Identify gestational diabetes mellitus by deep learning model from cell-free DNA at the early gestation stage.

Gestational diabetes mellitus (GDM) is a common complication of pregnancy, which has significant adverse effects on both the mother and fetus. The incidence of GDM is increasing globally, and early diagnosis is critical for timely treatment and reducing the risk of poor pregnancy outcomes. GDM is usually diagnosed and detected after 24 weeks of gestation, while complications due to GDM can occur much earlier. Copy number variations (CNVs) can be a possible biomarker for GDM diagnosis and screening in the early gestation stage. In this study, we proposed a machine-learning method to screen GDM in the early stage of gestation using cell-free DNA (cfDNA) sequencing data from maternal plasma. Five thousand and eighty-five patients from north regions of Mainland China, including 1942 GDM, were recruited. A non-overlapping sliding window method was applied for CNV coverage screening on low-coverage (~0.2×) sequencing data. The CNV coverage was fed to a convolutional neural network with attention architecture for the binary classification. The model achieved a classification accuracy of 88.14%, precision of 84.07%, recall of 93.04%, F1-score of 88.33% and AUC of 96.49%. The model identified 2190 genes associated with GDM, including DEFA1, DEFA3 and DEFB1. The enriched gene ontology (GO) terms and KEGG pathways showed that many identified genes are associated with diabetes-related pathways. Our study demonstrates the feasibility of using cfDNA sequencing data and machine-learning methods for early diagnosis of GDM, which may aid in early intervention and prevention of adverse pregnancy outcomes.

A Case of Extensive Thoracolumbar Spinal Intradural Cystic Echinococcosis.

Spinal cystic echinococcosis (CE) is a rare but devastating form of a neglected parasitic disease caused by the larval stage of the cestode Echinococcus granulosus. CE or hydatid disease most commonly affects the liver and lungs. Spinal CE occurs in less than 1% of all cases. Patients with cysts confined to the intradural space typically present with neurological impairment due to compression of the spinal cord. We report a case of a 32-year-old woman with unusual, extensive spinal intradural CE, located at the T2-L5 levels. She was treated with surgical removal of the cystic lesions by laminectomy and instrumentation. Long-term oral albendazole was recommended postoperatively. Her status was medically stable at 5-year follow-up, but lower limbs paralysis, urinary retention, and bowel dysfunction persisted.

Cultural Confidence on "Art & Engineering" Construction of Product Design under "New Liberal Arts".

A master's degree program in "new liberal arts" is a great opportunity to strengthen cooperation between art colleges and universities, to promote the construction of product design and digital molding majors, and to promote teaching and research on the "integration" of the theoretical foundations of engineering intelligent manufacturing. To take advantage of cooperative universities' advantageous disciplines and professional platforms, we should construct new art and emerging interdisciplinary majors, as well as promote the construction and exploration of joint training of doctors and masters in relevant disciplines in the interdisciplinary direction of art and engineering. The foregoing approaches are intended to create a new "art and engineering" model for the establishment of a product design speciality at our university. In order to meet the requirements of "Art & Engineering" advocated by the national new engineering construction, art disciplines have their own inherent rules and characteristics. We should actively create disciplinary and professional characteristics, help universities cooperate with each other in high-quality development, and share and win together, in order to continuously achieve new academic results.

MiR-802 Suppresses Colorectal Cancer Cell Viability, Migration and Invasion by Targeting RAN.

