Correlation between paroxysmal slow-wave events and cognitive impairment in patients with cerebral small vessel disease / 国际脑血管病杂志

Objective:To investigate the correlation between paroxysmal slow-wave events (PSWEs) and cerebral small vessel disease (CSVD) and CSVD-related cognitive impairment.Methods:Patients with CSVD visited Weihai Municipal Hospital from March 2021 to April 2022 were included, and sex- and age-matched healthy controls were recruited for cross-sectional analysis. The patients with CSVD were further divided into cognitive impairment group and non-cognitive impairment group. The self-developed Python script was used to detect the PSWE parameters in electroencephalogram records. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to evaluate cognitive function. Multivariate logistic regression analysis was used to determine whether PWSE parameters were the independent related factors of CSVD and CSVD-related cognitive impairment. Multiple linear regression analysis was used to determine the correlation between the PSWE parameters and overall cognitive function (MoCA total score) in patients with CSVD. Results:A total of 76 patients with CSVD (including 41 patients with cognitive impairment and 35 patients without cognitive impairment) and 45 healthy controls were included. Compared with the healthy control group, PWSEs in the F3 (left frontal area) and O1 (left occipital area) regions of the CSVD group occurred more frequently and lasted longer (all P<0.05). Multivariate logistic regression analysis showed that the frequency (odds ratio [ OR] 1.080, 95% confidence interval [ CI] 1.023-1.140; P=0.005) and duration ( OR 1.006, 95% CI 1.001-1.011; P=0.023) of PWSEs in the left frontal area, as well as the frequency ( OR 1.052, 95% CI 1.010-1.095; P=0.014) and duration ( OR 1.003, 95% CI 1.000-1.006; P=0.028) of PWSEs in the left occipital region were the independent related factors for CSVD. The frequency ( OR 1.106, 95% CI 1.033-1.183; P=0.004) and duration ( OR1.010, 95% CI 1.003-1.017; P=0.004) of PWSEs in the left frontal area were the independent risk factors for cognitive impairment in patients with CSVD. Multiple linear regression analysis showed that the frequency ( β= –0.242, P=0.045) and duration ( β= –0.235, P=0.046) of PWSEs in the left frontal region were negatively correlated with the overall cognitive function score in patients with CSVD. Conclusions:The frequency and duration of PSWEs in some brain regions of patients with CSVD increase, and there is an independent correlation between PSWEs and cognitive impairment, suggesting that the damage of blood-brain barrier may participate in the pathogenesis of cognitive impairment in patients with CSVD.

Correlation between heart rate variability and early neurological deterioration and poor outcomes in patients with branch atheromatous disease / 国际脑血管病杂志

Objective:To investigate the correlation between heart rate variability (HRV) and early neurological deterioration (END) and poor outcomes in patients with branch atheromatous disease (BAD).Methods:Patients with BAD admitted to the Department of Neurology, Weihai Municipal Hospital from September 2020 to September 2022 were enrolled prospectively. END was defined as an increase of ≥2 points in the total score of the National Institutes of Health Stroke scale (NIHSS) or an increase of ≥1 in motor item score within 72 h of admission compared with the baseline. Poor outcome was defined as the score of the modified Rankin Scale >2 at 6 months after the onset. Multivariate logistic regression analysis was used to determine whether HRV parameters were the independent influencing factors of END and poor outcomes in patients with BAD. Results:A total of 117 patients with BAD were enrolled, including 76 males (65.0%), aged 64.27±6.95 years. Thirty-eight patients (32.4%) had END, and 21 (17.9%) had poor outcomes. Percentage of the number of pairs of adjacent R-R intervals differentiating by more than 50 ms (pNN50), number of adjacent R-R intervals differentiating by more than 50 ms (NN50), power in low frequency range (LF) and power in high frequency range (HF) in the END group were significantly lower than those in the non-END group, and the LF/HF ratio was significantly higher than the non-END group (all P<0.05). The standard deviation of the R-R interval (SDNN), standard deviation of the average of R-R intervals in all 5-min segments (SDANN), and HF in the poor outcome group were significantly lower than those in the good outcome group. Multivariate logistic regression analysis showed that HF (odds ratio [ OR] 0.994, 95% confidence interval [ CI] 0.991-0.998; P<0.001) was an independent protective factor of END in patients with BAD, and LF/HF ratio ( OR 1.455, 95% CI 1.056-2.005; P=0.022) was an independent risk factor for END in patients with BAD; SDANN ( OR 0.997, 95% CI 0.993-0.999; P=0.023) was an independent protective factor of good outcomes in patients with BAD. Conclusion:HF and LF/HF ratios are the independent influencing factors of END in patients with BAD, and SDANN is an independent influencing factor of the poor outcomes in patients with BAD, suggesting that autonomic dysfunction is involved in the pathophysiological mechanism of END and poor outcomes in patients with BAD.

