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1.
Acta Neurochir (Wien) ; 162(7): 1767-1770, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436008

RESUMO

BACKGROUND: Microsurgical removal of cerebral cavernous malformations (CCMs) at the region of cerebellomesencephalic fissure is technical challenging. METHODS: A 51-year-old gentleman complained severe vertigo and vomiting for 10 days before admission. The symptoms did not improve after medicine treatment. Neuroimaging studies in other hospital revealed a CCM and hematoma at the region of cerebellomesencephalic fissure invading both the left cerebellum and its peduncles. The CCM was successfully removed through a suboccipital transtentorial approach. The detailed surgical techniques were reported. CONCLUSION: A suboccipital transtentorial approach could be used to remove CCMs at the region of cerebellomesencephalic fissure.

2.
World Neurosurg ; 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32251829

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction for the treatment of severe and rigid congenital scoliosis (SRCS) associated with tethered spinal cord (TSC) and type II split cord malformation (SCM). METHODS: Thirteen patients with SRCS associated with TSC and type II SCM underwent posterior-only surgical correction with heavy halo-femoral traction. The preoperative mean coronal Cobb angle was 88.87° ± 12.15°; the mean flexibility was 15.28% ± 3.88%; and the mean angle of thoracic kyphosis and lumbar lordosis was 39.63° ± 18.47° and 56.99° ± 10.02°, respectively. RESULTS: The mean duration of surgery was 320 ± 43.64 minutes and the mean blood loss was 1422.31 ± 457.59 mL. The mean follow-up period was 24.46 ± 7.53 months. After heavy halo-femoral traction, the mean coronal Cobb angle was reduced to 59.14° ± 8.75°. After posterior-only surgical correction, postoperative mean coronal Cobb angle was further reduced to 33.85° ± 8.77°. The postoperative mean correction rate was 62.46% ± 5.04%. The postoperative mean angle of thoracic kyphosis and lumbar lordosis was 29.31° ± 6.75° and 47.79° ± 3.68°, respectively. At the final follow-up, the corrective loss rate of Cobb angle was only 0.69%. There were no significant differences between final follow-up and preoperative modified Japanese Orthopaedic Association total scores. The Scoliosis Research Society-22 total score improved at the final follow-up evaluation compared with the preoperative total score. CONCLUSIONS: Without prophylactic neurosurgical intervention and spine-shortening osteotomy, posterior-only surgical correction with heavy halo-femoral traction could be safe and effective for the treatment of SRCS associated with TSC and type II SCM.

3.
Infect Genet Evol ; 82: 104292, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32240798

RESUMO

OBJECTIVE: To investigate the relationship between melanocortin-3 receptor (MC3R) gene polymorphism and tuberculosis (TB) susceptibility in Han population in southern China. METHODS: A total of 341 patients with TB (173 with pulmonary TB and 168 with multifocal TB) and 359 healthy controls were enrolled. Genotyping was performed by PCR and DNA sequencing, and detection of protein was performed by western blot. RESULTS: The distributions of genotype and allele frequencies of rs6127698 differed significantly between the pulmonary and multifocal TB groups, and between the multifocal TB and control groups. The GG genotype was significantly more common among multifocal TB patients than among pulmonary TB patients (P = .009) and those in the control group (P = .001) under the recessive model. GG+GT genotype was more common in multifocal TB than in pulmonary TB (P < .01) and control group (P < .01) under the dominant model. G allele was more common in multifocal TB than in pulmonary TB (P < .0167) and control group (P < .0167). Patients with multifocal TB had an increased expression of MC3R protein than healthy controls (P < .05). CONCLUSIONS: In the southern Chinese Han population, the MC3R rs6127698 polymorphism, which accompanying an increased expression of MC3R protein,was associated with susceptibility to multifocal TB. Presence of the G allele increased the risk of developing multifocal TB.