PURPOSE: Colorectal cancer is one of the most malignant tumors in the world, and the incidence is increasing every year. MicroRNAs (miRNA) are small non-coding RNAs that are involved in a variety of physiological or pathological processes. Abnormal expression of microRNA-802 (miR-802) has been demonstrated in various types of cancer. However, the expression and biological role of miR-802 in human colorectal cancer remain largely unknown. METHODS: Here, we used quantitative real-time PCR (qRT-PCR) to measure miR-802 expression levels in colorectal cancer tissues and cell lines. Cell Counting Kit-8 (CCK-8) was used to assess the effect of miR-802 on colorectal cancer cell viability. Migration and invasion assays were performed to determine the effect of miR-802 on metastasis of colon tumor cells by transwell analysis. Luciferase activity assays were used to confirm the target of miR-802. RESULTS: The results show that miR-802 is significantly downregulated in colorectal cancer tissues and cell lines. Overexpression of miR-802 profoundly inhibited viability, migration and invasion of colorectal cancer cells. In addition, we have newly discovered that the Ras-associated nucleus (RAN) is a direct target of miR-802 which could reverse the effects induced by miR-802 overexpression in colorectal cancer cells. CONCLUSION: In conclusion, our study shows that miR-802 is downregulated in colorectal cancer, and overexpression of miR-802 inhibits colorectal cancer cell viability, migration and invasion by directly targeting RAN.

Oblique Lateral Interbody Fusion (OLIF) with Supplemental Anterolateral Screw and Rod Instrumentation: A Preliminary Clinical Study.

OBJECTIVE: This study aimed to evaluate the technical details, clinical effectiveness, and complications of oblique lateral interbody fusion supplemented with anterolateral screw-rod instrumentation in managing degenerative lumbar diseases. METHODS: The clinical data of 14 patients with lumbar degenerative diseases who underwent oblique lateral interbody fusion and anterolateral screw-rod instrumentation in the Department of Neurosurgery, Sichuan Provincial People's Hospital, from April 2015 to May 2018, were retrospectively analyzed. The duration of operation, estimated blood loss, radiological exposure, length of hospital stay, and complications were recorded. The visual analog scale score, Oswestry Disability Index, and radiologic parameters were evaluated before and after surgery. RESULTS: The diagnosis included degenerative/isthmic spondylolisthesis (grade I), degenerative lumbar stenosis, disc hernia with instability, and adjacent segment disease. The follow-up period was 12-45 months. The clinical symptoms improved significantly after the operation according to the visual analog scale and Oswestry Disability Index scores. The average operation time, blood loss, and length of hospital stay were 72.50 ± 21.46 minutes, 53.21 ± 19.07 mL, and 5.57 ± 2.21 days, respectively. The postoperative radiographic examination demonstrated increased intervertebral height and foramen area (P < 0.05). The radiologic fusion rate was 95% at the last follow-up; cage subsidence was found in 1 case. No major complications, such as vascular injury, ureteral injury, or infection, occurred. CONCLUSIONS: As an alternative method of instrumentation, anterolateral screw-rod fixation minimized the total operation time, blood loss, radiological exposure, and soft tissue disruption, and realized 1-stage intervertebral fusion and instrumentation through a single small incision.

Low Serum Levels of miR-101 Are Associated with Poor Prognosis of Colorectal Cancer Patients After Curative Resection.

BACKGROUND Recent studies showed low expression of microRNA (miR)-101 in various malignancies. However, the association of serum miR-101 and colorectal cancer (CRC) remains unknown. We investigated diagnostic and prognostic significance of serum miR-101 in CRC. MATERIAL AND METHODS A total of 263 consecutive CRC patients and 126 healthy controls were enrolled in this study. Serum miR-101 levels were measured using real-time quantitative reverse transcription polymerase chain reactions. The association between serum miR-101 level and survival outcome was analyzed. RESULTS Serum miR-101 in CRC patients was significantly lower than in healthy volunteers (P<0.001). Low serum miR-101 level was significantly associated with advanced cancer stage. Moreover, survival analysis demonstrated that patients with a low serum miR-101 had poorer 5-year overall survival than patients with a high serum miR-101 level (p=0.041). Serum miR-101 level also were confirmed as an independent risk factor for CRC in multivariate analysis (hazard ratio, 1.468; 95%CI, 0.981-1.976; p<0.001). CONCLUSIONS Serum miR-101 level was significantly downregulated in CRC patients and was closely correlated with poor clinical outcome, suggesting that serum miR-101 might be a useful diagnostic and prognostic marker for CRC.

Interplay between long noncoding RNA ZEB1-AS1 and miR-101/ZEB1 axis regulates proliferation and migration of colorectal cancer cells.

