Effect of ginsenoside Rg1 on proliferation and neural phenotype differentiation of human adipose-derived stem cells in vitro.

AIMS: To investigate whether ginsenoside Rg1 can promote neural phenotype differentiation of human adipose-derived stem cells (hASCs) in vitro. METHODS: hASCs were isolated from lipo-aspirates, and characterized by specific cell markers and multilineage differentiation capacity after culturing to the 3rd passage. Cultured hASCs were treated with neural inductive media alone (group A, control) or inductive media plus 10, 50, or 100 µg/mL ginsenoside Rg1 (groups B, C, and D, respectively). Cell proliferation was assessed by CCK-8 assay. Neuron specific enolase (NSE) and microtubule-associated protein-2 (MAP-2) levels were measured by Western blot. mRNA levels of growth associated protein-43 (GAP-43), neural cell adhesion molecule (NCAM), and synapsin-1 (SYN-1) were determined by real-time PCR. RESULTS: Ginsenoside Rg1 promoted the proliferation of hASCs (groups B, C, and D) and resulted in higher expression of NSE and MAP-2 compared with the control group. Gene expression levels of GAP-43, NCAM, and SYN-1 in the test groups were higher than that in thw control. The results displayed a dose-dependent effect of ginsenoside Rg1 on cell proliferation and neural phenotype differentiation. CONCLUSION: This study indicated that ginsenoside Rg1 promotes cell proliferation and neural phenotype differentiation of hASCs in vitro, suggesting a potential use for hASCs in neural regeneration medicine.

Gekko Coil System for Intracranial Aneurysms Treatment in China (GREAT-China): A Prospective Randomized Controlled Open-Label Noninferiority Trial.

OBJECTIVE: This study aimed to evaluate the safety and efficacy of the Gekko coil system in treating intracranial aneurysms (IAs) in clinical practice. METHODS: A prospective multicenter randomized open-label parallel positive control noninferiority trial was conducted by 11 centers in China. Patients with a target IA were randomized 1:1 to coiling with either Gekko or Axium coils. The primary outcome was successful aneurysm occlusion at 6 months postoperative follow-up, whereas the secondary outcomes included the successful occlusion aneurysm rate in the immediate postoperative period, recanalization rate at the 6 months follow-up, and technical success and security. RESULTS: Between May 2018 and September 2020, 256 patients were enrolled and randomized. Per-protocol analysis showed that the successful aneurysm occlusion rate at 6 months was 96.08% for the Gekko coil group compared with 96.12% in the Axium coil group, with a difference of -0.04% (P = 0.877). The successful immediate aneurysm occlusion rates were 86.00% and 77.45% in the Gekko coil group and the Axium coil group, respectively, showing no significant difference between the 2 groups (P = 0.116), whereas the recanalization rates during the 6 months follow-up were 2.02% and 1.96% in the Gekko and Axium coil groups, respectively, which was not statistically significant (P = 1.000). CONCLUSIONS: This trial showed that the Gekko coil system was noninferior to the Axium coil system in terms of efficacy and safety for IA embolization. In clinical practice, the Gekko coil system can be considered safe and effective for treating patients with IA.

Autologous platelet-rich plasma promotes neurogenic differentiation of human adipose-derived stem cells in vitro.

Nervous system injury causes severe medical and social problems worldwide, and doctors have not found any ultimate solutions to it until now. The regenerative medicine using stem cells is a promising technology to conquer this challenge. In this study, we explored the influence of platelet-rich plasma (PRP) on neural differentiation of adipose-derived stem cells (ASCs). Human ASCs (hASCs) were harvested and isolated from lipoaspirates of liposuction operations. They were cultured to the third passage and characterized by specific cell markers and multilineage differentiation capacities. Autologous PRP was isolated and prepared from venous blood of the same patient underwent liposuction. The cultured hASCs were treated with either neural inductive conditioned medium plus 10% PRP (experimental group) or neural inductive conditioned medium alone (control group). The supplement of autologous PRP into culture medium obviously promoted proliferation of hASCs. After two weeks of neurogenic induction, the hASCs treated with PRP displayed higher level of neuron-specific enolase and membrane-associated protein-2 compared with the control group. Gene expression level of growth associated protein-43 (GAP-43), neural cell adhesion molecule (NCAM), and synapsin 1 (SYN-1) in the PRP group was also higher than in the control group. These results indicate PRP is capable of promoting cell proliferation and neurogenic differentiation of hASCs in vitro. Addition of autologous PRP could facilitate the potential use of hASCs in nerve regeneration.

