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Objective@#: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality rates. Although research on BBAs is well documented in different populations, the study of BBAs in the Tibetan population is extremely rare. This study aimed to evaluate the characteristics of BBAs and analyze the treatment modalities and long-term outcomes in the Tibetan population in comparison with the Han population. @*Methods@#: The characteristics of patients with BBAs of the ICA from January 2009 to January 2021 at our institution were reviewed. The features of aneurysms, treatment modalities, complications, and follow-up outcomes were retrospectively analyzed. @*Results@#: A total of 130 patients (41 Tibetan and 89 Han patients) with BBAs of the ICA who underwent treatment were enrolled. Compared with the Han group, the Tibetan group significantly demonstrated a high ratio of BBAs among ICAs (8.6%, 41/477 vs. 1.6%, 89/5563; p<0.05), a high ratio of vasospasm (34.1%, 14/41 vs. 6.7%, 6/89; p=0.001), a high risk of ischemic events (43.9%, 18/41 vs. 22.5%, 20/89; p<0.05), and a low ratio of good outcomes (modified Rankin scale, 0–2) at the 1-year follow-up (51.2%, 21/41 vs. 74.2%, 66/89; p<0.05). The multivariate regression model showed that ischemic events significantly contributed to the prediction of outcomes at 1 year. Further analysis revealed that microsurgery and vasospasm were associated with ischemic events. @*Conclusion@#: In comparison with Han patients, the Tibetan population had a high ratio of BBA occurrence, a high incidence of ischemic events, and a high ratio of poor outcomes. The endovascular approach showed more benefits in BBA patients.
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Objective:To investigate the efficacy of arthroscopic reduction and double-tunnel button fixation in the treatment of fractures of the tibial intercondylar eminence in children.Methods:From January 2019 to June 2022, 8 children with fracture of the tibial intercondylar eminence were treated at Orthopedics Department, Shenzhen Children's Hospital with arthroscopic reduction and double-tunnel button fixation. They were 6 boys and 2 girls, with an age of (8.4±1.9) years. Injured sites: 4 left knees and 4 right knees. Their operation time, intraoperative blood loss, knee flexion and extension, and complications were recorded. Their Lysholm scores were compared between preoperation and the last follow-up.Results:The operation time was (161.9±57.9)min. All patients were followed up for (12.1±5.7) months. The intraoperative blood loss was 3.5 (1.0,4.3)mL. Their knee flexion was 145.0°±5.0° and extension 0.9°±1.2° after operation. All their incisions healed at one stage, with no postoperative infection or other complications. Their preoperative Lysholm score [(20.3±15.8) points (from 2 to 54 points)] increased significantly to (99.3±1.0) points (from 98 to 100 points) after operation ( P<0.05). Conclusions:Arthroscopic reduction and double-tunnel button fixation is effective for fractures of the tibial intercondylar eminence in children, leading to limited complications, limited bleeding and a low infection rate.
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Intracranial and extracranial vascular bypass surgery is recognized as the main method for treatment of adult patients with moyamoya disease. However, its role in treatment of chronic non-moyamoya cerebral ischemia disease has not been fully elucidated, which involves a series of unknown fields of brain science, such as cerebral blood flow regulation, brain metabolism, cognitive function, and advanced neural activity. Therefore, this article reviews the history of intracranial and extracranial vascular bypass surgery in the treatment of chronic non-moyamoya cerebral ischemia disease to improve the understanding of clinical workers to better promote the application and promotion of intracranial and extracranial vascular bypass surgery.