Long noncoding RNAs (lncRNAs) are dysregulated in many diseases. MicroRNA-101 (miR-101) functions as a tumor suppressor by directly targeting ZEB1 in various cancers. However, the potential mechanism of lncRNA ZEB1-AS1 and miR-101/ZEB1 axis in CRC remains unknown. In this study, we further investigated the potential interplay between miR-101/ZEB1 axis and lncRNA ZEB1-AS1 in colorectal cancer (CRC). Results showed that ZEB1-AS1 was upregulated in CRC tissues and cells. MiR-101 was downregulated in CRC tissues and negatively correlated with ZEB1-AS1 and ZEB1 expression levels in CRC. Functional experiments showed that, consistent with ZEB1-AS1 depletion, miR-101 overexpression and ZEB1 depletion inhibited the proliferation and migration of CRC cells. Overexpression of miR-101 partially abolished the effects of ZEB1-AS1 on the proliferation and migration of these cells. Moreover, combined ZEB1-AS1 depletion and miR-101 overexpression significantly inhibited cell proliferation and migration of the CRC cells. Hence, ZEB1-AS1 functioned as a molecular sponge for miR-101 and relieved the inhibition of ZEB1 caused by miR-101. This study revealed a novel regulatory mechanism between ZEB1-AS1 and miR-101/ZEB1 axis. The interplay between ZEB1-AS1 and miR-101/ZEB1 axis contributed to the proliferation and migration of CRC cells, and targeting this interplay could be a promising strategy for CRC treatment.

microRNA-9 functions as a tumor suppressor in colorectal cancer by targeting CXCR4.

MicroRNAs (miRs) dysregulation has been proven to play a crucial role in the initiation and progression of colorectal cancer (CRC). miR-9 functions as a tumor suppressor in many cancer types, including CRC. However, the precise role of miR-9 and the underlying molecular mechanisms that miR-9 involves in CRC progression remain largely unknown. In this study, it was reported that miR-9 had lower expression in CRC tissue samples than in those matched adjacent non-tumor tissues. Deregulated miR-9 expression was inverse correlated with the TNM stage, lymph node metastasis, and prognosis of CRC patients. Ectopic miR-9 expression suppressed CRC cell proliferation, migration, and invasion. Dual-Luciferase Reporter Assay confirmed that C-X-C Motif Chemokine Receptor 4 (CXCR4) was a direct miR-9 target, and the effects of miR-9 were mimicked through CXCR4 depletion in vitro. CXCR4 rescue experiments further verified that CXCR4 is a functional target of miR-9. Animal xenograft assays also provided evidence that miR-9 functions as a tumor suppressor via targeting CXCR4 in vivo. Mechanistically, miR-9 overexpression or CXCR4 knockdown influenced cell proliferation and epithelial-mesenchymal transition (EMT). Results suggest that miR-9 acts as a tumor suppressor in CRC progression by regulating CXCR4.

Transcriptional Mechanism of Jasmonate Receptor COI1-Mediated Delay of Flowering Time in Arabidopsis.

Flowering time of plants must be tightly regulated to maximize reproductive success. Plants have evolved sophisticated signaling network to coordinate the timing of flowering in response to their ever-changing environmental conditions. Besides being a key immune signal, the lipid-derived plant hormone jasmonate (JA) also regulates a wide range of developmental processes including flowering time. Here, we report that the CORONATINE INSENSITIVE1 (COI1)-dependent signaling pathway delays the flowering time of Arabidopsis thaliana by inhibiting the expression of the florigen gene FLOWERING LOCUS T (FT). We provide genetic and biochemical evidence that the APETALA2 transcription factors (TFs) TARGET OF EAT1 (TOE1) and TOE2 interact with a subset of JAZ (jasmonate-ZIM domain) proteins and repress the transcription of FT. Our results support a scenario that, when plants encounter stress conditions, bioactive JA promotes COI1-dependent degradation of JAZs. Degradation of the JAZ repressors liberates the transcriptional function of the TOEs to repress the expression of FT and thereby triggers the signaling cascades to delay flowering. Our study identified interacting pairs of TF and JAZ transcriptional regulators that underlie JA-mediated regulation of flowering, suggesting that JA signals are converted into specific context-dependent responses by matching pairs of TF and JAZ proteins.

