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Objective To evaluate the short-term effect of Pipeline embolization device (PED)for the treatment of unruptured wide-necked intracranial aneurysms. Methods From October 2015 to September 2016,15 consecutive patients with unruptured wide-necked intracranial aneurysm (aneurysm neck and aneurysm body ratio ≥0. 5)treated with PED at the Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University were enrolled retrospectively. Their clinical and imaging data were analyzed. Kamran scale was used to evaluate the embolization rate of aneurysms and the changes of the parent arteries. DSA examination was performed again at 6 -12 months after operation. Results Fifteen PED were implanted in 15 patients with unruptured wide-necked intracranial aneurysms,including 13ophthalmic artery aneurysms,1 posterior communicating artery aneurysm,and 1 cavernous sinus aneurysm. The technical success rate was 100% . Immediately after PED implantation,Karman rating of 15 cases were aneurysm grade 2 embolization,parent artery grade A (grade 2a). DSA examination was performed again at 6 - 12 months after operation showed that 14 patients were aneurysm grade 4,parent artery was grade A (grade 4a). One patient (ophthalmic artery aneurysm)underwent the second DSA examinations at 6 and 12 months after operation showed that the residual development of aneurysms. The aneurysm embolization was grade 3, and the parent artery was grade A (grade 3a). No branch artery occlusion was observed. Non of them had neurological deficit. The modified Rankin scale score was 0 in all 15 patients. Conclusion The use of PED in the treatment of unruptured wide-necked intracranial aneurysms has a higher occlusion rate. Its long-term effect still needs further follow-up.
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<p><b>OBJECTIVE</b>To evaluate the application value of R.E.N. A.L. nephrometry score for surgery type decisions of T1 stage renal tumor.</p><p><b>METHODS</b>Clinical data including image data, surgery type and prognosis etc were collected retrospectively for 122 cases from January 2010 to December 2012. There were 76 male and 46 female patients and they were 29-82 years (mean 51 years). The body mass index was (22.8 ± 3.9) kg/m(2). The patients were undergoing surgical excision with renal tumor of T1 stage. The R.E.N. A.L. nephrometry score was analyzed to evaluate their relationships to surgery type (RN or NSS) and the approach of NSS (ONSS or LNSS) using chi-square tests, Fisher's exact tests, and logistic regressions analysis.</p><p><b>RESULTS</b>All surgery had been completed. The surgery included RN of 45 patients, LNSS of 45 patients and ONSS of 32 patients. The R.E.N. A.L. nephrometry score was significantly associated with the type of surgery (χ(2) = 27.89, P < 0.05), and the NSS approach (χ(2) = 12.87, P < 0.05). When the scores less than 7 points, it is majorly treated by nephron sparing surgery (92.9%), and when the scores more than 9 points, it is majorly treated by radical nephrectomy (69.4%). Individual component scores were analyzed to evaluate that they were all related to surgery type (χ(2) = 7.00-14.57, P < 0.05), and the individual component N associated the surgery type mostly. Furthermore, individual component R,E,N and L were statistically significant predictors of the NSS approach (χ(2) = 4.92-15.07, P < 0.05).</p><p><b>CONCLUSION</b>The R.E.N. A.L. nephrometry scoring system provides a simple, useful, and stable system to character the salient renal anatomy of T1 stage, and can provide the best surgery approach.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Kidney , Pathology , Kidney Neoplasms , Pathology , General Surgery , Neoplasm Staging , Nephrectomy , Prognosis , Retrospective StudiesABSTRACT
Objective To evaluate the efficacy of preoperative aspects and dimensions used for an anatomical (PADUA) scores in determining the surgical approach for T1 stage renal masses.Methods From Jan 2010 to Dec 2012,clinical data of 122 cases (76 males and 46 females),who underwent surgery for T1 stage renal masses,were collected retrospectively.The mean age was 51 years(range 21-81) and mean body mass index was (22.8±3.9) kg/m2.Sixty-three tumors were found in left kidney and 59 in right kidney.Among them,78 patients were diagnosed as T1a stage and 44 patients were T1b stage.In patients with T1a stage,56 received nephron sparing surgery (NSS) and 22 received radical nephrectomy (RN).In patients with T1b stage,21 received NSS and 23 received RN.The PADUA nephrometry score was analyzed to evaluate their relationships to surgical type and the approach of NSS.Results According to the PADUA nephrometry score,the number of low risk,middle risk and high risk patients were 24,62,26,respectively.Inlow risk group,middle risk group and high risk group,the proportion of RN and NSS was 8.3％/ 91.7％,30.6％/69.4％,66.7％/33.3％.In 77 patients received NSS,the unmber of laparoscopic NSS and open NSS was 18 ∶ 4,25 ∶ 18,2 ∶ 10,respectively.The PADUA nephrometry score was significantly associated with the type of surgery (x2 =23.16,P＜0.01),and the NSS approach (x2 =13.57,P＜0.01).Tumor size (HR =2.79 ; 95％ CI,1.29-6.02 ; P＜ 0.01),percentage of tumor deepening into the kidney (HR =3.82; 95％CI,1.77-8.09; P＜0.01),longitudinal (HR=4.00;95％CI,1.83-8.72; P＜0.01),tumor relationships with renal sinus(HR=103.13; 95％CI,21.85-486.81 ; P＜0.01),tumor relationships with urinary collecting system (HR =15.11 ; 95％ CI,5.95-38.35 ; P＜ 0.01),rim tumor location (HR =3.50 ; 95％ CI,1.61-7.59; P＜0.01) were closely related with surgery approach.The correlation coefficients of relationship with renal sinus was highest (r=0.70).Conclusions The PADUA nephrometry score provides a simple,useful and stable system to character the salient renal anatomy and guide the surgery.Low risk group should consider the NSS as the first line therapy.NSS could also be chosen in the middle risk group.However,the renal anatomy in those patients should be referred.RN should be chosen in high risk group.
