Endovascular Aneurysm Treatment with the Numen Coil Embolization System: A Prospective Randomized Controlled Open-Label Multicenter Noninferiority Trial in China.

OBJECTIVE: We investigated the safety and efficacy of the Numen coil compared with the Axium coil in the treatment of intracranial aneurysms. METHODS: Because CATCH (Coil Application Trial in China) is a prospective randomized controlled open-label noninferiority trial conducted in 10 centers across China, patients who fulfilled the inclusion and exclusion criteria were randomized 1:1 to either a test group (Numen) or a control group (Axium). The primary outcome was based on successful aneurysm occlusion at 6 months follow-up, whereas secondary outcomes included technical success, the recanalization and retreatment rates, and the rate of serious adverse events (SAEs) at 6 months and 12 months follow-up. RESULTS: Between August 2017 and December 2019, 350 patients presenting with 350 aneurysms were enrolled and randomized. Per-protocol analysis showed that the successful aneurysm occlusion rate at 6 months was 91.18% for the test group compared with 91.85% in the control group, with a difference of -0.68% (P = 0.8419), and the overall mortality during the 30-day follow-up period was 1.19% and 1.81% in the test and control group, respectively, showing no significant difference between the 2 groups (P = 0.6837), whereas the SAE incidence during the 12-month follow-up period was 12.50% and 17.47% in the test and control groups, respectively, which was not statistically significant (P = 0.2222). CONCLUSIONS: This trial showed that the Numen coil was noninferior to the Axium coil in terms of intracranial aneurysm embolization and can be considered as a safe and effective coil for treating patients with intracranial aneurysm in clinical practice.

Mechanism of Rhei Radix et Rhizoma-Coptidis Rhizoma Improving Liver Insulin Resistance in db/db Mice by Regulating AMPK/ULK1/Beclin1 Pathway / 中国实验方剂学杂志

ObjectiveThis study aims to examine the effect of Rhei Radix et Rhizoma-Coptidis Rhizoma on reducing insulin resistance in db/db mice by regulating the adenylate activated protein kinase （AMPK）/UNC-51-like kinase 1 （ULK1）/key molecule of autophagy， benzyl chloride 1 （Beclin1） pathway and elucidate the underlying mechanism. MethodSixty 6-week-old male db/db mice were studied. They were randomly divided into the model group， metformin group （0.26 g·kg-1）， and low-， middle-， and high-dose groups （2.25， 4.5， 9 g·kg-1） of Rhei Radix et Rhizoma-Coptidis Rhizoma. A blank group of db/m mice of the same age was set， with 12 mice in each group. After eight weeks of continuous intragastric administration， the blank group and model group received distilled water intragastrically once a day. The survival status of the mice was observed， and fasting blood glucose （FBG） was measured using a Roche blood glucose device. Fasting serum insulin （FINS） was measured using an enzyme-linked immunosorbent assay， and the insulin resistance index （HOMA-IR） was calculated. Hematoxylin-eosin （HE） staining was performed to observe the pathological changes in the liver of the mice. The protein expression levels of AMPK， Beclin1， autophagy associated protein 5 （Atg5）， and p62 in liver tissue were determined by using Western blot. The protein expression levels of autophagy associated protein 1 light chain 3B （LC3B） and ULK1 in liver tissue were determined using immunofluorescence. Real-time fluorescence quantitative PCR （Real-time PCR） was used to measure mRNA expression levels of AMPK， Beclin1， Atg5， ULK1， and p62. ResultCompared with the blank group， the model group exhibited a significant increase in body mass （P<0.01）. Additionally， the levels of FBG， FINS， and HOMA-IR significantly changed （P<0.01）. The structure of liver cells was disordered. The protein expression levels of AMPK， Beclin1， and Atg5 in liver tissue were significantly decreased （P<0.01）， while the expression level of p62 protein was significantly increased （P<0.01）. The expression levels of mRNA and proteins were consistent. Compared with the model group， the body mass of the metformin group and high and medium-dose groups of Rhei Radix et Rhizoma-Coptidis Rhizoma was significantly decreased （P<0.05）. FBG， FINS， and HOMA-IR were significantly decreased （P<0.05，P<0.01）. After treatment， the liver structure damage in each group was alleviated to varying degrees. The protein expressions of AMPK， Beclin1， Atg5， LC3B， and ULK1 were increased （P<0.05，P<0.01）， while the protein expression of p62 was decreased （P<0.01）. The expression levels of mRNA and proteins were generally consistent. ConclusionThe combination of Rhei Radix et Rhizoma-Coptidis Rhizoma can effectively improve liver insulin resistance， regulate the AMPK autophagy signaling pathway， alleviate insulin resistance in db/db mice， and effectively prevent the occurrence and development of type 2 diabetes.

Using Transcriptome Analysis to Identify Genes Involved in Switchgrass Flower Reversion.