Effect of 17β-estradiol on Ca2+ channels during osteogenic differentiation of rat bone marrow mesenchymal stem cells / 吉林大学学报(医学版)

Objective: To observe the effect of 17β-estradiol (17β-E2) on the calcium (Ca2) channels during the osteogenic differentiation of rat bone marrow mesenchymal stem cells (MSCs), and to elucidate the mechanism of 17β-E2 in the osteogenic differentiation of MSCs. Methods: The MSCs were separated by density gradient centrifugation and adherent screening, and passaged for 3 times continuously to induce osteoblast differentiation. The MSCs were divided into control group [cultivated in osteoblast culture medium alone (OBM)] and different doses of 17β-E2 groups (added with 0. 1, 1.0, 10. 0, and 100. 0 pmol · L-1 17β-E2 in OBM, respectively). On the 14th day of osteogenic induction, the cells in each group were stained with Fluo-3/AM, and the Ca2 levels were determinated by laser scanning confocal microscope; the mean fluorescence intensity (MFD was used to respresent the level of Ca2. Whole-cell Ca2 currents were recorded using whole-cell patch clamp technique under different conditions. Results: The MSCs with fibroblast-like cells, oval nuclei and visible nucleoli were successfully isolated by density gradient centrifugation and adherent screening. The subcultured MSCs grew vigorously and maintained the morphological characteristics of primary cells. Following the increase of 17β-E2 concentration, the Fluo-3 fluorescence staining intensity of Ca2 in each group was also gradually increased, especially in 100. 0 pmol · L-1 17β-E2 group. Compared with control group, the MFI of Ca' and the current peak values of Ca' in 10. 0 and 100. 0 pmol · L-1 17β-E2 groups were increased (P0. 05). Conclusion: The cells isolated by density gradient and adherent screening method are the rat MScs. 17β-E2 plays a role in promoting osteogenesis by enhancing the opening of Ca' channels in the MSCs and the inward current of calcium ions in a dose-dependent manner.

The application of hybrid operation suite in the management of cerebral and spinal vascular diseases and intracranial hypervascular tumors / 中华外科杂志

Objective@#To evaluate the effect of hybrid operation suite in the treatment of cerebral and spinal vascular diseases and intracranial hypervascular tumors.@*Methods@#A retrospective study was conducted on 132 patients with various cerebral and spinal vascular diseases and intracranial hypervascular tumors who were treated by hybrid surgery at Department of Neurosurgery, Huashan Hospital from October 2016 to December 2017.There were 70 male and 62 female patients with a mean age of 48.33 years (range: 14-78 years), including 64 cases of intracranial aneurysm (41 complicated aneurysm cases), 28 cases of brain arteriovenous malformation (BAVM), 12 cases of hypervascular tumor, 12 cases of dural arteriovenous fistula (DAVF), 6 cases of carotid artery stenosis, 5 cases of Moyamoya disease, 3 cases of intracranial aneurysm or BAVM combined with tumor, 1 case of scalp arteriovenous fistula and 1 case of critical brain trauma in which a foreign metal stick approached the basal vascular circuit.Abnormalities were found in 16 cases in intraoperative angiography. The clinical data of all patients was collected as a perspective cohort. The success rate of hybrid surgery, intra-operative and post-operative complications, morbidity, mortality, rate of infection, the length of hospital stay were all analyzed to illustrate the effect of hybrid operation mode to traditional surgical pattern.@*Results@#For 64 cases with intracranial aneurysms, the immediate complete occlusion rate was 90.5%, with a mortality of 4.7% and a morbidity of 14.0%. For 28 cases of BAVM and 12 cases of DAVF, all patients achieved total obliteration and favorable social independent outcomes after hybrid surgery, with no complication.For 6 cases of carotid artery stenosis and 5 cases of Moyamoya, intra-operative confirmed good cerebral reperfusion without any new post-operative neurologic deficits. After tumor vessels embolization, 4 out of 12 cases of hypervascular tumor needed intra-operative blood transfusion, and all patients achieved total tumor resection in a single stage. Only one patient with medulla oblongata hemangioblastoma died 6 months after operation due to respiratory deficit related pneumonia. Compared to traditional surgeries, the hybrid operation pattern did not significantly increase the total infection rate, central nervous system infection rate, hospital stay days and post-operative hospital stay days (all P>0.05) while the in-patient cost increased mildly (119 332 yuan vs.98 215 yuan, t=2.38, P=0.02).@*Conclusions@#The operations of complex cerebral and spinal vascular diseases and intracranial hypervascular tumors can be performed in hybrid operation suite safely.This surgical mode can ensure the quality of operation and promote the development of innovative and complicated surgical procedures.

