The safety and efficacy of tPA intravenous thrombolysis for treating acute ischemic stroke patients with a history of cerebral hemorrhage.

Alteplase (tPA) intravenous thrombolysis is an effective treatment for acute ischemic stroke (AIS) when administered within 4.5 h of initial stroke symptoms. Here, its safety and efficacy were evaluated among AIS patients with a previous history of cerebral hemorrhage. Patients who arrived at the hospital within 4.5 h of initial stroke symptoms and who were treated with tPA intravenous thrombolysis or conventional therapies were analyzed. The 90-day modified Rankin scale (90-d mRS) was used alongside mortality and incidence of symptomatic intracerebral hemorrhage (SICH) rates to evaluate the curative effect of these therapies. Among 1,694 AIS patients, 805 patients were treated with intravenous thrombolysis, including patients with (n=793) or without (n=12) a history of cerebral hemorrhage, and the rate of incidence of SICH significantly differed between them (8.3 vs 4.3%, P=0.039). No significant difference was found in 90-d mRS measurements (41.7 vs 43.6%, P=0.530) and 90-d mortality rates (8.3 vs 6.5%, P=0.946). A total of 76 AIS patients with a history of cerebral hemorrhage received tPA thrombolytic therapy (n=12) or conventional therapy (n=64), and a significant difference was noted in the 90-d mRS scores between the two groups (41.7 vs 23.4%, P=0.029), while no significant difference was found in SICH measurements (8.3 vs 4.6%, P=0.610) and 90-d mortality rates (8.3 vs 9.4%, P=0.227). A history of cerebral hemorrhage is not an absolute contraindication for thrombolytic therapy; tPA intravenous thrombolysis does not increase SICH measurements and mortality rates in patients with a history of cerebral hemorrhage, and they may benefit from thrombolytic therapy.

The safety and efficacy of tPA intravenous thrombolysis for treating acute ischemic stroke patients with a history of cerebral hemorrhage

Alteplase (tPA) intravenous thrombolysis is an effective treatment for acute ischemic stroke (AIS) when administered within 4.5 h of initial stroke symptoms. Here, its safety and efficacy were evaluated among AIS patients with a previous history of cerebral hemorrhage. Patients who arrived at the hospital within 4.5 h of initial stroke symptoms and who were treated with tPA intravenous thrombolysis or conventional therapies were analyzed. The 90-day modified Rankin scale (90-d mRS) was used alongside mortality and incidence of symptomatic intracerebral hemorrhage (SICH) rates to evaluate the curative effect of these therapies. Among 1,694 AIS patients, 805 patients were treated with intravenous thrombolysis, including patients with (n=793) or without (n=12) a history of cerebral hemorrhage, and the rate of incidence of SICH significantly differed between them (8.3 vs 4.3%, P=0.039). No significant difference was found in 90-d mRS measurements (41.7 vs 43.6%, P=0.530) and 90-d mortality rates (8.3 vs 6.5%, P=0.946). A total of 76 AIS patients with a history of cerebral hemorrhage received tPA thrombolytic therapy (n=12) or conventional therapy (n=64), and a significant difference was noted in the 90-d mRS scores between the two groups (41.7 vs 23.4%, P=0.029), while no significant difference was found in SICH measurements (8.3 vs 4.6%, P=0.610) and 90-d mortality rates (8.3 vs 9.4%, P=0.227). A history of cerebral hemorrhage is not an absolute contraindication for thrombolytic therapy; tPA intravenous thrombolysis does not increase SICH measurements and mortality rates in patients with a history of cerebral hemorrhage, and they may benefit from thrombolytic therapy.

Wharton's Jelly-derived mesenchymal stem cells alleviate memory deficits and reduce amyloid-ß deposition in an APP/PS1 transgenic mouse model.

