A nomogram for individualized prediction of the probability of hemorrhagic transformation in patients with acute ischemic stroke after endovascular treatment based on 4-dimensional CT angiography factors / 中华放射学杂志

Objective:To assess the value of 4-dimensional CT angiography (4D CTA) to predict hemorrhagic transformation (HT) with a new nomogram model in acute ischemic stroke (AIS) patients after endovascular treatment (EVT).Methods:Imaging and clinical data of 101 AIS patients with internal carotid artery and/or middle cerebral artery occlusion who underwent "one-stop" CTA-CT perfusion and EVT in green channel of Beijing Hospital from March 2016 to November 2020 were analyzed retrospectively. The patients were divided into HT group (45 patients) and non-HT group (56 patients). Multivariate logistic regression analysis was used to select relevant clinical and imaging variables, such as age, initial National Institute of Health stroke scale (NIHSS) score, 4D CTA collateral circulation score, Alberta stroke program early CT score (ASPECTS), clot burden score, and a predictive nomogram model were developed. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the efficacy of predictive nomogram model for diagnosing HT.Results:Univariate analysis showed that there were significant difference of age[79.00(68.00, 85.00) years, 73.00(62.75, 80.00) years, Z=-2.20, P=0.028], NIHSS score [16.00(12.00, 21.00), 9.50(6.00, 14.00), Z=-4.44, P<0.001], ASPECTS score [5.00(3.00, 8.00), 8.00(7.00, 9.00), Z=-4.23, P<0.001], 4D CTA collateral circulation score [2.00(0, 3.00), 3.00(3.00, 4.00), Z=-5.39, P<0.001], clot burden score [4.00(1.00, 7.00), 7.50(6.00, 9.00), Z=-3.42, P=0.001], location of the occlusion(internal carotid artery/middle cerebral artery occlusion was 23/22, 11/45 cases, χ2=9.70, P=0.002), and atrial fibrillation (27 and 19 cases respectively, χ2=5.83, P=0.016) between HT group and non-HT group. Multivariate logistic regression analysis showed that ASPECTS score (OR=0.64, 95%CI 0.47-0.87), NIHSS score (OR=1.13, 95%CI 1.01-1.26), 4D CTA collateral circulation score (OR=0.40,95%CI 0.22-0.76) were independent predictors of HT in AIS patients ( P<0.05). The AUC of the nomogram based on the ASPECTS score, NIHSS score and 4D CTA collateral circulation score to predict HT of AIS patients was 0.876 (95%CI 0.807-0.945), with a sensitivity of 77.8% and specificity of 87.5%. Conclusions:Patients with low ASPECTS score, high NIHSS score and low 4D CTA collateral circulation score have a higher risk of HT after EVT. The nomogram model may predict the probability of HT of AIS patients and provide effective assistance for clinical decision-making.

Establishment of interventional access via the sheathing of the caudal artery in rats / 中风与神经疾病杂志

@#Objective　Digital silhouette angiography in animal models is limited by the lack of methods that can perform continuous intra-arterial manipulations.We aimed to investigate the way that allowed to repeat interventional maneuvers through a single sheath access in the rat caudal artery.Methods　Six adult male Sprague Dawley rats (650~700 g) were anesthetized,the caudal arteries were exposed and a fish-mouth-shaped incision was made with a microscissor.After the access was established,whole brain angiography and aortic dilatation with balloon and stent catheters were performed via the tail artery sheath access to test the feasibility and effectiveness of the tail artery sheathing method as an interventional access.Results　The diameter of caudal artery approximately (1.19±0.14) mm,and the 18G sheath was successfully implanted with guidewire.The sheathing time of the caudal artery (11.00±1.90 min,P<0.01) was significantly reduced compared with the carotid artery (24.50±4.50) min and the femoral artery (18.17±3.43) min.A balloon catheter and a stent catheter could be passed through the caudal artery sheath and released in the aorta,and the catheter could be withdrawn smoothly after the release.Each rat can be used for multiple tail artery sheathing operations,and repeatable angiographic and interventional procedures can be performed through a single sheath channel.Conclusions　The method of establishing interventional access using a sheath introduced through the rat tail artery is suitable for intravascular imaging,treatment,and the construction of rat animal models.This method further enhances the scope of application of rats as human disease models.

