Origin of Immediate Damping of Coherent Oscillations in Photoinduced Charge-Density-Wave Transition.

In stark contrast to the conventional charge density wave (CDW) materials, the one-dimensional CDW on the In/Si(111) surface exhibits immediate damping of the CDW oscillation during the photoinduced phase transition. Here, we successfully reproduce the experimental observation of the photoinduced CDW transition on the In/Si(111) surface by performing real-time time-dependent density functional theory (rt-TDDFT) simulations. We show that photoexcitation promotes valence electrons from the Si substrate to the empty surface bands composed primarily of the covalent p-p bonding states of the long In-In bonds. Such photoexcitation generates interatomic forces to shorten the long In-In bonds and thus drives the structural transition. After the structural transition, these surface bands undergo a switch among different In-In bonds, causing a rotation of the interatomic forces by about π/6 and thus quickly damping the oscillations in feature CDW modes. These findings provide a deeper understanding of photoinduced phase transitions.

Determination of Fluorescent Whitening Agents in Cosmetics and Liquid Detergent by High-Performance Liquid Chromatography with Diode Array Detector in Tandem with Fluorescence Detector.

Five distyryl-type fluorescent whitening agents (FWA85, 210, 220, 351, and 353) were determined in cosmetics and liquid detergent by high-performance liquid chromatography with diode array detector in tandem with fluorescence detector. The samples were extracted with ultrasound in 33% acetonitrile for 10 minutes and the components were determined by ion-pair chromatography on an MG C18 column. The limits of detection were from 0.01 to 0.1 mg·kg-1 and the limits of quantification were from 0.04 to 0.4 mg·kg-1. The recovery was from 80.7 to 103.3%. A linear relationship was present from 0.10 to 100 µg·ml-1 of FWAs. The protocol was simple, sensitive, selective, and was successfully applied to analyze distyryl-type FWAs in cosmetics and liquid detergent. FWA351 and FWA85 were detected in several samples with the concentrations of 19.4-1,130 mg·kg-1.

Determination of zinc pyrithione in shampoos by HPLC and HPLC-MS/MS.

Methods have been developed for the determination of zinc pyrithione (ZPT) in shampoos using high-performance liquid chromatography (HPLC) and high-performance liquid chromatography-mass spectrometry/mass spectrometry (HPLC-MS/MS). Samples were washed by water first to remove surfactant and water-soluble impurities, then ultrasonic-extracted by acetonitrile-methanol for 30 min, and finally analyzed by MG C18 column (250 mm x 4.6 mm, 5 µm) or RP-18e (100 mm x 3 mm, 2 µm) plus APCI-MS/MS. Limits of detection were determined as 0.015% (HPLC) and 0.003% (HPLC-MS/MS), with a limit of quantization of 0.05% and 0.01%, respectively. The recoveries were 85.8-104% (HPLC) and 87.6-107% (HPLC-MS/MS). A good linear relationship was obtained from 3.20 µg·ml(-1) to 200 µg·ml(-1) (HPLC) and 1.00 µg·ml(-1) to 200 µg·ml(-1) (HPLC-MS/MS). The proposed methods have been successfully applied to the analysis of ZPT in many shampoos. The established two methods were rapid and reproducible with low interference.

[Long-term efficacies of sinus skeletonization plus abnormal venous reflux interruption in the treatment of parasinus dural arteriovenous fistula].

OBJECTIVE: To retrospectively explore the long-term efficacies of sinus skeletonization plus abnormal venous reflux interruption in the treatment of dural arteriovenous fistula interfering major dural sinus. METHODS: Among 15 consecutively treated patients, the lesions were located in superior sagittal sinus (n = 7), medial segment of transverse sinus (n = 3) and lateral transverse and sigmoid sinus (n = 5). And 40% of them clinically presented with intracranial hypertension and 13.3% with hemorrhage. Preoperatively, Gamma knife therapy and transarterial occlusion were used in 1 case each. All underwent sinus skeletonization plus abnormal venous reflux interruption if any. Interfered sinus was preserved in 12 cases. In another 3 cases, completely occluded segment of sinus was resected after skeletonization. RESULTS: Surgical mortality was none. At discharge, the symptoms were relieved or disappeared in 12 cases. Follow-up study was available in 11 cases over a mean period of 6 years. A Karnofsky performance status (KPS) score of 90 or more was achieved in 8 cases and a KPS score of 80, 60 or 40 was found in 1 case each. Digital subtract angiography was performed in 9 cases and computed tomographic angiography in 1 case after operation. Cure was achieved in 7 cases and 3 cases had minimal residue without recurrence. CONCLUSION: Sinus skeletonization may stably block most blood supply to fistula so as to offer cure or long-term control of dural arteriovenous fistula.