Effect of integrated traditional Chinese and western medicine on clinical efficacy and quality ;of life of the patients with early diabetic nephropathy / 国际中医中药杂志

Objective To evaluate the effect of the self-made Zishen decoction combined with conventional western medicine therapy and health education on the patients with early diabetic nephropathy. Methods The 112 patients with DN were randomly assigned to 2 groups (each group 56 patients) at a ratio of 1:1. The control group was treated with control of glucose, blood pressure, lipid, and diet therapy, and the treatment group was with self-made prescription of invigorating the kidney and health education based on the control group treatment. All patients were treated for 6 months. The SF-36 scale was used to assess the quality of life, and the clinical effect was determined based on the blood biochemical indexes. Results Total clinical effect of the treatment group was 85.7%(48/56), and the control group was 67.9%(38/56) (χ2=4.057, P=0.044). Compared with the control group after treatment for 6 months, the physical condition (72.17 ± 13.41 vs. 64.59 ± 11.83, t=3.172), social function (64.58 ± 14.54 vs. 58.94 ± 14.62, t=2.047), physical role function (55.82 ± 10.11 vs. 47.46 ± 10.18, t=4.360), emotional role function (60.43 ± 10.20 vs. 56.04 ± 11.44, t=2.143), energy (69.86 ± 11.43 vs. 62.47 ± 11.12, t=3.468), general health status (68.57 ± 11.25 vs. 62.45 ± 11.78, t=2.812) of the treatment group were significantly improved (P<0.01 or P<0.05). Conclusion The self-made Zishen decoction and health education combined with conventional western medicine can improve the clinical effect and quality of life of patients with DN.

Zishendecoction combined with standard treatment of western medicine for stage IV diabetic nephropathy with Qi and Yin deficiency / 国际中医中药杂志

ObjectiveTo evaluate the therapeutic effect ofZishen decoction combined with standard treatment of western medicine for for stage IV diabetic nephropathy with Qi and Yin deficiency.MethodsA total of 112 patients with stage IV diabetic nephropathy and Qi and Yin deficiency were randomized to thestandard treatment and the combined treatment groups, 56 in each. The standard treatment group received conventional treatment, including blood glucose controlling, antihypertensive, blood lipid regulating and diet controlling. The combined treatment group receivedZishen decoction on the basis of conventional treatment. All the patients were treated for 3 months. The blood urea nitrogen (BUN), serum creatinine (SCr), total cholesterol (TG), triacylglycerol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and glycated hemoglobin (HbA1c) were measured by an automatic chemistry analyzer. The urinary albumin excretion rate (UAER) was measured by the enzyme-linked immunosorbent assay.ResultsCompared with the standard treatment group, the SCr (53.51 ± 18.12μmol/Lvs. 62.66 ± 21.14μmol/L;t=2.459,P<0.05), UAER(100.73±84.24μg/minvs. 156.24 ± 96.38μg/min;t=3.245,P<0.05), TG(1.73±0.22 mmol/Lvs. 2.06 ± 0.21 mmol/L;t=8.112,P<0.01), TC(4.56 ± 0.62 mmol/Lvs. 5.10 ±0.31 mmol/L;t=5.830, P<0.01), LDL-C (2.42 ± 1.05 mmol/Lvs. 3.31 ± 0.81 mmol/L;t=5.022,P<0.01) in the combined treatment group decreased significantly, and the HDL-C (1.67 ± 0.33 mmol/Lvs. 1.36 ± 0.41 mmol/L;t=4.460,P<0.01) increased significantly. ConclusionZishen decoction on the basis of conventional treatment can improve the SCr and UAER, and regulate the blood lipid in the patients with stage IV diabetic nephropathy and Qi-Yin deficiency.