Floral reversion is a process in which differentiated floral organs revert back to vegetative organs. Although this phenomenon has been described for decades, the underlying molecular mechanisms remain unclear. In this study, we found that immature switchgrass (Panicum virgatum) inflorescences can revert to neonatal shoots when incubated on a basal medium with benzylaminopurine. We used anatomical and histological methods to verify that these shoots were formed from floret primordia through flower reversion. To further explore the gene regulation of floral reversion in switchgrass, the transcriptome of reversed, unreversed, and uncultured immature inflorescences were analyzed and 517 genes were identified as participating in flower reversion. Annotation using non-redundant databases revealed that these genes are involved in plant hormone biosynthesis and signal transduction, starch and sucrose metabolism, DNA replication and modification, and other processes crucial for switchgrass flower reversion. When four of the genes were overexpressed in Arabidopsis thaliana, vegetative growth was facilitated and reproductive growth was inhibited in transgenic plants. This study provides a basic understanding of genes regulating the floral transition in switchgrass and will promote the research of floral reversion and flower maintenance.

Multislice computed tomography performance in differential diagnosis of high-density thymic cyst and thymoma in lesions less than 3 cm.

BACKGROUND: This study was conducted to evaluate the performance of multislice computed tomography (MSCT) to diagnose high-density thymic cysts and thymomas in lesions measuring < 3 cm. METHODS: The records of 42 patients admitted to Ningbo No. 2 Hospital with an anterior mediastinal mass (diameter < 3 cm) suspected of carcinoma originating from the thymus were retrospectively analyzed. All patients underwent surgery and pathological examination. Twenty-eight were diagnosed with thymic cysts and 14 with thymoma. The features of thymic cysts and thymomas revealed on MSCT were compared. RESULTS: Mediastinal masses with a triangular or teardrop shape and a straight mediastina-lung border were more likely to be diagnosed as thymic cysts (P < 0.05), while those with a bulging nodule-lung border were more likely thymomas (P < 0.05). Using the CT value as a reference for differential diagnosis, the diagnostic sensitivity, specificity, and area under the receiver operating characteristic curve for CT values of non-contrast CT images, enhanced CT values, and ΔCT values were 0.65 (0.47-0.84), 0.95(0.86-1.00), and 0.96 (0.89-1.00), respectively. CONCLUSION: MSCT of high-density thymus gland nodules (maximum diameter ≤ 3 cm) can reveal specific features that could be helpful for differential diagnosis.

Efficacy and Safety of KRASG12C Inhibitors in Advanced Solid Tumors with KRASG12C-mutated: A Single-arm Meta-analysis / 肿瘤防治研究

Objective To systematically study the efficacy and safety of KRASG12C inhibitors in advanced solid tumors with KRASG12C-mutated. Methods Computer searches from PubMed, The Cochrane Library, Web of Science, Embase, CNKI, and CBM databases were conducted to collect clinical studies on KRASG12C inhibitors in advanced solid tumors with KRASG12C-mutated, with a search time from inception to October 12, 2022. Then, two investigators independently screened the literature, extracted information, assessed the risk of bias in included studies, and performed meta-analyses using RevMan 5.4 software. Results There were four publications included, all of which were single-arm clinical studies. The KRASG12C inhibitors that completed clinical phase Ⅰ and Ⅱ trials were sotorasib and adagrasib, with two publications each. A total of 388 and 394 patients were included in the efficacy evaluation and safety evaluation, respectively. Resultsof the Meta-analysis showed that the patients had objective response rate, overall disease control, and disease stabilization rates of 35%, 82%, and 45%, respectively. In addition, the rate of serious adverse events, general adverse events, and all adverse events in patients was 2%, 28%, and 79%, respectively. Moreover, the rate of partial remission of disease in NSCLC patients was 38%. Conclusion The KRASG12C inhibitors sotorasib and adagrasib exhibited good efficacy and high safety in advanced solid tumors.

Development of dose verification methods for boron neutron capture therapy / 中华放射医学与防护杂志

To summarize the progress in BNCT dose verification method in the world and discusses their development prospects. Boron neutron capture therapy (BNCT) utilizes the specific capture reaction between the neutrons and boron drugs enriched in tumor cells to selectively kill tumor cells. In order to verify the accuracy of the radiotherapy plan and ensure the therapeutic effect on patients, it is necessary to measure the dose before treatment and compare the experimental radiation dose with the planned dose. The current BNCT dose measurement method mainly include point dose measurement method based on ionization chambers, thermoluminescence dosimeters and activation foils, two-dimensional dose measurement method based on films, and three-dimensional dose measurement method based on gel dosimeters.