Determination of 11 Kinds of Hair Dyes in Hair-Dyeing Products by Liquid Chromatography-Tandem Mass Spectrometry.

Eleven kinds of hair dyes were determined in hair-dyeing products by liquid chromatography-tandem mass spectrometry (MS). The samples were extracted with ultrasound in methanol for 20 min. After centrifugation, the supernatant was diluted with 10% methanol/90% water (v/v). Then, the solution was analyzed by Shim-pack Scepter C18-120 column (100 mm × 2.1 mm, 1.9 µm) plus electrospray ionization-MS/MS. Matrix-matched standard solutions were used to analyze the samples. The limits of detection were from 0.15 to 10 mg/kg, the limits of quantification were from 0.5 to 40 mg/kg and the recovery was from 79.4 to 109.2%. The protocol was selective and accurate and was satisfyingly applied to analyze hair dyes in different kinds of commercial products. 1-Hydroxyethyl-4,5-diaminopyrazole sulfate, hydroxyethyl-p-phenylenediamine sulfate, 2-methyl-5-hydroxyethylaminophenol, 5-amino-6-chloro-o-cresol, 3-nitro-p-hydroxyethylaminophenol and 2-amino-6-chloro-4-nitrophenol were detected in 10 samples with the concentrations between limits of detection and quantification to 9.27 × 104 mg/kg.

Polymorphisms of VEGFA gene and susceptibility to hemorrhage risk of brain arteriovenous malformations in a Chinese population.

AIM: To evaluate the influence of the vascular endothelial growth factor A (VEGFA) polymorphisms on risk of presentation with intracerebral hemorrhage (ICH). METHODS: Nine selected VEGFA single-nucleotide polymorphisms (SNPs) were genotyped in 311 patients with brain arteriovenous malformations (BAVM) in a Chinese population. Associations between individual SNPs/haplotypes and the hemorrhage risk of BAVMs were evaluated using logistic regression analysis. RESULTS: In the single-locus analysis, rs1547651 was associated with increased risk of ICH (adjusted OR=2.11, 95% CI=1.01-4.42 compared with the AA genotype). In particular, an increased risk for ICH was associated with this variant in female patients (adjusted OR=3.21, and 95% CI=0.99-10.36). Haplotype-based analyses revealed that haplotype 'GC' in block 1 and haplotype 'ACC' in block 2 were associated with a 30%-38% reduction in the risk of ICH in patients with BAVMs compared to the most common haplotype (P(sim)=0.033 and P(sim)=0.005, respectively). The protective effect of haplotype 'ACC' in block 2 was more evident in male patients and subjects with BAVMs of a size ≥3 cm (adjusted OR=0.57, 95% CI=0.34-0.97 and adjusted OR=0.57, 95% CI=0.31-0.86, respectively). CONCLUSION: The results suggest that VEGFA gene variants may contribute to ICH risk of BAVM.

Recognition of moyamoya disease and its hemorrhagic risk using deep learning algorithms: sourced from retrospective studies.

Although intracranial hemorrhage in moyamoya disease can occur repeatedly, predicting the disease is difficult. Deep learning algorithms developed in recent years provide a new angle for identifying hidden risk factors, evaluating the weight of different factors, and quantitatively evaluating the risk of intracranial hemorrhage in moyamoya disease. To investigate whether convolutional neural network algorithms can be used to recognize moyamoya disease and predict hemorrhagic episodes, we retrospectively selected 460 adult unilateral hemispheres with moyamoya vasculopathy as positive samples for diagnosis modeling, including 418 hemispheres with moyamoya disease and 42 hemispheres with moyamoya syndromes. Another 500 hemispheres with normal vessel appearance were selected as negative samples. We used deep residual neural network (ResNet-152) algorithms to extract features from raw data obtained from digital subtraction angiography of the internal carotid artery, then trained and validated the model. The accuracy, sensitivity, and specificity of the model in identifying unilateral moyamoya vasculopathy were 97.64 ± 0.87%, 96.55 ± 3.44%, and 98.29 ± 0.98%, respectively. The area under the receiver operating characteristic curve was 0.990. We used a combined multi-view conventional neural network algorithm to integrate age, sex, and hemorrhagic factors with features of the digital subtraction angiography. The accuracy of the model in predicting unilateral hemorrhagic risk was 90.69 ± 1.58% and the sensitivity and specificity were 94.12 ± 2.75% and 89.86 ± 3.64%, respectively. The deep learning algorithms we proposed were valuable and might assist in the automatic diagnosis of moyamoya disease and timely recognition of the risk for re-hemorrhage. This study was approved by the Institutional Review Board of Huashan Hospital, Fudan University, China (approved No. 2014-278) on January 12, 2015.

