The surgical strategy and technical nuances of in situ side-to-side bypass for the management of complex intracranial aneurysms.

Background: Despite continuous advances in microsurgical and endovascular techniques, the treatment of complex aneurysms remains challenging. Aneurysms that are dilemmatic for conventional clipping or endovascular coiling often require bypass as part of a strategy to reduce the risk of ischemic complications. In anatomically favorable sites, the intracranial-intracranial in situ bypass may be an appealing choice. This article details the surgical strategies, operative nuances, and clinical outcomes of this technique with a consecutive series in our department. Methods: A retrospective review of a prospectively maintained neurosurgical patient database was performed to identify all patients treated with side-to-side in situ bypass from January 2016 to June 2022. In total, 12 consecutive patients, including 12 aneurysms, were identified and included in the series. The medical records, surgical videos, neuroimaging studies, and follow-up clinic notes were reviewed for every patient. Results: Of the 12 aneurysms, there were 5 middle cerebral artery aneurysms, 4 anterior cerebral artery aneurysms, and 3 posterior inferior cerebellar artery aneurysms. The morphology of the aneurysms was fusiform in 8 patients and saccular in the remaining 4 patients. There were 3 patients presented with subarachnoid hemorrhage. The treatment modality was simple in situ bypass in 8 cases and in situ bypass combined with other modalities in 4 cases. Bypass patency was confirmed in all cases by intraoperative micro-doppler probe and (or) infrared indocyanine green (ICG) video angiography intraoperatively and with digital subtraction angiography (DSA) or computed tomography angiography (CTA) postoperatively. None of the patients developed a clinically manifested stroke due to the procedure though a callosomarginal artery was intentionally removed in one patient. The median follow-up period was 16.2 months (6-36). All patients had achieved improved or unchanged modified Rankin scale scores at the final follow-ups. Conclusion: Cerebral revascularization technique remains an essential skill for the treatment of complex aneurysms. The in situ bypass is one of the most effective techniques to revascularize efferent territory when vital artery sacrifice or occlusion is unavoidable. The configuration of in situ bypass should be carefully tailored to each case, with consideration of variations in anatomy and pathology of the complex aneurysms.

Oral arsenic and retinoic acid for high-risk acute promyelocytic leukemia.

Acute promyelocytic leukemia (APL) has become curable over 95% patients under a complete chemo-free treatment with all-trans retinoic acid (ATRA) and arsenic trioxide in low-risk patients. Minimizing chemotherapy has proven feasible in high-risk patients. We evaluated oral arsenic and ATRA without chemotherapy as an outpatient consolidation therapy and no maintenance for high-risk APL. We conducted a multicenter, single-arm, phase 2 study with consolidation phases. The consolidation therapy included Realgar-Indigo naturalis formula (60 mg/kg daily in an oral divided dose) in a 4-week-on and 4-week-off regimen for 4 cycles and ATRA (25 mg/m2 daily in an oral divided dose) in a 2-week-on and 2-week-off regimen for 7 cycles. The primary end point was the disease-free survival (DFS). Secondary end points included measurable resident disease, overall survival (OS), and safety. A total of 54 participants were enrolled at seven centers from May 2019. The median age was 40 years. At the median follow-up of 13.8 months (through April 2022), estimated 2-year DFS and OS were 94% and 100% in an intention-to-treat analysis. All the patients achieved complete molecular remission at the end of consolidation phase. Two patients relapsed after consolidation with a cumulative incidence of relapse of 6.2%. The majority of adverse events were grade 1-2, and only three grade 3 adverse events were observed. Oral arsenic plus ATRA without chemotherapy was active as a first-line consolidation therapy for high-risk APL.Trial registration: chictr.org.cn number, ChiCTR1900023309.

High preoperative plasma fibrinogen and serum albumin score is associated with poor survival in operable esophageal squamous cell carcinoma.