Repairing Effects of Ginsenoside Rg1 on Traumatic Brain Injury in Mice / 实验动物与比较医学

Objective To explore the effects of ginsenoside Rg1 on blood-brain barrier, neuroinflammation and behavioral function of traumatic brain injury (TBI) mouse model.MethodsThe experiment was divided into two parts. In the first part, 27 SPF male BALB/c mice were randomly divided into blank group, sham operation group and TBI model group, with 9 mice in each group. TBI model group was made by controlled cortical impact (CCI) after craniotomy, while sham operation group was only performed craniotomy without any treatment, and the blank group was not treated at all. The effect of modeling was evaluated after operation. In the second part, 50 male BALB/c mice were randomly divided into sham operation group, three different drug dosage groups and solvent (DMSO) control group, with 8 mice in each group. The drug treatment groups were injected with ginsenoside Rg1 at the doses of 10, 20 and 40 mg/kg respectively 6 hours after TBI model had been successfully established, while the DMSO control group was given the same amount of 1% DMSO for one week, twice a day. Modified neurological severity scores (mNSS) were performed on the 1st, 3rd, 7th and 14th day after modeling, and the blood-brain barrier leakage was detected by Western blotting on the 3rd day after modeling. On the 14th and 16th day, the elevated cross maze test and water maze test were used to detect the neurobehavioral function. On the 28th day after anesthesia and perfusion, the brains were taken out, and the neuroinflammation such as activation of microglia and astrocytes was observed by immunofluorescence staining.ResultsThe expression level of MMP-9, a marker of blood-brain barrier, decreased in ginsenoside Rg1 treatment group (P<0.01). The number of microglia （Iba-1 positive) and astrocyte (GFAP positive) cells decreased significantly (P<0.05), which indicated that neuroinflammation was inhibited, and the best effect was achieved at the dosage of 20 mg/kg (P<0.01). The mNSS of mice in ginsenoside Rg1 treatment group were significantly lower than those in DMSO control group (P < 0.01), and the proportion of times they entered the open arm was significantly higher than that in DMSO control group (P < 0.05). The time ratio in the quadrant where the water maze experimental platform was located and the times of crossing the platform were significantly higher than those in control group (P < 0.05), and the dosage of 20 mg/kg had the best effect.ConclusionThe TBI mouse model was successfully constructed and applied to the study of ginsenoside Rg1 repair of mouse traumatic brain injury. Ginsenoside Rg1 can significantly improve blood-brain barrier, alleviate neuroinflammation and improve neurobehavioral function in TBI model mice, and the effect is the most significant at the dose of 20 mg/kg.

Dahuang Mudantang Alleviates Intestinal Injury in Rat Model of Acute Pancreatitis by Regulating HMGB1/RAGE/NF-κB Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of Dahuang Mudantang in alleviating the intestinal injury in the rat model of acute pancreatitis via the high-mobility group box 1 （HMGB1）/receptor for advanced glycation endproduct （RAGE）/nuclear factor-κB （NF-κB） signaling pathway. MethodOne hundred and twenty SPF-grade Wistar rats received retrograde injection of 5% sodium taurocholate into the biliopancreatic duct for the modeling of intestinal injury in acute pancreatitis. The rats were randomized into blank， model， low-， medium-， and high-dose （3.5， 7， 14 g·kg-1， administrated by gavage） Dahuang Mudantang， and octreotide （1×10-5 g·kg-1， subcutaneous injection） groups （n=20）. The rats in blank and model groups received equal volume of distilled water by gavage. Drugs were administered 1 h before and every 12 h after modeling， and samples were collected 24 h after modeling. The general status of the rats was observed. The biochemical methods were employed to measure the levels of amylase （AMS） and C-reactive protein （CRP） in the serum. The enzyme-linked immunosorbent assay （ELISA） was employed to measure the levels of tumor necrosis factor （TNF）-α， interleukin （IL）-1β， and IL-6 in the colon tissue. The morphological changes of pancreatic and colon tissues were observed by hematoxylin-eosin （HE） staining. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot were employed to measure the expression levels of HMGB1， RAGE， inhibitor of NF-κB kinase （IKK）， and NF-κB suppressor protein α（IκBα）in the colon tissue. ResultThe rats in the model group showed poor general survival， writhing response， reduced frequency of defecation， and dry stool. The symptoms of rats in the model group were mitigated in each treatment group， and the high-dose Dahuang Mudantang showed the most significant effect. Compared with the normal group， the model group had elevated AMS and CRP levels （P<0.05）， which were lowered by Dahuang Mudantang （P<0.05）， especially that at the high dose （P<0.05）. Compared with the normal group， the modeling elevated that levels of TNF-α， IL-1β， and IL-6 （P<0.05）. Such elevations were lowered by Dahuang Mudantang （P<0.05）， and the high-dose group and the octreotide group showed better performance （P<0.05）. The modeling caused necrotic， congested， and destructed pancreatic and colonic tissues， which were ameliorated by the drugs， especially high-dose Dahuang Mudantang. Compared with the normal group， the modeling up-regulated the mRNA levels of HMGB1， RAGE， IKK， IκBα， and NF-κB （P<0.05）. Compared with the model group， Dahuang Mudantang and octreotide down-regulated the mRNA levels of HMGB1， RAGE， IKK， IκBα， and NF-κB （P<0.05）， and the high-dose Dahuang Mudantang demonstrated the best performance （P<0.05）. Western blot results showed a trend consistent with the results of Real-time PCR. ConclusionDahuang Mudantang can improved the general status， reduce inflammation， and alleviate histopathological changes in the pancreatic and colon tissues in the rat model of acute pancreatitis by inhibiting the HMGB1/RAGE/NF-κB signaling pathway.