Alzheimer's disease (AD) is the leading cause of dementia in the elderly and is characterized by amyloid plaques, neurofibrillary tangles, and neuronal loss. Cumulative evidence supports that neuroinflammation is an important factor for the pathogenesis of AD and contributes to amyloid beta (Aß) generation. However, there has been no effective treatment for AD. Wharton's Jelly-derived mesenchymal stem cells (WJ-MSCs) have a potential therapeutic effect in the treatment for neurological diseases. In the present study, we evaluated the therapeutic effect of WJ-MSC transplantation on the neuropathology and memory deficits in amyloid precursor protein (APP) and presenilin-1 (PS1) double-transgenic mice and discussed the mechanism. WJ-MSCs were intravenously transplanted into the APP/PS1 mice. Four weeks after treatment, WJ-MSCs significantly improved the spatial learning and alleviated the memory decline in the APP/PS1 mice. Aß deposition and soluble Aß levels were significantly reduced after WJ-MSC treatment. Furthermore, WJ-MSCs significantly increased the expression of the anti-inflammatory cytokine, IL-10. Meanwhile, pro-inflammatory microglial activation and the expressions of pro-inflammatory cytokines, IL-1ß and TNFα, were significantly down-regulated by WJ-MSC treatment. Thus, our findings suggest that WJ-MSCs might produce beneficial effects on the prevention and treatment for AD through modulation of neuroinflammation.

[Influence of As2O3-lipiodol emulsion via transarterial embolization on a VX2 liver tumor model in rabbits].

OBJECTIVE: To investigate the anticancer efficacy and the hepatic and renal toxicity of As2O3-lipiodol emulsion via transarterial embolization in a rabbit VX2 liver tumor model. METHODS: VX2 tumors were implanted in rabbit livers successfully, followed by transarterial embolization with high-dose As2O3(5 mg/kg with 0.2 mL lipiodol, n=10), low-dose As2O3(1 mg/kg with 0.2 mL lipiodol, n=10), and control(0.2 mL lipiodol, n=10). The growth ratios and microvessel densities(MVDs) of the tumors were estimated by multi-row spiral CT and CD34 immunohistochemical staining, respectively. Hepatic and renal function was also evaluated by means of blood biochemical analysis. RESULTS: The growth ratios of the tumors differed significantly among three groups(P<0.01). The high-dose and low dose group showed significantly lower tumor growth ratios[44.05%(-36.40%~64.60%), 95.20%(-11.60%~159.40%)] than control group[145.55%(98.90%~250.30%), all P<0.05]. The MVDs of the tumors were significantly lower in the high-dose(21.4±10.6) and low-dose group(34.1±12.0) than those in control group(57.9±16.1,all P<0.05). The levels of blood ALT and AST obtained 28 days after transarterial embolization were significantly lower in the high-dose[(25.50±12.37)U/L,(24.25±10.89)U/L] and low-dose group[(45.00±14.04)U/L,(35.22±11.86)U/L] than in control group[(79.12±30.52)U/L,(75.25±25.89)U/L, all P<0.05]. CONCLUSION: As2O3-lipiodol emulsion via transarterial embolization has anticancer effect without significant hepatic and renal functional damage in rabbit VX2 liver tumors.

[Expression of S100A8 and A100A9 in giant cell tumor of bone and its relation with CT and MR imaging findings].

OBJECTIVE: To investigate the mRNA and protein expression levels of S100A8 and S100A9 in giant cell tumor (GCT) of bone, and its relation with radiological findings and biological behavior. METHODS: Forty three patient with GCT of bone admitted in Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2009 to June 2012 were enrolled in the study. The expression levels of S100A8 and S100A9 mRNA and protein were detected by using semiquantitative RT-PCR and Western blotting in 43 specimens of GCT and 6 specimens of normal bone marrow. The CT and MRI findings of patients were retrospectively reviewed, its relation with tissue expression of S100A8 and S100A9 was analyzed. RESULTS: Among 43 GCT cases 40 showed positive expression of S100A8 and S100A9 mRNA and protein, and the expression levels were significantly higher than those in normal bone marrow P<0.05). The expression level of S100A8 protein was significantly different in bone GCT with different composition ratio on MRI (P<0.05).The expression level of S100A9 protein was significantly different in GCT with different degree of bone destruction on CT scan (P<0.05). CONCLUSION: The expression of S100A8 and S100A9 mRNA and protein is up-regulated in GCT of bone. The expression of S100A8 and S100A9 is associated with the real composition ratio and the degree of bone destruction, respectively, indicating that S100A8 and S100A9 may be involved in the biological behavior of bone GCT.

