Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery.

BACKGROUND: Intracranial hemorrhage after spinal surgery is a rare and devastating complication. AIM: To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery. METHODS: A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded. RESULTS: A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years vs 58.39 ± 8.07 years, P = 0.001), previous history of cerebrovascular disease (50% vs 6.7%, P = 0.024), spinal dura mater injury (50% vs 3.3%, P = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 vs RMB 96290.7 ± 32029.9, P = 0.009), and discharge activity daily living score (40.00 ± 25.88 vs 75.40 ± 18.29, P = 0.019). CONCLUSION: The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.

Clinical effects of combined treatment of traditional Chinese medicine and western medicine for viral hepatitis B cirrhosis and the effects on serum miR-122, miR-200a.

The aim is to explore the clinical effects of combined treatment of Traditional Chinese Medicine (TCM) and western medicine in viral hepatitis B cirrhosis and the effects on microRNA (miR)-122 and miR-200a. 116 patients with chronic hepatitis B cirrhosis were admitted to our hospital. Real-time fluorescent quantitative PCR (qPCR) was employed to reveal the level of serum miR-122 and miR-200a in the three groups. The clinical effects of the two groups were compared, including alanine aminotransferase (ALT), aspartate amino transferase (AST), total bilirubin (TBIL) and alpha fetoprotein (AFP) indexes, coagulation function indexes, liver elasticity value and the main therapeutic effects. After treatment, the ALT, AST, TBIL and AFP indexes significantly decreased in both groups, which were much lower in the western medicine (WM) + TCM Group. The levels of albumin (ALB) all increased, and the increase was more significant in the WM + TCM Group. The prothrombin time (PT) was down-regulated while the prothrombin activity (PTA) was up-regulated in both groups. Both groups showed a decrease in liver elasticity after treatment, which was more obvious in the WM + TCM Group. The incidence of primary peritonitis, hepatic encephalopathy, hepatorenal syndrome, gastrointestinal bleeding and electrolyte disturbance in the WM + TCM Group was significantly lower than those in the WM Group. The combination of Chinese and western medicine in the treatment of cirrhosis can reduce the occurrence of complications, improve the clinical symptoms and improve the clinical effects effectively, which is worthy of further study and clinical popularization. Viral hepatitis B, Liver cirrhosis, Combination of TCM and Western medicine, miR-122, miR-200a.

Disruption of blood-brain barrier integrity associated with brain lesions in Chinese neuromyelitis optica spectrum disorder patients.

OBJECTIVE: The aims of this study were to report brain characteristic abnormalities and to evaluate the relationship of blood-brain barrier (BBB) disruption and brain lesions in Chinese patients with NMOSD. METHODS: Brain magnetic resonance imaging characteristics and cerebrospinal fluid (CSF) laboratory tests of 121 patients with NMOSD at acute attack were reviewed retrospectively. Qalb (CSF albumin/serum albumin) was used for assessment of disruption of BBB. RESULTS: Brain MRI abnormalities were observed in 36.4% (44/121) of the NMOSD patients. Thirty patients (25%) showed typical-NMOSD abnormalities, including dorsal medulla lesions (n = 16, 13.2%), brainstem/cerebellum (n = 11, 9.1%), thalamus/hypothalamus (n = 3, 2.5%), periventricular white matter lesions (n = 4, 3.3%) hemispheric white matter (n = 4, 3.3%). Twenty-five patients (20.7%) had nonspecific lesions. Compared to the NMOSD patients without brain lesion, the proportion of patients who had abnormal BBB permeability was significantly higher in the abnormal brain MRI group (47.7% vs. 27.3%, P < 0.05). BBB permeability was not correlated to distribution of brain lesions or enhancement lesions. Qalb was associated with higher Expanded Disability Status Scale scores (r = 0.689, P < 0.05). CONCLUSIONS: Brain lesions are common in NMOSD patients. Marker of BBB permeability is associated with brain lesion and EDSS scores of NMOSD.

Short transverse myelitis in Chinese patients with neuromyelitis optica spectrum disorders.

BACKGROUND: Short transverse myelitis (STM) is considered uncommon in neuromyelitis optica spectrum disorders (NMOSD). Poor recognition of STM occurring in NMOSD may lead to increased delay in diagnosis and appropriate treatment. OBJECTIVES: The aim of this study was to assess the frequency and characteristics of STM in Chinese patients with NMOSD. METHODS: We enrolled 91 patients with NMOSD based on the 2015 International Consensus Diagnostic Criteria for NMOSD. The patients were divided into STM group and longitudinally extensive transverse myelitis (LETM) group according to the length of initial spinal cord lesions at the initial myelitis manifestation of NMOSD. RESULTS: Initial STM was observed in 18 patients (18/91, 19.8%). The STM episode was the first manifestation of NMOSD in 9 patients (50%) and preceded by optic neuritis in 3 patients (16.7%), area postrema syndrome in 5(27.8%) and brainstem syndrome in 1(5.6%). Compared to the NMOSD patients with an initial LETM, patients with STM suffered less motor and bowel or bladder disability, had minor EDSS at clinical onset, but suffered earlier relapse (P＜.05). Thirteen patients had single short spinal lesion (13/18, 72.2%) and 5 patients had two short lesions. Of the 23 STM lesions, 4 lesions spanned 2.5 vertebral segments, 12 showed a length of continuous 2 vertebral segments, 7 were confined to single vertebral segment. The lesions on axial imaging involved the central grey matter in 61.1% (11/18) patients with STM and in 95.9%（70/73）patients with LETM (P＜.05). Both the patients with STM（50%）and LETM (34.2%) had brain lesions. CONCLUSIONS: Initial STM does not exclude consideration of NMOSD diagnosis.