Mechanism of Dahuang Mudantang in Improving Pancreatic Injury in Rats with Acute Pancreatitis of Dampness-heat in Large Intestine Syndrome Based on Network Pharmacology and Experimental Verification / 中国实验方剂学杂志

ObjectiveTo reveal the intervention effect of Dahuang Mudantang on pancreatic injury in rats with acute pancreatitis （AP） of dampness-heat in large intestine syndrome and explore its possible mechanism based on network pharmacology. MethodNinety-six SPF-grade Wistar rats were randomly divided into the following six groups： a blank group， a model group， low-， medium-， and high-dose Dahuang Mudantang groups （3.5， 7， and 14 g·kg-1）， and a Qingyi Lidan granules group （3 g·kg-1）， with 16 rats in each group. The AP model of dampness-heat in large intestine syndrome was induced in rats except for those in the blank group by "high-temperature and high-humidity environment + high-sugar and high-fat diet + retrograde injection of 5% sodium taurocholate into the pancreaticobiliary duct". The blank and model groups received equal volumes of distilled water by gavage， while the treatment groups were administered Dahuang Mudantang or Qingyi Lidan granules 1 hour before modeling， and 12 and 24 hours after modeling. Samples were collected 1 hour after the last administration. The general conditions of the rats were observed. The AP model of dampness-heat in large intestine syndrome was evaluated. Serum amylase （AMS） and C-reactive protein （CRP） levels were determined using biochemical methods. Pancreatic tissue morphology was observed using hematoxylin-eosin （HE） staining. Network pharmacology was employed to predict potential targets of Dahuang Mudantang in the intervention in AP， and molecular biology technique was used to verify relevant targets. ResultCompared with the blank group， the model group exhibited lethargy， unkempt fur， loose and foul-smelling stools， elevated anal temperature with arching and twisting reactions， significantly increased serum levels of AMS and CRP （P<0.05）， abnormal pancreatic ductules， disordered interlobular spaces， and inflammatory cell infiltration in histopathological examination， as well as pathological changes including pancreatic acinar cell swelling， congestion， and necrosis. Compared with the model group， the treatment groups showed varying degrees of improvement in general survival conditions， reduced twisting reactions， visibly improved stool characteristics， reduced pancreatic tissue edema and necrosis， decreased serum AMS and CRP levels （P<0.05）， with the high-dose Dahuang Mudantang group showing the most pronounced effects （P<0.05）. Network pharmacology prediction indicated that hederagenin， β-sitosterol， and quercetin were the most widely connected active compounds with disease targets. Protein-protein interaction （PPI） network analysis revealed that protein kinase B （Akt）， tumor protein P53 （TP53）， tumor necrosis factor （TNF）， interleukin-6 （IL-6）， transcription factor （JUN）， vascular endothelial growth factor α （VEGFα）， interleukin-1β （IL-1β）， and vascular cell adhesion molecule-1 （VCAM1） were key targets in the "drug-disease" interaction. KEGG enrichment analysis suggested that the response of the mitogen activated protein kinase （MAPK） signaling pathway might be a core mechanism for DHMDT in the intervention in AP. Molecular biology analysis showed that compared with the blank group， the model group had significantly increased levels of TNF-α， IL-6， and VCAM-1 in pancreatic tissue （P<0.05）， as well as significantly elevated expression levels of p38 mitogen-activated protein kinase （p38 MAPK）， mitogen-activated protein kinase-activated protein kinase 2 （MK2）， and human antigen R （HUR） genes and proteins （P<0.05）. Compared with the model group， the treatment groups exhibited decreased levels of TNF-α， IL-6， and VCAM-1 in pancreatic tissue （P<0.05）， reduced expression levels of p38 MAPK， MK2， and HUR genes and proteins， with the high-dose Dahuang Mudantang group showing the most pronounced effects （P<0.05）. ConclusionDahuang Mudantang activates and regulates the p38 MAPK/MK2/HUR signaling pathway to suppress the release of inflammatory factors， thereby improving pancreatic injury.