Carotid artery stenting in octogenarians : Clinical observation and follow-up / 中华老年医学杂志

Objective To observe the safety and long-term efficacy of carotid artery stenting (CAS)in octogenarians with carotid stenosis.Methods Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid-and long-term follow-up results were analyzed.Results A consecutive series of 61 patients (a median age of 81 years,54 males) were enrolled.Of 61 patients,23 (37.7％)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS,one patient underwent bilateral CAS,and 26 (42.6 ％)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0％.During the perioperative period,the incidence of stroke was 6.6％ (4/61),and no patient died.Eight (13.1％) patients had contrast-induced nephropathy,4 (6.6％) patients suffered from cardiac dysfunction,and 30 (49.2％)patients had hypotension requiring vasopressor support postoperatively,and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months,with an interquartile interval of 44 months).The incidence of stroke and death was 8.2％ (5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis,and was 93 months in asymptomatic patients,with the statistically significant difference between the two groups(x2 =4.258,P=0.039).Conclusions Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers,and the outcome of a mid-and long-term follow-up is good.

Carotid artery stenting in octogenarians: Clinical observation and follow-up / 中华老年医学杂志

Objective@#To observe the safety and long-term efficacy of carotid artery stenting(CAS)in octogenarians with carotid stenosis.@*Methods@#Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid- and long-term follow-up results were analyzed.@*Results@#A consecutive series of 61 patients(a median age of 81 years, 54 males)were enrolled.Of 61 patients, 23(37.7%)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS, one patient underwent bilateral CAS, and 26(42.6%)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0%.During the perioperative period, the incidence of stroke was 6.6%(4/61), and no patient died.Eight(13.1%)patients had contrast-induced nephropathy, 4(6.6%)patients suffered from cardiac dysfunction, and 30(49.2%)patients had hypotension requiring vasopressor support postoperatively, and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months, with an interquartile interval of 44 months). The incidence of stroke and death was 8.2%(5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis, and was 93 months in asymptomatic patients, with the statistically significant difference between the two groups(χ2=4.258, P=0.039).@*Conclusions@#Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers, and the outcome of a mid- and long-term follow-up is good.

A root-cause analysis of poor prognosis in patients aged 80 years and over with acute ischemic stroke after mechanical thrombectomy / 中华老年医学杂志

Objective To explore the safety and effectiveness of mechanical thrombectomy in patients ≥80 years old,and to analyze the causes of poor prognosis.Methods The data of twenty consecutive patients ≥ 80 years old with acute ischemic stroke who underwent mechanical thrombectomy in our hospital from January 2017 to June 2018 were retrospectively reviewed.Baseline information,imaging data,thrombectomy procedures,complications,and clinical prognosis were collected.The causes of poor prognosis were analyzed.Results A total of 20 advanced age patients were included,with an average age of (83.3±4.1)years(range 80 to 96 years).All patients underwent mechanical thrombectomy,and the successful recanalization rate(mTICI 2b-3)was 70 ％.The incidence of technical complications was 15％,of which the rate of symptomatic intracranial hemorrhage was 5％.Among the 11 patients with poor prognosis,the causes included the severe diseases and later revascularization in 2 patients,unsuccessful recanalization or complications in 3 cases,and advanced age-related factors in 6 cases,among which there were accompanied multiple severe stenoses,poor collaterals and the rapid progress of stroke in 3 cases and the aggravation of previous comorbidities in 3 cases.Conclusions The advanced age patients ≥80 years old often have more comorbidities,higher prevalence rates of multiple severe vascular stenosis except the occluded vessels,poor collateral compensation and the aggravation of original comorbidities.And all of them may be important factors for the poor prognosis after mechanical thrombectomy.

Sole angioplasty with tiny balloon for high-risk complex symptomatic intracranial atherosclerotic stenosis / 中华外科杂志