[Detection of anti-aquaporin 4 antibody in neuromyelitis optical].

OBJECTIVE: To assess the sensitivity and specificity of anti-aquaporin 4 antibody in the diagnosis of neuromyelitis optical (NMO) and analyze the relationship between clinical features and different NMO-IgG status. METHODS: A total of 269 serum specimens were collected from the patients with NMO, high-risk for NMO, multiple sclerosis (MS) and miscellaneous diseases and analyzed with HEK-293T cells transfected by aquaporin 4 cDNA. The sensitivity and specificity of anti-aquaporin 4 antibody in the diagnosis of NMO were calculated, Spearman correlation coefficients were used to examine the relationship between clinical features and antibody titer. RESULTS: (1) The results of cell-based immunofluorescence assay showed 36 examples of 47 NMO patient serums (76.6%) were positive, 7/23 high-risk for NMO positive (30.4%), 3/85 multiple sclerosis (3.5%) positive, 1/48 miscellaneous neurological disorders (2.1%), 2/16 immune system diseases positive (12.5%) and negative in all 50 healthy serum specimens. Sensitivity and specificity were 76.6% and 97.0% for discriminating NMO from MS and other diseases. (2) Anti-AQP4 antibody titer had no obvious correlation to relapses, spinal lesion length and EDSS (P > 0.05). (3) Anti-AQP4 antibody titer became lower after a high dose of intravenous methylprednisolone (P < 0.05). CONCLUSION: Anti-AQP4 antibody in NMO has a high specificity and sensitivity so as to contribute to early diagnosis and optimized treatment of NMO. And its titer decreases after a high dose of intravenous methylprednisolone. But there is no correlation between its titer and length of spinal cord lesions, relapsing frequency or expanded disability status scale (EDSS) score.

[The clinical and magnetic resonance imaging studies of brain damages in neuromyelitis optica].

OBJECTIVE: To investigate the feature brain damage and clinical manifestations in neuromyelitis optica (NMO) patients; To investigate the relationship between serum NMO-IgG antibody and NMO brain damage. METHODS: Clinical data of 37 NMO patients and their head and spinal cord MRI by 1.5T superconducting MR scanner, were analyzed; serum NMO-IgG antibody were measured by immunofluorescence. RESULTS: 17 cases were found to have abnormal signals on MRI, which were mainly in the white matter, pons, medulla, ventricle, aqueduct, and around the corpus callosum; According to pathological changes, brain damage can be divided into scattered irregularity (13 cases), fusion (3 cases), multiple sclerosis-like (1 case), with scattered irregularity more common, 5 cases had clinical manifestations of brain damage: somnolence, vomiting, diplopia, visual rotation, 11 cases patients with brainstem damage show positive serum NMO-IgG antibodies. CONCLUSIONS: Brain damage can be seen in half of NMO patients, they often located in the high expression area of AQP4: brain white matter, periventricular, brainstem and so on. Clinical symptoms has nothing to do with the size of lesions but the location, they often occur when brainstem was involved. Serum NMO-IgG is helpful in differentiating NMO with brain damage and MS.

Aquaporin-4 antibody positive neuromyelitis optica with syndrome of inappropriate antidiuretic hormone secretion.

Neuromyelitis optica (NMO) has been reported to be associated with endocrinopathies, such as amenorrhea, galactorrhea, and diabetes mellitus. However, its association with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is extremely rare. We herein report an adult case of NMO with SIADH in a female Chinese patient. The patient was aquaporin-4 antibody positive, and her hypothalamic dysfunction may have been related to the development of SIADH.

[Comparison of three anti-aquaporin 4 antibody detection methods in neuromyelitis optical].

OBJECTIVE: To evaluate three methods of detecting anti-aquaporin 4(AQP4) antibody in neuromyelitis optical(NMO), including indirect immunofluorescence assay organization (IIF), cell immunofluorescence method (CBA) and ELISA. METHODS: The patients were divided into NMO group (n = 29), multiple sclerosis (MS) group (n = 23), and healthy controls group (n = 50). IIF, CBA and ELISA were used in 3 groups to detect serum anti-AQP4 antibody. The sensitivity and specificity as well as the consistency of positive results were compared. RESULTS: In the aspect of the sensitivity of the three anti-AQP4 antibody to diagnosis NMO, CBA (72.4%) > IIF (62.1%) > ELISA (51.7%); in the aspect of specificity, CBA (100.0%) > ELISA (98.6%) > IIF (97.3%). Kappa testing and evaluation method showed that the three detection methods were all in good consistency, particular in CBA and ELISA (P < 0.01). CONCLUSIONS: CBA method showed a highest specificity and sensitivity in all these three anti-AQP4 antibody detection methods. CBA and ELISA are in better consistency of positive results.