Intraparenchymal papillary meningioma of brainstem: case report and literature review.

Both intraparenchymal papillary meningioma and papillary meningioma with cyst formation of brainstem have never been reported. The authors present an extremely rare case of patient with intraparenchymal papillary meningioma of brainstem. A 23-year-old Chinese male presented with a 4-month history of progressive left upper limb and facial nerve palsy. Magnetic resonance imaging revealed a cystic-solid, heterogeneously enhancing mass in pons and right cerebral peduncle with no dural attachment. The tumor was totally removed via subtemporal approach. During surgery, the lesion was found to be completely intraparenchymal. Histological and immunohistochemical examinations were compatible with the diagnosis of papillary meningioma. The lesion recurred nine months after primary surgery, a second surgery followed by radiotherapy was performed. Till to now (nearly 2 years after the treatment), the patient is tumor free survival. Intraparenchymal meningioma of brainstem with cystic formation is very rare, however, it should be considered as a differential diagnosis of a brainstem neoplasm. The present case strongly recommended that postoperative radiotherapy was essential for the patients with papillary meningiomas.

Efficacy and Safety of a Novel Thrombectomy Device in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial.

Purpose: The Tonbridge stent is a novel retriever with several design improvements which aim to achieve promising flow reperfusion in the treatment of acute ischemic stroke (AIS). We conducted a randomized controlled, multicenter, non-inferiority trial to compare the safety and efficacy of the Tonbridge stent with the Solitaire FR. Methods: AIS patients aged 18-85 years with large vessel occlusion in anterior circulation who could undergo puncture within 6 h of symptom onset were included. Randomization was performed on a 1:1 ratio to thrombectomy with either the Tonbridge stent or the Solitaire FR. The primary efficacy endpoint was successful reperfusion using a modified thrombolysis in cerebral infarction score (mTICI) of 2b/3. Safety outcomes were symptomatic intracranial hemorrhage (sICH) within 24 ± 6 h and all-cause mortality within 90 days. A clinically relevant non-inferiority margin of 12% was chosen as the acceptable difference between groups. Secondary endpoints included time from groin puncture to reperfusion, National Institutes of Health Stroke Scale (NIHSS) score at 24 h and at 7 days, and a modified Rankin Scale (mRS) score of 0-2 at 90 days. Results: A total of 220 patients were enrolled; 104 patients underwent thrombectomy with the Tonbridge stent and 104 were treated with the Solitaire FR. In all test group patients, the Tonbridge was used as a single retriever without rescuing by other thrombectomy devices. Angioplasty with balloon and/or stent was performed in 26 patients in the Tonbridge group and 16 patients in the Solitaire group (p = 0.084). Before angioplasty, 86.5% of those in the Tonbridge group and 81.7% of those in the Solitaire group reached successful reperfusion (p = 0.343). Finally, more patients in the Tonbridge group achieved successful reperfusion (92.3 vs. 84.6%, 95% CI of difference value 0.9-16.7%, p < 0.0001). There were no significant differences on sICH within 24 ± 6 h between the two groups. All-cause mortality within 90 days was 13.5% in the Tonbridge group and 16.3% in the Solitaire group (p = 0.559). We noted no significant differences between groups on the NIHSS at either 24 h or 7 days and the mRS of 0-2 at 90 days. Conclusion: The trial indicated that the Tonbridge stent was non-inferior to the Solitaire FR within 6 h of symptom onset in cases of large vessel occlusion stroke. Clinical Trial Registration:ClinicalTrials.gov, number: NCT03210623.