Endovascular recanalization of symptomatic non-acute internal carotid artery occlusion: a new patient classification proposal / 中华神经医学杂志

Objective:Based on single-center clinical results of endovascular recanalization for symptomatic non-acute internal carotid artery occlusion (ICAO), a new patient classification method is proposed to distinguish the most suitable ICAO patient subgroups for endovascular recanalization.Methods:A total of 140 patients with symptomatic non-acute ICAO accepted endovascular recanalization in Department of Cerebrovascular Intervention, He'nan Provincial People's Hospital from January 2019 to December 2021 were selected. These patients were divided into low risk group ( n=57), medium risk group ( n=54) and high risk group ( n=29) according to the occlusion segments, occlusion times, plaque features, calcification at the occlusion site and occlusion segment angulation. The immediate postoperative recanalization rate, perioperative complications, perioperative death, and prognoses 90 d after endovascular recanalization (modified Rankin scale scores of 0-2 as good prognosis) were evaluated in the 3 groups. Results:The immediate postoperative recanalization rate was 82.9% (114/140), perioperative complication rate was 11.4% (16/140), and perioperative mortality was 0.7% (1/140). The success recanalization rate decreased gradually from the low risk group to the high risk group (100%, 85.2%, and 37.9%), while the perioperative complication rate was the opposite (0%, 11.1%, and 34.5%), with significant differences ( P<0.05). Ninety d after endovascular recanalization, 109 patients had good prognosis and 27 had poor prognosis; the good prognosis rate in low risk group, medium risk group and high risk group was 98.2%, 79.6% and 34.5%, respectively, with significant differences ( P<0.05). The vascular restenosis rate in low risk group, medium risk group and high risk group was 0%, 8.7% and 18.2%, and re-occlusion rate was 0%, 6.5% and 27.2%, respectively, 90 d after endovascular recanalization, with significant differences ( P<0.05). Conclusion:Endovascular recanalization is technically feasible for patients with symptomatic non-acute ICAO, especially those met the criterions of low and medium risk groups in our study.

Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection: an application and follow-up study / 中华神经医学杂志

Objective:To investigate the safety and effectiveness of Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.Methods:A retrospective analysis was performed. Six patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection admitted to the 3 hospitals from May 2016 to December 2019 were chosen; their clinical data were collected. The surgical processes and complications were concluded, and the prognoses were evaluated by modified Rankin scale (mRS).Results:One patient was treated with intraoperative simple tamponade compression for hemostasis, and died for massive intracranial hemorrhage 2 weeks after surgery. Five patients were occluded by Willis covered stents; the occluded success rate was 100% but ophthalmic arteries were blocked in all. During the perioperative period, diabetes insipidus occurred in one patient and incomplete oculomotor paralysis occurred in one patient; 5 patients were followed up for 3-12 months: MRI indicated subtotal resection of tumor in 4 patients and total resection in one patient, no new bleeding or ischemic stroke events occurred in these 5 patients, and the prognosis was good.Conclusion:Willis covered stent is safe and effective in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.

The clinical diagnosis and treatment strategy of lumbar brucellar spondylitis / 中华骨科杂志

Lumbar brucellar spondylitis is an infectious disease caused by the invasion of brucella. The incidence has been on the rise in recent years. And it threatens people's health seriously. Early and proper diagnosis and treatment is the key to cure patients with lumbar brucella spondylitis. However, in the early stage of the disease, there are only nonspecific symptoms such as back pain, fever, and sweating. If the patient has the above symptoms and epidemiological history of direct or indirect livestock contact, and inflammatory signals of the vertebrae or intervertebral space are visible on MRI, the possibility of early infection of lumbar brucella spondylitis should be considered. It is not difficult to make the diagnosis of lumbar brucella spondylitis in the middle and late stages by taking into account the epidemiology, symptoms, signs, laboratory tests, and the imaging features such as narrowing of the intervertebral space, abnormal signals of the vertebral body and disc, bone destruction and sclerosis, "lace-like" appearance, sequestrum formation and limited paraspinal abscess. Patients in these stages often present with serious manifestations such as lumbar instability due to bone destruction, and the focus is on surgical intervention. The basic principle of surgical treatment is lesion removal combined with fixation. Intraoperative reduction of damage to bone and ligamentous structures such as the posterior ligamentous complex and strong fixation will contribute to the complete cure of the disease. By referring to the literature on lumbar brucellar spondylitis, this paper focuses on the etiology, pathogenesis, clinical manifestations, imaging features, laboratory tests and conservative and surgical treatment of the disease, aiming to provide a basis for clinical diagnosis and treatment.