Overexpression of tomato SlNAC1 transcription factor alters fruit pigmentation and softening.

BACKGROUND: Fruit maturation and ripening are genetically regulated processes that involve a complex interplay of plant hormones, growth regulators and multiple biological and environmental factors. Tomato (Solanum lycopersicum) has been used as a model of biological and genetic studies on the regulation of specific ripening pathways, including ethylene, carotenoid and cell wall metabolism. This model has also been used to investigate the functions of upstream signalling and transcriptional regulators. Thus far, many ripening-associated transcription factors that influence fruit development and ripening have been reported. NAC transcription factors are plant specific and play important roles in many stages of plant growth and development, such as lateral root formation, secondary cell wall synthesis, and embryo, floral organ, vegetative organ and fruit development. RESULTS: Tissue-specific analysis by quantitative real-time PCR showed that SlNAC1 was highly accumulated in immature green fruits; the expression of SlNAC1 increased with fruit ripening till to the highest level at 7 d after the breaker stage. The overexpression of SlNAC1 resulted in reduced carotenoids by altering carotenoid pathway flux and decreasing ethylene synthesis mediated mainly by the reduced expression of ethylene biosynthetic genes of system-2, thus led to yellow or orange mature fruits. The results of yeast one-hybrid experiment demonstrated that SlNAC1 can interact with the regulatory regions of genes related lycopene and ethylene synthesis. These results also indicated that SlNAC1 inhibited fruit ripening by affecting ethylene synthesis and carotenoid accumulation in SlNAC1 overexpression lines. In addition, the overexpression of SlNAC1 reduced the firmness of the fruits and the thickness of the pericarp and produced more abscisic acid, resulting in the early softening of fruits. Hence, in SlNAC1 overexpression lines, both ethylene-dependent and abscisic acid-dependent pathways are regulated by SlNAC1 in fruit ripening regulatory network. CONCLUSIONS: SlNAC1 had a broad influence on tomato fruit ripening and regulated SlNAC1 overexpression tomato fruit ripening through both ethylene-dependent and abscisic acid-dependent pathways. Thus, this study provided new insights into the current model of tomato fruit ripening regulatory network.

The impact of surgical timing on the management of aneurysms with acute hydrocephalus after aneurysmal subarachnoid hemorrhage.

AIM: To explore the feasibility and effectiveness of early microsurgical therapy for acute hydrocephalus resulting from a ruptured intracranial aneurysm. MATERIAL AND METHODS: Forty patients with Hunt-Hess grades II-III were assigned to group A; 27 patients with grades IV-V formed group B. The patients were also divided into 2 groups based on the time interval between the hemorrhage and surgery. Subjects in the early surgery group underwent aneurysm clipping within 3 days of subarachnoid hemorrhage (SAH), followed by intraoperative lateral ventricle puncture and third ventriculostomy. Subjects in the late surgery group underwent aneurysm clipping within 10 days of SAH, after initial treatment with lateral ventricular drainage. Three months after surgery, we used the Glasgow Outcome Scale (GOS) to compare the differences between the early and late surgery groups. RESULTS: More patients benefited from early surgery than from late surgery in both groups: GOS4-5 was achieved by 75% and 73.3% of early-surgery patients compared to 37.5% and 25% of late-surgery patients from Groups A and B, respectively (both p < 0.05). Analysis of the relationship between surgical timing and outcomes with the Ridit method showed that outcomes of early surgery were better than those of late surgery (p < 0.05). CONCLUSION: Aneurysmal SAH with acute hydrocephalus requires early surgery.

A novel tomato MYC-type ICE1-like transcription factor, SlICE1a, confers cold, osmotic and salt tolerance in transgenic tobacco.

