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Studies have confirmed that homocysteine is associated with ischemic stroke. This article reviews the correlation between homocysteine and ischemic stroke risk, etiological type, severity, outcome, as well as the research progress of reducing homocysteine to prevent ischemic stroke.
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An increasing number of studies have shown that homocysteine is associated with intracerebral hemorrhage. This article reviews the correlation between homocysteine and the incidence risk, clinical characteristics, clinical outcomes of intracerebral hemorrhage, as well as the treatment methods for reducing homocysteine.
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Carotid artery stenosis is an important cause of ischemic stroke. Carotid endarterectomy and carotid artery stenting are the effective methods for treating carotid artery stenosis, but postoperative restenosis remains a challenge. The pathogenesis of postoperative restenosis is currently not fully understood. However, multiple factors, including biomarkers, imaging features, and surgical related factors, have been proven to be associated with postoperative restenosis and can predict the occurrence of postoperative restenosis. This article reviews the predictors of restenosis after carotid endarterectomy and carotid artery stenting.
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Objective:To investigate the clinical experiences and outcomes of protection of branches during clipping of low grade internal carotid communicating segment (C7) aneurysms via frontolateral keyhole approach. Methods:Fifty-two patients with internal carotid C7 aneurysms and Hunt-Hess grading I-III, admitted to our hospital from January 2017 to December 2020, were chosen; 45 patients were with posterior communicating artery (PCoA) aneurysms, 6 patients were with anterior choroidal artery (ACHA) aneurysms, and one patient was with PCoA aneurysm combined with ACHA aneurysm. The relation between origin of the branch arteries and tumor neck was determined during surgery. The relation between shape of the branch arteries and tumor body was investigated in the Spaces II, III and V of the internal carotid artery (indocyanine green fluorescence angiography was used when necessary); the aneurysms were clipped by appropriate aneurysm clip or clips combination; after clipping, microspic or endoscopic exploration and indocyanine green fluorescence angiography were performed, and re-clipping was performed in the misclipped or stenosed branch arteries.Results:During the surgery, the branch arteries of 6 patients (4 from posterior communicating artery, 1 from anterior choroidal artery, and 1 from perforator artery at the bifurcation of internal carotid artery) were misclipped, and therefore, the aneurysm clips were adjusted or replaced and then re-clipped. Aneurysms were successfully clipped in all 52 patients. Brain CT examination within 24 h of surgery showed that focal cerebral infarction in the branch artery feeding area was noted in 5 patients, of which 3 patients were accompanied by contralateral limb muscle strength decline (grading 4, grading 3 and grading 1, respectively) and medication and neurological rehabilitation were given. The other 47 patients had good general condition without special condition. During the follow-up of 9-12 months, the muscle strength of 3 patients with decreased contralateral limb strength recovered to grading 5, 4 and 2, respectively. There were no residual or recurrent aneurysms in all patients. At the last follow-up, 47 patients had Glasgow Outcome scale (GOS) scores of 5, 3 patients had GOS scores of 4, 1 patient had GOS scores of 3, and 1 patient had GOS scores of 2.Conclusion:In the treatment of low-grade internal carotid artery C7 segment aneurysms via frontolateral keyhole approach, multiple protective strategies can be adopted to actively prevent branch artery injury, which can effectively reduce the incidence of postoperative cerebral infarction and improve the prognosis.
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Objective:To investigate the effect and mechanism of NACK knockdown on the proliferation and apoptosis of T-cell acute lymphoblastic leukemia (T-ALL) Jurkat cells. Methods:Lentivirus transfection technology was used to transfect Jurkat cells and knock down NACK gene.Real time fluorescent quantitative PCR and Western blot were used to detect the silencing efficiency of NACK gene.CCK-8 method and flow cytometry were used to detect the effects of NACK knockdown on the proliferation and apoptosis of Jurkat cells.The expressions of protein related with Notch1 pathway, such as Hes1 and c-Myc, were detected by Western blot. Results:After NACK-shRNA was successfully transfected into Jurkat cells by lentiviral vector, the expression of NACK mRNA and protein was reduced signi-ficantly ( P<0.05). Compared with the negative control group and the blank control group, the CCK-8 method showed that the cell proliferation in the experimental group was significantly inhibited [The inhibition rates of cell proliferation in the experimental group, negative control group and blank control group were (37.27±4.48)%, (4.25±2.10)% and (2.43±1.40)%, respectively]( F=132.640, P<0.05), and the flow cytometry test showed that the apoptosis in the experimental group increased significantly [The apoptosis rates of experimental group, negative control group and blank control group were (26.38±3.03)%, (6.07±2.61)% and (3.40±1.98)%, respectively]( F=90.534, P<0.05). Western blot results confirmed that the expression of Notch1 pathway-related proteins Hes1 and c-Myc was down-regulated compared with the negative control group and the blank control group, and the difference was statistically significant ( P<0.05). Conclusions:Targeting silent NACK can down-regulate the expression of Notch1 pathway-related proteins, which leads to the inhibition of Jurkat cell proliferation and increased apoptosis, thereby exerting its anti-T-ALL effect.
