Effect analysis of Gamma knife radiosurgery for cavernous sinus cavernous hemangioma / 中国脑血管病杂志

ObjectIve To evaluate the safety and efficacy of Gamma knife radiosurgery for the treatment of cavernous sinus cavernous hemangioma. Methods From June 2010 to July 2016, 35 consecutive patients with cavernous sinus cavernous hemangioma treated with Gamma knife radiosurgery at the Department of Neurosurgery,West China Hospital,Sichuan University were enrolled retrospective, including 22 females and 13 males. All patients were diagnosed by MRI before procedure. They were confirmed by postoperative histopathology or further verification by MRI. The irradiation dose of Gamma knife around tumors were 11-16 Gy (mean 14. 3 ± 1. 1 Gy),covered by 45%-50% isodose line and ensured that the exposure dose of the optic cross was less than 8 Gy. In the first year after operation,they were followed up at 3,6,9,and 12 months,and after that,the clinical efficacy,surgical complications and tumor volume were evaluated once a year. Results Thirty-five patients were followed up for 12-77 months (mean 36 ± 4 months). No surgery-related optic nerve injury and new cranial nerve injury occurred in all cases . Symptomatic patients were 28 (80%)and symptomatic improvement rate was 96. 4%(n＝27),among them,the symptoms were improved in 15 cases (53. 6%),and the symptoms disappeared in 12 cases (42. 9%),did not have any change in 1 (3. 6%)case,and no symptom deterioration occurred. The symptom improvement time was 2-7 months after surgery (mean 3. 7 ± 0. 3 months). Imaging follow-up revealed that in 35 patients with cavernous sinus cavernous hemangioma treated by gamma knife radiosurgery,the tumor volume was significantly reduced after treatment compared with that before treatment,and the difference wasstatisticallysignificant(8.8±0.9cm3vs.32.6±3.6cm3,t＝8.492,P＜0.01).Theratesoftumor volume change were ≤25%,26%-50%,51%-75%,and ≥75%. There were 3 patients (8. 6%), 2 (5. 7%),8 (22. 9%),and 22 (62. 9%),respectively. Conclusions Gamma knife radiosurgery is safe and effective in the treatment of cavernous sinus cavernous hemangioma. It can be used as the preferred treatment modality for this disease,but long-term follow-up is needed to observe its long-term efficacy.

[Effects and risks of hypothermia during blood purification in the treatment of postoperative cardiogenic shock in valvular heart diseases].