[Neuromyelitis optica IgG and related clinical features of patients with neuromyelitis optica].

OBJECTIVE: To investigate the differential diagnostic value of NMO-IgG for neuromyelitis optica (NMO) versus multiple sclerosis (MS) and to analyze its possible clinical features related to NMO-IgG. METHODS: Forty-one NMO patients and 44 MS patients in acute phase and 40 healthy controls were investigated. Serum NMO-IgG was tested by indirect immunofluorescence assay. The disability severity in NMO and MS patients was assessed by Expanded Disability Status Scale (EDSS). Clinical features and MRI imaging profiles were analyzed between NMO-IgG positive patients and negative ones. RESULTS: 70.7% (29/41) NMO patients were NMO-IgG positive compared to 9.1% (4/44) MS patients and all healthy controls were NMO-IgG negative (P < 0.01). The sensitivity and specificity were 70.7% and 90.9% respectively when NMO-IgG was used to discriminate NMO from MS. NMO patients with positive NMO-IgG had significantly higher EDSS scores (P < 0.05). More NMO-IgG seropositive patients had longitudinally extensive cord lesions (≥ 3 segments) than the NMO-IgG seronegative patients (93.1% vs 66.7%). But the difference was insignificant. CONCLUSION: NMO-IgG is a specific biomarker of NMO. NMO-IgG can facilitate an early differentiation of NMO from MS. NMO-IgG seropositivity is related to graver symptoms and it may predict an aggravation.

[Construction and clinical application of lentivirus-AQP4 expressing vector].

OBJECTIVE: To construct the human aquaporin-4 (AQP4) expressing vector and detect anti-AQP4 antibody in serum of patients with neuromyelitis optica (NMO). METHODS: RNA was extracted from human glioblastoma and AQP4 cDNA obtained through RT-PCR.The fragment was cloned into the lentiviral expressing vector (iDUET101) and transformed into competent strain Hb101 for later amplification; plasmids were extracted from the amplified positive-bacteria-colony, sequenced and transfected into HEK-293T cells. Expression of AQP4 was identified by RT-PCR, Western blot and immunofluorescence assay. And anti-AQP4 antibody in human serum was tested. RESULTS: The sequence of target fragment matched with that of human AQP4 fragment sequences (NM_001650) completely. The constructed AQP4 fragment transfected in HEK-293T cell was tested by immunofluorescent examination and it exhibited obvious fluorescence located in cell membrane. Western blot test was positive. And the fragment was about 34 KD. Cellular immunofluorescence examination showed 11 examples of 12 NMO patient serums (91.7%) were positive, 4 in 34 multiple sclerosis (11.8%) positive and negative in all 50 serum samples of healthy controls. CONCLUSION: The HEK-293T cell transfected with lentivirus-AQP4 vector can express stably. And the expressed fragment may be applied in clinical examination.

[Serum uric acid level and related clinical features in neuromyelitis optica].

OBJECTIVE: To investigate serum uric acid (UA) levels and related clinical characteristics of neuromyelitis optica (NMO). METHODS: The serum uric acid levels were measured in 65 patients with NMO, compared to control groups which were 76 cases with multiple sclerosis (MS), 126 cases with cerebral vascular diseases (CVD) and 130 healthy controls (HC). The disability severity in NMO was assessed by the Expanded Disability Status Scale (EDSS). Magnetic resonance imaging (MRI) was performed to strengthen assessment the involved lesions. Serum AQP4 antibody was tested in a cell based immunofluorescence assay. RESULTS: In male groups, serum UA levels in NMO patients [(298.90 ± 74.14) µmol/L] were significantly lower than that in CVD [(355.37 ± 50.30) µmol/L] and HC subjects [(340.33 ± 58.23) µmol/L, P < 0.05]. No difference was found between NMO and MS [(292.36 ± 92.95) µmol/L] groups. In female groups, serum UA levels in NMO patients [(198.21 ± 62.62) µmol/L] were significantly lower than that in CVD [(274.51 ± 70.66) µmol/L] and HC subjects [(243.26 ± 60.65) µmol/L, P < 0.05]. No difference was found between NMO and MS [(232.29 ± 71.95) µmol/L] groups. UA levels were significantly lower in females [(198.21 ± 62.62) µmol/L] than in males [(298.90 ± 74.14) µmol/L]. UA levels were significantly lower in patients with EDSS ≥ 5 [(195.48 ± 83.70) µmol/L] than EDSS < 5 [(241.00 ± 63.20) µmol/L] NMO patients. In our study UA levels were not correlated with longitude of spinal lesions, activity revealed by MRI and AQP4 antibody tires. CONCLUSION: Lower serum UA levels were found in patients with NMO and related to more severe symptoms.