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Biological denitrification is the most widely used technology for nitrate removal in wastewater treatment. Conventional denitrification requires long hydraulic retention time, and the nitrate removal efficiency in winter is low due to the low temperature. Therefore, it is expected to develop new approaches to enhance the denitrification process. In this paper, the effect of adding different concentrations of Fe₃O₄ nanoparticles on the denitrification catalyzed by Pseudomonas stutzeri was investigated. The maximum specific degradation rate of nitrate nitrogen improved from 18.0 h⁻¹ to 23.7 h⁻¹ when the concentration of Fe₃O₄ increased from 0 mg/L to 4 000 mg/L. Total proteins and intracellular iron content also increased along with increasing the concentration of Fe₃O₄. RT-qPCR and label-free proteomics analyses showed that the relative expression level of denitrifying genes napA, narJ, nirB, norR, nosZ of P. stutzeri increased by 55.7%, 24.9%, 24.5%, 36.5%, 120% upon addition of Fe₃O₄, and that of denitrifying reductase Nap, Nar, Nir, Nor, Nos increased by 85.0%, 147%, 16.5%, 47.1%, 95.9%, respectively. No significant difference was observed on the relative expression level of denitrifying genes and denitrifying reductases between the bacteria suspended and the bacteria adhered to Fe₃O₄. Interestingly, the relative expression level of electron transfer proteins of bacteria adhered to Fe₃O₄ was higher than that of the bacteria suspended. The results indicated that Fe₃O₄ promoted cell growth and metabolism through direct contact with bacteria, thereby improving the denitrification. These findings may provide theoretical support for the development of enhanced denitrification.
الموضوعات
Aerobiosis , Denitrification , Nitrates , Nitrogen , Pseudomonas stutzeri/geneticsالملخص
The anterior clinoid process (ACP) is an important anatomical structure of the skull base. Some surgeries for intracranial lesions require to remove the ACP in order to achieve visual field exposure of the lesions and surrounding anatomical structure, and provide sufficient operating space. In this paper, the research progress in anatomy and variation of the ACP, methods of anterior clinoidectomy, and applications of anterior clinoidectomy in neurosurgical surgerys are summarized as follows.
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Objective:To investigate the efficacy and clinical experiences of fluorescein angiography assisted occlusion via lateral-orbital keyhole approach in internal carotid bifurcation aneurysms. Methods:The clinical data of 16 patients with internal carotid artery bifurcation aneurysms admitted to our hospital from January 2016 to December 2020 were retrospectively analyzed. All patients accepted fluorescein angiography assisted occlusion via lateral-orbital keyhole approach. The patients were followed up at one, 3, and 6 months after surgery by medical imaging. The therapeutic efficacy of these patients was assessed by Glasgow outcome scale (GOS). Results:All aneurysms in these 16 patients were clipped at one-stage operation. Intraoperative fluorescein angiography and FLOW 800 showed that the aneurysms were completely clipped without residual, and the blood flow of the parent artery and perforating arteries was unobstructed. Six months after surgery, 14 patients recovered well (GOS scores of 5), and 3 developed limb hemiplegia (GOS scores of 4).Conclusion:Intraoperative fluorescein angiography assisted occlusion via lateral-orbital keyhole approach is safe and effective in internal carotid bifurcation aneurysms.
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The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.