Factors influencing Intracranial aneurysm rupture / 国际脑血管病杂志

Increasing detection of unruptured intracranial aneurysms,catastrophic outcomes from subarachnoid hemorrhage,and risks and cost of treatment necessitate defining objective predictive parameters of aneurysm rupture risk.However,long-term follow-up have shown the risk of intracranial aneurysm rupture is associated with its morphologic characteristics,hemodynamic factors and patient's own situation.

Association of leptin receptor gene polymorphisms with hypertension in Chinese population: a meta-analysis / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the association between leptin receptor gene polymorphisms and hypertension in Chinese population.</p><p><b>METHODS</b>The keywords "Hypertension", "Blood Pressure, high", "Leptin Receptor", "OB Receptor", "LEPR Protein", "CD295 Antigens", and "LEPR" were used to search the literature to identify the relevant studies for meta-analysis using software RevMan 5.0 and Stata 11.0 software.</p><p><b>RESULTS</b>Thirteen studies involving 3210 cases of hypertension and 1881 controls were included in the meta-analysis. Overall, a significant association was found between Gln223Arg gene polymorphism and hypertension in allele contrast and dominant genetic model (for allele contrast genetic model: OR=1.17, 95%CI=1.48-2.15, P<0.0001; for dominant model: OR=2.18, 95%CI=1.75-2.72, P<0.00001). No statistically significant correlation was found between Lys109Arg polymorphism and hypertension (for allele model: OR=1.13, 95%CI=0.84-1.51, P=0.42; for recessive genetic model: OR=0.88, 95%CI=0.33-2.32, P=0.79; for dominant genetic model: OR=1.20, 95%CI=0.85-1.71, P=0.29; for additive genetic model: OR=0.90, 95%CI=0.34-2.42, P=0.84).</p><p><b>CONCLUSION</b>There is no significant correlation between Lys109Arg variant of LEPR gene and hypertension in Chinese population, but the Gln223Arg polymorphism is associated with hypertension in allele contrast and dominant genetic model. Chinese population with an A allele are at a high risk of developing hypertension.</p>

Incidence and risk factors of prehypertension among adults in mainland China: a meta-analysis / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the incidence and risk factors of prehypertension among adults in mainland China and identify the high-risk population.</p><p><b>METHODS</b>Six databases including Chinese Biological Medical Literature Database (CBM), Chinese Science and Technology Periodical Database (VIP), China National Knowledge Infrastructure (CNKI), Wanfang Database (WF), PubMed and Web of Knowledge were searched for publications documenting the incidence and risk factors of prehypertension among general population in Chinese adults. Eligible studies were selected according to the inclusion and exclusion criteria for meta-analysis using Stata software and RevMan software.</p><p><b>RESULTS</b>Twenty-one published studies were finally included. The results showed that the incidence of prehypertension was 37% in Chinese adults. The pooled SMD (95% confidence interval [CI]) was 0.37 (0.29-0.46) for body mass index, 0.20 (0.12-0.27) for fasting blood glucose (FPG), 0.17 (0.15-0.19) for total cholesterol (TC), 0.22 (0.17-0.27) for triglyceride (TG), 0.13 (0.10-0.15) for low-density lipoprotein cholesterol (LDL-C), and -0.07 (-0.16-0.02) for high-density lipoprotein cholesterol (HDL-C). For smoking, drinking and family history of hypertension, the pooled OR (95% CI) were 1.44 (1.40-1.47), 1.60 (1.44-1.79), and 1.19 (1.04-1.35), respectively.</p><p><b>CONCLUSION</b>The incidence of prehypertension among adults in mainland China is relatively high, especially in males. BMI, FBG, TC, TG, LDL-C, smoking, drinking and family history of hypertension are positively related to prehypertension, and early intervention is recommended to reverse these modifiable risk factors.</p>

Factors influencing intracranial aneurysm recurrence after endovascular coil embolization / 国际脑血管病杂志

Endovascular coil embolization has become an important way because of its advantages of less trauma and quick recovery.However,long-term follow-up studies have shown that the recurrence rate of aneurysm after coil embolization is much higher than that of the surgical clipping.It is mainly associteed with the factors such as incomplete packing coil compression and aneurysm regrowth.This article reviews the factors influencing intracranial aneurysm recurrence after endovascular coil embolization.