4.
Oxid Med Cell Longev ; 2020: 9641904, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32148660

RESUMO

Postoperative cognitive dysfunction (POCD) is a common sequela following surgery and hospitalization. The prevention and management of POCD are important during clinical practice. POCD more commonly affects elderly patients who have undergone major surgery and can result in major decline in quality of life for both patients and their families. Acupuncture has been suggested as an effective intervention for many neurological disorders. In recent years, there are increasing interest in the use of acupuncture to prevent and treat POCD. In this review, we summarized the clinical and preclinical evidence of acupuncture on POCD using a narrative approach and discussed the potential mechanisms involved. The experimental details and findings of studies were summarized in tables and analyzed. Most of the clinical studies suggested that acupuncture before surgery could reduce the incidence of POCD and reduce the levels of systematic inflammatory markers. However, their reliability is limited by methodological flaws. Animal studies showed that acupuncture reduced cognitive impairment and the associated pathology after various types of surgery. It is possible that acupuncture modulates inflammation, oxidative stress, synaptic changes, and other cellular events to mitigate POCD. In conclusion, acupuncture is a potential intervention for POCD. More clinical studies with good research design are required to confirm its effectiveness. At the same time, findings from animal studies will help reveal the protective mechanisms, in which systematic inflammation is likely to play a major role.

5.
Turk Neurosurg ; 30(2): 285-292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32091128

RESUMO

AIM: To summarize the clinical outcomes, follow-up results and to discuss the optimal therapeutic strategy for pericallosal artery aneurysms (PAAs). MATERIAL AND METHODS: From January 2013 to May 2017, the charts of 49 patients with PAAs, representing 2.43% of 2,018 consecutive patients with intracranial aneurysms (IAs) were reviewed. The clinical and radiological data of these patients were retrospectively analyzed. RESULTS: There were no technical failures in the clipping group, but one patient in the coiling group presented rebleeding during the operation, resulting in a poor prognosis. Although the difference was not significant, the coiling group had a better complete recovery rate than the clipping group [overall: coiling, n=20 (87.0%) vs clipping, n=11 (68.8%), p=0.33; unruptured PAAs: coiling, n=12 (92.3%) vs clipping, n=5 (83.3%); ruptured PAAs: coiling, n=8 (80%) vs clipping, n=6 (60%), p=0.63]. One patient in the coiling group exhibited recurrence. No patients experienced rebleeding during the follow-up period in either group. CONCLUSION: In our study, both endovascular coiling and microsurgery were technically feasible and achieved favorable clinical outcomes in patients with PAAs. Longer radiological follow-up is necessary. Patients should be evaluated by a multidisciplinary team prior to determining the optimal treatment modality.

6.
BMC Musculoskelet Disord ; 21(1): 98, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054465

RESUMO

BACKGROUND: Whether or not, prophylactic neurosurgical interventions of split cord malformation (SCM) before undertaking corrective surgery was the focus of debate. The present study was performed to evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction for the treatment of rigid congenital scoliosis (RCS) associated with SCM. METHODS: From 2011 to 2017, 24 patients suffered from RCS associated with SCM underwent posterior-only surgical correction with heavy halo-femoral traction. The apex of the deformity was lumbar (n = 9), thoracic (n = 11), and thoracolumbar (n = 4). There were 13 cases of failure of segmentation; 4 cases of failure of formation and 7 cases of mixed defects. Based on SCM classification, there were 14 patients with SCM type 1 and 10 patients with SCM type 2. The Scoliosis Research Society (SRS)-22 and modified Japanese Orthopaedic Association (mJOA) scores were assessed preoperatively and at the final follow up. RESULTS: The mean duration of surgery was 327.08 ± 43.99 min and the mean blood loss was 1303.33 ± 526.86 ml. The mean follow-up period was 20.75 ± 8.29 months. The preoperative mean coronal Cobb angle was 80.38° ± 13.55°; on the bending radiograph of the convex side, the mean Cobb angle was 68.91° ± 15.48°; the mean flexibility was 15.04% ± 7.11%. After heavy halo-femoral traction, the mean coronal Cobb angle was reduced to 56.89° ± 13.39°. After posterior-only surgical correction, postoperative mean coronal Cobb angle was further reduced to 32.54° ±11.33°. The postoperative mean correction rate was 60.51% ± 7.79%. At the final follow up, the corrective loss rate of Cobb angle was only 3.17%. The SRS-22 total score improved at the final follow-up evaluation compared with the preoperative SRS-22 total score. The spinal cord function was stable and there were no new neurological symptoms after correction. There were no significant differences between final follow-up and preoperative mJOA total scores. CONCLUSIONS: Without prophylactic neurosurgical intervention and spine-shortening osteotomy, posterior-only surgical correction with heavy halo-femoral traction could be safe and effective for the treatment of RCS associated with SCM.