ICE1 (inducer of CBF expression 1), a MYC-type bHLH transcription factor, is an important activator of CBF3/DREB1A for regulating cold signaling and stress tolerance. In this study, we isolated the novel ICE1-like gene SlICE1a from tomato which contains the conserved bHLH domain, an S-rich motif, and ACT-domain. It is localized in the nucleus and harbors transcription-activating activity in the N-terminal. In addition, the SlICE1a transcript is slightly upregulated by cold stress, salt stress, and osmotic stress. SlICE1a overexpression in tobacco enhances the induction of CBF/DREB and their target genes, consequently increasing the levels of proline, soluble sugars, and late embryogenesis abundant (LEA) proteins, and enhancing tolerance to cold stress, osmotic stress, and salt stress. SlICE1a functions in abiotic stress responses by regulating the expression of stress-tolerant genes, and is thus beneficial for crop improvement.

Overexpression of thylakoidal ascorbate peroxidase shows enhanced resistance to chilling stress in tomato.

Photosynthesis provides a strong reducing power and a high risk for generation of reactive oxygen species (ROS) particularly under chilling stress. Ascorbate peroxidases (APXs) reduce H(2)O(2) to water and play an important role in the antioxidant system of plants. Though thylakoid ascorbate peroxidase (tAPX) has been thought to be key regulator of intracellular levels of H(2)O(2), its physiological significance in the response to chilling stress is still under discussion. To study the contribution of tAPX to the ROS scavenging, a tomato thylakoidal ascorbate peroxidase gene (LetAPX) was isolated and transgenic tomatoes were obtained. The LetAPX-GFP fusion protein was targeted to chloroplast in Arabidopsis mesophyll protoplast. RNA blotting analysis revealed that the LetAPX transcript expression was up-regulated by chilling, high light, exogenous salicylic acid (SA) and methyl viologen (MV). Over expression of LetAPX in tomatoes conferred tolerance to chilling stress by maintaining higher reduced glutathione (GSH) content, chlorophyll and APX activities compared with wild type (WT) plants. Furthermore, transgenic plants showed lower levels of hydrogen peroxide (H(2)O(2)) and ion leakage, lower malendialdehyde (MDA) content, higher net photosynthetic rate (Pn) and higher maximal photochemical efficiency of PSII (Fv/Fm). The oxidizable P700 decreased more obviously in WT than that in transgenic plants under chilling stress in low irradiance. The results suggested that over expression of tAPX played a key role both in alleviating photo inhibition of PSI and PSII and enhancing their tolerance to chilling stress.

Spinal subdural hematoma following cranial surgery: a case report and review of the literature.

Spinal subdural hematoma (SDH) following a cranial surgery is extremely rare. We described a 26-year-old patient who developed an SDH at L3-S1 level after the excision of intraventricular meningioma. He was surgically treated with an excellent outcome. It is postulated that the SDH resulted from downward migration of intracranial hematoma.

Primary glioblastoma of the cerebellopontine angle in adults.

Gliomas are rare entities in the cerebellopontine angle (CPA) in adults. The authors present clinical, neuroradiological, serological, and neuropathological findings in a 60-year-old man with an extraaxial CPA glioblastoma arising from the proximal portion of cranial nerve VIII. The patient presented with progressive left-sided deafness and left-sided facial palsy lasting less than 2 months and progressive dysarthria and dysphagia lasting 2 weeks. Preoperative neuroimaging suggested the diagnosis of CPA meningioma with "dural-tail" sign and involvement of the internal auditory canal. Serological examination showed an increase in the malignant markers of ferritin and neuron-specific enolase, which suggested underlying malignancy. The tumor was subtotally removed, and it was confirmed to be completely separated from the brainstem and cerebellum. Cranial nerves VII and VIII were destroyed and sacrificed. Transient severe bradycardia occurred during surgery due to entrapment of the caudal cranial nerve complex by the tumor in such an infiltrative way. The neuropathological examination revealed a glioblastoma. The patient underwent no further treatment and died of cachexia 2 months postoperatively. To the authors' knowledge, this represents the first case of a primary glioblastoma in the CPA in an adult. A high index of suspicion along with reliance on clinical assessment, radiological findings, and serum detection of specific malignant markers is essential to diagnose such uncommon CPA lesions.