Comparison of outcome and cost of endovascular coiling versus surgical clipping in the treatment of ruptured anterior or posterior communicating artery aneurysm aneurysms / 国际脑血管病杂志

Objective To compare the efficacy and cost of surgical clipping and endovascular embolization in the treatment of anterior and posterior communicating artery aneurysm and to conduct cost-effectiveness analysis. Methods The data of treatment outcomes and costs in patients with anterior or posterior communicating artery aneurysms admitted to Huashan hospital from 2002 to 2006 were analyzed using a retrospective cohort study. Results A total of 302 patients were included in the study. They were divided into surgical clipping group (n = 150; 65 males, age [48. 11 ±9. 94] years), interventional treatment group (n = 152;75 males, age [52. 56 ± 11. 09] year). The age of the former was lower than that of the latter (t = -3. 670, P =0. 000). There was no significant difference in preoperative clinical conditions (such as location of aneurysms and Hunt-Hess grade) between the two groups. The good outcome rate in the interventional treatment group was significantly higher than that in the surgical clipping group (84. 87% vs. 74. 67%, χ2 = 4. 875, P = 0. 027). There was no significant difference in hospital mortality (5. 33% vs. 3. 94%,χ2 =0. 328, P =0. 567) and complication rate (26.67% vs. 19. 74% , χ2 =2.036, P =0.154) between the surgical clipping group and the interventional treatment group, but the intraoperative aneurysm rupture (10. 67% vs. 3. 95%, χ2 =5.047, P =0.028) and the incidence of postoperative intracranial infection (6/144 vs. 0/152, χ2 = 6.203, P =0.014) in the surgical clipping group were higher than those in the interventional treatment group. The length of hospital stay in the interventional treatment group was significantly shorter than that in the surgical clipping group ([10. 0 ± 7. 0] dvs. [23.0 ± 11. 0] d, Z = -10. 35, P ＜0.001). The median cost of treatment was 95 327.63 %,yuan in the interventional treatment group, and the interquartile range (IQR) was 26 312. 98 yuan; it was significantly higher than the surgical clipping group (median 30 072. 01 yuan, IQR 11 178. 54 yuan) (Z = -14.449, P＜0.001). Compared with the surgical clipping group, while the mRS score improved in the interventional treatment group 0. 10, the cost was about 66 438 yuan, so that the surgical clipping was more cost-effective. Conclusions The efficacy of the intervention treatment of anterior and posterior communicating artery aneurysms is better than that of the surgical clipping The mortality and total complication rate are almost the same with the surgical clipping Thehospital stay is shorter, but the cost of treatment is higher. From an economic point of view, the surgical clipping is more cost-effective.

Comparison between Willis covered stent placement and coil embolization in the treatment of cranial internal carotid artery aneurysm: a nonrandomized prospective trial / 中华放射学杂志

Objective To evaluate the clinical results of Willis covered stent implantation and coil embolization in the treatment of cranial internal carotid artery (CICA) aneurysm. Methods Eighty-nine patients with CICA aneurysms were selected for treatment with Willis covered stents (n = 43, group A) or coil embolization (n =46, group B) according to the patients'will. Data on the technical success, initial procedure time and in-hospital interval, initial and final angiographic results, mortality, morbidity, and final clinical outcomes were collected and analyzed for the two groups at 6 months post-procedure. Results Endovascular covered stent placement and coil embolization were technically successful in all patients,except for one patient in group A. The initial angiographic results showed complete occlusion in 34 patients of group A (81%, 95% CI: 69%, 93% ) and 24 patients of group B (52%, 95% CI: 37%, 67% ) ( P ＜0. 05). The final angiographic results indicated complete occlusion in 39 patients of group A (39/41,95%,95% CI: 88%, 102% ) and 22 patients of group B (22/45,49%, 95% CI: 34%, 64% ,P ＜0. 01 ). The average procedure time was(103 ± 13)min in group A and (143 + 39) min in group B (P＜0. 01). No significant differences were seen between the two groups in technique success, mortality, morbidity, or final clinical outcomes. Conclusion In this nonrandomized, prospective trial, CICA aneurysm treatment with covered stents yielded midterm angiographic results that were superior to those of coil embolization.