Objective@#To explore the safety and short-term efficacy of sole angioplasty with tiny balloon for symptomatic intracranial atherosclerotic stenosis (ICAS) patients with complex lesions refractory.@*Methods@#Consecutive 11 patients with complex ICAS lesions treated by sole angioplasty with tiny balloon (diameter≤2 mm) from September 2016 to November 2017 at Department of Neurosurgery, Beijing Hospital were retrospectively reviewed. Patients′ demographics, lesions characteristics, procedures, complications, and clinical and imaging follow-up data were collected. There were 6 male and 5 female patients with mean age of 63.6 years (range: 45 to 77 years). Clinical manifestations were transient ischemia attack (TIA) in 4 cases, progressive ischemic stroke in 3 cases, recurrent stroke in 3 cases, and 1 case for preparation of scheduled radical resection of colon cancer. ICAS locations were middle cerebral artery M1 segment in 5 cases, M2 segment in 1 case, anterior cerebral artery A1 segment in 2 cases, and intracranial vertebral artery in 3 cases. Mean degree of ICAS stenosis was 92%. Lesion morphology was type A in 3 cases, B in 4 cases and C in 4 cases by Mori classification. Forward flow by modified thrombolysis in cerebral infarction (mTICI) was grade 1 to 2a in 8 cases, 2b in 3 cases. Collateral compensation grading was grade 2 in 5 cases, grade 3 in 6 cases.@*Results@#Technique success rate was 10/11, peri-procedural complication rate was 1/11. Post-procedural forward flow in all cases had been enhanced and 10 cases obtained mTICI 2b to 3. Ten patients got favorable outcomes (modified Rankin score 0 to 2) at discharge. With a mean clinical follow-up time of 5.4 months, 1 patient was found to have TIA recurrence. With a mean clinical follow-up time of 7.4 months, 1 patient was found to have TIA recurrence. Eight in 11 cases obtained imaging follow-up during 3 months, and none restenosis was found.@*Conclusion@#For symptomatic ICAS complex lesions, sole angioplasty with tiny balloon demonstrates relatively high safety with satisfactory short-term clinical and imaging results.

Clinical observation on treatment of severe craniocerebral injury by decompressive craniotomy with bilateral integrated frontotemporal bone flap / 中华神经医学杂志

Objective To explore the value of decompressive craniotomy with bilateral integrated frontotemporal bone flap in treatment of severe craniocerebral injury.Methods Nineteen patients with severe craniocerebral injury,admitted to our hospital from September 2015 to February 2017,were chosen in our study.These patients were applied decompressive craniotomy with bilateral integrated frontotemporal bone flap.The clinical data and treatment efficacy were retrospectively analyzed.Results Contralateral brain tissues were detected in 2 patients with unilateral lesions during the operation due to brain tissue swelling,and no other patients were forced to close the skull because of malignant brain swelling.Within 10 d of surgery,the average fluctuation of intracranial pressure was about 20 mmHg.Three months after operation,Glasgow outcome scale (GOS) indicated 10 patients (52.6％) with good recovery,4 (21％) with mild disability,2 (10.5％) with severe disability,2 (10.5％) with plant survival,and one (5.26％) death.There were 4 with mild subdural effusion,and 3 of them got recovery after craniotomy.Five patients were complicated with epilepsy,2 with cerebrospinal fluid leakage and 3 with intracranial infection.Conclusion Decompressive craniotomy with bilateral integrated frontotemporal bone flap can achieve effective decompression,effectively prevent related complications,reduce damage of nerve function,and improve overall clinical prognosis at the same time for suitable cases.

Comprehensive training of rat abdominal aorta and common iliac artery for neurosurgical microvascular anastomosis / 中国脑血管病杂志

Objective To establish an animal model suitable for neurosurgeons for the comprehensive training of microvascular anastomosis using rat abdominal aorta and common iliac artery. Methods Twelve adult SD rats were selected,they were generally anesthetized and laparotomized.The abdominal aortas and bilateral common iliac arteries were exposed and fully separated.The lengths and diameters of abdominal aortas and common iliac arteries of each segment were measured.The end-to-end anastomosis were performed choosing the main trunk of the abdominal aorta without a branching artery and longer segment.The unilateral common iliac artery and the sacral median artery were used for end-to-side anastomosis.The bilateral common iliac arteries were used for end-to-side and side-to-side anastomosis.The micro Doppler ultrasound probe was used to detect the blood flow patency of each anastomotic stoma. Results Anatomical separation of the abdominal aortas and the common iliac arteries was successfully performed in 12 SD rats.Each rat could provide 4 vascular anastomosis exercises.The length of abdomen aorta trunk was 15.6 ± 2.5 mm and the diameter was 1.6 ±0.2 mm between the lower left renal artery and right iliolumbar artery.The side-to-side anastomosis was performed.The mean diameter of the median sacral arteries was 0.80 ±0.08 mm.After the fish mouth-like cutting,the end-to-side anastomosis of the right common iliac arteries were conducted.The lenth of left common iliac artery was 9.0 ± 1.5 mm,the diameter was 1.0 ± 0.1 mm,and was cut off at its origin and then the end-to-side anastomosis of the right common iliac arteries were conducted.After end-to-side anastomosis of bilateral common iliac arteries,its distal segment was arranged in parallel with a length of 5.1 ± 0.3 mm,and then the side-to-side anastomosis could be conducted. Conclusions The rat abdominal aorta and iliac artery model can be comprehensively used to simulate the commonly used neurosurgery bypass graft.It is suitable for neurosurgeons with a certain microsurgical basis to conduct a preliminary vascular anastomosis training.

Endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms / 中国脑血管病杂志

Objective To investigate the safety and efficacy of endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms (VAFAs).Methods The clinical,imaging and follow-up data of 26 consecutive patients with VAFA treated with endovascular reconstruction at the Department of Neurosurgery,Beijing Hospital between October 2009 and September 2017 were analyzed retrospectively.Results (1) Twenty-six patients had 26 VAFAs.Their age ranged from 38 to 69 years old.Nine patients had ruptured aneurysms and 17 had unruptured aneurysms.The diameter of the aneurysms ranged from 5 to 12 mm.The success rate of reconstruction technology was 100％.(2)In 9 patients of the rupture group,8 were embolized by stent-assisted coils,1 was treated with stent-assisted coil embolization alone.Five patients were treated with multiple-stent reconstruction and 4 were treated with stent reconstruction alone.Of the 17 patients in the unrupture group,13 were treated with stent-assisted embolization and 4 were treated with stent implantation alone;7 were treated with multiple-stent reconstruction,and 10 were treated with stent reconstruction alone.No perioperative complications occurred.(3) The patients were followed up for 8.0-97.5 months with a median time of 39.5 months.No new cerebral infarction or cerebral hemorrhage occurred.The patients with good prognosis (the modified Rankin scale scale 0-2) was 100％.Twenty-two patients were followed up for 3.5 to 34.0 months with a median time of 10.3 months.Fourteen patients (63.6％) were cured,4 (18.2％) were stable or improved,and 4 (18.2％) had recurrence;Five of 8 patients were cured in the rupture group;9 of 14 were cured in the unrupture group.There were 2 cases of relapse in each of the two groups.Conclusions Endovascular reconstruction for ruptured and unruptured VAFAs is clinically feasible and the safety is higher.The efficacy of mid-term and long-term follow-up is better.The recurrence rate of ruptured VAFAs has an increasing trend,and close follow-up is required after procedure.

Study of correlation between carotid artery tortuosity and atherosclerotic carotid artery stenosis / 中华外科杂志

Objective@#To investigate the correlation between carotid artery tortuosity and atherosclerotic carotid artery stenosis.@*Methods@#A total of 73 patients who underwent carotid computed tomography angiography with unilateral atherosclerotic carotid artery stenosis at Department of Neurosurgery of Beijing Hospital from January 2011 to June 2016 were retrospectively reviewed. There were 51 males and 22 females ranging from 48 to 90 years old, the average age was (65.9±9.5) years. There were 38 patients with carotid stenosis in the left carotid artery and 35 in the right, the stenosis degree of carotid artery ranged from 30% to 90% with the median was 44.0% (25.5%). According to the degree of carotid artery stenosis, the patients were classified into mild stenosis group and moderate/severe stenosis group. There were 43 patients in the mild stenosis group with an average stenosis degree of (37.5±5.4)%, there were 30 patients in moderate/severe stenosis group with an average stenosis degree of (65.6±10.9)%. The carotid artery (CCA) tortuosity, extracranial internal carotid artery (EICA) tortuosity and CCA-ICA bifurcation tortuosity were quantified by measuring the CCA tortuosity index, EICA tortuosity index and the internal carotid artery (ICA) angle, respectively. Comparison of diseased and normal carotid arteries was performed using t test or Wilcoxon signed-ranked test.@*Results@#There were no statistically significant differences in CCA tortuosity index (Z=-0.584, P=0.559), ICA angle (t=0.278, P=0.781), and EICA tortuosity index (Z=-0.377, P=0.706) between diseased and normal carotid arteries in 73 patients. The diseased carotid arteries showed larger ICA angles (39.0° (19.0°) vs. 30.0° (15.0°)) (Z=-2.439, P=0.015) in the mild stenosis group, but smaller ICA angles ((31.5±11.7)° vs. (39.1±16.2)°) (t=-2.529, P=0.017) in the moderate/severe stenosis group, compared with the contralateral normal carotid arteries. There was no statistically significant difference in CCA (Z=-0.720, P=0.472; Z=-0.013, P=0.990) and EICA tortuosity index (Z=-0.349, P=0.727; Z=-0.114, P=0.909) between diseased and normal carotid arteries.@*Conclusions@#Compared with normal carotid arteries, carotid arteries with mild atherosclerotic stenosis demonstrate a more tortuous CCA-ICA bifurcation, while those with moderate/severe stenosis demonstrate a straighter CCA-ICA bifurcation. There is no correlation between CCA, EICA tortuosity and carotid artery stenosis.