Recognition of Cognitive Impairment in Adult Moyamoya Disease: A Classifier Based on High-Order Resting-State Functional Connectivity Network.

Objective: Vascular cognitive impairment (VCI) is a common complication in adult patients with moyamoya disease (MMD), and is reversible by surgical revascularization in its early stage of mild VCI. However, accurate diagnosis of mild VCI is difficult based on neuropsychological examination alone. This study proposed a method of dynamic resting-state functional connectivity (FC) network to recognize global cognitive impairment in MMD. Methods: For MMD, 36 patients with VCI and 43 patients with intact cognition (Non-VCI) were included, as well as 26 normal controls (NCs). Using resting-state fMRI, dynamic low-order FC networks were first constructed with multiple brain regions which were generated through a sliding window approach and correlated in temporal dimension. In order to obtain more information of network interactions along the time, high-order FC networks were established by calculating correlations among each pair of brain regions. Afterwards, a sparse representation-based classifier was constructed to recognize MMD (experiment 1) and its cognitive impairment (experiment 2) with features extracted from both low- and high-order FC networks. Finally, the ten-fold cross-validation strategy was proposed to train and validate the performance of the classifier. Results: The three groups did not differ significantly in demographic features (p > 0.05), while the VCI group exhibited the lowest MMSE scores (p = 0.001). The Non-VCI and NCs groups did not differ significantly in MMSE scores (p = 0.054). As for the classification between MMD and NCs, the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity of the classifier reached 90.70, 88.57, 93.67, and 73.08%, respectively. While for the classification between VCI and Non-VCI, the AUC, accuracy, sensitivity, and specificity of the classifier reached 91.02, 84.81, 80.56, and 88.37%, respectively. Conclusion: This study not only develops a promising classifier to recognize VCI in adult MMD in its early stage, but also implies the significance of time-varying properties in dynamic FC networks.

[Relationship between characteristic geometry and risk of rupture in cerebral saccular aneurysm].

OBJECTIVE: To explore the relationship between the characteristic geometry and the risk of rupture in cerebral saccular aneurysm. METHODS: The clinical features of 473 cerebral saccular aneurysm patients with complete materials of cerebral angiography, 426 with ruptured aneurysm and 47 with unruptured aneurysm, were analyzed retrospectively. The relation of depth, neck width, and aspect ratio (AR) of aneurysms to the risk of rupture were analyzed. RESULTS: The mean depth, neck width, and the AR of the patients with ruptured aneurysm were (5.9+/-3.0) mm, (3.0+/-1.2) mm, and (2.1+/-0.9), all significantly lower than those of the unruptured aneurysm patients [(8.0+/-4.2) mm, (4.8+/-2.4) mm, and (1.7+/-0.6) respectively, all P<0.01]. CONCLUSION: AR is not correlated with the location of aneurysms, but reflects the geometrical and hemodynamic features of cerebral saccular aneurysms very well. High AR may be useful in predicting imminent aneurysmal rupture. But by now, no definitive AR level is accepted in discriminating between unruptured and ruptured aneurysms.

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of spontaneous subarachnoid haemorrhage.

Aim: Spontaneous subarachnoid haemorrhage (SAH) caused by ruptured cerebral aneurysm is a severe subtype of haemorrhagic stroke. Although the incidence of SAH is relatively low among all cerebrovascular diseases, the mortality is the highest. The critical management of SAH is challenging. We provide this evidence-based guideline to present current and comprehensive recommendations for the diagnosis and treatment of non-trauma SAH. Methods: A formal literature search of MEDLINE (1 January 1990-30 June 2019) was performed. Data were synthesised with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The Chinese Stroke Association's levels of evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by Chinese Stroke Association's Stroke Fellow Committees. It is intended that this guideline be fully updated every 3 years. Results: Evidence-based guidelines are presented for the care of patients presenting with non-trauma SAH. The focus of the guideline was subdivided into transfer and systems of care, diagnosis flowchart, aetiology and differentiation, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, management of vasospasm and delayed cerebral ischaemia, management of hydrocephalus, management of seizures and management of medical complications. Conclusions: The guideline offers a framework for SAH management. Early professional and aggressive care of SAH might help dramatically.