[Diffusion weighted imaging combined with dynamic contrast enhanced magnetic resonance imaging in monitoring therapeutic efficacy for hepatocellular carcinoma after transcatheter arterial chemoembolization].

OBJECTIVE: To evaluate the diagnostic value of diffusion weighted imaging (DWI) combined with dynamic contrast-enhanced (DCE) MRI in monitoring the efficacy for hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). METHODS: MRI and CT scan were performed 4-6 weeks after TACE in 31 patients.With digital signature algorithm (DSA) examination as the reference standard, the value in detection of the residue and recurrence of HCC was compared between MRI and CT results. RESULTS: Seventy-three lesions were detected in 31 patients. Fourteen lesions confirmed by DSA had no tumor staining, and 59 lesions had tumor staining. Diagnostic sensitivity and specificity of DCE-CT were 78.0% and 85.7%, respectively; while those of DWI combined with DCE-MRI were 100% and 92.9% (P<0.001). CONCLUSION: DWI combined with DCE-MRI is more effective than DCE-CT in detecting the residue and recurrence of HCC after TACE.

[CT and MRI findings in patients with autoimmune pancreatitis].

OBJECTIVE: To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings in patients with autoimmune pancreatitis (AIP). METHODS: The imaging findings of pancreas and extra-pancreas in 24 patients with AIP were retrospectively reviewed. Among them, CT scan was performed in 18 patients, MRI in 11, and bGth CT and MRI in 10. RESULTS: The pancreas showed diffuse enlargement (25%, 6/24), focal enlargement (37. 5%, 9/24), combined enlargement (25%, 6/24) ,and no enlargement (12. 5%, 9/24). Unenhanced CT showed hypoattenuation in AIP area (n = 2) . After intravenous injection of contrast medium, 17 patients showed abnormal contrast enhancement in the affected pancreatic parenchyma, including hypoattenuation during the arterial phase (50%, 9/18) and hyper attenuation during the delayed phase (94. 4%, 17/18). Precontrast MRI showed abnormal signal intense (n =9), including hypointense on T1-weight images (T1 WI) (n = 7), hyperintense (n = 7) and hypointense (n = 2) on T2-weight images (TIWI). Enhanced MRI demonstrated abnormal contrast enhancement within lesions (n = 11), including hypoattenuation during the arterial phase (81. 8%, 9/11) and good enhancement during the delayed phase (100%, 11111). A capsule-like rim was seen around pancreas (37. 5%, 9/24), among which CT detected in 6 out of 18 patients and MRI found in 7 out of 11 patients.The main pancreatic duct lumen within lesions has no visualization (100%, 24/24) and upstream dilation of the main pancreatic duct (n = 8) , ranging from 2. 2 to 4. 5 mm(mean 3. 1 0. 47 mm) in diameter. Narrowing of the common bile duct was shown in 14 patients. Miscellaneous findings were: infiltration of extrapancreatic vein (n = 9) and artery (n = 1); mild fluid collection around pancreas (n = 2); pseudocysts (n = 3). Fourteen patients also presented one or more of the following extrapancreatic imaging findings: narrowing of the intra-hepatic bile duct or hilar duct (n = 5); thickening of gallbladder wall (n = 5); fibrosis in mesenteric (n = 2), in retroperitoneal (n = 2) and in ligamentum teres hepatis (n = 1); renal involvement (n = 3); peri-pancreatic or para-aortic lymphadenopathy (n = 10); and ulcerative colitis (n = 3). CONCLUSION: AIP display some characteristic CT and MRI imaging features: sausage-like change of the pancreas; capsule-like rims around lesions; delayed contrast enhancement in the affected pancreatic parenchyma; segment or diffuse pancreatic duct stenosis but mild upstream dilation and extrapancreatic organs involvement. CT and MRI findings combining with serological tests and pancreas biopsy can assist physicians to make accurate and timely diagnosis.