7.
World Neurosurg ; 133: e320-e326, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520758

RESUMO

BACKGROUND: Compared with intracranial aneurysms (IAs) at other locations, pericallosal artery aneurysms (PAAs) have demonstrated an extremely high risk of rupture. However, owing to their rarity, our understanding of their morphological characteristics has been limited, and whether the morphological characteristics of PAAs contribute to this high rupture risk has remained unexplored. In the present study, we aimed to provide a detailed description of the morphological characteristics of PAAs and investigate the association between its morphology and rupture risk compared with anterior circulation IAs at other locations. METHODS: A total of 40 patients with 45 PAAs and 348 patients with 392 anterior circulation IAs at other locations were recruited. The clinical and radiological data for these patients were retrospectively reviewed. The differences in the morphological parameters, including the aneurysm diameter, neck width, height, width, parent artery diameter, inflow angle, aspect ratio (AR), size ratio (SR), and aneurysm diameter/width ratio, between PAAs and other IA groups were compared. RESULTS: Of the 45 PAAs, 22 (48.9%) had ruptured. The proportion of ruptured aneurysms was greater for PAAs than for anterior circulation IAs at other locations. For both ruptured and unruptured anterior circulation IAs, PAAs had the highest AR and SR among all IA groups and had the largest inflow angle. CONCLUSION: The morphological characteristics of PAAs are unique. Compared with other anterior circulation IAs, PAAs have significantly increased ARs, SRs, and inflow angles, which, ultimately, promote their high propensity toward rupture.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Artéria Cerebral Anterior/diagnóstico por imagem , Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Adolescente , Adulto , Idoso , Aneurisma Roto/epidemiologia , Aneurisma Roto/patologia , Artéria Cerebral Anterior/patologia , Corpo Caloso/irrigação sanguínea , Suscetibilidade a Doenças , Feminino , Humanos , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
8.
World Neurosurg ; 135: e116-e125, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31756509

RESUMO

OBJECTIVE: The main objective of the present study was to analyze the efficacy and feasibility of surgical management for patients with monosegmental lumbar or lumbosacral pyogenic vertebral osteomyelitis (PVO) by using one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. METHODS: From February 2014 to May 2016, 27 patients with lumbar or lumbosacral PVO were treated by posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. The degree of damage to the patients' vertebral bodies was one third to one half height. There were 16 male and 11 female, with a mean age of 43.5 years (range, 32-56 years) at the time of surgery. The mean follow-up time was 35.7 months (range, 26-53 months). The clinical efficacy was evaluated on average operation time, blood loss, visual analog scale, erythrocyte sedimentation rate, C-reactive protein level, and neurologic function recovery. RESULTS: PVO was completely cured and the grafted bone was fused in all 27 patients. There was no recurrent vertebral osteomyelitis infection. Erythrocyte sedimentation rate and C-reactive protein level achieved normal limits within 3 months in all patients. The American Spinal Injury Association neurologic classification was improved in all cases. Pain relief was obtained in all patients. CONCLUSIONS: Our results showed that one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion was an effective treatment for patients with one third to one half height of vertebral body damaged in monosegmental lumbar or lumbosacral PVO. The surgical method is characterized as minimum surgical trauma, good pain relief, good neurologic recovery, and good reconstruction of spinal stability.