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Objective:To evaluate the effectiveness of multi-disciplinary treatment (MDT) for reducing carbapenem-resistant Enterobacteriaceae (CRE) infections in intensive care unit(ICU).Methods:Patients admitted in the emergency ICU (EICU) and neurosurgical ICU (NICU) of the First People’s Hospital of Lianyungang during January 2018 to December 2019 were enrolled in the study, which was analyzed by historical control study. For patients admitted in 2018, the conventional method was adopted for prevention and control of drug-resistant bacteria (control group, n=1, 076), and for patients admitted in 2019, the MDT was adopted for the prevention and control of CRE (intervention group, n=1, 237). Chi-square test was used to compare the incidence rate of CRE infection, CRE detection rate, rate of rational antibiotic use and compliance with implementation of prevention and control measures between two groups. Results:Compared to control group, the incidence rate of CRE infection in EICU and NICU decreased from 3.45% (14/406) and 3.58% (24/670) to 1.65% (9/547) and 2.32% (16/690) in intervention group, respectively; while the detection rate of CRE decreased from 66.21% (96/145) and 57.72% (86/149) to 41.11% (51/124) and 33.06% (40/121), the pathogens were mainly carbapenem-resistant Klebsiella pneumoniae (CRKP). The rational medication rate of carbapenem antibiotics was significantly increased from 65.00%(78/120) in 2018 to 92.73%(319/344) in 2019 ( χ2=55.382, P<0.05). In addition, the single room isolation rate, the rate of specialized nursing care, the cleaning and disinfection quality of bench surface and the special use rate of articles were also significantly improved( χ2=21.646, 18.116, 39.869 and 19.713, P<0.01). Conclusion:The establishment of multi-department collaborative management based on MDT can effectively improve the prevention and control effect of CRE in ICU and significantly reduce the prevalence of CRE infection.
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Objective:To explore the clinical experiences and treatment outcomes of partial complicated posterior communicating artery aneurysms (PCoAs) via Dolenc approach.Methods:The clinical data of 27 patients with partial complicated PCoAs accepted clipping via Dolenc approach in our hospitals from July 2014 to June 2019 were retrospectively reviewed. The clinical efficacies were analyzed and the surgical experiences were summarized in these patients.Results:Among 27 patients with partial complicated PCoAs, 26 accepted clipping successfully via Dolenc approach, and one accepted clipping and wrapping. For clinical ourcomes, 2 out of 3 patients with preoperative oculomotor paralysis got improvement after surgery, and one was without change; in 4 patients with new-onset oculomotor paralysis after surgery, 2 returned to normal after conservative treatment, one got improvement, and one was without change. After surgery, 2 had basal ganglia focal cerebral infarction and one had ventriculoperitoneal shunt due to hydrocephalus. DSA or CTA examination within two weeks after surgery showed all 26 aneurysms were completely clipped and without residual. During the 9-12 months of follow up, Glasgow outcome scale (GOS) showed that 20 patients had GOS 5 scores, 3 had GOS 4 scores, 2 had GOS 3 scores, one had GOS 2 scores, and one died. No patients showed aneurysm recurrent in the imaging examination.Conclusion:Via Dolenc approach, anterior clinoid process and its surrounding bony structures are drilled off via extradural way, and proximal of parent artery is exposed well, therefore, more operation space can be provided to deal with partial complicated PCoAs.
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Aneurysmal subarachnoid hemorrhage (aSAH) has high disability and mortality.Cerebral vasospasm is the main cause of ischemic neurological deficit and even cerebral infarction after aSAH.At present,there are many studies on molecular signaling pathways of cerebral vasospasm.This article reviews the signaling pathways of cerebral vasospasm after aSAH.
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Studies have shown that bone marrow mesenchymal stem cells (BMSCs) transplantation can restore the sensory and motor function of patients with ischemic stroke. BMSCs transplantation is a promising therapeutic strategy because of its ability to differentiate into neuron-like cells. This article reviews the inducers that promote BMSCs to differentiate into neuron-like cells in vitro.
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Hypothyroidism is a common adverse reaction in clinical multi-target tyrosine kinase inhibitor (TKI) and may be used as a predictor of efficacy of TKI drugs.Studies show that hypothyroidism is significantly associated with good prognosis in patients with renal cell carcinoma treated with multi-target TKI,which may be related to inhibition of vascular endothelial growth factor receptor pathway,potential off-target effects and inhibition of cell proliferation.Whereas in the patients with hepatocellular carcinoma who received multi-target TKI therapy,hypothyroidism is an indicator of poor prognosis,which is related to the T3/TR pathway regulating liver cancer growth and invasion.The predictive function and mechanism of thyroid hormone levels in different tumor patients receiving multi-target TKI drugs are different,and further research is still needed.