Overexpression and suppression of violaxanthin de-epoxidase affects the sensitivity of photosystem II photoinhibition to high light and chilling stress in transgenic tobacco.

Tobacco (Nicotiana tabacum) transformed with the sense and antisense constructs of tomato (Lycopersicon esculentum) violaxanthin de-epoxidase gene (LeVDE) was obtained under the control of the cauliflower mosaic virus 35S promoter (35S-CaMV). Reverse transcription-polymerase chain reaction and western blot analysis demonstrated that the exogenous gene was integrated into the tobacco genome. Wild type (WT), the sense-transgenic line T(1)-24(+) and the antisense-transgenic line T(1)-17(-) were used for physiological measurement. The ratio of (A+Z)/(V+A+Z) and non-photochemical quenching in WT were lower than that in sense plants and higher than that in antisense ones under high light and chilling stress with low irradiance. The maximal photochemical efficiency of photosystem II (PSII) (Fv/Fm) and the net photosynthetic rate (Pn) in the sense line decreased less, while Fv/Fm and Pn in the antisense line decreased most obviously among all lines. These results suggest that the expression of the violaxanthin de-epoxidase gene in transgenic plants affects the sensitivity of PSII photoinhibition to high light and chilling stress.

Overexpression of violaxanthin de-epoxidase gene alleviates photoinhibition of PSII and PSI in tomato during high light and chilling stress.

A tomato (Lycopersicon esculentum) violaxanthin de-epoxidase gene (LeVDE) was isolated. The deduced amino acid sequence of LeVDE showed high identities with violaxanthin de-epoxidase in other plant species. RNA gel blot analysis showed that the mRNA accumulation of LeVDE in the wild-type (WT) was regulated by diurnal rhythm and temperature. RNA and protein gel blot analyses confirmed that the sense LeVDE was transferred into the tomato genome and overexpressed under the control of 35S-CaMV. The ratio of (A+Z)/(V+A+Z) and the values of non-photochemical quenching (NPQ) were higher in transgenic plants than those in WT under high light and chilling stress (4 degrees C). The net photosynthetic rate (Pn) decreased markedly in WT compared to transgenic lines under high light stress. The maximum quantum yield of primary photochemistry of PSII (Fv/Fm) in transgenic plants decreased more slowly during stresses and recovered faster than that in WT under optimal conditions. The oxidizable P700 in transgenic plants was higher than that in WT under chilling stress. These results suggest that overexpression of LeVDE increased the function of the xanthophyll cycle and alleviated photoinhibition of PSII and PSI in tomato during high light and chilling stress with low irradiance.

Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: an outcome analysis.