Microstructural damage pattern of vascular cognitive impairment: a comparison between moyamoya disease and cerebrovascular atherosclerotic disease.

Moyamoya disease and cerebrovascular atherosclerotic disease are both chronic ischemic diseases with similar presentations of vascular cognitive impairment. The aim of the present study was to investigate the patterns of microstructural damage associated with vascular cognitive impairment in the two diseases. The study recruited 34 patients with moyamoya disease (age 43.9 ± 9.2 years; 20 men and 14 women, 27 patients with cerebrovascular atherosclerotic disease (age: 44.6 ± 7.6 years; 17 men and 10 women), and 31 normal controls (age 43.6 ± 7.3 years; 18 men and 13 women) from Huashan Hospital of Fudan University in China. Cognitive function was assessed using the Mini-Mental State Examination, long-term delayed recall of Auditory Verbal Learning Test, Trail Making Test Part B, and the Symbol Digit Modalities Test. Single-photon emission-computed tomography was used to examine cerebral perfusion. Voxel-based morphometry and tract-based spatial statistics were performed to identify regions of gray matter atrophy and white matter deterioration in patients and normal controls. The results demonstrated that the severity of cognitive impairment was similar between the two diseases in all tested domains. Patients with moyamoya disease and those with cerebrovascular atherosclerotic disease suffered from disturbed supratentorial hemodynamics. Gray matter atrophy in bilateral middle cingulate cortex and parts of the frontal gyrus was prominent in both diseases, but in general, was more severe and more diffuse in those with moyamoya disease. White matter deterioration was significant for both diseases in the genu and body of corpus callosum, in the anterior and superior corona radiation, and in the posterior thalamic radiation, but in moyamoya disease, it was more diffuse and more severe. Vascular cognitive impairment was associated with regional microstructural damage, with a potential link between, gray and white matter damage. Overall, these results provide insight into the pathophysiological nature of vascular cognitive impairment. This study was approved by the Institutional Review Board in Huashan Hospital, China (approval No. 2014-278). This study was registered with ClinicalTrials.gov on December 2, 2014 with the identifier NCT02305407.

Minocycline reduces intracerebral hemorrhage-induced white matter injury in piglets.

AIMS: White matter (WM) injury after intracerebral hemorrhage (ICH) results in poor or even fatal outcomes. As an anti-inflammatory drug, minocycline has been considered a promising choice to treat brain injury after ICH. However, whether minocycline can reduce WM injury after ICH is still controversial. In the present study, we investigate the effect and underlying mechanism of minocycline on WM injury after ICH. METHODS: An ICH model was induced by an injection of autologous blood into the right frontal lobe of piglets. First, transcriptional analysis was performed at day 1 or 3 to investigate the dynamic changes in neuroinflammatory gene expression in WM after ICH. Second, ICH piglets were treated either with minocycline or with vehicle alone. All piglets then underwent magnetic resonance imaging to measure brain swelling. Brain tissue was used for real-time polymerase chain reaction (RT-PCR), immunohistochemistry, Western blot, and electron microscopy. RESULTS: Transcriptional analysis demonstrated that transforming growth factor-ß (TGF-ß)/mitogen-activated protein kinase (MAPK) signaling is associated with microglia/macrophage-mediated inflammation activation after ICH and is then involved in WM injury after ICH in piglets. Minocycline treatment results in less ICH-induced brain swelling, fewer neurological deficits, and less WM injury in comparison with the vehicle alone. In addition, minocycline reduces microglial activation and alleviates demyelination in white matter after ICH. Finally, we found that minocycline attenuates WM injury by increasing the expression of TGF-ß and suppressing MAPK activation after ICH. CONCLUSION: These results indicate that TGF-ß-mediated MAPK signaling contributes to WM injury after ICH, which can be altered by minocycline treatment.

Effect of white matter changes on risk score for peri-procedural complications after carotid artery stenting.

