Unraveling the role of HIF-1α in sepsis: from pathophysiology to potential therapeutics-a narrative review.

Sepsis is characterized by organ dysfunction resulting from a dysregulated inflammatory response triggered by infection, involving multifactorial and intricate molecular mechanisms. Hypoxia-inducible factor-1α (HIF-1α), a notable transcription factor, assumes a pivotal role in the onset and progression of sepsis. This review aims to furnish a comprehensive overview of HIF-1α's mechanism of action in sepsis, scrutinizing its involvement in inflammatory regulation, hypoxia adaptation, immune response, and organ dysfunction. The review encompasses an analysis of the structural features, regulatory activation, and downstream signaling pathways of HIF-1α, alongside its mechanism of action in the pathophysiological processes of sepsis. Furthermore, it will delve into the roles of HIF-1α in modulating the inflammatory response, including its association with inflammatory mediators, immune cell activation, and vasodilation. Additionally, attention will be directed toward the regulatory function of HIF-1α in hypoxic environments and its linkage with intracellular signaling, oxidative stress, and mitochondrial damage. Finally, the potential therapeutic value of HIF-1α as a targeted therapy and its significance in the clinical management of sepsis will be discussed, aiming to serve as a significant reference for an in-depth understanding of sepsis pathogenesis and potential therapeutic targets, as well as to establish a theoretical foundation for clinical applications.

Engineering thiol-ene click chemistry for the preparation of a chiral stationary phase based on a [4+6]-type homochiral porous organic cage for enantiomeric separation in normal-phase and reversed-phase high performance liquid chromatography.

In this study, a new chiral stationary phase (CSP) was fabricated by covalent bonding of a [4+6]-type homochiral porous organic cage (POC) CC19-R onto thiolated silica via a thiol-ene click reaction. The CC19-R was synthesized via Schiff-base reaction between 2-hydroxybenzene-1,3,5-tricarbaldehyde and (1R, 2R)-(-)-1,2-diaminocyclohexane. The enantioseparation capability of the resulting CC19-R-based CSP was systematically evaluated upon separating various chiral compounds or chiral pharmaceuticals in normal phase HPLC (NP-HPLC) and reversed phase HPLC (RP-HPLC), including alcohols, organic acids, ketones, diols, esters, and amines. Fifteen racemates were enantioseparated in NP-HPLC and 11 racemates in RP-HPLC. Some racemates have been well separated, such as 4-chlorobenzhydrol, cetirizine (in the form of dihydrochloride), 1,2-diphenyl-1,2-ethanediol, and 3-(benzyloxy)propane-1,2-diol whose resolution values reached 3.66, 4.23, 6.50, and 3.50, respectively. When compared with a previously reported chiral POC-based column (NC1-R column), eight racemates were not separated on the NC1-R column in NP-HPLC and five racemates were not separated in RP-HPLC, but were well resolved on this column, revealing that the enantioselectivity and separable range of chiral POCs-type columns could be significantly widened using this fabricated CC19-R column. Moreover, the resolution performance of the CC19-R column was also compared with commercial Chiralpak AD-H [CSP: Amylose tris(3,5-dimethylphenylcarbamate)] and Chiralcel OD-H [CSP: Cellulose tris(3,5-dimethylphenylcarbamate)] columns. The column also can separate some racemates that could not be separated or not well be separated by the two commercial columns, showing its good complementarity to the two commercial columns on chiral separation. In addition, the column also had good stability and reproducibility with the relative standard deviation (n = 5) of the retention time and resolution lower than 1.0% and 1.8%, respectively, after it had undergone multiple injections (100, 200, 300, and 400 times). This work indicated that the features of good resolution ability and simple synthesis methods using with this POC-based CSP provided chiral POCs with potential application prospects in HPLC racemic separation.

A novel pillar[3]trianglimine macrocycle with a deep cavity used as a chiral selector to prepare a chiral stationary phase by thiol-ene click reaction for enantioseparation in high-performance liquid chromatography.