VEGF-induced angiogenesis ameliorates the memory impairment in APP transgenic mouse model of Alzheimer's disease.

Vascular endothelial growth factor (VEGF) was investigated in the present study to see whether it could provide a therapeutic opportunity for the treatment of Alzheimer's disease (AD). PDGF-hAPP(V717I) transgenic mice were treated with VEGF or PBS by intraperitoneal injection for three consecutive days. The results showed that VEGF ameliorated the memory impairment of mice, accompanied by CD34(+) cells increasing in peripheral blood, vWF(+) vessels increasing in hippocampus, and CD34(+)/VEGFR2(+), vWF(+)/VEGFR2(+) and BrdU(+)/vWF(+) cells expressing in hippocampus. Furthermore, the level of choline acetyltransferase (ChAT) was considerably enhanced and Aß deposition was decreased in the brains of mice upon VEGF treatment. These observations suggest that VEGF should be pursued as a novel therapeutic agent for treatment of AD.

[CT scan findings of primary pulmonary non-Hodgkin's lymphoma and their relation to pathological features].

OBJECTIVE: To investigate the CT scan findings of primary pulmonary non-Hodgkin's lymphoma (PPNHL) and their relation to pathological features. METHODS: The CT scan findings of 17 PPNHL cases confirmed pathologically from August 1992 to June 2007 were analyzed in relation to their pathological foundation. RESULT: In 17 cases the CT findings showed: 1) Five were single mass or nodule, including 3 with air-bronchograms, 1 with straddling-lobe distribution and 3 with slight enhancement; 2) One was multi-nodules with air-bronchograms; 3) Six were consolidation with air bronchogram,including 3 with straddling-lobe distribution and 3 with slight enhancement; 4) Five were combined changes, including 5 with air-bronchograms, 2 with straddling-lobe distribution and 4 with slight enhancement. The CT features of PPNHL corresponded to their pathological process and pathological features. CONCLUSION: Primary pulmonary non-Hodgkin's lymphoma should be considered when CT scan shows variety of images found in one patient, middle lobe of right lung involved, air-bronchograms and straddling-lobe distribution in consolidation with slight enhancement.

[Value of 3D-DCE MRA in diagnosis of cavernous transformation of portal vein].

OBJECTIVE: To evaluate three dimensional dynamic contrast-enhanced magnetic resonance angiography (3D-DCE MRA) in diagnosis of cavernous transformation of portal vein (CTPV). METHODS: Twenty-four patients with CTPV underwent 3D-DCE MRA examinations and the reconstructed images were retrospectively analyzed. A series of clinical, laboratory and imaging studies were performed on all these cases. Among all cases 14 underwent operations and 2 with hepatocellular carcinoma complicated portal thrombosis received transhepatic artery chemoembolization. RESULT: The CTPA was located in the main trunk in 10 cases, in both the main trunk and left/right branches in 8, and in left or right branches of the portal vein in 4. In the remaining 2 cases CTPA was located at the level of superior mesenteric vein. MRA revealed multiple circuitous collateral veins striding over obstruction to extend into the liver in 9 cases,and in 7 it simultaneously showed streaky or dot-like low signal intensities representing thrombi in the extensively dilated network of portal system. MRA did not clearly demonstrate the structure of the portal vein but only showed multiple sinuous network of venous collaterals strangling together in 6 cases. In 15 cases it also showed the route and distribution of multiple hepatofugal venous collaterals. CONCLUSION: 3D-DCE MRA can provide adequate information about the site and severity of CTPA.