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BACKGROUND: How to lessen neuronal necrosis to promote recovery of nerve function after ischemic cerebral injury? Cerebral ischemic preconditioning (IP) alleviates ischemic cerebral injury caused by re-ischemia to certain extent. It has been verified that sodium ferulate can lessen the incidence of neuron apoptosis after cerebral ischemia. Whether does sodium ferulate enhance the nerve protection of IP brain to not?OBJECTIVE: To explore the protection of sodium ferulate allied with IP in cerebral ischemic-reperfusion injury.DESIGN: Randomized controlled animal experiment was designed.SETTING: Neurological Surgery Department of 2nd Affiliated Hospital of Jiangxi Medical College, Department of Physiology of Jiangxi Medical College, Institute of Urinary Surgery of Jiangxi Medical College.MATERIALS: The experiment was perforned in Laboratory Room of Neurological Surgery Department of 2nd affiliated Hospital of Jiangxi Medical College from May 2001 to April 2002, in which, 85 Wistar male rats were employed, mass weighted varied from 250-300 g.METHODS: The rats were randomized into 4 groups: ① The control without ischemia (10 rats): Vertebral artery was ligatured bilaterally and common carotid artery was not clipped bilaterally. ② The control with ischemia (25 rats): Vertebral artery was ligatured bilaterally for 48 hours and common carotid artery was clipped for 10 minutes. ③ IP group (25rats): Vertebral artery was ligatured bilaterally for 48 hours and common carotid artery was clipped for 2 minutes, and 24 hours later, the common carotid artery was clipped again for another 10 minutes. ④ Sodium ferulate allied with IP group (Allied group) (24 rats): After IP, the common carotid artery was clipped again for 30 minutes and sodium ferulate (200 mg/kg)was injected intravenously from tail. The control without ischemia was subdivided into two groups of 2 days and 7 days after reperfusion respectively (5 rats for each one). The control with ischemia, IP group and allied group were subdivided into 5 groups of 6 bours, 12 hours, 24 hours,2 days and 7 days after reperfusion successively (5 rats for each one).The rats were sacrificed to collect brains at phase spots in each group.Coronary brain slice was collected 2.2 mm posterior to the optic chiasm and the effects of allied with was observed on neuron count and apoptotic cell count in cortex and hippocampal CA1 in cerebral ischemia reperfusion.MAIN OUTCOME MEASURES: Neuron count and apoptotic cell count in cortex and hippocampal CA1.RESULTS: Totally 85 experimental rats all entered result analysis. ①Neuron count in cerebral cortex and hippocampal CA1: On the 7th day after ischemia, the counts in IP group and allied group were higher than ischemia control (268±8.5, 244±12.5, 135±5.6, P ＜ 0.01). ② Count of TUNEL positive cell in cerebral cortex and hippocampal CA1: The count in allied group was lower than that in IP group and ischemia control (12 hours:1.2±0.8, 15.5±2.1, 39.8±3.9; 24 hours: 1.8±1.6, 39.3±11.8, 191.3±19.1;2 days: 2.8±1.2, 68.3±13.6, 328.4±24.0, P ＜ 0.01), and that in IP group was lower than ischemic control (P ＜ 0.01).CONCLUSION: IP lessens apoptotic neuron count in ischemic region.Sodium ferulate allied with IP further intensifies such effect and provides the protection of ischemic reperfusion injury of brain.
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BACKGROUND: Bone marrow cell transplantation is a simple and effective treatment to promote angiogenesis. The neovascularization and reestablishment of blood circulation is crucial to the repair of injured but still living neurons as well as to the survival and differentiation of the implanted tissues and cells. However,it is not clearly known whether autologous bone marrow cells implantation could promote neovascularization and facilitate reestablishment of circulation in ischemic regions of the brain.OBJECTIVE: To investigate the effect of autologous bone marrow cell transplantation via the carotid artery on angiogenesis in the ischemic regions of the brain.DESIGN: A randomized controlled experiment based on experimental animals.SETTING: Department of neurosurgery and institute of urinary surgery in a university hospital.MATERIALS: The experiment was conducted in the Laboratory of the Department of Neurosurgery,Second Affiliated Hospital,and the Institute of Urinary Surgery,Jiangxi Medical College during the period from September 2002 to April 2003,using 10 specific pathogen-free male SD rats weighing 250 - 300 g.INTERVENTIONS: Rat models of focal cerebral ischemia model were established and randomized equally into two groups. The rats in the transplantation group were injected with autologous bone marrow cells via the carotid artery and those in the control group normal saline injection. The angiogenesis in the ischemic regions of the brain was observed with immunohistochemical staining for microvessel counting.MAIN OUTCOME MEASURES: The density of microvessels. Immunohistochemical staining for F8.RESULTS: Greater density of the microvessels was found in the ischemic regions after bone marrow cell transplantation than in the control group[(159. 15 ±40.4)/mm2 vs(81.70 ± 32. 18)/mm2,P ＜ 0. 05] . Numerous endothelial cells were found scattered in the ischemic cortex of the transplantation group,but scarcely in the control group.CONCLUSION: Autologous bone marrow cell transplantation via the carotid artery can promote angiogenesis in the ischemic regions of the brain.