A chiral pillar[3]trianglimine (C60 H72 N6 O6 ) with a deep cavity has been developed as a chiral selector and bonded to thiolated silica by thiol-ene click reaction to fabricate a novel chiral stationary phase for enantioseparation in high-performance liquid chromatography. The enantioseparation performance of the fabricated chiral stationary phase has been evaluated by separating various racemic compounds, including alcohols, esters, amines, ketones, amino acids, and epoxides, in both normal-phase and reversed-phase elution modes. In total, 14 and 17 racemates have been effectively separated in these two separation modes, respectively. In comparison with two widely used chiral columns (Chiralcel OD-H and Chiralpak AD-H), our novel chiral stationary phase offered good chiral separation complementarity, separating some of the tested racemates that could not be separated or were only partially separated on these two commercial columns. The influences of analyte mass, mobile phase composition, and column temperature on chiral separation have been investigated. Good repeatability, stability, and column-to-column reproducibility of the chiral stationary phase for enantioseparation have been observed. After the fabricated column had been eluted up to 400 times, the relative standard deviations (n = 5) of resolution (Rs) and retention time of the separated analytes were < 0.39% and < 0.20%, respectively. The relative standard deviations (n = 3) of Rs and retention time for column-to-column reproducibility were < 4.6% and < 5.2%, respectively. This study demonstrated that the new chiral stationary phase has great prospects for chiral separation in high-performance liquid chromatography.

Preparation of Chiral Porous Organic Cage Clicked Chiral Stationary Phase for HPLC Enantioseparation.

Porous organic cages (POCs) are a new subclass of porous materials, which are constructed from discrete cage molecules with permanent cavities via weak intermolecular forces. In this study, a novel chiral stationary phase (CSP) has been prepared by chemically binding a [4 + 6]-type chiral POC (C120H96N12O4) with thiol-functionalized silica gel using a thiol-ene click reaction and applied to HPLC separations. The column packed with this CSP presented good separation capability for chiral compounds and positional isomers. Thirteen racemates have been enantioseparated on this column, including alcohols, diols, ketones, amines, epoxides, and organic acids. Upon comparison with a previously reported chiral POC NC1-R-based column, commercial Chiralpak AD-H, and Chiralcel OD-H columns, this column is complementary to these three columns in terms of its enantiomeric separation; and can also separate some racemic compounds that cannot be separated by the three columns. In addition, eight positional isomers (iodoaniline, bromoaniline, chloroaniline, dibromobenzene, dichlorobenzene, toluidine, nitrobromobenzene, and nitroaniline) have also been separated. The influences of the injection weight and column temperature on separation have been explored. After the column has undergone multiple injections, the relative standard deviations (RSDs) for the retention time and selectivity were below 1.0 and 1.5%, respectively, indicating the good reproducibility and stability of the column for separation. This work demonstrates that POCs are promising materials for HPLC separation.

"Click" preparation of a chiral macrocycle-based stationary phase for both normal-phase and reversed-phase high performance liquid chromatography enantioseparation.

Chiral polyimine macrocycles (CPMs) constitute a new family of organic macrocycles that have defined cavities, rigid shapes, inherent chirality and multiple cooperative binding sites, and have shown great potential in diverse areas. However, the application of CPMs for high performance liquid chromatography (HPLC) enantioseparation has rarely been reported. In this work, a novel chiral stationary phase (CSP) for HPLC was prepared by chemical bonding of a CPM (C54H72N6O3) onto thiolated silica via thiol-ene click reaction. The CSP exhibited good enantioselectivity in both normal- and reversed-phase HPLC. Chiral compounds included alcohols, diols, ketones, organic acids, esters, ethers, amines, and epoxides were enantioseparated on the column in normal-phase mode (17 compounds) and reversed-phase mode (20 compounds). Importantly, broader chiral resolution was observed with the column than that obtained using our previously studied chiral macrocycle H3L-based column, indicating the potential to significantly improve and broaden applicability of this novel macrocycle-type CSPs. Moreover, the CSP exhibited good complementary enantioseparation to Chiralpak AD-H and Chiralcel OD-H columns, enabling separation of some racemates that could not be separated by the two popular chiral HPLC columns. In addition, the fabricated column exhibited good stability and reproducibility. The relative standard deviations (RSDs) (n = 5) of retention time and resolution after multiple injections were < 0.20 % and < 0.39 %, respectively. The results demonstrated the great potential of this type of CPM for HPLC separation of enantiomers.