Association of age, gender and carotid artery atherosclerosis with carotid artery tortuosity / 中华老年医学杂志

Objective To investigate the relationship of age,gender,carotid artery atherosclerosis with carotid artery tortuosity.Methods The data of patients with carotid computed tomography angiography (CTA)at Beijing Hospital from January 2014 to June 2016 were retrospectively reviewed.A total of 100 patients aged ≥50 years with normal carotid arteries and 100 patients with atherosclerotic carotid artery diseases were selected with age-and gender-stratified and random sampling method.Three-dimensional images of bilateral carotid arteries were reconstructed by using Mimics software.The common carotid artery(CCA)tortuosity index,extracranial internal carotid artery(EICA) tortuosity index,and the CCA-ICA bifurcation angle were measured.Association of laterality,age and gender with carotid artery tortuosity was analyzed and the differences in parameter values of carotid artery tortuosity were compared between normal carotid artery subjects and patients with atherosclerotic carotid artery.Results In normal carotid artery group,the EICA tortuosity index and ICA angle were larger in left-side than in right side(P＜0.001),and CCA tortuosity index was less in left side than in right side(all P＜0.001).The bilateral EICA and CCA tortuosity index were positively correlated with age(the left ICA:rs=0.284,P =0.004;the right ICA:rs =0.308,P =0.002;the left CCA..rs=0.371,P＜0.001;the right CCA:rs=0.243,P=0.015).The EICA and CCA were more tortuous in women than in men[the left EICA:1.180(0.200)vs.1.105(0.140),Z=-2.996,P=0.003;the right EICA:1.150(0.128)vs.1.105(0.123),Z=-2.189,P=0.029;the left CCA:1.060(0.073)vs.1.045(0.060),Z=-2.145,P=0.032;the right CCA:1.145(0.158)vs.1.080(0.083),Z=2.324,P=0.020].The ICA angle was not related with advanced age or gender(P＞0.05).Manne-Whitney tests showed no statistically significant differences in EICA tortuosity,ICA angle or CCA tortuosity between patients with versus without atherosclerotic carotid artery stenosis(P ＞0.05).Conclusions The tortuosity in both EICA and CCA increases with age,and the EICA and CCA are more tortuous in female.There is no significant correlation between carotid artery tortuosity and atherosclerotic carotid artery disease.

Application of 3.0T TOF-MRA in the Follow-up of Coiled Intracranial Aneurysm / 医学研究杂志

Objective To evaluate the application of 3.0T TOF magnetic resonance angiography (MRA) in intracranial aneurysm coiling follow-up retrospectively.Methods In our hospital,48 patients who underwent intracranial aneurysm coiling were followed up for one to two years with radiologic examination,which inclouded 3.0T TOF-MRA and Digital subtraction angiography(DSA) examination.DSA served as the golden standard.The MRA image quality and the results were compared.Results 3.0T TOF-MRA to determine aneurysm recurrence sensitivity was 85.7％,specificity was 95.7％,total accuracy rate was 93.8％,and the accuracy of the patency of the parent arterial was 93.8％.There was no significant difference between the 3.0T TOF-MRA and DSA (P ＞ 0.05).Conclusion In the patients after coiling,3.0T TOF-MRA in the judgment of the aneurysm embolization results and the patency of the parent artery had a high degree of consistency compare with DSA.We can use 3.0T TOF-MRA as a routine means in the follow-up.We should analysis individually for positive results and uncertainties.By optimizing imaging and scanning parameters might obtain better images.Perform DSA if necessary,when MRA was positive or uncertainty.

Application of magnetic resonance angiography in the follow-up of patients after embolization of intracranial aneurysms with stent-assisted coils / 中国脑血管病杂志