OBJECTIVES: The presence of more severe white matter changes (WMC) may be associated with a higher risk of peri-procedural strokes in patients undergoing carotid artery stenting (CAS). However, to what extent WMC affects peri-procedural risk of CAS is unclear. We aimed to evaluate the effect of WMC on peri-procedural complications by modifying a CAS peri-procedural risk scale through adding the assessment of WMC. PATIENTS AND METHODS: A database of patients undergoing CAS was sampled from 2007 to 2014 in a single Chinese medical center. Risk factors were evaluated for peri-interventional cerebral and cardiac events and mortality. A risk score including contralateral stenosis ≥ 50%, diabetes with HbA1c > 7%, age ≥ 80 years old, symptomatic stenosis or with an ulcer lesion was applied to predict peri-interventional risk. Age-related white matter change (ARWMC) score was calculated and added to this risk scale. The predictive power of the new scale was evaluated. RESULTS: 151 patients were enrolled in the study. 14 peri-interventional events were recorded. Patients with peri-procedural complications had higher rates of diabetes (57.1% vs 18.2%, P = 0.001), contralateral stenosis (64.29% vs 32.85%, P = 0.019), coronary heart disease (42.9% vs 14.6%, P = 0.008) and ARWMC ≥ 7 (64.3% vs 25.5%, P = 0.002) compared with patients without peri-procedural complications. ARWMC ≥ 7 was an independent risk factor for peri-procedural complications from factors of the CAS scale after adjusting other confounders including contralateral stenosis ≥ 50%, HbA1c > 7%, age ≥ 80 years old and symptomatic stenosis or with an ulcer lesion. After the ARWMC score was added to the original scale, the AUC value of the new scale to predict the risk of peri-procedural complications after CAS was elevated (0.808 vs 0.730, p = 0.068). CONCLUSION: More severe WMC was a risk factor for peri-procedural complications after CAS in patients with carotid artery stenosis. ARWMC score may help to improve the predictive power of the risk scale for peri-procedural complications after CAS.

A phase II clinical trial with cytotropic heterogeneous molecular lipids (CHML) for patients with hepatic malignancies.

Hepatocellular carcinoma (HCC) and other forms of metastatic liver cancer (MLC) have poor outcomes due to the limited treatment options. Surgery, radiotherapy and chemotherapy have a limited success. Thus, there is an urgent need for novel therapies for patients with advanced HCC and MLC. The response and toxicity profile of a novel biological anticancer agent, cytotropic heterogeneous molecular lipids (CHML), in 135 Asian patients with hepatic malignancies treated at five different hospitals in China from April 1998 to August 2003 is described. This trial included 97 patients with HCC and 38 with MLC. The majority of these patients had received conventional therapies and many had failed to respond or relapsed. CHML was administered by intra-arterial (i.a.) infusion with or without simultaneous intravenous (i.v.) infusion for 25 days with a rest of 2-4 weeks between each cycle. Fifty three percent of patients received two cycles, and 47% received three cycles. The complete response (CR) rates were 23% for HCC and 29% for MLC with an overall CR of 24%. The overall partial response (PR) was 53%. The patients with earlier stages and limited tumor burden had a better response, but a few patients with advanced disease also achieved PR. The patients who achieved CR or PR had a significant increase in long-term survival for up to five years. The treatment with CHML resulted in minimal toxicity and the reported adverse reactions were not higher than grade II. CHML is an effective therapy for hepatic malignancies, showing responses and increases in survival in patients in whom other therapies have failed. CHML is well tolerated and is an excellent candidate for Phase III clinical trials.

Tentorial dural arteriovenous fistulas.