Morphological and hemodynamic stress characteristics of infundibular dilatation of the posterior communicating artery / 中华神经医学杂志

Objective:To investigate the morphological and hemodynamic stress characteristics of infundibular dilatation of the posterior communicating artery.Methods:From January 2018 to May 2020, 30 patients with infundibular dilatation of the posterior communicating artery (observation group) found by digital substraction angiography (DSA) for suspecting as having equivocal posterior communicating artery aneurysm in our hospital were selected. The angle between posterior communicating artery and internal carotid artery, and hemodynamics stress parameters at the infundibular dilatation of the posterior communicating artery (total pressure and shear force) were measured by DSA and quantitatively analyzed by computational fluid dynamics methods. Thirty patients without intracranial aneurysm and with normal posterior communicating arteries admitted to our hospital at the same period were used as control group.Results:The mean value of the bending angle between the posterior communicating artery and internal carotid artery in the control group was ([80.1±8.4]°), which was significantly higher than that in the observation group ([73.2±5.8]°, P<0.05). The shear force and total pressure of infundibular dilatation of the posterior communicating artery of the observation group ([8.32±0.70] Pa and [85.61±6.04] Pa), which were significantly higher than those of the control group at the same locations ([3.95±0.28] Pa and [25.72±7.18] Pa, P<0.05). Conclusion:There are significant differences in hemodynamic stress between the normal posterior communicating artery and the infundibular dilatation of the posterior communicating artery, which might play an important role in triggering the formation of aneurysms.

Recanalization for symptomatic chronic internal carotid artery occlusion: a preliminary study / 中华放射学杂志

Objective:To evaluate the value of endovascular recanalization and hybrid recanalization for chronic internal carotid artery occlusion(COICA), and to evaluate its feasibility, safety, success rate, and clinical outcomes.Methods:Totally 35 patients who received endovascular recanalization or hybrid recanalization with symptomatic COICA were enrolled from January 2019 to December 2019 in Department of Cerebrovascular Disease,Zhengzhou University People′s Hospital. The clinical characteristics, treatment strategies, success rate, and major events of the patients were analyzed retrospectively.Results:Thirty of 35 patients were successfully recanalized. Among them, hybrid recanalization was performed in 3 cases, carotid endarterectomy was performed in 1 case, and endovascular recanalization was performed in 26 cases, 5 patients failed because they could not reach the distal true cavity. Among the successful patients, 5 patients had operation-related complications, 3 patients had embolism cerebral infarction, 1 patient had hyperperfusion cerebral hemorrhage, 1 patient still had transient ischemic attack after operation. All patients were followed up clinically, 2 patients had reoccurrence of obstruction, 2 patient had restenosis, the remaining patients had no hemodynamic stenosis or reocclusion.Conclusion:In highly-selected cases, intracavitary recanalization for symptomatic COICA is feasible, relatively safe and effective.

Endovascular recanalization in non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery / 中华神经医学杂志

Objective To investigate the safety,efficacy and feasibility of endovascular recanalization in non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery,and analyze the factors affecting its success.Methods Fifty-four patients with non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery,underwent endovascular recanalization in our hospital from January 2013 to December 2017,were enrolled.Modified Rankin scale (mRS) and National institutes of health stroke scale (NIHSS) scores were compared before and after treatment;the prognosis results were analyzed after 2 years of follow-up.Independent factors influencing the prognoses were identified by Logistic regression analysis.Results Recanalization was achieved in 52 patients and failure was noted in two patients.The mRS scores and NIHSS scores before treatment (2.25±0.13,18.43±1.36) were significantly higher than those after treatment (1.44±0.05,11.81±0.71,P＜0.05).After 2 years of follow-up,good prognosis was noted in 42 patients,poor prognosis in 8 patients,and loss of follow-up in 2 patients.Multivariate Logistic analysis showed that history of hypertension and history of diabetes were independent risk factors for the prognoses of patients with non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery after endovascular reeanalization (OR=1.429,95CI:1.146-1.783,P=0.005;OR=2.597,95CI:2.364-2.854,P=0.005).Conclusion The curative effect of interventional therapy for non-acute occlusion of symptomatic internal carotid artery is reliable,and histories of hypertension and diabetes can affect the prognoses of patients.

Treatment of posterior longitudinal ligament ossification of thoracic spine with posterior transforaminal spinal decompression / 中华骨科杂志