OBJECTIVE: To implement hypothermia during blood purification to investigate its effect and risk in the treatment of postoperative cardiogenic shock in valvular heart disease. METHODS: A non-blinded prospective randomized controlled trial (RCT) was conducted. Patients with valvular heart disease suffering from postoperative cardiogenic shock admitted to intensive care unit (ICU) of Wuhan Asian Heart Hospital from January 2011 to December 2014 were enrolled, and they were randomly divided into normothermic continuous blood purification (CBP) group (NT group) and hypothermia CBP group (HT group) according to random number table and envelope enclosed method. The patients in both groups were given continuous renal replacement therapy (CVVH), the blood temperature in NT group was remained at 36.5-37.3 °C , and it was controlled at 34.0-35.0 °C in HT group. The data were collected before and 1, 2, 3 days after treatment, including cardiac index (CI), the oxygen supply/oxygen consumption ratio (DO2/VO2), acute physiology and chronic health evaluation III (APACHE III) score, multiple organ dysfunction (MODS) score. The length of ICU stay, duration of mechanical ventilation, duration of CBP, ICU mortality and the incidence of complication were recorded. RESULTS: A total of 95 patients were enrolled, with 47 patients in NT group, and 48 in HT group. There was no significant difference in gender, age, preoperative cardiac function, cardiothoracic ratio and type of valve replacement between two groups. Compared with those before treatment, no significant difference was found in CI, DO2/VO2 ratio, APACHE III score, MODS score on 1, 2, 3 days after treatment in NT group (all P > 0.05). But in HT group, DO2/VO2 ratio was significantly improved on 1 day after treatment (2.5 ± 0.7 vs. 1.8 ± 0.4, P < 0.05), CI (mL · s⁻¹ · m⁻²: 50.01 ± 8.34 vs. 31.67 ± 11.67), APACHE III score ( 50.6 ± 6.2 vs. 77.5 ± 5.5), and MODS score (6.0 ± 1.5 vs. 9.3 ± 3.4) were significantly improved 3 days after treatment (all P < 0.05). Compared with those in NT group, DO2NO2 ratio in HT group was significantly increased from 1 day after treatment (2.5 ± 0.7 vs. 1.8 ± 0.4, P < 0.05), and CI (mL · s⁻¹ · m⁻²: 38.34 ± 10.00 vs. 35.01 ± 6.67), APACHE III score (68.9 ± 7.1 vs. 81.2 ± 7.3), and MODS score (8.9 ± 2.7 vs. 10.6 ± 2.4) were significantly improved from 2 days after treatment (all P < 0.05). In respect of clinical outcomes, compared with NT group, the length of ICU stay (days: 6.9 ± 3.4 vs. 12.5 ± 3.5, t = 2.024, P = 0.017) and duration of mechanical ventilation (days: 4.2 ± 1.3 vs. 7.5 ± 2.7, t = 1.895, P = 0.034) in HT group was significantly shortened, duration of CBP was also significantly shortened (days: 4.6 ± 1.4 vs. 10.5 ± 4.0, t = 2.256, P = 0.019), and ICU mortality was significantly lowered (12.50% vs. 23.40, χ² = 1.987, P = 0.024), but there was no significant difference in incidence of infection (54.17% vs. 53.19%, χ² = 0.689, P = 0.341), ventricular arrhythmia (31.25% vs. 36.17%, χ² = 0.772, P = 0.237), and muscle fibrillation (14.58% vs. 8.51%, χ² = 0.714, P = 0.346), and blood loss (mL: 617.0 ± 60.7 vs. 550.9 ± 85.2, t = 1.290, P = 0.203) between HT group and NT group. The incidence of bradycardia in HT group was significantly higher than that of the NT group (29.17% vs. 14.89%, χ² = 2.368 P = 0.029). CONCLUSION: Blood purification under hypothermia is a safe and effective therapeutic procedure for postoperative cardiogenic shock in patients with valvular heart disease, and it may improve the prognosis of postoperative patients.

Effects and risks of hypothermia during blood purification in the treatment of postoperative cardiogenic shock in valvular heart diseases / 中华危重病急救医学