Assuntos
Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Osteomielite/cirurgia , Telas Cirúrgicas , Adulto , Desbridamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Estudos Retrospectivos , Fusão Vertebral/métodos , Telas Cirúrgicas/efeitos adversos , Vértebras Torácicas/cirurgia , Titânio/efeitos adversos , Resultado do Tratamento , Tuberculose da Coluna Vertebral/cirurgia
11.
Biochem Biophys Res Commun ; 518(2): 259-265, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31421834

RESUMO

Adolescent idiopathic scoliosis (AIS) is a severe spinal deformity that often occurs during puberty. The occurrence of AIS is suggested to be related to abnormal development of cartilage. Our previous study found increased serum ghrelin levels in AIS patients that may linked to the development of AIS. However, whether ghrelin affects cartilage in AIS patients is unclear. We used quantitative real-time PCR (qRT-PCR) and immunohistochemistry to detect the expression of cartilage-specific genes and the ghrelin receptor, growth hormone secretagogue receptor (GHSR). The mRNA and protein levels of collagen II (COLII), SOX9, AGGRECAN (ACAN) and GHSR were higher in AIS patients than in controls. In addition, the protein levels of GHSR downstream signaling pathway members p-STAT3 (Ser727), and p-ERK1/2 were increased. Furthermore, we treated chondrocytes from AIS patients with 100 nM ghrelin, the cell proliferation assay and Western blotting showed that ghrelin promotes chondrocyte proliferation and enhances COLII, SOX9, ACAN, p-ERK1/2 and p-STAT3 expression, respectively. Interestingly, all these observed alterations were abolished by ghrelin + [D-Lys3]-GHRP-6 (a ghrelin receptor inhibitor) treatment. And after U0126 (an inhibitor of ERK1/2 phosphorylation) treatment, ERK1/2 and STAT3 (Ser727) phosphorylation was simultaneously suppressed indicating that ERK1/2 is an upstream pathway protein of STAT3 (Ser727). In conclusion, ghrelin plays an important role in upregulating cartilage-specific genes on AIS primary chondrocytes by activating ERK/STAT3 signaling pathway.

12.
Neural Regen Res ; 14(10): 1780-1786, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31169196

RESUMO

Combinations of biomaterials and cells can effectively target delivery of cells or other therapeutic factors to the brain to rebuild damaged nerve pathways after brain injury. Porous collagen-chitosan scaffolds were prepared by a freeze-drying method based on brain tissue engineering. The scaffolds were impregnated with rat bone marrow mesenchymal stem cells. A traumatic brain injury rat model was established using the 300 g weight free fall impact method. Bone marrow mesenchymal stem cells/collagen-chitosan scaffolds were implanted into the injured brain. Modified neurological severity scores were used to assess the recovery of neurological function. The Morris water maze was employed to determine spatial learning and memory abilities. Hematoxylin-eosin staining was performed to measure pathological changes in brain tissue. Immunohistochemistry was performed for vascular endothelial growth factor and for 5-bromo-2-deoxyuridine (BrdU)/neuron specific enolase and BrdU/glial fibrillary acidic protein. Our results demonstrated that the transplantation of bone marrow mesenchymal stem cells and collagen-chitosan scaffolds to traumatic brain injury rats remarkably reduced modified neurological severity scores, shortened the average latency of the Morris water maze, increased the number of platform crossings, diminished the degeneration of damaged brain tissue, and increased the positive reaction of vascular endothelial growth factor in the transplantation and surrounding areas. At 14 days after transplantation, increased BrdU/glial fibrillary acidic protein expression and decreased BrdU/neuron specific enolase expression were observed in bone marrow mesenchymal stem cells in the injured area. The therapeutic effect of bone marrow mesenchymal stem cells and collagen-chitosan scaffolds was superior to stereotactic injection of bone marrow mesenchymal stem cells alone. To test the biocompatibility and immunogenicity of bone marrow mesenchymal stem cells and collagen-chitosan scaffolds, immunosuppressive cyclosporine was intravenously injected 12 hours before transplantation and 1-5 days after transplantation. The above indicators were similar to those of rats treated with bone marrow mesenchymal stem cells and collagen-chitosan scaffolds only. These findings indicate that transplantation of bone marrow mesenchymal stem cells in a collagen-chitosan scaffold can promote the recovery of neuropathological injury in rats with traumatic brain injury. This approach has the potential to be developed as a treatment for traumatic brain injury in humans. All experimental procedures were approved by the Institutional Animal Investigation Committee of Capital Medical University, China (approval No. AEEI-2015-035) in December 2015.