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Objective:To evaluate the value of mammography and MRI combined with clinical features in predicting upgrade to malignancy in high-risk breast lesions.Methods:Data from 230 patients who were diagnosed with high-risk breast lesions and underwent both mammography and MRI examinations before biopsy were analyzed retrospectively from Jan 2017 to Mar 2018 in Fudan University Shanghai Cancer Hospital. The imaging features of both mammography and MRI were analyzed, and the association between mammography, MRI and clinical features were evaluated using pathology as the gold standard. Independent t test and χ 2 test were used to compare the difference of clinical and imaging features between upgrade and non-upgrade groups, using receiver operating characteristic (ROC) curve to test the diagnostic value between mammography and MRI. Binary logistic regression was used to evaluate the correlation between upgrade and clinical, imaging findings. Results:Two hundred and thirty patients had 230 lesions, and 47 cases had atypia upgrade to malignancy during second surgery (upgrade rate was 20.4%). There were statistically significant differences in age, maximum diameter of lesion, and menopausal status between the upgraded and non-upgraded groups ( P<0.05). There was no statistically significant difference in mammographic features between two groups ( P>0.05), while there was statistically significant difference in breast MRI features and background parenchymal enhancement ( P<0.05). For the diagnostic value in predicting upgrade of high-risk lesions, MRI was better than mammography (the areas under ROC curve were 0.913 and 0.606, Z=6.919, P<0.01). Single factor analysis showed that age, lesion size, menopausal status, MRI negative and background parenchymal enhancement on MRI were significantly different for upgrade to malignancy ( P<0.05). Multiple factors analysis showed age and background parenchymal enhancement on MRI were independent factors for predicting upgrade ( P<0.01). Conclusion:For the upgrade to malignancy in high-risk lesions, the diagnostic value of MRI is better than mammography. The elder age and moderate or marked background parenchymal enhancement on MRI may serve as useful predictors of upgrade.
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Background@#and Purpose As a leading cause of disability and death in China, stroke as well as its epidemiologic features have gained increasing attention. Prior studies, however, have overgeneralized the north-to-south gradient in China. Whether the differences exist across urban and rural areas remains unexplored. This study therefore aims to investigate the north-to-south gradient in stroke incidence across urban and rural China. @*Methods@#The present prospective cohort study analyzed data from the China Health and Nutrition Survey 1997 to 2015. By including 16,917 individuals from diverse social contexts, we calculated the age-standardized incidence of stroke across regions and the age-adjusted risk ratio (aRR). Cox proportional hazards models with time-varying covariates were employed to analyze variations in incident stroke. @*Results@#During the follow-up, age-standardized incidence of stroke ranged from 4.17 per 1,000 person-years (95% confidence interval [CI], 3.38 to 4.96) in the north region to 1.95 (95% CI, 1.60 to 2.30) in the south region (aRR, 2.04; 95% CI, 1.58 to 2.64; P<0.001). The north-to-south gradient of stroke incidence was observed only in rural areas, but not in urban areas. Hierarchical modelling analyses further indicated that the regional differences could be mostly explained by the disparities in the prevalence of hypertension. @*Conclusions@#The present study extends the current evidence on the north-to-south gradient by demonstrating that the difference varied across urban and rural China. Our findings highlight the importance of hypertension management as the measure for alleviating regional differences in stroke incidence.
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Objective To explore the management of spontaneous intraspinal hematoma.Methods From January 2011 to July 2018,29 cases with spontaneous intraspinal hematoma were admitted to our department.Date on etiology,clinical presentation,radiological features,treatment strategy and prognosis were analyzed retrospectively.The prognosis was assessed by American Spinal Injury Association impairment scale (ASIA) before and after the treatment.Results Total of 29 cases,only 10 cases (34.5％) revealed specific etiology,including 7 cases of spinal vascular malformation,2 of tumor apoplexy,1 of cavernous hemangioma.After 2 weeks of conservative treatment,3 patients with grade D and 3 patients with grade E were assessed for spinal function.The average interval from onset to surgery was(9.4±7.5) days,the ASIA after two weeks of the operation was as follows:5 patients were assessed at grade A,5 patients at grade C,8 patients at grade D and 4 patients at grade E.28 patients were followed up for (48.7±23.1) months on average,6 patients without surgery were E,22 cases with surgery were as follows:4 cases A,18 cases D/E.Conclusions The etiology of spontaneous intraspinal hematoma is hard to define even after complete preoperative examination and exploratory operation.The preoperative neurologic functions are important predicting factors for the prognosis of spontaneous intraspinal hematoma.For patients who had neurologic function deficit,surgical treatment should be performed urgently to remove the hematoma and release the decompression of spinal cord.The majority of these patients can achieve a positive prognosis after surgery.