BACKGROUND: Tentorial dural arteriovenous fistula is uncommon but is a life-threatening lesion. We present our experience with 5 patients with TDAVFs, review the relevant literature, and present the rationale of our current management strategy. METHOD: The data of 5 patients with TDAVFs treated in Huashan Hospital, Shanghai, China, between June 2002 and May 2003 were reviewed retrospectively, including their illness history, neuroimaging, operation records, and follow-up data. RESULTS: There were 3 females and 2 males with ages from 25 to 52 years (average, 38 years). Clinical manifestations were acute SAH in 2 patients and progressive neurologic deficits in 3 patients. Magnetic resonance imaging and DSA were major diagnostic and follow-up modalities. All cases belonged to Borden classification type 3. A tentorial marginal type was present in 3 cases, a tentorial lateral type in 1 case, and a tentorial medial type in 1 case. Preoperative transarterial embolization was done in 3 patients. All patients underwent craniotomy with the coagulation of the fistulas and surrounding tentorial dura mater, and the disconnection of leptomeningeal venous drainage. The surgical approaches were via transanterior petrous approach in 3 cases, subtemporal intradural approach in 1 case, and unilateral occipital and transtentorial approach in 1 case. All patients had clinical improvement. There was no surgical mortality and morbidity. Postoperative DSA confirmed obliteration of TDAVFs in 3 cases; MRI demonstrated the thrombosis of venous aneurysm and disappearance of previous brainstem edema in 1 case, and partial thrombosis of venous aneurysm in another case. Follow-up study ranging from 2 to 3 years (average, 2.5 years) showed no recurrence, and all patients have resumed their normal activities. CONCLUSIONS: Tentorial dural arteriovenous fistulas are aggressive vascular lesions causing SAH and progressive neurologic deficits. Prompt diagnosis and definite treatment are mandatory. Obliteration of the fistulas and/or leptomeningeal venous drainage should be the goal of treatment. Microsurgical procedures with/without endovascular intervention are the best choice of treatment.

[Antioxidant activity of natural and cultured Cordyceps sp].

OBJECTIVE: Investigating the antioxidant activities of water and ethanol extracts of natural Cordyceps sinensis and Cordyceps militaris and their fermentation preparations. METHOD: The samples were tested through 6 assays: inhibition ability of linoleic acid oxidation; scavenging activity of DPPH, hydrogen peroxide, hydroxyl radical and superoxide anion; and metal chelating activity. RESULT: Samples showed different antioxidant ability, and there was not an extract that exhibited high activity in all assays; however, water extract of natural C. militaris could be regarded as the most powerful antioxidant among 8 samples. It had high activity in inhibition of linoleic acid oxidation, chelating metal ions, and scavenging DPPH and hydroxyl radical. The research also indicated that the contents of phenolic compounds in water and ethanol extracts of natural and cultured Cordyceps sp. had huge difference. CONCLUSION: Natural Cordyceps sp. and its fermentation preparations could be used as potential natural antioxidants. The fermented process affected the antioxidant ability of cultured Cordyceps sp., and the antioxidant activity of both natural and cultured Cordyceps sp. did not significantly related with the quantity of phenolics.

Epidemiological Features of Nontraumatic Spontaneous Subarachnoid Hemorrhage in China: A Nationwide Hospital-based Multicenter Study.

BACKGROUND: Nontraumatic spontaneous subarachnoid hemorrhage (SAH) is associated with a high mortality. This study was conducted to investigate the epidemiological features of nontraumatic spontaneous SAH in China. METHODS: From January 2006 to December 2008, the clinical data of patients with nontraumatic SAH from 32 major neurosurgical centers of China were evaluated. Emergent digital subtraction angiography (DSA) was performed for the diagnosis of SAH sources in the acute stage of SAH (≤3 days). The results and complications of emergent DSA were analyzed. Repeated DSA or computed tomography angiography (CTA) was suggested 2 weeks later if initial angiographic result was negative. RESULTS: A total of 2562 patients were enrolled, including 81.4% of aneurysmal SAH and 18.6% of nonaneurysmal SAH. The total complication rate of emergent DSA was 3.9% without any mortality. Among the patients with aneurysmal SAH, 321 cases (15.4%) had multiple aneurysms, and a total of 2435 aneurysms were detected. The aneurysms mostly originated from the anterior communicating artery (30.1%), posterior communicating artery (28.7%), and middle cerebral artery (15.9%). Among the nonaneurysmal SAH cases, 76.5% (n = 365) had negative initial DSA, including 62 cases with peri-mesencephalic nonaneurysmal SAH (PNSAH). Repeated DSA or CTA was performed in 252 patients with negative initial DSA, including 45 PNSAH cases. Among them, the repeated angiographic results remained negative in 45 PNSAH cases, but 28 (13.5%) intracranial aneurysms were detected in the remaining 207 cases. In addition, brain arteriovenous malformation (AVM, 7.5%), Moyamoya disease (7.3%), stenosis or sclerosis of the cerebral artery (2.7%), and dural arteriovenous fistula or carotid cavernous fistula (2.3%) were the major causes of nonaneurysmal SAH. CONCLUSIONS: DSA can be performed safely for pathological diagnosis in the acute stage of SAH. Ruptured intracranial aneurysms, AVM, and Moyamoya disease are the major causes of SAH detected by emergent DSA in China.