13.
Brain ; 142(8): 2265-2275, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31211368

RESUMO

The natural history of intradural spinal cord arteriovenous shunts is unknown. We performed an observational study in a consecutive patient cohort with symptomatic intradural spinal cord arteriovenous shunts who were admitted to three institutes to investigate the clinical course of this complex disease, which would provide valuable evidence to inform clinical decision-making. The clinical course of patients with symptomatic intradural spinal cord arteriovenous shunts from initial presentation to occurrence of clinical deterioration, initiation of treatment, or last follow-up was analysed. Patients with at least 1 month of observation were included in this study. Clinical onset and deterioration patterns were divided into acute and gradual. Annual and cumulative rates of clinical deterioration as well as their risk factors were analysed using Kaplan-Meier life table analysis and Cox proportional hazards model. To assess risks and benefits of treatment, post-treatment clinical courses were further assessed. Four hundred and sixty-six patients with a mean observational period of 36.9 ± 58.8 months were included; 56.7% of patients presented with acute onset, of whom 77.3% experienced spontaneous recovery. Age of onset older than 28 years, initial modified Aminoff and Logue scale of >3, mid-thoracic lesions and non-ventral lesions were independent predictors of failure for spontaneous recovery. The annual risk of general, acute and gradual clinical deterioration after onset was 30.7%, 9.9% and 17.7%, respectively. Risk of deterioration was highest in the early period after initial onset. Acute onset was the only independent risk factor [hazard ratio 1.957 (95% confidence interval, CI 1.324-2.894); P = 0.0008] of acute deterioration and gradual onset was the strongest predictor [hazard ratio 2.350 (95% CI 1.711-3.229); P < 0.0001] of the gradual deterioration among all the stratifying factors. After invasive treatment, complete obliteration was achieved in 37.9% of patients (138 of 364) and improved or stable clinical status was noted in 80.8% of patients. Forty-two patients (11.5%) experienced permanent complications. Overall post-treatment deterioration rate was 8.4%/year, and 5.3%/year if permanent complications were excluded. The natural history of symptomatic spinal cord arteriovenous shunts is poor, especially in the early period after onset, and early intervention is thus recommended. Initial onset pattern significantly affects the natural history of the lesion, which prompts a differentiated treatment strategy.

14.
World Neurosurg ; 127: e407-e415, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30910755

RESUMO

OBJECTIVE: We aimed to compare the clinical efficacy of titanium mesh cage with that of allogeneic bone graft to reconstruct the anterior column through posterior approach for the surgical management of patients with thoracolumbar spinal tuberculosis with kyphosis. METHODS: From January 2011 to March 2013, 57 patients with single-segment or two-segments thoracolumbar spinal tuberculosis with kyphosis were treated by debridement, interbody graft, posterior instrumentation, and fusion via a posterior-only procedure. Twenty-four patients in group A were treated with allogeneic bone graft to reconstruct the anterior column, whereas 33 patients in group B were treated with titanium mesh cage. The clinical efficacy was evaluated by visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neurologic function recovery, kyphotic Cobb angle, and postoperative complications. RESULTS: The mean follow-up was 72.4 months. Neurologic function was significantly improved after surgery in all cases. There were significant differences of VAS, ESR, and CRP between preoperation and postoperation at the final follow-up, with no significant difference between the two groups. The kyphotic Cobb correction was significantly improved when compared with those in preoperation, but there was no significant difference between the two groups. One patient in group A with two segments involved experienced graft fracture. He had anterior bone graft with titanium mesh cage. CONCLUSIONS: Minimum 5-year follow-up outcomes showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion is an effective treatment for patients with thoracolumbar spinal tuberculosis accompanied by kyphosis. It may obtain better clinical efficacy than allogeneic bone graft for treating two-segments thoracolumbar spinal tuberculosis.


