Safety and Efficacy of Wingspan Stenting for Severe Symptomatic Atherosclerotic Stenosis of the Middle Cerebral Artery: Analysis of 278 Continuous Cases.

OBJECTIVE: Our objective is to investigate the safety and long-term efficacy of the Wingspan stent (Boston Scientific, Natick, MA, USA) for treating severe atherosclerotic stenosis of the middle cerebral artery (MCA). METHODS: A total of 278 consecutive patients from our stroke database with clinical symptoms within the prior 90 days and intracranial atherosclerotic stenosis of 70% or above of the MCA were enrolled in this study between September 2012 and November 2014, and these patients were followed until the end of June 2015. The endpoint events included any stroke or death within 30 days after stenting and any subsequent ipsilateral ischemic stroke. RESULTS: Among the 278 enrolled patients, 277 patients (99.6%) successfully underwent stenting. The mean rate of stenosis decreased from 82.5 ± 7.9% to 9.0 ± 3.2% following treatment. Within 30 days after stenting, 12 patients (4.3%) experienced endpoint events, including 8 cases (2.9%) of hemorrhagic stroke and 4 cases (1.4%) of ischemic stroke; 2 perioperative deaths occurred. During 8-33 months of follow-up, 19 patients developed endpoint events. The 1- and 2-year endpoint event rates were 5.8% (95% confidence interval [CI], 5.0%-15.7%) and 7.2% (95% CI, 4.3%-10.1%), respectively. CONCLUSIONS: From this study, we can conclude that the treatment of severe symptomatic atherosclerotic stenosis of the MCA using the Wingspan stent was safe and effective and that the long-term stroke recurrence rate after stenting was low.

The treatment of high concentration wastewater in the natural gas processing industry.

The operation of the Cansolv tail gas treatment device in natural gas plants generates acidic and alkaline wastewater from the venturi unit and amine purification unit (APU), respectively. The APU wastewater is complex in composition and contains hard-to-degrade organic matter, which can adversely impact the normal functioning of the water treatment system. This study assesses the efficacy of three ozone-based advanced oxidation processes (ozone (O3), ozone/hydrogen peroxide (O3/H2O2), and ozone/Fenton (O3/Fenton)) for treating Cansolv wastewater, with chemical oxygen demand (COD) and total organic carbon (TOC) serving as indicators of organic degradation. The findings demonstrate that all three processes effectively eliminate coloration and reducible sulfur, with O3/Fenton exhibiting superior performance in removing organic substances. The treated wastewater has a clarified light-yellow appearance with residual COD levels at 43 mg L-1. Under the optimum Fenton oxidation conditions (initial pH 5, H2O2 dosage 97.8 mmol L-1, FeSO4·7H2O dosage 550 mg L-1), average TOC and COD removal rates reached 50% and 97%, respectively. After a treatment duration of 60 minutes, the wastewater demonstrated an enhanced membrane-specific flux, confirming the effectiveness of the O3/Fenton oxidation process in mitigating membrane fouling while ensuring the stable operation of the wastewater treatment system.

Altitude-related features and prognosis in patients with reversible splenial lesion syndrome.

INTRODUCTION: RESLES (Reversible splenial lesion syndrome) can be observed secondary to various diseases, and intramyelinic edema may play a crucial role in the pathogenesis of SCC (Splenium of the corpus callosum). Some studies have suggested that hypoxic-ischaemic encephalopathy may constitute a risk factor for SCC lesions. However, the potential impact of high-altitude environments on SCC, especially during chronic exposure, remain obscure. METHODS: Our study included 19 patients who satisfied the diagnostic criteria of RESLES at high altitudes. Ten low-altitude patients with RESLES were included as controls. All participants received MRI (Magnetic resonance imaging) scans twice. Routine blood tests, liver, kidney and thyroid function, coagulation function, electrolytes and vitamins were detected during hospitalization and before discharge. In addition, the patients were followed up in May 2023. RESULTS: Hypoxic environments at high altitudes may increase the risk of RESLES. The two groups showed different clinical symptoms. High-altitude patients had significantly higher CRP levels than low-altitude patients. The lesion size in high-altitude patients showed a positive correlation with SaO2 levels. However, the patients at low altitudes had positive correlation trends between lesion size and several inflammatory markers (WBC, NEU and CRP). All patients had a benign prognosis that may not be affected by the use of prednisone acetate. CONCLUSIONS: Hypoxic environments at high altitudes may play a role in the aetiology of RESLES. Additionally, RESLES is a reversible disease and the administration of glucocorticoids may be dispensable for its treatment.