Postoperative executive function in adult moyamoya disease: a preliminary study of its functional anatomy and behavioral correlates.

OBJECTIVE Chronic frontal hemodynamic disturbances are associated with executive dysfunction in adult patients with moyamoya disease (MMD). However, the impact of surgical revascularization on executive dysfunction and its underlying mechanism remains unclear. The aim of the present study was to examine the postoperative radiological correlates of cognitive improvement and thereby explore its underlying mechanism. METHODS Fourteen patients who met the inclusion criteria were identified at Huashan Hospital, were operated on, and were successfully followed up for 6 months. Postoperative changes in cortical perfusion and regional amplitude of low-frequency fluctuations (ALFF) were examined by SPECT and resting-state functional MRI, respectively. Executive function was evaluated by 2 tests (Trail Making Test Part B and the summation of executive subtests of Memory and Executive Screening [MES-EX]). Follow-up neuropsychological outcomes were then correlated with radiological changes to identify nodes functioning as leading contributors to postoperative executive outcomes. RESULTS All patients underwent successful unilateral bypass procedures, with some operations performed on the left side and some on the right side. At the 6-month follow-up, the baseline and follow-up test scores for the different sides did not differ significantly. The group with good collaterals (Matsushima Grade A, 9 patients) exhibited significantly increased postoperative perfusion (change in [△] hemodynamics) in bilateral frontal (left, p = 0.009; right, p = 0.003) and left parietal lobe (p = 0.014). The Spearman's correlation test suggested that only the right frontal lobe exhibited significant positive postoperative radiological correlates with cognitive performance (△MES-EX vs △hemodynamics, r = 0.620, p = 0.018; △MES-EX vs △ALFF, r = 0.676, p = 0.008; △hemodynamics vs △ALFF, r = 0.547, p = 0.043). Subsequent regional ALFF analysis revealed that the right dorsolateral prefrontal cortex (DLPFC) was the only node in the responsible hemisphere to exhibit significant postoperative changes. CONCLUSIONS The results not only advance our understanding of pathological interactions of postoperative executive performance in adult MMD, but also indicate that the right DLPFC amplitude might be a quantitative predictor of postoperative executive control improvement.

Risk factors for intracranial aneurysm in a Chinese ethnic population.

BACKGROUND: Intracranial aneurysm (IAN) is a protruding bubble or a sac on a brain artery that balloons out over time, which may lead to spontaneous subarachnoid hemorrhage (SAH), ultimately disability and mortality. Current research indicates that the disease is due to multiple causes, including environmental factors and various congenital abnormalities of blood vessels. Apart from congenital predisposition, various high-risk factors such as sex, age, hypertension, and atherosclerosis are involved in the formation of intracranial aneurysms. The aim of this study was to investigate the risk factors associated with the formation of sporadic intracranial aneurysms in Chinese Han ethnic patients. METHODS: A total of 251 patients with intracranial aneurysm and 338 patients with other cerebral diseases (control group) were enrolled in this study. Single factor and logistic regression model were used to analyze the association of intracranial aneurysms with age; sex; cigarette smoking; alcohol or cocaine consumption; history of hypertension, coronary artery disease, diabetes mellitus and inherited connective tissue disease; and the levels of fasting blood glucose and blood fat. The data expressed as mean +/- standard deviation were processed with the statistical software SPSS13. Quantitative and qualitative data were analyzed by the independent-sample t test, and the chi-square test respectively. Logistic regression method was used to analyze the multiple factors. RESULTS: In the 251 patients, 163 (64.94%) were at age of 40 to 60 years. Sex (OR, 1.41; 95% CI, 1.01 - 1.96), cigarette smoking (OR, 1.81; 95% CI, 1.06 - 3.10), hypertension (OR, 2.32; 95% CI, 1.30 - 4.16) and fasting blood glucose were significantly associated with intracranial aneurysm (P < 0.05). Intracranial aneurysm was correlated with alcohol consumption, coronary artery disease, and the level of blood lipids (P > 0.05). Using logistic regression analysis, we identified female sex and advanced age as significant risk factors for sporadic intracranial aneurysms. CONCLUSIONS: Sporadic intracranial aneurysms mostly occur in people aged 40 to 60 years. Feminine, cigarette smoking, and hypertension are independent risk factors for the disease, and the gender is the most significant factor. Advanced age can increase the effect of these risk factors.