Preparation and evaluation of a chiral porous organic cage based chiral stationary phase for enantioseparation in high performance liquid chromatography.

Porous organic cages (POCs) are a new kind of porous molecular materials, which have gained widespread interest in many fields due to their intriguing properties, including excellent molecular solubility, inherent molecular cavity and rich host-guest chemistry. To date, many chiral POCs have been explored as chiral stationary phases (CSPs) for gas chromatographic (GC) separation of enantiomers. However, the applications of chiral POCs for high performance liquid chromatography (HPLC) enantiomeric separation is extremely rare. In this study, we report the construction of thiol-ene click reaction for the preparation of CSP for HPLC by using a [4+8]-type chiral POC NC4-R as chiral selector. The fabricated CSP showed good chiral resolution performance not only in normal-phase HPLC (NP-HPLC) but also in reversed-phase HPLC (RP-HPLC). Seventeen and ten racemates were well resolved in the two separation modes, respectively, including ketones, esters, alcohols, phenols, amines, ethers, organic acids, and amino acids. Moreover, the fabricated column also shows good chiral recognition complementarity to two popular chiral HPLC columns (Chiralpak AD-H and Chiralcel OD-H columns) and previously reported chiral POC NC1-R-based HPLC column, which can resolve some racemates that unable to be resolved by the two commercially available chiral HPLC columns and NC1-R-based column. The relative standard deviation (RSD) values (n = 4) of retention time and resolution (Rs) of analytes separated on the column were less than 0.3 % and 0.5 % after it was subjected to different injections, showing the good reproducibility and stability of the NC4-R-based column. This work demonstrated high potentials of chiral POCs for HPLC enantioseparation and the applicability of chiral POC-based HPLC columns can be broadened by developing more chiral POCs with diverse structures as chiral selector for HPLC.

Preparation of chiral stationary phase based on a [3+3] chiral polyimine macrocycle by thiol-ene click chemistry for enantioseparation in normal-phase and reversed-phase high performance liquid chromatography.

Polyimine macrocycles are a new class of organic macrocycles with cyclic structures, well-defined molecular cavities, and multiple cooperative binding sites, which have recently aroused considerable research interest in molecular recognition and separation. Herein, we report the bonding of a [3+3] chiral polyimine macrocycle (H3L, C78H78N6O3) on thiol-functionalized silica gel using thiol-ene click chemistry to prepare a chiral stationary phase (CSP) for high performance liquid chromatography (HPLC). The fabricated column exhibited excellent chiral separation capability under both normal-phase and reversed-phase conditions. Fourteen and 10 racemates were well resolved on the column in normal-phase mode (using n-hexane/isopropanol as the mobile phase) and reversed-phase mode (using methanol/water as the mobile phase), respectively, including alcohols, esters, ethers, ketones, aldehydes, epoxides and organic acids. Moreover, the column also shows good selectivity toward positional isomers. Six positional isomers (dinitrobenzene, chloroaniline, bromoaniline, iodoaniline, nitrobrobenzene and nitrochlorobenzene) were well separated on the column. In addition, the effects of the injection mass and mobile phase composition on the separation were investigated. The column shows good reproducibility and stability after multiple injections with the relative standard deviation (RSD) (n = 5) of the retention time and resolution being < 0.96 % and 0.65 %, respectively. This study indicates that this type of chiral polyimine macrocycles is a promising chiral selector for HPLC enantioseparation and will push forward the applications of more novel chiral macrocycles for chiral chromatographic separation.

OSI-027 inhibits the tumorigenesis of colon cancer through mediation of c-Myc/FOXO3a/PUMA axis.

Colon cancer is a gastrointestinal malignancy that is one of the leading causes of tumor-associated deaths. It has been reported that the mammalian target of rapamycin (mTOR) can lead to the progression of colon cancer. However, the mechanism by which mTOR inhibitor (OSI-027) mediates the tumorigenesis of colon cancer remains largely unknown. Cell function of colon cancer was investigated by cell counting kit-8 flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labeling staining. In addition, quantitative real-time polymerase chain reaction and Western blot were used to investigate the mechanism underlying the function of OSI-027 in colon cancer. OSI-027 dose-dependently reduced colon cancer cell viability by inducing cell apoptosis. In addition, OSI-027 induced the apoptosis of colon cancer cells via upregulation of PUMA. OSI-027 promoted the expression of PUMA by activation of forkhead box protein O3a (FOXO3a), and c-Myc knockdown partially increased FOXO3a and PUMA levels. Moreover, OSI-027 attenuated the tumor growth of colon cancer through the mediation of the mTOR/c-Myc/FOXO3a axis. OSI-027 attenuates colon cancer progression through the mediation of the c-Myc/FOXO3a/PUMA axis. Thereby, this study might shed new insights on exploring the strategies against colon cancer.