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OBJECTIVE: Rehemorrhage is the most severe complication of postoperative patients with spontaneous intracerebral hemorrhage. The aim of the present study was to assess independent predictors of rehemorrhage and find the possibility of preventing rehemorrhage in postoperative patients with spontaneous intracerebral hemorrhage (sICH).METHODS: Medical records of 263 postoperative patients with sICH from our Hospital were reviewed. The relationships between rehemorrhage and parameters were examined by univariate and multivariate analyses. The parameters include time from onset to surgery, hematologic paremeters, neuroimaging characteristics, level and variability of systolic blood pressure, medical histories, operation duration, and blood loss. In addition, relationship between rehemorrhage and clinical outcome were analyzed by using multivariate analyses.RESULTS: Thirty-five (13.31%) patients experienced rehemorrhage after operation. Multivariate analyses indicated that the following factors were independently associated with rehemorrhage : history of diabetes mellitus (odds ratio [OR], 2.717; 95% confidence interval [CI], 1.005–7.346; p=0.049), and midline shift (for every 1 mm increase, OR, 1.117; 95% CI, 1.029–1.214; p=0.009). Rehemorrhage was an independent risk factor of poor functional outcome (OR, 3.334; 95% CI, 1.094–10.155; p=0.034).CONCLUSION: Our finding revealed that history of diabetes mellitus and admission midline shift were possibly associated with rehemorrhage in postoperative patients with sICH.
الموضوعات
Humans , Blood Pressure , Case-Control Studies , Cerebral Hemorrhage , Diabetes Mellitus , Hypertension , Medical Records , Multivariate Analysis , Neuroimaging , Risk Factorsالملخص
Background and purpose: Solid pseudopapillary tumor of the pancreas (SPTP) is rare, and there are some differences between benign and malignant SPTP not only in clinical treatment but also in future prognosis. The purpose of this study was to investigate the characteristics of benign and malignant SPTP and differential diagnosis on computed tomography scan, in order to improve the accuracy of preoperative diagnosis. Methods: A total of 69 SPTP patients cofirmed by pathology were included. Each patient was diagnosed through the clinical and CT features by 3 radiologists. Results: Thirteen (18.84％) patients (9 females and 4 males) were confirmed as malignant SPTP. The tumors in 56 (81.16％) patients (45 females and 11 males) were diagnosed as benign SPTP. There was no significant difference in gender (P=0.458) between the groups. The mean age of malignant SPTP patients was significantly higher than that of benign SPTP patients [39 (16-56) years vs 31 (14-56) years, P=0.001]. The mean tumor size was 6.2(2.2-12.0)cm in malignant group and 5.5(1.2-13.0) cm in benign group, respectively. The size of tumor was equal or larger than 5.0 cm in 31 patients (benign vs malignant 21∶10, P=0.014). Twenty-eight lesions showed incomplete fibrous pseudocapsule (benign vs malignant 19∶9, P=0.028). There were no significant differences in lesion location, morphology, proportion of cystic or solid component between malignant and benign groups (P＞0.05). Conclusion: Malignant SPTP patients were significantly older than benign SPTP patients. The large tumor size (≥5 cm) and incomplete fibrous pseudocapsule may suggest malignancy of SPTP.
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Objective To investigate the gut microbial characteristics in patients with acute ischemic stroke and resilience of the gut microbiota after a stroke. Methods Ninety-five fecal samples from 28 ischemic stroke patients and 28 fecal samples from 28 healthy volunteers were collected.DNA was extracted from these samples and the bacterial 16S rRNA were amplified through real-time quantitative polymerase chain reaction (qPCR). All PCR products were mixed together and then sequenced using the Illumina Hiseq 2500 platform. Microbiome analysis was implemented in QIIME. Results Patients with acute ischemic stroke showed significantly higher diversity than controls (phylogenetic diversity, P=0.002). The overall composition of the gut microbial communities also differed significantly between acute ischemic stroke patients and healthy controls as indicated by the clear separation in principle coordinate analysis (Adonis test on Bray-Curtis, P<0.001). Stroke patients' intestines had more opportunistic pathogens, such as Enterobacteriaceae, Veillonellaceae and Streptococcaceae, fewer commensal or beneficial genera including Bacteroides and Prevotella. Four weeks after onset, the gut microbiota in stroke patients began to restore, but the alpha diversity declined (P<0.05). Conclusion The present study has revealed the characteristic of gut microbial dysbiosis and recovery in acute ischemic stroke patients.However,the significance of the dynamic gut microbiota in stroke patients needs further study.