Objective To implement hypothermia during blood purification to investigate its effect and risk in the treatment of postoperative cardiogenic shock in valvular heart disease.Methods A non-blinded prospective randomized controlled trial (RCT) was conducted.Patients with valvular heart disease suffering from postoperative cardiogenic shock admitted to intensive care unit (ICU) of Wuhan Asian Heart Hospital from January 2011 to December 2014 were enrolled,and they were randomly divided into normothermic continuous blood purification (CBP) group (NT group) and hypothermia C BP group (HT group) according to random number table and envelope enclosed method.The patients in both groups were given continuous renal replacement therapy (CVVH),the blood temperature in NT group was remained at 36.5-37.3 ℃,and it was controlled at 34.0-35.0 ℃C in HT group.The data were collected before and 1,2,3 days after treatment,including cardiac index (CI),the oxygen supply/oxygen consumption ratio (DO2/VO2),acute physiology and chronic health evaluation 1Ⅲ (APACHE Ⅲ) score,multiple organ dysfunction (MODS) score.The length of ICU stay,duration of mechanical ventilation,duration of CBP,ICU mortality and the incidence of complication were recorded.Results A total of 95 patients were enrolled,with 47 patients in NT group,and 48 in HT group.There was no significant difference in gender,age,preoperative cardiac function,cardiothoracic ratio and type of valve replacement between two groups.Compared with those before treatment,no significant difference Was found in CI,DO2/VO2 ratio,APACHE Ⅲ score,MODS score on 1,2,3 days after treatment in NT group (all P ＞ 0.05).But in HT group,DO2/VO2 ratio was significantly improved on 1 day after treatment (2.5 ± 0.7 vs.1.8 ± 0.4,P ＜ 0.05),CI (mL·s-1·m-2:50.01±8.34 vs.31.67±11.67),APACHE Ⅲ score (50.6±6.2 vs.77.5±5.5),and MODS score (6.0± 1.5 vs.9.3±3.4) were significantly improved 3 days after treatment (all P ＜ 0.05).Compared with those in NT group,DO2/VO2 ratio in HT group was significantly increased from 1 day after treatment (2.5 ± 0.7 vs.1.8± 0.4,P ＜ 0.05),and CI (mL·s-1·m-2:38.34 ± 10.00 vs.35.01 ± 6.67),APACHE Ⅲ score (68.9 ± 7.1 vs.81.2 ± 7.3),and MODS score (8.9± 2.7 vs.10.6 ± 2.4) were significantly improved from 2 days after treatment (all P ＜ 0.05).In respect of clinical outcomes,compared with NT group,the length of ICU stay (days:6.9 ± 3.4 vs.12.5 ± 3.5,t =2.024,P =0.017) and duration of mechanical ventilation (days:4.2± 1.3 vs.7.5±2.7,t =1.895,P =0.034) in HT group was significantly shortened,duration of C BP was also significantly shortened (days:4.6 ± 1.4 vs.10.5 ± 4.0,t =2.256,P =0.019),and ICU mortality was significantly lowered (12.50％ vs.23.40,x2 =1.987,P =0.024),but there was no significant difference in incidence of infection (54.17％ vs.53.19％,x2 =0.689,P =0.341),ventricular arrhythmia (31.25％ vs.36.17％,x2 =0.772,P =0.237),and muscle fibrillation (14.58％ vs.8.51％,x2 =0.714,P =0.346),and blood loss (mL:617.0±60.7 vs.550.9±85.2,t =1.290,P =0.203) between HT group and NT group.The incidence of bradycardia in HT group was significantly higher than that of the NT group (29.17％ vs.14.89％,x2 =2.368,P =0.029).Conclusion Blood purification under hypothermia is a safe and effective therapeutic procedure for postoperative cardiogenic shock in patients with valvular heart disease,and it may improve the prognosis of postoperative patients.

Treatment of brain glioblastoma multiforme with pcDNA3.1-Egr. 1p-p16 combined with gamma knife radiation: an experimental study on nude mice.

BACKGROUND: High post-operative recurrence and poor prognosis are likely to be related to the infiltrative growth of the glioblastoma multiforme (GBM). OBJECTIVES: The primary objective of this study is to investigate the possible synergistic effect of the combined treatment of gamma knife radio-surgery (GKRS) and gene therapy for GBM and secondary objective is to explore the role of GKRS for the temporal and spatial regulation of the gene expression. MATERIALS AND METHODS: The study performed on 70 nude mice and randomly divided into seven groups. Subcutaneous injection of human GBM tumor cells (T98G) was carried out to establish the animal models. Various doses of liposome-mediated pcDNA3.1-Egr. 1p-p16 recombinant plasmid were transfected through intra-tumor injection. GKRS was scheduled following the plasmid transfection. Tumor volumes were measured every 4 days after the treatment. Subcutaneous tumor nodule specimens were collected to analyze the cell apoptosis and p16 gene expression using terminal-deoxynucleoitidyl transferase mediated nick end labeling staining and reverse transcription-polymerase chain reaction. Tumor volumes, levels of cell apoptosis and p16 gene expression were compared between groups. RESULTS: Rates of tumor growth were significantly lower in the pcDNA3.1-Egr. 1p-p16 plasmid + GKRS groups than that in the remaining groups 28 days following the GKRS management. The p16mRNA expression was noted in both of the pcDNA3.1-Egr. 1p-p16 plasmid group and the pcDNA3.1-Egr. 1p-p16 plasmid + GKRS with marginal-dose of 20 Gy group. The level of messenger ribonucleic acid expression was higher in the pcDNA3.1-Egr. 1p-p16 plasmid + GKRS with the marginal-dose of 20 Gy group, with a markedly increased apoptotic and necrotic cells, than that in the pcDNA3.1-Egr. 1p-p16 plasmid group. CONCLUSIONS: In animal studies, pcDNA3.1-Egr. 1p-p16 in combination with GKRS is a preferable management option for the GBM to the sole use of GKRS or gene therapy. It may be a novel approach for the treatment of human patient with GBM.