Genome-wide identification of the expansin gene family reveals that expansin genes are involved in fibre cell growth in cotton.

BACKGROUND: Expansins (EXPs), a group of proteins that loosen plant cell walls and cellulosic materials, are involved in regulating cell growth and diverse developmental processes in plants. However, the biological functions of this gene family in cotton are still unknown. RESULTS: In this paper, we identified a total of 93 expansin genes in Gossypium hirsutum. These genes were classified into four subfamilies, including 67 GhEXPAs, 8 GhEXPBs, 6 GhEXLAs, and 12 GhEXLBs, and divided into 15 subgroups. The 93 expansin genes are distributed over 24 chromosomes, excluding Ghir_A02 and Ghir_D06. All GhEXP genes contain multiple exons, and each GhEXP protein has multiple conserved motifs. Transcript profiling and qPCR analysis revealed that the expansin genes have distinct expression patterns among different stages of cotton fibre development. Among them, 3 genes (GhEXPA4o, GhEXPA1A, and GhEXPA8h) were highly expressed in the initiation stage, 9 genes (GhEXPA4a, GhEXPA13a, GhEXPA4f, GhEXPA4q, GhEXPA8f, GhEXPA2, GhEXPA8g, GhEXPA8a, and GhEXPA4n) had high expression during the fast elongation stage, and GhEXLA1c and GhEXLA1f were preferentially expressed in the transition stage of fibre development. CONCLUSIONS: Our results provide a solid basis for further elucidation of the biological functions of expansin genes in relation to cotton fibre development and valuable genetic resources for future crop improvement.

Protective role of down-regulated microRNA-31 on intestinal barrier dysfunction through inhibition of NF-κB/HIF-1α pathway by binding to HMOX1 in rats with sepsis.

BACKGROUND: Intestinal barrier dysfunction is a significant clinical problem, commonly developing in a variety of acute or chronic pathological conditions. Herein, we evaluate the effect of microRNA-31 (miR-31) on intestinal barrier dysfunction through NF-κB/HIF-1α pathway by targeting HMOX1 in rats with sepsis. METHODS: Male Sprague-Dawley rats were collected and divided into the sham group, and the cecum ligation and perforation group which was subdivided after CACO-2 cell transfection of different mimic, inhibitor, or siRNA. Levels of serum D-lactic acid, diamine oxidase and fluorescence isothiocyanate dextran, FITC-DX concentration, and bacterial translocation were detected. Superoxidedismutase (SOD) activity and malondialdehyde (MDA) content were evaluated using the colorimetric method and an automatic microplate reader, respectively. Additionally, the levels of tumor necrosis factor, interleukin (IL)-6, and IL-10 were tested using enzyme-linked immunosorbent assay. The expression of miR-31, HMOX1, NF-κB, HIF-1α, IκB, ZO-1 and Occludin were assessed by reverse transcription quantitative polymerase chain reaction and Western blot analysis. RESULTS: Inhibition of miR-31 decreased intestinal mucosal permeability and intestinal barrier function. The increased levels of miR-31 could cause oxidative damage and affect the expression of inflammatory factors in intestinal tissue of rats. HMOX1 was confirmed as a target gene of miR-31. MiR-31 affected intestinal mucosal permeability and intestinal barrier function, as well as oxidative damage and inflammation level by regulating HMOX1. Down-regulation of miR-31 inhibited NF-κB/HIF-1α pathway related genes by regulating HMOX1 expression. Furthermore, inhibition of miR-31 increased survival rates of rats. CONCLUSION: Overall, the current study found that inhibition of miR-31 protects against intestinal barrier dysfunction through suppression of the NF-κB/HIF-1α pathway by targeting HMOX1 in rats with sepsis.