This study was performed to investigate the prognostic significance of a cumulative score based on the preoperative plasma fibrinogen and serum albumin (FA score) in operable esophageal squamous cell carcinoma (ESCC). Clinicopathologic characteristics, preoperative fibrinogen, and albumin concentrations were retrospectively reviewed in patients who underwent transthoracic esophagectomy. The optimal cutoff value was defined as 4.0 g/L for fibrinogen according to previous studies and as 41.0 g/L for albumin for the lower quartile. Subjects with elevated fibrinogen and decreased albumin levels were allocated a score of 2, those with only one of these two abnormalities were assigned a score of 1, and those with neither of the abnormalities were allocated a score of 0. The preoperative FA score was significantly associated with tumor length, depth of invasion, lymph node involvement, tumor-node-metastasis (TNM) stage, and the modified Glasgow Prognostic Score (mGPS). No significant differences in age, gender, tumor location, degree of differentiation, smoking or alcohol consumption were found between groups. Univariate survival analysis revealed that high preoperative FA score (1/2) was significantly associated with unfavorable disease-free survival (DFS) [hazard ratio (HR), 1.675; 95% confidence interval (CI), 1.278-2.195; P < 0.001] and overall survival (OS) (HR, 1.685; 95% CI, 1.268-2.239; P < 0.001). Furthermore, it remained an independent prognostic indicator for both DFS (HR, 1.394; 95% CI, 1.035-1.879; P = 0.029) and OS (HR, 1.369; 95% CI, 1.010-1.878; P = 0.048) in multivariable Cox regression analysis. A high preoperative FA score could significantly predict impaired long-term survival for ESCC patients who underwent transthoracic esophagectomy.

Are gastrointestinal and sleep problems associated with behavioral symptoms of autism spectrum disorder?

Many children with autism spectrum disorder (ASD) suffer from concurrent medical symptoms, including gastrointestinal (GI) and sleeping problems. However, there is limited information on the correlation between co-morbidities and autistic behavioral symptoms. In this study, we estimated the prevalence of GI and sleep problems in Chinese ASD children, examined the impacts of GI and sleep problems on autistic behavioral symptoms, and investigated the factors associated with GI and sleep problems. The survey included 169 ASD and 172 healthy children. Data regarding demographic characteristics, GI symptoms, sleep disturbances and behavioral symptoms were collected through questionnaires. GI and sleep problems were prevalent in Chinese ASD children. Moreover, ASD children with GI symptoms reported more severe ASD core symptoms than others. Autistic children's GI symptoms were associated with maternal sleep problems during pregnancy, child's 0-6 month food sources and picky eating. ASD children with sleep disturbances had lower performance in daily living skills, social cognition, social communication and intellectual development than ASD children without sleep disturbances. Sleep disturbances were associated with extra nutrient supply during lactation and feeding, and child's picky eating. Autistic children with GI or/and sleep problems may represent clinically relevant subtypes of ASD, for which targeted treatments may be needed.

Family-based association study of ZNF533, DOCK4 and IMMP2L gene polymorphisms linked to autism in a northeastern Chinese Han population.

OBJECTIVE: A study in a Caucasian population has identified two single-nucleotide polymorphisms (SNPs) in ZNF533, one in DOCK4, and two in IMMP2L, which were all significantly associated with autism. They are located in AUTS1 and AUTS5, which have been identified as autism susceptibility loci in several genome-wide screens. The present study aimed to investigate whether ZNF533, DOCK4, and IMMP2L genes are also associated with autism in a northeastern Chinese Han population. METHODS: We performed a similar association study using families with three individuals (one autistic child and two unaffected parents). A family-based transmission disequilibrium test (TDT) was used to analyze the results. RESULTS: There were significant associations between autism and the two SNPs of ZNF533 gene (rs11885327: χ(2)=4.5200, P=0.0335; rs1964081: χ(2)=4.2610, P=0.0390) and the SNP of DOCK4 gene (rs2217262: χ(2)=5.3430, P=0.0208). CONCLUSIONS: Our data suggest that ZNF533 and DOCK4 genes are linked to a predisposition to autism in the northeastern Chinese Han population.

Parent-reported health care expenditures associated with autism spectrum disorders in Heilongjiang province, China.