OBJECT: The purpose of this paper is to elucidate the safety and efficacy of, and indications and outcome prognosis for endoscopic third ventriculostomy (ETV) in 58 patients with obstructive hydrocephalus. METHODS: Between September 1999 and April 2003, 58 ETVs were performed in 58 patients with obstructive hydrocephalus (36 male and 22 female patients) at the authors' institution. The ages of the patients ranged from 5 to 67 years (mean age 35 years) and the follow-up period ranged from 3 to 41 months (mean duration of follow up 24 months). Patients were divided into four subgroups based on the cause of the obstructive hydrocephalus: 21 with intracranial tumors; 11 with intracranial cysts; 18 with aqueductal stenosis: and eight with intracranial hemorrhage or infection. Both univariate and multivariate statistical analyses were performed to assess the prognostic relevance of the cause of the obstructive hydrocephalus, early postoperative clinical appearance, and neuroimaging findings in predicting the result of the ETV. The survival rate was 87% at the end of the 1st year and 84% at the end of the 2nd year post-ETV. One month after ETV an overall clinical improvement was observed in 45 (77.6%) of 58 patients. If we also consider the successful revision of ETV in two patients, a success rate of 78.3% (47 of 60 patients) was reached. The ETV was successful in 17 (81%) of 21 patients with intracranial tumors, nine (82%) of 11 with cystic lesions, 16 (88.9%) of 18 with aqueductal stenosis, and three (38%) of eight with intracranial hemorrhage or infection. A Kaplan-Meier analysis illustrates that the percentage of functioning ETVs stabilizes between 75 and 80% 1 year after the operation. In a comparison of results 1 year after ETV, the authors found that the aqueductal stenosis subgroup had the highest proportion of functioning ETV (89%). The proportions of the tumor and cyst subgroups were 84 and 82%, respectively, whereas the proportion was only 50% in the ventriculitis/intracranial hemorrhage subgroup (strata log-rank test: chi2 = 7.93, p = 0.0475). In the present study, ETV failed in eight patients (13.8%) and the time to failure after the procedure was a mean of 3.4 months (median 2 months, range 0-8 months). The logistic regression analysis confirmed an early postoperative improvement (within 2 weeks after ETV, significance [Sig] of log likelihood ratio [LLR] < 0.0001) and a patent stoma on cine phase-contrast magnetic resonance (MR) images (Sig of LLR = 0.0002) were significant prognostic factors for a successful ETV. The results demonstrated the multivariate model (B = -53.7309, standard error = 325.1732, Wald = 0.0273, Sig = 0.8688) could predict a correct result in terms of success or failure from ETV surgery in 89.66% of observed cases. The Pearson chi-square test demonstrated that little reliance could be placed on the finding of a reduced size of the lateral ventricle (chi2 = 5.305, p = 0.07) on neuroimaging studies within 2 weeks after ETV, but it became a significant predictive factor at 3 months (chi2 = 8.992, p = 0.011) and 6 months (chi2 = 10.586, p = 0.005) post-ETV. Major complications occurred in seven patients (12.1%), including intraoperative venous bleeding in three, arterial bleeding in one, and occlusion of the stoma in three patients. The overall mortality rate was 10.3% (six patients). One of these patients died of pulmonary infection and another of ventriculitis. Four additional patients died of progression of malignant tumor during the follow-up period. CONCLUSIONS: The results indicate that ETV is a most effective treatment in cases of obstructive hydrocephalus that is caused by aqueductal stenosis and space-occupying lesions. For patients with infections or intraventricular bleeding, ETV has considerable effects in selected cases with confirmed CSF dynamic studies. Early clinical and cine phase-contrast MR imaging findings after the operation play an important role in predicting patient outcomes after ETV. The predictive value of an alteration in ventricle size, especially during the early stage following ETV, is unsatisfactory. Seventy-five percent of ETV failures occur within 6 months after surgery. A repeated ventriculostomy should be considered to be a sufficient treatment option in cases in which stoma dysfunction is suspected.

Three-dimensional CT angiography and surgical correlation in the evaluation of intracranial aneurysms.

OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional CT angiography in the surgical treatment of intracranial aneurysms. METHODS: Twenty-four patients suspected of intracranial aneurysms underwent routine catheter four-vessel angiography, three dimensional CT angiography (3D-CTA), magnetic resonance angiography (MRA) or conventional digital subtraction angiography (DSA). RESULTS: A total of 28 aneurysms were detected by CT angiography in this study. Twenty-one patients each had a single aneurysm, two patients each had two aneurysms, and one had three aneurysms. The shapes of aneurysms revealed by 3D-CTA were round in 20 lesions, elliptical in 5, and 1 obulated in 3. Of the 24 lesions which were completely disclosed during surgery, the shapes correlated well with the 3D-CT angiograms. The mean diameter of the aneurysmal neck was 5.9 mm in 3D-CTA images, with the smallest being 1.6 mm and the largest 13.7 mm. The size was very close to the actual size measured at surgery (P < 0.001), revealing that 3D-CT angiograms correlated well with surgical findings. Compared with images obtained by routine catheter four-vessel angiography, MRA and DSA, 3D-CTA images depicted the relationship of aneurysms to parent vessels and other branches more clearly. CONCLUSION: 3D-CTA enables surgeons to understand the 3D structure of intracranial aneurysms and is very useful in planning the surgical treatment of cerebral aneurysms.