[Correlation between pathology and imaging characteristics of hepatic agiomyolipoma].

OBJECTIVE: To discuss CT and MRI characteristics of hepatic angiomyolipoma based on pathological findings. METHODS: The CT and MRI appearances with related pathohistological subtypes of 11 hepatic angiomyolipomas from 10 patients were retrospectively analyzed. RESULT: Ten patients with hepatic angiomyolipomas were subcategorized into lipomatous (3 cases), angiomatous (1 case), myomatous (1 case) and mixed (5 cases) subtypes. Lesions of the lipomatous type were mainly composed of adipocytes which could be easily recognized on both CT and MRI. Abnormal vessels were commonly seen in the angiomatous lesions, which showed pronounced enhancement in the early arterial phase and remained higher than or isodense with the normal parenchyma in the portal phase. The myomatous type was predominantly composed of leiomyoid cells mixed with small amount of adipocytes. The mixed type was the most frequent,evenly comprising sheets of epithelioid muscle cells admixed with islands of adipocytes and abnormal vessels, and showing homogeneously low density on plain CT and low signal intensity on T1-weighted,intermediately high signal intensity on T2-weighted MRI scans. On dynamic study with both CT and MRI, the mixed type exhibited obvious enhancement, which retained to some degree during the portal phase. CONCLUSION: The discrete CT and MRI appearances of hepatic angiomyolipomas with different pathological subtypes depend on the components of the tumor.

[Experimental study of hippocampal neuronic lesion in ischemic rat by magnetic resonance spectroscopy].

AIM: To evaluate N-acetylaspartate reflecting the neuronal lesion in middle cerebral artery occlusion and reperfusion rat by magnetic resonance spectroscopy (MRS). METHODS: Sixteen adult Wistar rats with MCAO reperfusion and ten pseudooperation rats were performed MRS in vivo at the sixth weeks, then pathologic examination of HE staining and immunohistochemical staining were made. We compared hippocampus modality, cell density and immunohistochemical results with N-acetylaspartate, creatine changes and ration of NAA/Cr. RESULTS: The values of NAA, Cr and NAA/Cr of ipsilateral hippocampus lesion in MCAO reperfusion rats (2.05 +/- 0.33, 2.42 +/- 0.41 and 0.86 +/- 0.10) were visiblly decreased than contralateral hippocampus (3.45 +/- 0.58, 3.10 +/- 0.93, 1.18 +/- 0.32) and control group (3.42 +/- 0.43, 3.57 +/- 0.47, 0.98 +/- 0.14). But the level of decreased NAA is not corresponding to the degree of neuronal death in ipsilateral region of hippocampus in histochemistry. CONCLUSION: MRS has perfect explanation of cell metabolic changes in CA1 region. Decrease of NAA represented neuron delayed injury. But the decreased level of NAA is not perfectly corresponded to the degree of neuron lost. This change has closed correlation with reactive astrocytes proliferation.

[Imaging diagnosis of abdominal solitary fibrous tumor].

OBJECTIVE: To investigate the imaging characteristics of abdominal solitary fibrous tumor (SFT) with its pathological features. METHODS: Six cases of abdominal solitary fibrous tumors were studied using X-ray, CT, MRI examination as well as histopathological and immunohistochemical techniques. RESULT: Contrast enhanced CT showed early intense enhancement as a result of the rich vascularization. On MRI the parenchyma of the tumors showed hypointensity on T1WI, T2WI and some tumors might manifest areas of hyperintensity on T2WI due to myxoid degeneration or hemorrhage. Microscopically, SFT was composed of spindle cells with various patterns and these spindle cells were CD34 positive on immunohistochemistry. CONCLUSION: SFT is a soft tissue tumor originating from mesenchyma. Abdominal SFT shows variable appearance and enhancement pattern on CT and MRI according to tumor cells distribution and myxoid degeneration or hemorrhage within the tumor pathologically.