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Objective To study the effect of Tamibarotene on the SH-SY5Y cell proliferation inhibition ability and the mRNA and protein expressions of tyrosine kinase receptor a (TrkA) and N-myc (MYCN) in order to provide some experimental bases for the treatment of neuroblastoma.Methods The SH-SY5Y cells were treated with different concentrations of Am80 (0,10,20,40,80,160 μmol/L) for 48 h,then Cell Counting Kit-8 (CCK-8) was used to test the cell proliferation.Reverse transcription PCR(RT-PCR) and Western blot were used to test the mRNA and protein expressions of TrkA and MYCN at 48 hours.Results When the concentration was 10 μmol/L,Am80 had no significant inhibitory effect on SH-SY5Y cells [(3.51 ± 1.68)％,inhibition ratio ＜ 5 ％];but when the concentration was 20 μmol/L,it showed weak inhibition [(9.60 ± 1.97) ％,inhibition ratio ＜ 10％].The inhibition rate of SH-SY5Y cell proliferation[(57.43 ± 4.95)％] was significantly enhanced at Am80 with a concentration of 80 μmol/L.The concentrations of Am80 could effectively inhibit SH-SY5Y cell proliferation in a dose-dependent manner(P ＜0.05).The expression of TrkA increased with the increase of Am80 concentration.Am80 significantly decreased the expression of MYCN in SH-SY5Y cells(10 μmol/L:0.65 ±0.05 vs.20 μmol/L:0.36 ±0.06),and the difference was statistically significant(P ＜ 0.05).Conclusions It is suggested that Am80 can effectively inhibit SH-SY5Y cell proliferation in a concentration-dependent manner.The underlying mechanism involves increasing the expression of TrkA by down-regulation of MYCN.
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Objective To explore the application of limbs and fingers movement combined with moxibustion in patients with PICC catheterization. Methods A total of 346 PICC catheterized patients treated from August 2014 to July 2017 were randomly divided into control group (173 cases) and observation group (173 cases) according to random number table method. The control group was given local hot-wet compression at 3-4 cm of puncture point after 24 h of catheterization, and the observation group was given preventive moxibustion with the direction of the punctured vein at the same site in the control group, and then was given limbs and fingers movement. The levels of serum monocyte chemoattractant protein- 1 (MCP- 1), tumor necrosis factor- α (TNF- α) and interleukin- 8 (IL- 8), hemorheological parameters [rate of high and low shear whole blood viscosity (RBV), rate of plasma specific viscosity (RPV), hematocrit (HCT)] and the incidence rates of mechanical phlebitis and venous thrombosis were compared between the two groups after intervention. Results The levels of MCP-1, TNF-αand IL-8 were (53.03±7.86), (85.93±10.72), (54.65±9.23) ng/L in the observation group, (60.27± 8.45), (94.74±11.36), (63.08±10.07) ng/L in the control group, and there were significant differences (t=8.252, 7.419, 8.117, all P<0.05). The levels of high shear RBV, low shear RBV, RPV and HCT were (3.94 ± 0.85) mPa · s, (6.55 ± 1.22) mPa · s, (1.70 ± 0.54) mPa · s and (43.71 ± 4.82)％ respectively in the observation group, (4.18±0.74) mPa·s, (6.97±1.25) mPa·s, (1.92±0.59) mPa·s and (45.13±4.65)％in the control group, and there were significant differences (t=2.789-3.618, P<0.05). The incidence rates of venous thrombosis and phlebitis were 1.16％(2/173) and 5.78％(10/173) respectively in the observation group, 5.78％(10/173) and 13.29％(23/173) in the control group, there were significant differences (χ2=4.230, 5.661, P<0.05). Conclusions Limbs and fingers movement combined with moxibustion can effectively improve the blood flow status, and reduce the occurrence of mechanical phlebitis and venous thrombosis in patients with PICC catheterization.