MRI study of left ventricular remodeling after acute myocardial infarction in rabbit model / 中华放射学杂志

ObjectiveTo observe the change of cardiac function after acute myocardial infarction (AMI) in rabbit model,and to study MRI characteristics of left ventricular remodeling (LVR).Methods Forty-five japanese white rabbits underwent chest-opening coronary artery ligation surgery to obtain rabbit myocardial infarction model The animals were scanned on a 1.5 T MR scanner ( GE Healthcare,Chalfont St.Giles,UK) at six time-points as surgery,1,2,4,6,8 weeks after surgery. Cardiac function parameters were measured,including left ventricular end diastolic volume ( EDV ),stroke volume ( SV ),ejection fraction (EF),peak ejection rate ( PER ) and peak firing rate (PFR).At each time point,5 rabbits were randomly selected and performed re-thoracotomy to obtain heart specimen.Each specimen was examined by MRI with the diffusion tensor imaging ( DTI ).The value of ADC and fractional anisotropy (FA) were collected. Cardiac function data sets of different time points were analyzed using repeated measures data of ANOVA.The FA and ADC values of infarction myocardium set of different time points or different parts of the myocardium were analyzed using one-way ANOVA. The average was compared statistically between two adjacent groups using LSD-t test. Results Left ventricular EDV increased in progress with the time.It was increased from ( 2.21 ± 0.35 ) ml preoperatively to ( 3.15 ± 0.57 ) ml 8-week postoperatively.But the difference was not statistical significant ( F =1.384,P =0.220).EF was decreased from(57.31 ± 11.11 )％ to( 34.71 ± 8.72 )％.It dropped significantly and the difference was statistically significant (F =27.134,P =0.001 ).EF showed a downward trend with the increase of EDV.By linear regression analysis,an equation was set up with y =- 5.58x + 57.7 ( F =8.855,P =0.005 ).On the other hand,PER showed a progressive decline from (27.31 ± 13.06) ml/s to ( 17.31 ± 6.41 ) ml/s ( F =2.105,P =0.037 ),and PFR decreased from ( 23.79 ± 14.15 ) ml/s to ( 12.07 ± 6.91 ) ml/s ( F =2.366,P =0.011 ).FA value decreased from 0.442 ±0.093 to 0.107 ±0.037( F =12.61,P =0.001 ),and ADC valueshowed upward trend from (5.07 ± 1.15) ×10-4 mm2/s to(6.39 ±0.78) ×10-4 mm2/s (F=4.166,P =0.022 ).FA values of infarct,adjacent and remote region were 0.201 ± 0.049,0.316 ± 0.127 and 0.323 ± 0.117 respectively( F =3.896,P =0.004 ),and the ADC values in these regions were (6.19 ± 1.78 ) ×10 -4,(5.44 ± 2.63 ) × 1 0 -4,(5.29 ± 2.02 ) × 10 -4 mm2/s respectively ( F =3.248,P =0.018 ).FA and ADC values were significantly different between the infarct region and adjacent region ( t =7.327,P =0.001 ;t =3.292,P =0.005,respectively),but there was no significantly different between adjacent region and remote region ( t =1.024,P =0.129 ; t =1.467,P =0.164,respectively ).ConclusionsMRI measurement of parameters of cardiac function can be used to monitor the process of left ventricular function remodeling after AMI.The process of micro-structural remodeling of myocardium can be reflected by DTI.MRI provides a feasible imaging modality for LVR after AMI.

Assessment of Left Ventricular Systolic function in Elderly Isolated Systolic Hypertension / 中华高血压杂志

Aim To explore the hemodynamic change of elderly isolated hypertension(EISH). Methods Color doppler ultrasonography were applied to examine thirty EISH patients and twenty eight elderly healthy subjects. The left ventricular systolic function as well as hemodynamic parameters were measured. Results The indices of left ventricular systolic function in EISH group such as SV,CO,EF and CI were obviously higher than those of control group(P<0.05),Linear relevant analysis show that pulse pressure was remarkable related to SV,CO,EF and CI in EISH group,with r value 0.43,0.56,0.46,0.45 respectively.Conclusion EISH patients apparently had ventricular systolic dysfunction and hemodynamic abnormality. Pulse pressure may be associated with development of sysytolic dysfunction.