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Objective To retrospectively investigate the characteristics of background parenchymal enhancement(BPE)in the contralateral breast following neoadjuvant chemotherapy(NAC)and whether BPE could help predict tumor response in early stage of advanced breast cancer. Methods Data from 161 patients who were diagnosed with unilateral breast cancer and then underwent NAC before surgery were analyzed retrospectively from August 2014 to December 2016.All the patients underwent both bilateral breast MRI scan with contrast enhancement. Two experienced radiologists independently categorized the patients' levels of BPE into four categories (1=minimal, 2=mild, 3=moderate, 4=marked) at baseline and after the 2nd cycle of NAC. All the patients were divided in to pathologic complete response (pCR) group and non-pCR group according to the histopathologic tumour response.The status of estrogen receptor(ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) were recorded before underwent NAC.The t test and Pearson chi-squared test were used to compare the baseline characteristics of the pCR and Non-pCR groups.The kappa test was used to test the inter-observer agreement.The Wilcoxon test was used to test for changes of BPE categories after NAC.The Mann-Whitney U test was used to test the difference of BPE between pre-and post-menopausal status. Associations were evaluated using Binary logistic regression models. Results Fifty nine patients achieved pCR, and 102 patients had residual disease (non-pCR). Age, tumor size, distribution of size, menopausal status and lymph node showed no significance between pCR and non-pCR groups(all P>0.05),while only ER/PR status and HER2 status had a significant difference (P>0.05 in both). Inter-observer agreement regarding BPE categorization was moderate and substantial before and after NAC(Kappa value 0.644 and 0.708).The level of BPE was higher in premenopausal than post-menopausal women both at baseline and after the 2nd cycle of NAC(P<0.01). Decreased BPE was observed in 106 cases(premenopausal 60 cases and postmenopausal 46 cases),and no change in BPE were observed in 55 cases (premenopausal 27 cases and postmenopausal 28 cases). A significant reduction in BPE was observed after the 2nd NAC cycle in the overall cases, pre-and post-menopausal cases (all P<0.01). Logistic model showed that hormonal receptor (HR) negative and HER-2 receptor at baseline and the change of BPE after NAC were the independent factors for predicting pCR. Conclusions Regardless of the menopausal status, BPE showed a reduction after NAC, and it can serve as an additional imaging biomarker of tumour response at an early stage of NAC.
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OBJECTIVE: Rehemorrhage is the most severe complication of postoperative patients with spontaneous intracerebral hemorrhage. The aim of the present study was to assess independent predictors of rehemorrhage and find the possibility of preventing rehemorrhage in postoperative patients with spontaneous intracerebral hemorrhage (sICH). METHODS: Medical records of 263 postoperative patients with sICH from our Hospital were reviewed. The relationships between rehemorrhage and parameters were examined by univariate and multivariate analyses. The parameters include time from onset to surgery, hematologic paremeters, neuroimaging characteristics, level and variability of systolic blood pressure, medical histories, operation duration, and blood loss. In addition, relationship between rehemorrhage and clinical outcome were analyzed by using multivariate analyses. RESULTS: Thirty-five (13.31%) patients experienced rehemorrhage after operation. Multivariate analyses indicated that the following factors were independently associated with rehemorrhage : history of diabetes mellitus (odds ratio [OR], 2.717; 95% confidence interval [CI], 1.005–7.346; p=0.049), and midline shift (for every 1 mm increase, OR, 1.117; 95% CI, 1.029–1.214; p=0.009). Rehemorrhage was an independent risk factor of poor functional outcome (OR, 3.334; 95% CI, 1.094–10.155; p=0.034). CONCLUSION: Our finding revealed that history of diabetes mellitus and admission midline shift were possibly associated with rehemorrhage in postoperative patients with sICH.
الموضوعات
Humans , Blood Pressure , Case-Control Studies , Cerebral Hemorrhage , Diabetes Mellitus , Hypertension , Medical Records , Multivariate Analysis , Neuroimaging , Risk Factorsالملخص
Objective To evaluate the influence of menopause status on breast fibrograndular tissue (FGT),background parenchymal enhancement volume ratio (BPEv) and intensity ratio (BPEI) by breast MR image automatic quantitative analysis.Methods From 14 033 consecutive patients who underwent breast MR in our center from 2009 to 2012,we randomly selected 101 normal cases (47cases of premenopausal and 54 cases of postmenopausal).Premenopausal status was subclassified into four groups (8 cases in the 1st week and 13 cases in the 2nd,3rd and 4th week,respectively) based on the menstrual cycle.We evaluated FGT,BPEv and BPEI at early (2 minutes),medium (4 minutes) and late (6 minutes) enhanced time phases of breast MRI for quantitative assessment.The FGT,BPEv and BPEI in premenopausal and postmenopausal women were compared using the Mann-Whitney U test.Comparison of each menstrual cycle was made using the Kruskal-Wallis test.Results The FGT,BPEv and middle-late BPEI of postmenopausal women were significantly lower than that of premenopausal women (P＜0.05).The maximum BPEI was in the 1st week,the minimum in the 2nd week in premenopausal women (P＜0.05).The FGT and BPEv in the 1st week were the highest among the 4 weeks,but there was no significant difference.Conclusions The FGT,BPEv and BPEI were significantly decreased after menopause.The optimal time of breast MR examination is in the 2nd week of menstrual cycle.