Objective To explore the safety,efficacy and outcomes of posterior transforaminal spinal cord reduction in the treatment of severe thoracic ossification of the posterior longitudinal ligament.Methods Since May 2010 to May 2016,21 patients with thoracic spinal stenosis with ossification of the posterior longitudinal ligament and embedding rate of more than 50％ underwent posterior circular decompression,12 males and 9 females;age 42-71 years old,with an average of 63.3±1.6 years old.There were severe spinal cord compression symptoms before surgery.The operation was from the posterior median approach.First,the pedicle screw tract was preset in the upper and lower segments where decompression was required,and then the posterior wall of the spinal canal was removed by the "uncovering method" to complete the posterior decompression.Through the superior and inferior articular joints,the joints were removed,the intercostal nerves were pushed outward,the extracorporeal intervertebral space and intervertebral disc tissue were revealed,and the vertebral cancellous bone of the lower vertebral body was removed.Separate the adhesion of the dura mater,use the special tool to cut the upper and lower edges of the posterior longitudinal ligament,collapse,remove the posterior longitudinal ligament ossification block,and complete the decompression of the front of the spinal cord through one or both sides.Finally,the pedicle screw fixation and the intervertebral bone graft were completed.Postoperative follow-up (mean 38.5 months) CT and MRI scans were performed to observe the patency of the spinal canal and the state of the internal fixation.The Frankel graded evaluation function was restored,the JOA score was used to evaluate the neurological function,the Otani evaluation system was used to evaluate the surgical outcome,the clinical excellent rate was calculated,and the treatment effect was evaluated.Results Nineteen cases recovered after operation,and 1 case showed a transient decrease in unilateral lower extremity motor function on the second day after surgery.It returned to normal after dehydration and neurotrophic support treatment,and 1 case had bilateral lower limbs on the day after surgery.Muscle strength was transiently lost,feeling recovered after 6 hours,and exercise resumed after 48 hours.The operation time was 180-300 min,with an average of 240±23 min.The intraoperative blood loss was 168±12 ml.Postoperative spinal cord function recovered significantly.At the last follow-up,Frankel graded F in 8 cases and grade E in 13 cases.Preoperative average JOA score was 3.5,and the JOA score of the follow-up was increased from 3.5±0.98 points to 9.0±0.9 points.The improvement rate of JOA score was excellent in 14 cases,good in 5 cases,and fair in 2 cases.According to Otani system there was excellent in 14 cases,good in 6 cases,and fair in 1 case.The excellent and good rate was 95.24％.Cerebrospinal fluid leakage occurred in 3 cases and healed after symptomatic treatment.No chest occurred during the follow-up period.The vertebral instability,internal fixation loose,broken.Conclusion Posterior transforaminal spinal decompression of posterior longitudinal ligament ossification of thoracic spine can be finished using self-developed special surgical tools,which is safe,effective and can achieve full decompression of spinal cord.

Study on the relationship between 25-hydroxyl vitamin D deficiency and food allergy in children with atopic dermatitis / 重庆医学

Objective The purpose of this study was to detect serum 25-hydroxyvitamin D [25-(OH) VitD] levels in children with atopic dermatitis (AD) and to explore its association with food allergy (FA).Methods Sixty cases of infant patients with AD have been collected.The morning fasting venous blood were obtained to check the 25-(OH)VitD level in serum.Moreover,IgE in 6 kinds of common food was also tested.Multiple regression analysis was used to analyze the relation between 25-(OH)VitD level in serum and FA.The potential risks and confounding factors were adjusted.Results Among the 60 AD children,67.4％ of them had FA,and the majority of them had milk allergy (86.84％),no wheat allergy was found.There was a positive correlation between 25-(OH) VitD levels and age (r=0.46,P＜ 0.01),but no statistical correlation with total IgE levels (P＞0.05).25-(OH)VitD deficiency may significantly increase the risk of suffering from FA (OR=11.20,95％CI:1.35-73.66,P=0.023).Conclusion The decrease of the 25-(OH)VitD level in infant patients with AD is associated with FA.What's more,25-(OH)VitD deficiency may be a risk factor for increasing FA.

Comparison of the effects of different fixation methods on open-door side in posterior expansive open-door laminoplasty / 中华骨科杂志

Objective To investigate the clinical outcome and complications of different types of expansive open door laminoplasty in cervical spondylotic myelopathy.Methods From December 2008 to June 2012,221 patients with cervical spondylotic myelopathy treated with expansive open-door laminoplasty were divided into micro-titanium plate fixed group (96 cases),wire hanging fixed group(66 cases),anchor suspension fixed group (59 cases).The clinical outcome was evaluated including JOA score,operation time,bleeding volume,spinal cord pressure (a/M),cervical range of motion (ROM),open door angle,posterior shift distance of spinal cord and postoperative complications.Results All patients were followed up for more than 2 years.There were no significant differences in general condition,operation time,intraoperative blood loss,preoperative and postoperative 2 years JOA score,JOA score improvement rate,spinal cord shift distance,spinal cord compression among three groups;In the incidence of C5 nerve root paralysis,there was no significant difference between the silk suspension fixation group (12.1％) and the anchored suspension group (11.9％).The incidence of C5 nerve root paralysis for microplate fixation group (2.1％) was significantly lower than that of the silk suspension fixation group and anchored suspension fixation group,and the difference was statistically significant.There was no significant difference in the fusion rate between the 3-month and 6-month portal arteries in the group of silk suspension fixation group(65％,82％) and anchor fixation group(61％,82％).The fusion rate of the microtiter plate fixation group(90％,98％) was significantly higher than that of the silk suspension group and the anchorage group at 3 months and 6 months after operation.There were no significant differences in the incidence of recurrence,the total amount of cervical spine loss and the incidence of axial symptoms after 6 months of operation in the suspension group and the anchor suspension group.The incidence of occlusion,the total amount of cervical spine loss and the incidence of axial symptoms were significantly lower in the micro titanium plate fixation group than those in the silk suspension group and the anchorage fixation group,the difference was statistically significant.Conclusion Using micro-titanium plate to fix the side of open door could achieve full spinal cord decompression and access to satisfactory neurological improvement rate.At the same time,compared with the traditional silk or anchor suspension,the use of micro-titanium plate is more conducive to the door axis bone healing,prevent the occurrence of reclosing,significantly reduce the loss of postoperative cervical range of motion,and reduce the incidence of axial symptoms with the satisfaction of the clinical outcome.