A Comparison of Safety and Effectiveness Between Wingspan and Neuroform Stents in Patients With Middle Cerebral Artery Stenosis.

Background: Percutaneous transluminal angioplasty and stenting with the Wingspan stent has proven safe and effective in patients with middle cerebral artery stenosis (MCAS), but the off-label use of the Neuroform stent might be an alternative treatment. This study aimed to compare the safety and effectiveness of the above two intracranial stents in patients with MCAS. Methods: We retrospectively analyzed consecutive patients with symptomatic MCAS who had been treated with the Neuroform EZ or the Wingspan stent. A propensity score was generated to control for differences in baseline characteristics. The endpoints were the rate of peri-procedural complications within 30 days after stenting, the in-stent restenosis rate, and any target-vessel-related stroke or deaths during follow-up. Results: After matching for propensity score, the peri-procedural complication rate in the Wingspan group was 7.4% compared with 5.6% in the Neuroform group (p = 1.00), while the follow-up in-stent restenosis rates were 23.3 vs. 14.3%, respectively (p = 0.41). In the restenosis group, the patients tended to be younger (p < 0.01) and the degree of artery stenosis before stenting was higher (p < 0.01). Conclusion: This study indicated that in patients with symptomatic MCAS, Neuroform EZ stents are an alternative to Wingspan. Moreover, younger age and higher degree of artery stenosis before stenting might be a risk factor of in-stent restenosis.

Wall enhancement ratio determined by vessel wall MRI associated with symptomatic intracranial aneurysms.

PURPOSE: To study the association of the enhancement ratio (ER) of aneurysmal wall enhancement (AWE) with symptomatic intracranial aneurysms (IAs), we hypothesized that the ER of AWE would be stronger in symptomatic IAs than in asymptomatic IAs, as assessed by high-resolution magnetic resonance imaging (HRMRI). MATERIALS AND METHODS: Between February 2016 and February 2018, 80 consecutive patients with 89 unruptured IAs were reviewed. Patients and IAs were divided into symptomatic and asymptomatic groups. In addition to the clinical characteristics, the IA features (e.g., size, shape) were evaluated via computed tomography angiography, while the ER and enhanced patterns were evaluated by HRMRI. Multiple logistic regression analysis was performed to determine the independent risk factors for symptomatic IAs. Receiver operating characteristic curve analysis was used for the final model to obtain the optimal thresholds. RESULTS: Multiple logistic regression analysis indicated that only the ER was associated with symptomatic IAs. The threshold value of the ER was 60.5%. CONCLUSIONS: A higher ER was more frequently identified in symptomatic IAs. More attention should be paid to this factor in the management of IAs.

Angioplasty and stenting for severe symptomatic atherosclerotic stenosis of intracranial vertebrobasilar artery.

This retrospective study is to investigate the safety and efficacy of the stent implanting for treating severe symptomatic atherosclerotic stenosis of the intracranial vertebrobasilar artery (ICVBA). 213 patients who had undergone intervention for severe symptomatic ICVBA stenosis between September 2012 to May 2018 were enrolled into this study. Among the 213 enrolled patients, 210 patients (98.6%) obtained successfully revascularization and 206 patients (96.7%) had good revascularization after stenting. The extent of stenosis before and after intervention was 86.3 ±â€¯6.8% and 9.1 ±â€¯3.7%, respectively. Within 90 days after stenting, 10 patients (4.7%) experienced primary endpoint events, including 4 cases (4.2%) in the intracranial vertebral artery (V4) group and 6 (5.1%) in basilar artery (BA) group. Among them, 2 (2.1%) and 3 cases (2.5%) of ischemic stroke in V4 and BA group, respectively; and 2 (2.1%) and 2 (1.7%) cases of TIA in V4 and BA group, respectively. One (0.8%) case in the BA group dead because of the acute stent occlusion resulted in the top of the basilar syndrome. Six patients (2.8%) experienced adverse events, including 2 (2.1%) and 4 (3.4%) cases of groin hematoma in the V4 and BA group, respectively. No cases of hemorrhagic stroke, stent dislocation and vessel dissection in both groups. Our study showed that a low complication rate and a high and good revascularization rate would be achieved by the treatment of severe symptomatic atherosclerotic stenosis of the ICVBA using the stents.

Wall enhancement ratio and partial wall enhancement on MRI associated with the rupture of intracranial aneurysms.