Objective To evaluate the application of 3.0 T magnetic resonance angiography (MRA) in follow-up after embolization of intracranial aneurysms with stent-assisted coils.Methods From June 2013 to June 2015,32 consecutive patients with subarachnoid hemorrhage due to ruptured intracranial aneurysms underwent stent-assisted coil embolization at the Department of Neurosurgery,the Sixth People′s Hospital of Shenzhen were enrolled retrospectively,including 12 males and 20 female,their mean age was 56±10 years.All patients were confirmed to be solitary intracranial aneurysms by digital subtraction angiography (DSA) before embolization.They were followed up with 3.0 T time of flight MRA (TOF-MRA) and contrast enhanced MRA (CE-MRA) at 1 to 2 years after embolization.DSA findings were served as the golden standard.The effect of aneurysm embolization (stabilization,further embolization,recanalization/recurrence) and patency of the parent arteries (without stenosis/mild stenosis,moderate to severe stenosis and occlusion) were compared.Results (1) The comparisons of evaluating the aneurysmal effects and consistencies of DSA among TOF-MRA,CE-MRA and TOF-MRA+source images after stent-assisted coil embolization were poor (Kappa=0.039,P=0.002),medium (Kappa=0.582,P<0.01),and higher (Kappa=0.615,P<0.01),respectively.(2) The comparison of the consistencies in the patency of the parent artery after stent-assisted coil embolization between TOF-MRA,CE-MRA and DSA were poor (Kappa=0.171,P=0.211;Kappa=0.376,P=0.010).(3) With the DSA findings as reference,the accuracy rates of TOF-MRA,TOF-MRA+source images and CE-MRA for interpretation of aneurysm embolization were 37.5% (12/32),75.0% (24/32),and 71.9% (23/32),respectively.TOF-MRA compared with TOF-MRA+source images and CE-MRA respectively,there were significant differences in the accuracy rates (χ2=9.04,P=0.003;χ2=7.63,P=0.006);there were no significant differences in the accuracy rates between TOF-MRA+source images and CE-MRA (χ2=0.08,P=0.777).(4) With the DSA findings as reference,the accuracy rates of TOF-MRA and CE-MRA for interpretation of the patency of the parent artery were 37.5% (12/32) and 62.5% (20/32) respectively.There was no significant difference in the accuracy rate (χ2=4.67,P=0.097).Conclusions The accuracy rate of 3.0 T CE-MRA for evaluating the embolization effect of intracranial aneurysms after stent-assisted coil embolization was superior to that of TOF-MRA.It can be used as a preferred non-invasive examination during the follow-up.TOF-MRA+source images are equivalent to CE-MRA,however,TOF-MRA and CE-MRA for the evaluation of the accuracy of patency of the parent arteries are low.For positive or indeterminate results of MRA examinations,the individualized analysis should be performed,if necessary,perform DSA examination.

Prospective control study of precise stereotactic hematoma evacuation and expectant treatment in small hypertensive cerebral hemorrhage / 中华神经医学杂志

Objective To evaluate the clinical valence and resource consumption between precise stereotactic hematoma evacuation and expectant treatment in treating small hypertensive cerebral hemorrhage. Methods A total of 68 patients with small hypertensive cerebral hemorrhage (hemorrhage volume less than 30 mL), admitted to our hospital from January 2012 to August 2015, were divided into precise stereotactic hematoma evacuation group (n=32) and expectant treatment group (n=36) by clinical research methods of prospective randomized controlled and blind assessment. Preliminary treatment effects were evaluated by CT scan, Glasgow coma scale (GCS) and modified Rankin scale (mRS); hospital day and hospitalization costs were used for evaluating the consumption of social resources. Results Evacuation rate of hematoma was 88.38%±2.15%, hospital day was (7.2 ± 2.8) days, average hospitalization fee was (22257.6 ±2512.3) yuans, GCS scores were 14.5 ±0.5, mRS scores were 2.21 ±0.46 at 6 weeks after treatment in precise stereotactic hematoma evacuation group;evacuation rate of hematoma was 26.17%±1.99%%, hospital day was (18.6+3.2) days, average hospitalization fee was (25226.3 ±2212.8) yuans, GCS scores were 12.0 ±0.75, mRS scores were 3.18 ± 0.41 at 6 weeks after treatment in precise stereotactic hematoma evacuation group; the differences between the two groups were statistically significant (P<0.05). Conclusion For small hypertensive cerebral hemorrhage, precise stereotactic hematoma evacuation is prior to expectant treatment and can shorten rehabilitation period and improve the overall prognosis.