MRI Features and Site-specific Factors of Ischemic Changes in White Matter: A Retrospective Study.

Brain magnetic resonance imaging (MRI) of the elderly often reveals white matter changes (WMCs) with substantial variability across individuals. Our study was designed to explore MRI features and site-specific factors of ischemic WMCs. Clinical data of consecutive patients diagnosed with ischemic cerebral vascular disease who had undergone brain MRI were collected and analyzed. Multi-logistic regression analysis comparing patients with mild versus severe WMCs was performed to detect independent associations. Analyses of variance (ANOVAs) were used to detect regionally specific differences in lesions. We found that lesion distribution differed significantly across five cerebral areas, with lesions being predominant in the frontal lobe and parieto-occipital area. To explore WMCs risk factors, after adjusting for gender, diabetes mellitus, and hypertension, only age (P<0.01), creatinine (P=0.01), alkaline phosphatase (ALP) (P=0.01) and low-density lipoprotein cholesterol (LDL-C) (P=0.03) were found to be independently associated with severe WMCs. Age (P<0.001) was strongly associated with WMCs in the frontal lobe while hypertension was independently related to lesions in the basal ganglia (P=0.048) or infratentorial area (P=0.016). In conclusion, MRI of WMCs showed that ischemic WMCs occurred mostly in the frontal lobe and parieto-occipital area. The infratentorial area was least affected by WMCs. Typically, age-related WMCs were observed in the frontal lobes, while hypertension-related WMCs tended to occur in the basal ganglia and infratentorial area.

Aggressive Blood Pressure Lowing Therapy in Patients with Acute Intracerebral Hemorrhage is Safe: A Systematic Review and Meta-analysis.

BACKGROUND: The influence of blood pressure (BP) lowering on intracerebral hemorrhage (ICH) patients is unclear. To assess the safety and efficacy of aggressive antihypertensive therapies in acute ICH patients, we carried out a systematic review and meta-analysis. METHODS: PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and VIP database up to July 2014 were searched. High-quality randomized controlled trials were included. Low-quality trials were excluded. Serious adverse events were defined as the primary outcome. The secondary outcomes were hematoma enlargement (HE) at 24 h after onset, mortality, and favorable clinical outcome at 90 days. RESULTS: Four high-quality trials involving a total of 1427 patients met the inclusion criteria and were analyzed. Odds ratios (ORs) of primary outcome was 0.96 (95% confidence interval [CI ]: 0.82-1.13, P = 0.61). ORs of HE at 24 h after onset, mortality and favorable clinical outcome at 90 days were 0.91 (95% CI: 0.72-1.17, P = 0.47), 0.97 (95% CI: 0.79-1.20, P = 0.81), 1.13 (95% CI: 0.98-1.30, P = 0.09) respectively. CONCLUSIONS: Aggressive BP management policies are safe and might have a potency of reducing HE and improving clinical outcome.

Diabetes mellitus is associated with increased risk of surgical site infections: A meta-analysis of prospective cohort studies.

BACKGROUND AND OBJECTIVE: Observational studies have suggested an association between diabetes mellitus and the risk of surgical site infections (SSIs), but the results remain inconclusive. We conducted a meta-analysis of prospective cohort studies to elucidate the relationship between diabetes mellitus and SSIs. METHODS: We searched PubMed, Embase, and Web of Science databases and reviewed the reference lists of the retrieved articles to identify relevant studies. Associations were tested in subgroups representing different patient characteristics and study quality criteria. The random-effect model was used to calculate the overall relative risk (RR). RESULTS: Fourteen prospective cohort studies (N = 91,094 participants) were included in this meta-analysis, and the pooled crude RR was 2.02 (95% confidence interval, 1.68-2.43) with significant between-study heterogeneity observed (I(2) = 56.50%). Significant association was also detected after we derived adjusted RRs for studies not reporting the adjusted RRs and calculated the combined adjusted RR of the 14 studies (RR, 1.69; 95% confidence interval, 1.33-2.13). Results were consistent and statistically significant in all subgroups. Stratified analyses found the number of confounders adjusted for, sample size, and method of diabetes case ascertainment might be the potential sources of heterogeneity. Sensitivity analysis further demonstrated the robustness of the result. CONCLUSIONS: This meta-analysis suggests diabetes mellitus is significantly associated with increased risk of SSIs. Future studies are encouraged to reveal the mechanisms underlying this association.

Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer: technical aspects.

BACKGROUND: Endovascular therapy plays an important role in the treatment of brain arteriovenous malformations (BAVMs). Ethylene vinyl alcohol copolymer (Onyx) is a novel liquid embolic material. This study aimed to summarize our experience of using Onyx for embolization of BAVMs with the focus on embolization technique. METHODS: From September 2003 to November 2007, 115 patients (43 women and 72 men, with a mean age of 29 years) with BAVMs were endovascularly treated with Onyx in our department. The following features of all AVMs were evaluated prior to treatment: type of nidus and shunt, draining veins, and feeding arteries. A total of 196 endovascular procedures were performed. RESULTS: The course of endovascular treatment was completed in 88 patients. Additional sessions were planned in 27 patients. Of the 88 patients, total occlusion was obtained in 23 patients (26.1%), near-total (> 80% of the original volume) occlusion was obtained in 35 patients (39.8%) and partial occlusion (< 80% of the original volume) was obtained in 30 patients (34.1%) using embolization as the sole therapeutic technique. Mean volume reduction was 72% (range 30% - 100%) in 115 patients. Thirty four patients (38.6%, 34/88) underwent radiosurgical treatment. Additional embolization sessions were planned in 27 patients. Complications occurred in 19 patients (16.5%, 19/115), leading to death in one patient (mortality 0.9%) and permanent disabling in 3 patients (morbidity 2.6%). CONCLUSIONS: Onyx was shown to be feasible and safe for embolization of BAVMs. Proper use of the Onyx injection technique largely improved the endovascular treatment of BAVMs. Large AVMs can be adequately reduced in size through the use of additional treatment.

Endovascular treatment of wide-necked intracranial aneurysms using of "remodeling technique" with the HyperForm balloon.

BACKGROUND: Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the "remodeling technique" with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result. METHODS: From June 2004 to September 2006, forty-two patients (20 men, 22 women) with wide-necked or large neck/fundus ratio aneurysms were treated by using the "remodeling technique" with the HyperForm balloon. RESULTS: Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases (80.9%), subtotal in 4 (9.5%) and incomplete in 2 (4.8%). One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months. CONCLUSIONS: The "remodeling technique" with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms-located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurysms when the standard remodeling technique might have failed.

[Treatment of chronic and painful vertebral compressive fractures with vertebroplasty in senior patients].

OBJECTIVE: To evaluate the efficiency of treatment of chronic and painful compressive fractures of vertebral bodies with vertebroplasty in senior patients. METHODS: 98 patients of chronic and painful compressive fractures of vertebral bodies suffering from severely back pain and activity of daily living, 33 males and 65 females, aged 71 +/- 12, with the average medical history of 12 months, underwent vertebroplasty. Follow-up was conducted for 3 - 40 months. Six-point Behavioral Rating Scale and Activity of Daily Living (ADL) Scale were used to evaluate the efficacy. RESULTS: 123 affected compressive vertebral bodies in the 98 cases were treated with vertebroplasty. After 3.5 - 7 ml of bone cement was injected into the lesions, complete relief was got in 20 cases, obvious relief was achieved in 59 cases, improvement was made in 14 cases, and no progress was seen in 5 case. The score of 6-point Behavioral Rating Scale decreased from 4.2 +/- 1.1 before vertebroplasty to 1.2 +/- 0.9 (P < 0.01). The ADL score decreased from 4.2 +/- 1.1 before vertebroplasty to 1.9 +/- 0.6 (P < 0.01). CONCLUSION: Vertebroplasty significantly improves the painful symptoms and ability of daily life in senior patients with chronic painful vertebral compressive fractures.

[Endovascular treatment of posterior cerebral artery aneurysm: analysis of 21 patients].