[Correlation between pathology and image characteristics of retroperitoneal liposarcoma].

OBJECTIVE: To investigate the correlation between the pathological and image features of different subtypes of retroperitoneal liposarcoma. METHODS: Pathological and image characteristics of 21 retroperitoneal liposarcomas were retrospectively analyzed comparing their different histopathological subtypes. RESULTS: This series consisted of 11 well-differentiated, 4 myxoid, 3 round-cell, 2 pleomorphic and 1 dedifferentiated liposarcoma. Well-differentiated liposarcomas were predominantly composed of lipoma-like and sclerosing components. On CT and MRI image, the attenuation and signal intensity of lipoma-like components resembled those of fat, whereas the signal intensity of sclerosing components was similar to those of muscle. Unenhanced CT image of the myxoid subtype showed density resembling that of water. On contrast-enhanced CT image, it showed gradual reticular or sheet-like enhancement. The CT and MRI image appearance of the round cell and pleomorphic subtypes resembled those of nonfatty soft tissue masses with foci of necrosis. The dedifferentiated liposarcoma showed the image feature of a well-differentiated component clearing enhanced soft tissue mass. CONCLUSION: Different subtypes of retroperitoneal liposarcoma show different CT and MRI features relating to their major histologic components. A good understanding of the relation between their radiological and pathological features is helpful to arrive at a correct diagnosis for retroperitoneal liposarcoma.

[Clinical value of three-dimensional dynamic contrast-enhanced MR angiography in diagnosis of angiostenosis after liver transplantation].

OBJECTIVE: To evaluate the clinical application of three-dimensional dynamic contrast-enhanced MR angiography (3D DCE MRA) in diagnosis of angiostenosis after liver transplantation. METHODS: Twenty recipients of liver transplantation underwent 3D DCE MRA examination. The blood vessel rating grades were accessed and the relative diameter of vascular anastomosis was measured; and the results were compared with those of US or DSA examination. RESULTS: Satisfactory angiography images were obtained in all cases by 3D DCE MRA, including 11 cases with normal and mild stenosis, 5 with moderate and 4 with severe stenosis in hepatic artery. Except one case in which 3D DCE MRA showed severe stenosis but DSA showed moderate stenosis, the results of MRA were all consistent with those of US or/and DSA in the stenosis degree of the portal vein, hepatic vein and the postcava. CONCLUSION: 3D DCE MRA is an effective technique to evaluate the degree of angiostenosis after liver transplantation.

Evaluation of selective hepatic angiography and embolization in patients with massive hemobilia.

BACKGROUND: Massive hemobilia is a rare but potentially life-threatening cause of upper gastrointestinal hemorrhage. Transarterial embolization is considered the first line of intervention to stop the bleeding for most causes of hemobilia. This study was conducted to evaluate selective hepatic angiography and embolization in the diagnosis and treatment of patients with massive hemobilia. METHODS: The clinical data of 16 patients with massive hemobilia were analyzed retrospectively. These patients underwent emergency celiac and selective right or left hepatic artery angiography and treated by embolization using Gelfoam particles and/or coils. RESULTS: Hepatic artery angiography revealed hepatic artery pseudoaneurysms in 6 patients, cystic artery pseudoaneurysms in 2, diffuse hemorrhage of hepatic artery branches in 5, and right hepatic artery-bile duct fistulae in 3. The patients were diagnosed rapidly by angiography and treated successfully by embolization of the hepatic artery branch proximal to the bleeding point, and hemorrhage was stopped immediately. Two patients were embolized the second time for rebleeding. Neither recurrence of bleeding nor serious complication was found during the follow-up for 3 months to 2 years. The other 2 patients whose hemorrhage failed to be controlled died several days later. CONCLUSION: Being safe, reliable and minimally invasive, selective hepatic artery angiography and embolization are effective in the diagnosis and treatment of massive hemobilia.