Progress of research in the improvement of the antithrombogenic property of biomedical polyurethane / 生物医学工程学杂志

The progress of research of the physical and chemical modification methods to improve the antithrombogenic property of biomedical polyurethane (PU) in the past five years is reviewed in this paper. The physical modification method includes physical blending, physical vapor deposition (PVD) and replication molding technique. Meanwhile, chemical modification method is focused on the covalent bonding to immobilized special molecular. Moreover, the covalent bonding method covered functionalizing the PU surface with tailor-made groups in the bulk and the activation of the surface to form unstable active sites for further reactions.

Treatment of recurrent intracranial aneurysms / 中华神经医学杂志

Objective To explore recurrent mechanism and combined treatment for the patients with recurrent intracranial aneurysms. Methods Clinical manifestations and image data of 18 patients with intracranial aneurysms (13 anterior and 5 posterior communicating artery aneurysms)who were treated with aneurysm clipping or endovascular interventional therapy from 1997 to 2004 were comprehensively analyZed to establish individual combined treatment strategies.In the 18 recurrent cases,15 underwent again endovascular embolotherapy,4 were implanted intracranial stent due to wide-necked aneurysm, and 3 received clipping operation. Results Intravascular embolotherapy and clipping operation were both successful in these patients. All cases achieved satisfactory recovery except that 1 case died and 2 suffered from hemiplegia. Conclusions The combined treatment strategies based on individual characteristics of current aneurysms,such as surgical clipping,endovascular therapy combined with stenting,can improve post-operative quality,of patients'life and decrease mortality.

Clinical experience of 70 cases of cerebral arteriovenous malformations embolization with Onyx, a novel liquid embolic agent / 中华外科杂志

<p><b>OBJECTIVE</b>To report our clinical experience of using Onyx, a new liquid embolic agent, to treat cerebral arteriovenous malformations (AVMs) as well as its efficacy.</p><p><b>METHODS</b>Seventy cases were placed with 6F sheath in the femoral artery after Seldinger puncture and 6F guiding catheter was introduced into the internal carotid artery or vertebral artery, then a microcatheter was navigated into the nidus of AVMs. Slow injection of Onyx under fluoroscopic control was performed to embolize cerebral AVMs using the "plug and push" technique.</p><p><b>RESULTS</b>Thirteen AVM cases (18.6%) were totally occluded by Onyx and 5 cases of which didn't recurrence at 6-month after operation. Thirty-eight cases (54.3%) were subtotally occluded, while another 19 cases (27.1%) were partially embolized. Severe cerebral hemorrhage occurred in 4 cases, 2 of which had mild to severe hemiplegia after operation, and one died. Mild hemiplegia was also found in 1 case due to functional area embolization, and visual field deficit in 2 cases.</p><p><b>CONCLUSIONS</b>Onyx has unique and distinctive superiority in treating cerebral AVMs. Nonetheless, the correct embolization technique should be learned to achieve good clinical results and avoid complications.</p>

Risk factors for intracranial aneurysm in a Chinese ethnic population / 中华医学杂志(英文版)

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

Diagnosis and treatment of tentorial dural arteriovenous fistulae / 中华外科杂志

<p><b>OBJECTIVE</b>Tentorial dural arteriovenous fistulae are uncommon but life-threatened lesions. We present our experience of 5 cases with tentorial dural arteriovenous fistulae, review the relevant literature and present the rationale of our current management strategy.</p><p><b>METHODS</b>The data of five patients with tentorial DAVF treated in Huashan Hospital between June 2002 and May 2003 were reviewed retrospectively, including their ill history, neuroimagings, operation records and follow-up data.</p><p><b>RESULTS</b>There were 3 females and 2 males with age from 25 to 52 years (average, 42.6 years). Clinical manifestations were acute subarachnoid hemorrhage in 2 cases, progressing neurological deficits in 3 cases. MRI and DSA were major diagnostic and follow-up modalities. Borden classification type II was in 1 case, type III in 4 cases. According to DAVF location, tentorial marginal type were in 3 cases, tentorial lateral type 1 case, tentorial medial type 1 case. Two patients had transarterial embolization preoperatively. All patients underwent craniotomy with the coagulation of the nidus and tentorium, disconnection of leptomeningeal venous drainage. The surgical approaches were via trans-anterior-petrous approach in 3 cases, transpterional subdural approach 1 case, transoccipital and transtentorial approach 1 case. All patients had clinical improvement, there was no surgical mortality and morbidity. Postoperative DSA confirmed obliteration of DAVF in 3 cases, MRI demonstrated the thrombosis of venous aneurysm and the disappearance of previous brainstem edema, partial thrombosis of venous aneurysm in 1 case. Follow-up study ranging from 1 to 2 year showed no recurrence and all patients resume their full activities.</p><p><b>CONCLUSIONS</b>Tentorial DAVF is an aggressive vascular lesion, causing subarachnoid hemorrhage and progressive neurological deficits. Prompt diagnosis and definite treatment for tentorial DAVF are mandatory. Obliteration of the nidus and/or leptomeningeal venous drainage should be the goal of treatment. Microsurgical procedures with/without endovascular intervention are the best choice of treatment.</p>