BACKGROUND: The aim of this study was to determine the health expenses incurred by families with children with autism spectrum disorder (ASD) and those expenses' relation to total household income and expenditures. METHODS: In this cross-sectional study, health care expenditure data were collected through face-to-face interviews. Expenses included annual costs for clinic visits, medication, behavioral therapy, transportation, and accommodations. Health care costs as a percentage of total household income and expenditures were also determined. The participants included 290 families with ASD children who were treated at the Children Development and Behavior Research Center, Harbin Medical University, China. RESULTS: Families with ASD children from urban and rural areas had higher per-capita household expenditures by 60.8% and 74.7%, respectively, compared with provincial statistics for 2007. Behavioral therapy accounted for the largest proportion of health expenses (54.3%) for ASD children. In 19.9% of urban and 38.2% of rural families, health care costs exceeded the total annual household income. Most families (89.3% of urban families; 88.1% of rural families) in that province reported higher health care expenditures than the provincial household average. CONCLUSION: For families with ASD children, the economic burden of health care is substantially higher than the provincial average.

[Familial aggregation of metabolic syndrome in adolescents with paternal metabolic syndrome].

OBJECTIVE: To analyze the impact of parental Metabolic Syndrome (MS) on adolescents, and to explore the familial aggregation of MS with its components. METHODS: Using a 1:3 case-control familial study design to choose 26 MS male patients as proband and 78 healthy men as controls. Data regarding phenotype of their adolescence offspring were collected. Height, weight, waist circumference (WC), blood pressure, body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were measured or calculated. FPG, TC, TG, HDL-C and LDL-C were detected by automatic biochemical analyzer and hs-CRP was detected. RESULTS: WC, WHtR, WHR, DBP and hs-CRP of those adolescents with paternal MS were significantly higher than in controls (P < 0.05). Rates of MS, Obesity depend WC, low level of HDL-C of adolescent with paternal MS were significantly higher than in controls (P < 0.05). The rate of number on MS was significantly higher in case group than in control (r = 0.231, P < 0.05). CONCLUSION: The phenotypes of MS were different between adolescents with or without parental MS, indicating that the familial aggregation of MS had been existed in their adolescent offspring, and mainly presented in central obesity, increased blood pressure and inflammation.

Psychological distress and its correlates in Chinese adolescents.

OBJECTIVES: The aim of the present study was to estimate the prevalence of severe psychological distress in Chinese adolescents, and to identify the demographic and psychosocial factors associated with psychological distress in this population. METHOD: A multi-stage stratified sampling procedure was used to select a sample of adolescents (n = 3109) in Heilongjiang Province (Northeast of China), who were aged 13-18 years old. Psychological distress was measured by the Kessler Psychological Distress Scale (K10). A K10 score between 22 and 30 was defined as moderate psychological distress; a score of >or= 31 was defined as severe psychological distress in this study. RESULTS: The rates of moderate and severe psychological distress were 27.9% and 12.2%, respectively in the participants. There were no statistical differences in severe psychological distress by gender. Multivariate analysis showed that family environmental variables, schooling variables, self-perception with life and appearance, perceived health and negative life events were significantly associated with psychological distress. CONCLUSION: Severe psychological distress is prevalent in the Chinese adolescent population. Family dysfunction, higher academic pressure, poor relationship with others and negative self-perception are important risk factors associated with psychological distress in adolescents. More studies using the K10 scale are needed so that national and international comparisons can be made.

[The comparative study on maturation of metacarpal bone in puberty children during their growth spurt period between urban and rural areas].

OBJECTIVES: To study maturation of the metacarpal bone in puberty children during their growth spurt period and its difference between urban and rural areas. METHODS: Totally, 560 pupils/students were selected from primary and secondary schools in urban and rural areas each, with 35 children in each gender and age group, ranging 12 - 15 years of age for boys and 10 - 13 for girls. An X-ray film of left hand-wrist site was taken for each of them. Length and width of the metacarpal bone were measured and the metacarpal index was calculated. RESULTS: Increment of length of the metacarpal bone was great in puberty children both in urban and rural areas, (6.26 - 9.31) mm in boys and (5.28 - 9.12) mm in girls. Mean length of the metacarpal bone was longer in children of urban areas than that of rural ones, regardless of their age and gender. There was significant difference in mean length of the metacarpal bone between boys aged 14 - 15 years and girls aged 12. Mean width of the metacarpal bone in most children was wider in rural areas than that in urban ones. Mean metacarpal index in children was higher in urban areas than that in rural ones, with very statistical significance, except for girls of 13 year age group. The peak age of metacarpal maturation was 1 year earlier in urban areas than in rural ones. CONCLUSIONS: Maturation of the metacarpal bone was rapid during puberty growth spurt period, with relatively significant difference in urban and rural ares.