Assuntos
Transplante Ósseo , Fixadores Internos , Cifose/cirurgia , Telas Cirúrgicas , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Transplante Ósseo/métodos , Feminino , Seguimentos , Humanos , Fixadores Internos/efeitos adversos , Cifose/complicações , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Titânio , Transplante Homólogo , Resultado do Tratamento , Tuberculose da Coluna Vertebral/complicações
15.
J Transl Med ; 17(1): 64, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819183

RESUMO

BACKGROUND: Osteopenia have been well documented in adolescent idiopathic scoliosis (AIS). Adiponectin has been shown to be inversely proportional to body mass index and to affect bone metabolism. However, the circulating levels of adiponectin and the relationship between adiponectin and low bone mass in AIS remain unclear. METHODS: A total of 563 AIS and 281 age-matched controls were recruited for this study. Anthropometry and bone mass were measured in all participants. Plasma adiponectin levels were determined by enzyme-linked immunosorbent assay (ELISA) in the AIS and control groups. An improved multiplex ligation detection reaction was performed to study on single nucleotide polymorphism. Facet joints were collected and used to measure the microstructure, the expression of RANKL, OPG, osteoblast-related genes, inflammatory factors, adiponectin and its receptors by qPCR, western blotting and immunohistochemistry. Furthermore, primary cells were extracted from facet joints to observe the reaction after adiponectin stimulation. RESULTS: Compared with the controls, lower body mass index and a marked increase in circulating adiponectin were observed in AIS osteopenia (17.09 ± 1.09 kg/m2 and 21.63 ± 10.30 mg/L). A significant difference in the presence of rs7639352was detected in the AIS osteopenia, AIS normal bone mass and control groups. The T allele showed a significant higher proportion in AIS osteopenia than AIS normal bone mass and control groups (41.75% vs 31.3% vs 25.7%, p < 0.05). micro-CT demonstrated that the AIS convex side had a significant lower bone volume than concave side. RNA and protein analyses showed that in cancellous bone, higher RANKL/OPG and adipoR1 levels and lower runx2 levels were observed, and in cartilage, higher adipoR1 and IL6 levels were observed in AIS. Furthermore, convex side had higher RANKL/OPG, IL6 and adipoR1 than concave side. Compared with normal primary cells, convex side primary cells showed the most acute action, and concave side primary cells showed the second-most acute action when exposed under same adiponectin concentration gradient. CONCLUSION: Our results indicated that high circulating adiponectin levels may result from gene variations in AIS osteopenia. Adiponectin has a negative effect on bone metabolism, and this negative effect might be mediated by the ADR1-RANKL/OPG and ADR1-IL6 pathways.


Assuntos
Adiponectina/metabolismo , Doenças Ósseas Metabólicas/complicações , Osso e Ossos/patologia , Interleucina-6/metabolismo , Osteoprotegerina/metabolismo , Ligante RANK/metabolismo , Escoliose/complicações , Transdução de Sinais , Adiponectina/sangue , Adolescente , Doenças Ósseas Metabólicas/sangue , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/genética , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Tamanho do Órgão , Osteoblastos/patologia , Osteoclastos/patologia , Polimorfismo de Nucleotídeo Único/genética , Receptores de Adiponectina/metabolismo , Escoliose/sangue , Escoliose/diagnóstico por imagem , Escoliose/genética , Coluna Vertebral/patologia , Microtomografia por Raio-X , Articulação Zigapofisária/patologia
16.
Acta Neurochir (Wien) ; 161(3): 607-610, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30756244

RESUMO

BACKGROUND: Microsurgical clipping of large ophthalmic-carotid artery (OA) aneurysms is technically challenging. Among the reported approaches, pterional combined epidural and subdural approach is one of the efficient choices. METHOD: We have applied this approach to treat a 33-year old female patient with a left large OA aneurysm. The step-wise technical details of this approach are reported. CONCLUSION: We show that it is a safe way to clip large OA aneurysms through a step-wise pterional combined epidural and subdural approach, which could make a clear anatomy and a confident manipulation.