Efficacy analysis of vertebral artery origin and adjacent subclavian artery stenosis treated with a single self-expandable stent implantation / 中国脑血管病杂志

Objective Toinvestigatethetechnicalfeasibilityandefficacyofvertebralarteryorigin and adjacent subclavian artery stenosis treated with a single self-expandable stent implantation simultaneously. Methods Twenty-onepatientswithposteriorcirculationischemicsymptomsweretreatedwithasingle stent implantation for vertebral artery origin (stenosis rate≥70%)and adjacent subclavian artery stenosis (stenosis rate ≥50%)simultaneously. The head end of a single self-expandable open-cell stent was implanted into the middle or distal V1 segment of vertebral artery,and the caudal end was implanted at the proximal subclavian artery during procedure. At 6 -12 months after procedure they received followed-up with CTA and/or DSA. The clinical and image data of the patients were analyzed retrospectively. Results Allstentswereimplantedsuccessfully.Thevertebralarterystenosisratewasdecreasedfrom 87. 1 ± 5. 7% before procedure to 7. 4 ± 6. 4% and the subclavian artery stenosis rate was decreased from 61.9±8.4% to4.5±5.7% aftertheprocedure.Therewassignificantdifference(allP<0.05).No perioperative complications occurred. The in-stent restenosis (about 50%) was found in one patient (4.8%)during the follow-up and he did not have any relevant clinical symptoms. One patient (4. 8%) had recurrent vertigo at 6 months after procedure. CTA and DSA examinations revealed stent compression and vertebralarteryocclusion.Conclusion Asingleself-expandablestentimplantationforthetreatmentof vertebral artery origin and adjacent subclavian artery stenosis simultaneously is feasible and safe. The incidences of in-stent stenosis and stent compression are low.

The damage of liver cells and the expression of GRP 78 in rats liver tissue after repeated and sustained exposure to different +Gz / 基础医学与临床

Objective To observe the damage of liver cells and to investigate the distribution and expression of glu-cose-regulated protein 78 (Glucose regulated protein78, GRP78/Bip) in liver tissue under the positive acceleration (+Gz) exposure.Methods Totally 24 wistar rats were randomly assigned to four groups:blank control,+6Gz,+9Gz and +12Gz.Each rat was clamped to the centrifuge arm , prone position, with the head of the rat facing the axis of the centrifuge for +Gz orientation.The onset rate was +0.5 Gz/s, which was used trapezoidal acceleration curve effect and controlled by computer .Blank control group rats were placed on the arm of centrifuge and under-went a process similar to that described above , but they were not exposed to acceleration .+6Gz group,+9Gz group and +12Gz group were subjected at peak time 3 min in animal centrifuge , acceleration rate 0.5 G/s, five times with interval 30 min between times.In addition, liver tissue of rats were respectively observed by H .E.staining.Mean while, plasma aspartate aminotransferase ( AST) and alanine aminotransferase ( ALT) were tested determine the damageofliverfunction.Results +GzaccelerationstressinjuryincreasedserumASTandALTlevel.Compared with the stress control, +9Gz group and +12Gz group significantly increased in plasma ALT and AST as compared with control group ( P<0.05 ) .+12 Gz stress induced the highest level in these groups .The level of ALT in+2 Gz group was higher than that in +6 Gz group ( P<0.05 ) .HE staining showed derangement of liver cells , irregular shape, the cell gap is not clear, vacuolar changes in +Gz groups, and with the increase of G value.Compared with the control group, the expression of GRP78/Bip was focused in the cytoplasm;the expression of GRP78 in the experimental group is higher than that in the control group ( P<0.05 ) .+12 Gz group was significantly higher than+6Gz group and the control group (P<0.05).The expression of GRP78/Bip in liver tissue increased with the in-creasing of G value levels;the expression level of GRP78/Bip in +12Gz and +9Gz groups were higher than that in +6Gz and control group (P<0.05).Conclusions There is positively related expression of GRP78/Bip, which was associated with exposure of increasing G values .

Application of intraoperative magnetic resonance imaging and multimodal navigation in surgical resection of glioblastoma / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of intraoperative magnetic resonance imaging (iMRI) and multimodal navigation in surgical resection of glioblastoma.</p><p><b>METHODS</b>Between February 2009 and July 2010, 76 glioblastoma patients underwent surgical resection guided by iMRI and multimodal navigation. The cohort consisted of 43 male and 33 female patients, with a mean age of 49 years (range: 14-79 years). Rates of gross total resection (GTR) and extent of resection (EoR) were calculated at first and final iMRI scans.Pearson χ(2) test was used to compare the rates of GTR.</p><p><b>RESULTS</b>iMRI and multimodal navigation were successfully implemented in all cases. Rates of GTR were misestimated by neurosurgeons in 24 cases (31.6%), which were confirmed by first iMRI. Total tumor resection were achieved in 20 cases (26.3%) as a result of iMRI scan, increasing the rates of gross total resection from 52.6% to 78.9% (χ(2) = 11.692, P = 0.001). Extent of resection in 28 patients who underwent further tumor resection were increased from 81.5% to 98.1%, leading to the overall extent of resection improved from 92.3% to 98.4%. At 3-month follow-up, 3 cases (3.9%) developed permanent neurologic deficits. The mean clinical follow-up was 15.6 months (range 3.0-45.0 months). The 2-year overall survival rate was 19.7%. The median progression-free survival of gross total resection group was 12 months (95% CI: 10.1-13.9 months), compared with 9 months (95%CI: 7.9-10.1 months) of the subtotal resection group (χ(2) = 4.756, P = 0.029). The overall survival of gross total resection group was 16 months (95% CI: 13.7-18.3 months), compared with 12 months (95% CI: 9.7-14.3 months) of the subtotal resection group (χ(2) = 7.885, P = 0.005).</p><p><b>CONCLUSION</b>Combined with multimodal navigation, iMRI helps maximize surgical resection of glioblastoma, preserving neurological function while increasing progression-free survival and overall survival.</p>