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Objective@#To explore the clinical characteristics, therapeutic methods and effects of blood blister-like aneurysms (BBA) of the supraclinoid segment of the internal carotid artery (ICA).@*Methods@#A total of 40 patients with BBAs of the ICA treated at Department of Neurosurgery of West China Hospital between January 2010 and January 2016 were retrospectively reviewed. There were 14 males and 26 females with the mean age of 44.7 years (ranging from 25 to 64 years). There were 38 patients presented with subarachnoid hemorrhage (SAH), and 2 patients were found incidentally with unruptured aneurysms in regular examination. Surgical treatment was performed in 22 patients, including direct clipping, clipping over wrapping and trapping. Endovascular treatment with single or multiple stents and coiling was performed in 18 patients. Clinical outcomes were assessed with modified Rankin Scale. The patients were followed up with CT angiography.@*Results@#Direct clipping of BBA was performed in 18 patients, clipping over wrapping in 3 patients and trapping of ICA in 1 patient. Intraoperative rupture occurred in 5 patients. Postoperative cerebral infarction developed in 6 cases, 4 patients died. Single stent-assisted coiling was performed in 8 cases, and multiple stents with coiling in 10 patients. Procedure-related hemorrhage occurred in 2 patients, postoperative massive cerebral infarction developed in 1 patient with stent-assisted coiling. The follow-up time was 26.8 months (ranging from 6 to 72 months), among the patients with surgery, good results (modified Rankin Scale 0-2) were achieved in 16 patients; one patient was score 3, and the other was 4. In endovascular group, 15 patients had good results and one with mRS 4. Follow-up angiography revealed recurrence of BBA in 2 patients treated with stent and coiling, which was retreated with coiling. No recurrence was found in surgical group.@*Conclusions@#BBA of the supraclinoid ICA is a specific and complicated intracranial aneurysm with high risk and complications no matter the treatment is surgical or endovascular, take proper operation methods could achieve satisfactory results.
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Hypertensive intracerebral hemorrhage (HICH) is one of the most serious public health problems in China.With innovation of idea and improving of tools,minimally invasive clearances of hematoma have increasingly become the main means of surgical treatment of HICH patients.In this review,we focus on the status and trend of the minimally invasive clearances ofhematoma in treatment of HICH in China.
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Objective To investigate the diagnostic value and characteristics of breast lesion in digital breast tomosynthesis (DBT) in combination with synthesized two-dimensional (2D) images. Methods The prospective study enrolled women older than 18 years with clinically suspected breast lesion.One hundred and sixty seven patients with 177 lesions confirmed by biopsy or surgery were included. All the patients underwent full-field digital mammography(FFDM)and DBT examinations,and synthesized 2D images(V-preview)were reconstructed from DBT.The images of FFDM,V-preview images and DBT plus FFDM, V-preview images were analyzed. The breast imaging reporting and data system (BI-RADS) and characteristic for predicting benign and malignant lesion were also evaluated.The average glandular dose for a single mammographic view between FFDM and DBT was recorded.The Nonparametric Z test was used to compare the differences among four different mammographic images in BI-RADS.The differential diagnostic performance among different mammography was evaluated by ROC analysis.Independent t test was used to compare the average glandular dose between FFDM and DBT.Results One hundred three benign lesions and 74 malignant lesions were confirmed. Compared with FFDM images alone or plus DBT,the diagnostic values of V-preview images alone/or plus DBT were not significantly different(Z=0.187 and 0.226,P=0.851 and 0.821), but compared with V-preview, the diagnostic values of V-preview images plus DBT revealed significant difference(Z=3.546,P<0.01).The area under ROC for V-preview plus DBT were 0.899,and the sensitivity,specificity,and accuracy were 90.5%,89.3%,and 89.3%,separately.For the average glandular dose, there was no significant difference between FFDM (1.48 ± 0.52) mGy and DBT (1.56 ± 0.39) mGy examination(t=1.714,P=0.087).Conclusion Synthesized 2D images from DBT,which may eliminate the need for FFDM,in combination with DBT can improve the diagnostic efficiency.
