured values of the aneurysm diameters which was clearly revealed on the both images.Conclusion The use of VE technique for reconstruction analysis of the DSA images can more directly and accurately measure the diameters of the aneurysm necks,so as to better guide the interventional therapy.
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Traumatic brain injury is always associated with hemorrhage and coagulopathy, leading the occurrence of anemia, platelet function inactivation, platelet and coagulation factor consumptive reduction. Theoretically, transfusion therapy should be given to supplement the missing component in an appropriate range. However, whether the transfusion therapy can improve the prognosis of patients with traumatic brain injury, and the indications of transfusion, have been the focus of academic debate for a long time. This article reviews the latest progress of transfusion therapy in traumatic brain injury, and provides reference for better guidance of transfusion in clinical treatment.
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Objective@#To compare the diagnosis and treatment experience of brain abscesses and improve prognosis.@*Methods@#The data of 302 patients of brain abscess at Department of Neurosurgery in Tianjin Medical University General Hospital from 1980 to 2014 was analyzed retrospectively. There were 215 male and 87 female patients aged from 11 to 82 years with mean age of (30±8) years. The patients was divided into 1980-2001 group and 2002-2014 group according to different diagnosis and the treatment methods. The therapy methods include operation and conservative treatment. There were 196 cases received operation, including 95 cases of excision, 89 cases of ventriculopuncture, 12 cases of excision after ventriculopuncture, 106 cases received drug conservative therapy. Two groups of information including clinical manifestation, abscess location, therapeutic effect and prognosis were compared by χ2 test.@*Results@#Compared to 1980-2001 group, adjacent infection incidence declined(χ2=8.000, P=0.005). The ratio of single abscess declined and multiple abscess increased(χ2=11.060, P=0.001), the infection proportion of frontal lobe and temporal lobe decreased(χ2=9.080, P=0.003; χ2=15.440, P=0.000). The ratio of headache and vomit and papilledema declined significantly(χ2=23.290, P=0.000; χ2=21.020, P=0.000; χ2=2.290, P=0.001). Total mortality of 302 patients were 23 cases and 5 cases of 1980-2001 group and 2002-2014 group (10.4% vs. 6.3%, χ2=1.180, P=0.277). However, there were statistical difference in postoperative mortality between both groups (14.4% vs. 4.0%, χ2 =3.880, P=0.049).@*Conclusion@#With the application of antibiotics and the development of neurosurgical techniques, the prognosis of brain abscess has been improved.
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Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. The finding that cellular microparticles (MPs) generated by injured cells profoundly impact on pathological courses of TBI has paved the way for new diagnostic and therapeutic strategies. MPs are subcellular fragments or organelles that serve as carriers of lipids, adhesive receptors, cytokines, nucleic acids, and tissue-degrading enzymes that are unique to the parental cells. Their sub-micron sizes allow MPs to travel to areas that parental cells are unable to reach to exercise diverse biological functions. In this review, we summarize recent developments in identifying a casual role of MPs in the pathologies of TBI and suggest that MPs serve as a new class of therapeutic targets for the prevention and treatment of TBI and associated systemic complications.
Subject(s)
Animals , Humans , Astrocytes , Metabolism , Pathology , Biological Transport , Blood Coagulation Factors , Genetics , Metabolism , Brain , Metabolism , Pathology , Brain Injuries, Traumatic , Genetics , Metabolism , Pathology , Cell-Derived Microparticles , Chemistry , Metabolism , Pathology , Cytokines , Blood , Genetics , Disease Models, Animal , Disseminated Intravascular Coagulation , Genetics , Metabolism , Pathology , Gene Expression Regulation , Microglia , Metabolism , Pathology , Neurons , Metabolism , Pathology , Signal TransductionABSTRACT
Objective:To explore the relationship of lymphocyte function-associated antigen 3 (LFA-3, CD58) expression in glioma with clinical features and its role in clinical prognosis. Methods:Clinical data and mRNA microarray data of 514 patients with glioma were obtained from The Cancer Genome Atlas and were used to study the expression of LFA-3 (CD58). Cox regression was used to analyze the relationship between CD58 expression and survival of patients with glioma. Multivariate analysis of variance was used to further analyze the relationship of CD58 with age, sex, and pathological grade of glioma. Results:The results of the stratified χ2 test of CD58 expression and tumor grading were shown, considering tumor type, gender and age of diagnosis (all P<0.05). CD58 expression was sig-nificantly correlated with overall survival (OS) and disease-free survival (DFS) of patients with glioma. Patients with high CD58 expres-sion presented short OS and DFS (P<0.0001). Conclusion:CD58 possibly promotes tumorigenesis in gliomas and thus can serve as a potential tumor diagnostic marker and individual therapeutic target.