Integration of metabolism images into multimodal neuronavigation for frameless stereotaxy / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the efficacy of integration of metabolism images into multimodal neuronavigation for frameless stereotactic biopsy.</p><p><b>METHODS</b>From January to December 2012, 32 patients with brain lesions underwent frameless stereotactic biopsy guided by positron emission tomograph (PET) and proton magnetic resonance spectroscopy ((1)H-MRS)-based multimodal neuronavigation and intraoperative magnetic resonance imaging (iMRI). The cohort consisted of 16 male and 16 female patients, with a mean age of 45 years (range: 7 - 62 years). Biopsy targets were identified according to PET and (1)H-MRS. Biopsy was performed with Varioguide frameless biopsy system. Diagnostic yield and complications were assessed.</p><p><b>RESULTS</b>Metabolism images-based multimodal neuronavigation and iMRI were successfully implemented in all cases. iMRI confirmed accuracy of biopsy targets. All the specimens obtained pathological diagnosis, the diagnostic yield was 100%. In 1 patient, iMRI found small hematoma (< 5 ml), surgical evacuation wasn't needed with intraoperative complication rate 3.1%. With the help of multimodal neuronavigation, no patients had new or worsened neurologic deficits.</p><p><b>CONCLUSIONS</b>Integration of metabolism images into multimodal neuronavigation provide not only anatomical, but also metabolic and functional information for frameless stereotaxy, increasing diagnostic yield and avoiding postoperative neurologic deficits.</p>

Reliability and accuracy of arcuate fasciculus navigation: analysis of 43 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the reliability and accuracy of arcuate fasciculus (AF) navigation for AF localization and reconstruction.</p><p><b>METHODS</b>Reconstruction of the AF and assessment of the aphasia quotient (AQ) were performed in 43 cases before and after surgical removal of lesions in the language area of the brain. The minimal distance between the AF and the lesion (D(1)), preoperative AQ (AQ(1)), the minimal distance between the AF and the surgical cavity (D(2)), and the postoperative AQ (AQ(2)) were measured. Linear correlation analysis was conducted between D(1) or D(2) and the corresponding AQ(1) or AQ(2) to assess the relationship between the AF and language function. The language function of each patient was evaluated postoperatively.</p><p><b>RESULTS</b>The AF was successfully reconstructed in all the cases. The tractography results of the identical AF generated by 3 different users showed good congruency. A positive linear correlation was demonstrated between D(1) and AQ(1) (P<0.001) and between D(2) and AQ(2) (P=0.001). Only two patients (4.7%) showed language deficits at postoperative follow-up.</p><p><b>CONCLUSION</b>AF navigation is a reliable and accurate technique for AF reconstruction and localization and helps to preserve the language function after surgical removal of lesions in the language area of the brain.</p>

The Effect of Aspiration of Hematoma on the Serum Neuron-specific Enolase Concentration in Patients with Intracerebral Hemorrhage and Clinical Meaning / 医学研究杂志

Objective To explore the effect of aspiration of hematoma on the serum neuron-specific enolase(NSE)concentration in patients with hypertensive intracerebral hemorrhage and its clinical meaning.Methods 45 cases of intracerebral hemorrhage with hematoma volumes of 30ml to 50ml were selected and divided into operative group(23 cases)and conservative group(22cases).The control group(18 cases)were healthy.Serum NSE was detected with ELISA method.Results ①The concentration of NSE in conservative group was obviously higher than that in control group within 21 days(P0.05).③The concentration of NSE in operative group was no significant difference than that in conservative group with in 7 days,but decreaced rapidly and was obviously lower than that in conservative group respectively in 14 days and 21 days(P