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Objective To investigate the significance of androgen and estrogen receptor expression levels on aneurysm walls.Methods From November 2007 to June 2016,32 patients received craniotomy for clipping intracranial aneurysms in the West China Hospital,Sichuan University were enrolled prospectively.Nineteen intracranial aneurysm walls and 26 superficial temporal artery branches were obtained (a total of 45 qualified specimens).Immunohistochemical method was used to detect the superficial temporal artery branches and smooth muscle layer of intracranial aneurysm wall and the expression levels of estrogen receptor-α,β and androgen receptors.Image Pro Plus 6.0 software was used to analyze and detect the integral optical density values of the positive cell expression levels.The χ2 test and rank-sum test were used for statistical analysis.Results The median (M) and interquartile range (P25,P75) of the expression levels of estrogen receptor-α,β of the intracranial aneurysm walls were 3 049 (2 112,5 554) and 4 364 (2 314,5 667) respectively.They were lower than 6 544 (3 507,10 103) and 6 972 (5 694,10 024) of the superficial temporal artery branches.The expression level of androgen receptor of aneurysm wall was 3 299 (1 375,4 895),it was higher than 1 130 (794,1 922) of the superficial temporal artery branches.There was significant difference between the two groups (all P<0.05).Conclusion The decreased expression levels of estrogen receptor-α,β and the increased expression level of androgen receptor in the cerebrovascular walls may promote the progress of intracranial aneurysms,however,the specific mechanism needs further study.
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Objective To explore the surgical techniques and effects of one-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base.Methods The clinical data of 13 pediatric cases with one-stage reconstruction surgery for comminuted and depressed fractures of the frontal bone and anterior skull base were reviewed retrospectively,including 8 male and 5 female,aged from 4 to 14 years,with a mean age of 8 years.Admission Glasgow Coma Scale (GCS) was as follows:3 to 8 scores in 2 cases,9 to 11 scores in 4 cases,and 12 to 15 scores in 7 cases.The intraoperative one-stage osseous and vascular pedicle membranous reconstruction of frontal bone and anterior skull base had been performed in all patients.The periosteum-bone fragments-periosteum had been used in 4 cases whose bony defect diameter of anterior cranial fossa was over 1 cm,multimodality therapy were carried out postoperatively.The follow-ups were regularly executed after discharge.Results GCS at discharge was as follows:3 to 8 scores in 1 case,9 to 11 scores in 2 cases,and 12 to 15 scores in 10 cases.No significant difference was found in GCS between those on admission and at discharge(χ2=3.02,P>0.05).Eleven cases had a phenomenon of nasal hemorrhage and the duration was not exceeding 48 hours.No intracranial infection and cerebrospinal fluid leakage occurred in all patients.All patients received an acceptable appearance without obvious frontal depre-ssion or proptosis.Postoperative computed tomography image showed normal cranial volume,well reset of fracture pieces,no fracture pieces existing in intracerebral tissue,satisfactory hematoma evacuation,and orbital contents without compression.The complications like cerebrospinal fluid leakage,poor incision healing,brain abscess or mucous cyst had not been found in all patients from 3 months to 6 years follow-up period.Conclusions The one-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base suggests a better prognosis,effectively less complications,which helps to avoid secondary surgery,but regular follow-ups are absolutely necessary.This procedure is worth applying and spreading to pediatric patients and medical institutions if necessary.