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Objective To investigate the hemodynamic monitoring and clinical significance of transcranial Doppler (TCD) combined with indocyanine green (ICG) fluorescence angiography and FLOW 800 in carotid endarterectomy (CEA).Methods Forty-eight patients with extracranial carotid atherosclerotic stenosis underwent CEA in our hospital from October 2015 to September 2018 were chosen to our study. The mean blood flow velocity (Vm) of the middle cerebral artery (MCA) was monitored by TCD throughout the operation. The intraoperative blood pressures were adjusted according to the monitoring results, and the average blood Vm of the narrowed arteries was measured using TCD probe before and after artery temporary occlusion. ICG fluorescence angiography and FLOW 800 were used to monitor vascular morphology and patency simultaneously.Results One patient, who was observed to have severe stenosis by TCD, ICG fluorescence angiography, and FLOW 800 after arteries temporary occlusion, showed significantly improved by multimodal monitoring after re-suture; one patient showed external carotid artery occlusion by ICG fluorescence angiography and FLOW 800 had noexternal carotid artery occlusion; other 46 patients showed no carotid artery stenosis and good intracranial perfusion by TCD, ICG fluorescence angiography, and FLOW 800 after initial suture. Two patients developed ischemic stroke (IS) after CEA, and both of them were recovered after conservative medical treatment for two weeks without any neurological dysfunction; two patients had cerebral hyperperfusion syndrome (CHS), and both of them relieved after blood pressure control three d after treatment; one patient had subcutaneous hematoma in the operation area, and the hematoma was gradually absorbed after conservative treatment; the rest patients recovered well. All patients were followed up for 4-6 months after CEA, and CT angiography showed that carotid artery stenosis was relieved; CT perfusion imaging and TCD examinations showed that cerebral perfusion was significantly improved as compared with those before operation.Conclusion Intraoperative TCD combined with ICG fluorescence angiography and FLOW 800 can effectively monitor the intracranial and extracranial blood flow of intraoperative carotid artery, which is of great significance in reducing the risk of IS and CHS during carotid endarterectomy.
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Objective To compare lateral orbital keyhole approach(LOK) with conventional keyhole approach including supraorbital keyhole approach (SOK) and pterional approach(PTK) for exposuring the sellar region and oper-ation ability, to provide theoretical and practical basis for the clinic. Methods From January, 2017 to Feburary, 2018, 15 cadaver head specimens of Chinese (30 sides) fixed by formalin were randomly divided into 3 groups, simu-lating SOK, LOK and PTK, application of frameless neuronavigation system, intersection of the posterior margin of the optic chiasma and the lamina terminalis served as the base point. Six different reference points were selected to radi-ate into the parasellar region of the skull base. The direction of the 2 adjacent reference points were connected to the base point to form a triangle. Six triangles constituted the sellar region to represent the total area. The supratentorial area, ipsilateral area, inferior area and contralateral area were calculated by stacking triangle. The comparison was made between groups. The Salma operation exposure scale was used to simulate the aneurysms of the common parts in the brain and the quantitative scores were performed. Results The total parasellar regions by SOK, LOK and PTK respectively were:(1641.6±295.6)mm2, (1782.3±294.6)mm2 and (1552.5±307.4)mm2. There was no statistical differ-ence(P>0.05); To compare the supratentorial region, SOK and LOK were both bigger than PTK ( P<0.05); To compare the ipsilateral and infratentorial area, LOK and PTK were both bigger than SOK respectively ( P<0.05);To compare the contralateral area, SOK, LOK and PTK were increased in turn (P<0.05). Salma operation exposure scale was used to get the scores:the score of SOK was 29.7 (39.08％), LOK was 37.0 (48.68％), and PTK was 36.1 (47.50％). Conclusion Anatomical analysis displayed that the 3 keyhole approaches showed different exposure of each part the parasellar re-gions, the LOK had a good exposure to the parasellar region and so as the higher maneuverability. But the clinical appli-cation should be comprehensive analysis, pay attention to specific lesions and make an appropriate choice. It has impor-tant clinical significance to improve the prognosis of patients.
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Reducing plasma homocysteine levels by B vitamins supplementation may be an effective intervention to prevent ischemic stroke, but early relevant clinical trials have show n that patients do not benefit from it.Recent trials have show n that folic acid supplementation can significantly reduce the risk of ischemic stroke.Therefore,the potential benefits of B vitamins in the prevention of ischemic stroke still need further study.
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The incidence, mortality and disability of ischemic stroke are higher, which has caused serious harm to people's health. In recent years, red blood cell distribution width as an independent risk factor and predictor of various diseases is receiving increasing attention. This article reviews the relationship between red blood cell distribution width and ischemic stroke.