Assuntos
Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Feminino , Humanos , Procedimentos Neurocirúrgicos/instrumentação
17.
World Neurosurg ; 125: e884-e890, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30743025

RESUMO

BACKGROUND: The superficial temporal artery (STA) to proximal middle cerebral artery bypass has been reported before. However, the flow supply capacity of the double-barrel STA to proximal MCA bypass in treating complex intracranial aneurysms has not been well documented. METHODS: Consecutive cases using double-barrel STA to proximal MCA bypass to treat complex intracranial aneurysms during the past 5 years were collected. Somatosensory evoked potential monitoring and motor evoked potential monitoring were applied for each patient to identify any ischemic events during surgery. After bypass, the aneurysm was trapped, or the proximal parent artery was occluded. Digital subtraction angiography or computed tomography angiography was used to evaluate the patency of bypass postoperatively. Blood flow was measured by ultrasound before discharge. RESULTS: Among 1561 patients treated for intracranial aneurysms in our institute, 6 were included for the current report. There were 2 dominant M2 fusiform aneurysms, 2 M1 fusiform aneurysms, 1 supraclinoid internal carotid artery fusiform aneurysm, and 1 M1 bifurcation giant aneurysm. All 6 cases were successfully treated using this technique. One patient had temporary numbness in the contralateral extremities, which was caused by perforator complications. The blood flow carried by the STA was 108-232 mL/minute. CONCLUSIONS: When anastomosed to proximal branches, a double-barrel STA to MCA bypass can reliably provide a high blood flow of >100 mL/minute. Combined with aneurysm trapping or parent artery occlusion, this bypass algorithm could be an alternative treatment for complex intracranial aneurysms.


Assuntos
Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Artérias Temporais/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
18.
J Trauma Acute Care Surg ; 86(3): 440-447, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30489503

RESUMO

BACKGROUND: Genetic backgrounds have been recognized as significant determinants of susceptibility to sepsis. CXC chemokines play a significant role in innate immunity against infectious diseases. Genetic polymorphisms of CXC chemokine genes have been widely studied in inflammatory and infectious diseases but not in sepsis. Thus, we aimed to investigate the clinical relevance of CXC chemokine gene polymorphisms and susceptibility to sepsis in a traumatically injured population. METHODS: Thirteen tag single nucleotide polymorphisms were selected from CXC chemokine genes using a multimarker tagging algorithm in the Tagger software. Three independent cohorts of injured patients (n = 1700) were prospectively recruited. Selected single nucleotide polymorphisms were genotyped using an improved multiplex ligation detection reaction method. Cytokine production in lipopolysaccharide-stimulated whole blood was measured using an enzyme-linked immunosorbent assay. RESULTS: Among the 13 tag single nucleotide polymorphisms, four single nucleotide polymorphisms (rs1429638, rs266087, rs2297630, and rs2839693) were significantly associated with the susceptibility to sepsis, and three (rs3117604, rs1429638, and rs4074) were significantly associated with an increased multiple organ dysfunction score in the derivation cohort. However, only the clinical relevance of rs1429638 and rs266087 was confirmed in the validation cohorts. In addition, rs2297630 was significantly associated with interleukin 6 production. CONCLUSION: The rs1429638 polymorphism in the CXCL1 gene and the rs2297630 polymorphism in the CXCL12 gene were associated with altered susceptibility to sepsis and might be used as important genetic markers to assess the risks of sepsis in trauma patients. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level II.