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Objective To investigate the relationship between low serum calcium concentration and hematoma volume in patients with intracerebral hemorrhage.Methods Between January 2012 and October 2014,870 consecutive patients with intracerebral hemorrhage admitted to the Department of Neurosurgery,West China Hospital,Sichuan University were enrolled prospectively.The patients completed laboratory serum calcium concentration and head CT examinations within 24 h after attack,and the baseline data and laboratory findings were collected.According to the normal reference value of laboratory serum calcium concentration,the patients were divided into a hypocalcemia calcium group (<2.1 mmol/L;n=193) and a normal calcium group (2.1-2.7 mmol/L;n=677).Spearman correlation analysis was used to analyze the correlation between the blood serum calcium concentration and the hematoma volume on admission.Results (1) The hypocalcemia group compared with normal calcium group,the proportion of male patients was high (73.6% [n=142] vs.66.0% [n=447]),the median score for Glasgow coma scale was lower (9 vs.11),and the median hematoma volume was larger (33.86 cm3 vs.21.69 cm3).The differences were statistically significant (all P<0.05).(2) Spearman correlation analysis showed that the lower serum calcium level on admission was weakly negatively correlated with the volume of hematoma in patients with intracerebral hemorrhage (r=-0.113,P<0.01).Conclusion The study suggested that the hypocalcemia on admission was mostly males in patients with intracerebral hemorrhage,the condition was serious,the volume of hematoma was larger,and the lower serum calcium concentration was negatively correlated with the hematoma volume.
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<p><b>OBJECTIVE</b>To investigate the effect of intermittent fasting on metabolize and gut microbiota in obese presenium rats fed with high-fat-sugar-diet.</p><p><b>METHODS</b>We fed the Wistar rats with high-fat and high-sugar diet to induce adiposity, and the rats for intermittent fasting were selected base on their body weight. The rats were subjected to fasting for 72 h every 2 weeks for 18 weeks. OGTT test was performed and fasting blood samples and fecal samples were collected for measurement of TC, TG, HDL-C and LDL-C and sequence analysis of fecal 16S rRNA V4 tags using Illumina. Gut microbial community structure was analyzed with QIIME and LEfSe.</p><p><b>RESULTS</b>After the intervention, the body weight of the fasting rats was significantly lower than that in high-fat diet group (P<0.01). OGTT results suggested impairment of sugar tolerance in the fasting group, which showed a significantly larger AUC than compared with the high-fat diet group (P<0.05). Intermittent fasting significantly reduced blood HDL-C and LDL-C levels (P<0.05) and partially restored liver steatosis, and improved the gut microbiota by increasing the abundance of YS2, RF32 and Helicobacteraceae and reducing Lactobacillus, Roseburia, Erysipelotrichaceae and Ralstonia. Bradyrhizobiaceae was found to be positively correlated with CHOL and HDL-C, and RF39 was inversely correlated with the weight of the rats.</p><p><b>CONCLUSION</b>Intermittent fasting can decrease the body weight and blood lipid levels and restore normal gut microbiota but can cause impairment of glucose metabolism in obese presenium rats.</p>
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Animals , Rats , Body Weight , Diet, High-Fat , Fasting , Fatty Liver , Microbiology , Gastrointestinal Microbiome , Lipids , Blood , Obesity , Microbiology , RNA, Ribosomal, 16S , Rats, Wistarالملخص
The etiology and pathogenesis of moyamoya disease (MMD) remain elusive. Some inflammatory proteins, such as cyclooxygenase (COX)-2, are believed to be implicated in the development of MMD. So far, the relationship between COX-2 and MMD is poorly understood and reports on the intracranial vessels of MMD patients are scanty. In this study, tiny pieces of middle cerebral artery (MCA) and superficial temporal artery (STA) from 13 MMD patients were surgically harvested. The MCA and STA samples from 5 control patients were also collected by using the same technique. The expression of COX-2 was immunohistochemically detected and the average absorbance (A) of positively-stained areas was measured. High-level COX-2 expression was found in all layers of the MCA samples from all 5 hemorrhagic MMD patients, while positive but weak expression of COX-2 was observed only in the endothelial layer of the MCA samples from most ischemic MMD patients (6/8, 75%). The average A values of COX-2 in the hemorrhagic MMD patients were substantially higher than those in their ischemic counterparts (t=4.632, P=0.001). There was no significant difference in the COX-2 expression among the "gender" groups, or "radiographic grade" groups, or "lesion location" groups (P>0.05 for all). The COX-2 expression was detected neither in the MCA samples from the controls nor in all STA specimens. Our results suggested that COX-2 was up-regulated in the MCA of MMD patients, especially in hemorrhagic MMD patients. We are led to speculate that COX-2 may be involved in the pathogenesis of MMD and even contribute to the hemorrhagic stroke of MMD patients.