Cerebral revascularization in treatment of intractable aneurysms / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the effectiveness of cerebral revascularization in the treatment of intractable aneurysms and to discuss the indications, surgical techniques, and the outcome of the revascularization.</p><p><b>METHODS</b>During the recent 4-year period, 9 radical artery grafts were performed in patients with intractable or giant internal carotid artery (ICA) aneurysms. The indications for cerebral revascularization included parent vessel occlusion during the treatment of the intractable aneurysms with poor collateral circulation or the young patients. Modified techniques were taken to use the main trunk of superficial temporal artery (STA) as donor, while M3 branches near the bifurcation of the M2 segment of the middle cerebral artery (MCA) were chosen as the recipient arteries. STA-Radial artery (RA)-MCA bypass was followed by parent vessel occlusion via chronic cervical ICA ligation or balloon occlusion.</p><p><b>RESULTS</b>Postoperative angiography demonstrated the patency of the grafts in eight cases. The procedure of the parent vessels occlusion was uneventful in these patients. Follow-up showed the patients were in excellent conditions after successful treatment of aneurysms. Significantly delayed filling of the graft was revealed in one patient, who could not tolerate balloon occlusion test and occlusion of parent artery failed.</p><p><b>CONCLUSIONS</b>Extracranial-to-intracranial bypass followed by parent vessel occlusion is a safe and effective method to treat intractable ICA aneurysms. Radical artery as graft can offer high-flow revascularization with less complications. Combined surgical and endovascular treatment might be the future direction for the treatment of the difficult aneurysms.</p>

Effect of Treatment of Tibia and Fibula Fracture with internal Fixation of Fibula / 中华创伤骨科杂志

Objective To study the effect of internal fixation of fibula on treatment of tibia and fibula unstable fractures. Methods 50 cases with middle and lower 1/3 fractures of tibia and fibula were treated with internal fixation of fibula and close reduction and external stabilization of tibia. Fibula was stabilized with plate and screw or intramedullary nail. Results All the 50 cases of the fracture achieved clinic union, reduction was satisfactory, and the average time of clinical union was 5 months. The functions of the joint were normal. No skin necrosis or infection occurred. Conclusion Fixation of fibula is suitable for treatment of close fracture combined with local skin injury or open fractures of tibia and fibula and lower 1/3 comminuted fracture of tibia combined with fibula fracture.

Embolization of intracranial aneurysms with new mechanically detachable coils / 中国医学科学院学报

<p><b>OBJECTIVE</b>To primarily embolize intracranial aneurysms with new-developed mechanically detachable coils, which is called Detachable Coil System (DCS).</p><p><b>METHODS</b>Five intracranial aneurysms were embolized with DCS, in which 2 were giant aneurysms. DCS with J coils were initially used to make baskets in giant aneurysms, and then other kinds of coils were utilized to pact the aneurysmal cavity. Whereas, spiral coils were mostly used in smaller aneurysms. Coils of DCS were detached by rotating the delivering wire after the coils were satisfactorily positioned in aneurysms.</p><p><b>RESULTS</b>Two of the 5 cases were totally occluded with DCS. Two was sub-totally embolized. Pushing, withdrawal, and adjusting of DCS were safe and efficient. Detachment of DCS was fast. In one case of wide-necked giant aneurysm, coils could not stay inside the aneurysm, which was treated by occlusion of the parent artery.</p><p><b>CONCLUSIONS</b>DCS is a new addition to the interventional radiologist's armamentarium. Detachment is faster. J coils are suitable for giant aneurysms for its unique way of coiling. But more evaluation depends on accumulation of the clinical usage.</p>