OBJECTIVE: To investigate the effect of endovascular treatment on posterior cerebral artery (PCA) aneurysm. METHODS: The clinical data of 21 patients with PCA aneurysm, 12 males and 9 females, aged 3 - 60, totally 22 aneurysms, 3 located in the P1 segment, 16 (in 15 patients) on the P2 segment, and 3 being serpentine aneurysms and involving P2-3 segment, were analyzed. One patients gave up treatment, 6 patients, with 7 aneurysms, underwent aneurysm sac occlusion, and 14 patients underwent parent vessel occlusion. RESULTS: Complete aneurysm sac occlusion was achieved in 5 patients with 6 aneurysms, and incomplete occlusion was achieved in 1 patient who died of bleeding of aneurysm the next day after the operation. All 14 patients undergoing parent vessel occlusion survived without aneurysm detected by angiography, among which 3 presented hemianesthesia of the contralateral side and 2 recovered completely. CONCLUSION: Endovascular treatment is safe and effective for PCA aneurysm.

[Transvenous embolization in treatment of refractory carotid-cavernous sinus fistula].

OBJECTIVE: To investigate the effects of transvenous embolization in treatment of refractory carotid-cavernous sinus fistula (CCF). METHODS: Twenty-five patients of refractory CCF with 28 foci underwent transvenous embolization, femoral vein-inferior petrosal sinus approach was used in 12 of which, and femoral vein-facial vein-superior ophthalmic vein approach was used in 12 of which. The embolizing materials included controllable coils (GDC, EDC), free coil, and silk. Three to twenty-four months after the treatment angiography was conducted on 10 patients and telephone follow-up was conducted on the other 15 patients. RESULTS: Immediate complete angiographic obliteration of the fistula was achieved in 20 patients. Residual shunting was left in 5 patients, 2 with pterygoid drainage and 3 with inferior petrosal sinus drainage. Headache and vomiting were the common symptoms after embolization. The angiography during follow-up showed that there were residual shunting in 4 patients, residual inferior petrosal drainage in 1 patient, and residual pterygoid drainage in 1 patient, and that no reoccurrence was found in the 6 patients with complete angiographic obliteration. The patients undergoing telephone follow-up reported that they had not any symptom. CONCLUSION: Safe and effective, transvenous embolization can be the first choice after the failure in treatment of the carotid-cavernous sinus fistula.

[Endovascular stent implantation in treatment of intracranial wide-necked aneurysms].

OBJECTIVE: To evaluate the effectiveness and feasibility of treatment of intracranial wide-necked aneurysms with a new technique of Neuroform self-expanding stent combined with detachable coil. METHODS: A retrospective analysis of thirty patients with intracranial wide-necked aneurysms, 14 males and 16 females, aged 48 (18-68), wide-necked aneurysms, underwent occlusion of aneurysms using Neuroform self-expanding stent combined with detachable coil. RESULTS: 21 of the 30 aneurysms were completely occluded (70%) and 9 of the 30 aneurysms were incompletely occluded (30%) after initial coils embolization. Thromboembolic events were found in one case and migration of stent in two cases. Clinical follow-up performed in 29 patients showed that only one patient had permanent mild hemi-paralysis. Twenty-one patients were followed up for 6-12 months, 7 of which needed second treatment and 4 of which showed complete occlusion. CONCLUSION: A flexible device, Neuroform self-expanding stent can be safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. The new technique of Neuroform stent combined with detachable coil increases the early outcome of intracranial wide-necked aneurysm.

[Treatment of severe vertebral compressive fractures in the elderly with percutaneous vertebroplasty].

OBJECTIVE: To evaluate the efficacy of treating severe and chronic vertebral compressive fractures in the elderly with percutaneous vertebroplasty. METHODS: Sixteen patients who suffered from severe back pain and whose daily living was badly affected were retrospectively reviewed. The average age was 72.5 years, the average disease history was 19 months, and the average compressive rate of the affected vertebral bodies was 74.1%. RESULTS: Nineteen affected compressive vertebral bodies in 16 cases were treated with percutaneous vertebroplasty. All the procedures were successful without any complication. After 3.5-7 ml of cement was injected into the lesions, complete relief was achieved in 3 cases, remarkable relief was achieved in 11 cases, and improvement was observed in 2 cases. The scores of 6-point Behavioral Rating Scale and Activity of Daily Living (ADL) declined significantly after the treatment (P < 0.001). CONCLUSION: Percutaneous vertebroplasty can significantly improve the symptoms and quality of life in the elderly patients with severe and chronic vertebral compressive fractures.