The application of indwelling guide-wire technique in performing mechanical thrombectomy for acute cerebral artery occlusion / 介入放射学杂志

Objective To discuss the application value,safety and feasibility of indwelling guidewire technique in performing mechanical thrombectomy for acute cerebral artery occlusion.Methods The clinical data of 15 patients with acute ischemic stroke,who were treated with mechanical thromnectomy at authors' hospital during the period from December 2015 to February 2016,were retrospectively analyzed.The diseases included middle cerebral artery occlusion (n=6),internal carotid artery and middle cerebral artery occlusion (n=5) and vertebral basilar artery occlusion (n=4).Indwelling guide-wire technique was adopted to quickly and accurately determine the vascular occlusion characteristics,then,endovascular mechanical thrombectomy was carried out.Results By using indwelling guide-wire technique,the occlusive features of the diseased arteries were successfully and precisely determined.Immediate recanalization of the occluded artery was obtained in 13 patients (87％).The blood flow classification score after thrombolysis in cerebral infarction (TICI) reached 3 points in 10 patients and 2b points in 5 patients.In 2 patients,the vascular recanalization procedure failed because the thrombus load was large,the length of occluded segment was long,and the effect of mechanical thromnectomy was poor.According to American National Institutes of Health Stroke Scale (NIHSS),the evaluation score was improved from preoperative (19.2±7.0) to postoperative (6.3±3.6),the difference was statistically significant (P＜0.05).Three months after the treatment,the score measured by modified Rankin scale(mRS) was ≤2 points in 10 patients.Conclusion Mechanical thrombectomy is safe and effective for the treatment of acute cerebral artery occlusion.The indwelling guide-wire technique can safely,conveniently,quickly and accurately determine the characteristics of the occluded blood vessels,which is very helpful in assisting surgical manipulation,reducing procedure-related complications,and improving vascular recanalization rate.(J Intervent Radiol,2017,26:202-205)

Cervical expensive open-door laminoplasty combined with vitamin B12 treatment for patients of cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord / 中华骨科杂志

Objective To investigate the clinical outcome of cervical expensive open-door laminoplasty combined with vitamin B12 treatment for patients of cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord.Methods Data of 10 patients with cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord in February 2013 to August 2013 were retrospectively analyzed.There were 7 males and 3 females with an average age of 46 years (range,32-73 years).Eight patients' history was in six months,and others' was beyond six months.All patients had undergone cervical expansive open-door laminoplasty with mini-plate fixation combined with intramuscular injection or pre os vitamin B 12.Patient imaging data were used to assess the stability of the cervical spine,and spinal cord compression in the fixed position before and after their surgery.Japanese Orthopaedic Association (JOA) score was used to evaluate function,and the rate of neurological improvement was calculated.The American Spinal Injury Association was used to evaluate the neurological function inpatients before and after surgery.The preoperative and postoperative numerical changes of SEP and vitamin B 12 were compared using correlation analysis.Each dimension of preoperative and postoperative scores change was compared by Life quality evaluation F-36 scale.Results All patients were followed up for an average period of 15 months (range,6-26 months).There were no complications related to the internal fixation,such as fixation loosened or broken.Cerebrospinal fluid surrounding the spinal cord within the C3-7 range of the signal on MRI T2WI of the continuous had been recovered.JOA score increased from preoperative 9.6±2.04 to postoperative 14.7±2.04,and postoperative neurological improvement rate was 20％-80％.The excellent and good rate was 90％ (9/10) including 4 excellent and 5 good.Vitamin B12 level before operation:78.30±42.82 pg/ml,postoperative:176.50±85.77 pg/ml.Electromyography and SEP had been all recovered.There was correlation between preoperative and postoperative vitamin B 12 levels with spinal cord function score.According to ASIA score,there were 4 cases in C level,6 in D level preoperatively,while 2 in C level,5 in D level,3 in E level postoperatively.Conclusion Cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord could be treated by surgery.Vitamin B 12 by per os or intramuscular injection with removal of the cervical spinal cord compression which creates a space for recovery of spinal cord could improve the surgical curative effect.