19.
Pharmacology ; 103(1-2): 101-109, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30522105

RESUMO

It has been reported that taxifolin inhibit osteoclastogenesis in RAW264.7 cells. In our research, the inhibition effects of taxifolin on the osteoclastogenesis of human bone marrow-derived macrophages (BMMs) induced by receptor activator of NF-κB ligand (RANKL) as well as the protection effects in lipopolysaccharide-induced bone lysis mouse model have been demonstrated. In vitro, taxifolin inhibited RANKL-induced osteoclast differentiation of human BMMs without cytotoxicity. Moreover, taxifolin significantly suppressed RANKL-induced gene expression, including tartrate-resistant acid phosphatase, matrix metalloproteinase-9 nuclear factor of activated T cells 1 and cathepsin K, and F-actin ring formation. Further studies showed that taxifolin inhibit osteoclastogenesis via the suppression of the NF-κB signaling pathway. In vivo, taxifolin prevented bone loss in mouse calvarial osteolysis model. In conclusion, the results suggested that taxifolin has a therapeutic potential for osteoclastogenesis-related diseases such as osteoporosis, osteolysis, and rheumatoid arthritis.


Assuntos
Reabsorção Óssea/induzido quimicamente , Reabsorção Óssea/tratamento farmacológico , Lipopolissacarídeos/farmacologia , Macrófagos/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Quercetina/análogos & derivados , Ligante RANK/antagonistas & inibidores , Actinas/metabolismo , Animais , Catepsina K/metabolismo , Diferenciação Celular/efeitos dos fármacos , Modelos Animais de Doenças , Humanos , Quinase I-kappa B/metabolismo , Macrófagos/citologia , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/genética , NF-kappa B/metabolismo , Fatores de Transcrição NFATC/metabolismo , Osteólise/induzido quimicamente , Osteólise/tratamento farmacológico , Osteólise/patologia , Quercetina/farmacologia , Ligante RANK/farmacologia , Células RAW 264.7 , Transdução de Sinais , Fator de Transcrição RelA/metabolismo
20.
World Neurosurg ; 122: e315-e324, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30339909

RESUMO

OBJECTIVE: Spinal arteriovenous malformations (SAVMs) and intramedullary spinal cord cavernous malformations (ISCCMs) have a very low incidence of disease. The purpose of this study was to compare the differences in electrophysiologic monitoring in these 2 surgeries. METHODS: The study included 109 patients (SAVMs, n = 55; ISCCMs, n = 54) recruited from November 2012 to January 2016. All patients underwent electrophysiologic monitoring during the entire operation, including somatosensory-evoked potentials, motor-evoked potentials, and electromyography. We used an amplitude reduction of >80% as warning criterion for motor-evoked potentials and an amplitude reduction of more than 50% and latency prolongation of more than 10% as warning criteria for somatosensory-evoked potentials. RESULTS: In our study, the sensitivity and specificity of intraoperative monitoring during SAVM surgery were 77.3% and 87.1%, respectively. The sensitivity and specificity of intraoperative monitoring during ISCCM surgery were 68.8% and 83.3%, respectively. We found that 21 patients with SAVM showed permanent changes, 17 had immediate postoperative impairment, 8 recovered before discharge, and 5 showed neurologic deficits at long-term follow-up. Of the 17 patients with ISCCMs showing permanent changes, 11 had immediate postoperative impairment, 5 recovered before discharge, and 2 had long-term residual neurologic deficits. CONCLUSIONS: Electrophysiological monitoring provides effective guidance during operation on spinal vascular malformations. Electrophysiologic monitoring revealed that surgical resection of SAVMs resulted in more permanent changes and postoperative dysfunction when compared with ISCCMs. The incidence of both false-positive and -negative results suggests that electrophysiologic monitoring cannot fully predict the complete function of the patients.


Assuntos
Malformações Arteriovenosas/fisiopatologia , Malformações Arteriovenosas/cirurgia , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Monitorização Neurofisiológica Intraoperatória , Adolescente , Adulto , Idoso , Criança , Eletromiografia , Potencial Evocado Motor , Potenciais Somatossensoriais Evocados , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Sensibilidade e Especificidade , Medula Espinal/irrigação sanguínea , Adulto Jovem
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