Traumatic basilar-cavernous fistula associated with aneurysm of basilar artery.

A 19-year-old boy's left temporal region was struck by a screwdriver, he immedietly lost consciousness for several minutes, when he came back he had a serious headache and obvious left ptosis. CT scanning showed an intracranial air accumulation and obvious traumatic subarachnoid hemorrhage (SAH), 2 weeks later magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed a traumatic aneurysm in basilar artery. Digital subtraction angiography (DSA) was performed 4 weeks later, revealing a basilar-cavernous fistula and a saccular aneurysm of the basilar artery in his head. After the patient was treated with endovascular embolization therapies twice and with mechanical detachable spiral (MDS) for 5 months the patient was cured finally.

[Endovascular embolization of cerebral arteriovenous malformation].

OBJECTIVE: To evaluate the effect of endovascular embolization with alpha-NBCA on cerebral arteriovenous malformation with NBCA and emphasize the mainpoint of the embolizing technique. METHODS: 469 patients with cerebral arteriovenous malformation underwent endovascular embolization with alpha-NBCA by using microcatheter under digital subtraction angiography. RESULTS: 469 patients were treated successfully, 467 cases recovered clinically, 2 patients died. 469 patients underwent embolization therapy 1 108 times, ranging 1 to 8 times with an average of 2.3 times. 100% embolization was achieved in 155 cases, 90% approximately 100% in 93, 80% approximately 90% in 105, 70% approximately 80% in 78, 60% approximately 70% in 27, below 60% in 11. Nineteen cases received gamma-knife (or X-knife) therapy alone. 117 cases received gamma-knife (or X-knife) therapy after embolization, 32 cases received operations. Six cases suffered from different complications: 1 case with cerebral infarction recovered after urokinase injection, 4 cases suffered from intracranial hemorrhage, and 1 suffered from catheter resorting in nidus. CONCLUSION: Endovascular embolization is a safe, reliable and effective treatment for cerebral arteriovenous malformation.

[Recurrence of cerebral aneurysm after embolization by mechanical detachable spiral: report of one case].

A patient with cerebral aneurysm received embolism therapy using mechanical detachable spiral, but the aneurysm recurred because of absorption of the coil. Secondary embolism therapy was successfully implemented using Guglielmi detachable coil.

[Interventional treatment of dural arteriovenous fistula].

OBJECTIVES: To summarize the characteristics of interventional treatment of dural arteriovenous fistulae (DAVFs) and improve clinical curative effects. METHODS: The clinical data from 135 patients with DAVFs were analyzed retrospectively. RESULTS: Seventy-four patients were cured, 53 were significantly improved, 8 unchange, and 1 died of intracranial haemorrhage. CONCLUSIONS: Clinical presentations and prognosis of DAVF depend on the types of venous drainage. Compression of the affected carotid artery and endovascular embolization are safe and effective.

[Interventional treatment of 126 patients with anterior communicating artery aneurysm].

OBJECTIVES: To analyse the characteristics of interventional treatment for anterior communicating artery aneurysm (AcoAA) and improve curative effects. METHODS: In 126 patients, detachable microcoils were used to embolize the AcoAA via endovascular approach. Those patients failed to be embolized were treated by surgical clipping. RESULTS: Of the 109 patients who were embolized successfully, 97 were achieved 100% occlusion, 12 95% - 98% occlusion. In the other 17 patients who failed to interventional treatment 15 were treated surgically and 2 no treatment because of cerebral vascular spasm. 123 patients were cured, one died, and 2 had aneurysms disappeared without any operations, as proved by follow-up for 5 months to 1 years. Of 32 patients checked by cerebral angiography 3 weeks to 30 months after operation, 30 showed disappeared of aneurysms and 2 had recurrence. The recurred aneurysms were successfully reembolized. CONCLUSIONS: Most of AcoAAs can be cured by endovascular interventional treatment. Those who failed to be treated by embolization can be cured surgically. Few patients may be healed spontaneously. The long term effects of treatment should be followed-up for a long time.