OBJECTIVES: To evaluate the risk factors for rupture of intracranial aneurysms (IAs) using high resolution MRI (HRMRI). METHODS: 91 consecutive patients with 106 IAs were reviewed from February 2016 to April 2017. Patients and IAs were divided into ruptured and unruptured groups. In addition to the clinical characteristics of the patients, the features of IAs (eg, shape) were evaluated by CT angiography, whereas wall thickness, enhanced patterns, and enhancement ratio (ER) were evaluated by MRI. Multiple logistic regression analysis was used to identify independent risk factors associated with the rupture of IAs. Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained. RESULTS: ER (OR 6.638) and partial wall enhancement (PWE) (OR 6.710) were not markers of aneurysms more prone to rupture, but simply were more commonly found in the ruptured aneurysm cohort. The threshold value for ER was 61.5%. CONCLUSIONS: ER (≥61.5%) and IAs with PWE are better predictors of rupture. Increased attentions should be paid to these factors during assessment of IA rupture.

Clinical significances and features of prompt brain CT scan after intracranial artery stenting: analysis of 501 cases.

Cerebral hemorrhage is a serious complication of intracranial artery stenting that could be fatal without timely identification and treatment. Prompt brain CT scan would help to evaluate whether cerebral hemorrhage occurs, however, the diverse features of the CT scan immediately after stenting could influence the judgement sometimes. Therefore, we analyzed and summarized these features to help to determine the clinical significance of these CT features. The prompt CT features after stenting were classified into three types. Type I indicates that no high-density shadows. Type II indicates that high-density shadows scattered in the infarct areas and/or subarachnoid spaces without mass effect. Type III indicates high-density shadows scattered in and/or out of the infarct areas and/or subarachnoid space with obvious mass effects. Based on this classification, the patients in both Type I and II would continue the double anti-platelet treatment (DAPT) and anti-coagulation treatment, while the later need closer monitoring. However, patients in Type III must immediately withdraw the DAPT and anti-coagulation treatment with close monitoring and surgical intervention was needed when necessary. Nineteen (3.79%) patients were classified into Type III, and 5 (1.00%) of the 19 were accepted surgical intervention. Two of these patients died (0.40%). The prompt CT scan timely distinguishing the cerebral hemorrhage was necessary after intracranial artery stent angioplasty. Additionally, based on the different prompt CT features to take different therapeutic strategies after stenting would achieve better outcomes for ischemic stroke or transient ischemic stroke (TIA) patients underwent intracranial artery endovascular therapy.

[Triplex-forming oligonucleotide inhibits the expression of tissue factor gene in endothelial cells induced by the blood flow shear stress in rats].

AIM: To study the effect of antiparallel phosphorothioate triplex-forming oligonucleotide (apsTFO) matching with the shear stress response element (SSRE) of tissue factor (TF) gene promoter region on the expression of TF in endothelial cells (ECs) of rat common carotid artery stenosis. METHODS: The model of common carotid artery middle segment stenosis was established by silica gel pipe loop ligation in SD rats. The mRNA expression and protein synthesis of TF, early growth response-1 (Egr-1) and specificity protein 1 (Sp1) were measured by in situ hybridization (ISH) and immunohistochemistry (IHC) technique. GT21-apsTFO, GT20-apsTFO, GT20-psTFO and FITC-labeled apsTFO, matching with the SSRE of TF gene promoter region, were designed, and intravenously injected into rats at 0.5 h before operation. TFO was detected 4 h after the operation, and the mRNA expression and protein synthesis of TF, Egr-1 and Sp1 were detected 6 h after the operation. RESULTS: There were much fluorescence in vascular tissue, especially in the nuclear of ECs 4.5 h after the injection of apsTFO. The mRNA expression and protein synthesis of TF reduced by 22% - 23% with injection of GT20-apsTFO 6.5 h after stenosis (P < 0.01) and by 10% - 11% with GT21-apsTFO at the same time (P < 0.05). The inhibition by GT20-apsTFO was stronger than that of the GT21-apsTFO (P < 0.05). The expression of TF was not inhibited by the GT20-psTFO (P > 0.05). The mRNA expression and protein synthesis of Egr-1 and Sp1 did not change in the rat treated with GT20-apsTFO, GT20-psTFO and GT21-apsTFO (P > 0.05). CONCLUSION: apsTFO could mero-inhibit the expression of TF gene but could not change the expression of Egr-1 and Sp1 protein.

[Pathologic changes caused by highly pathogenic H5N1 avian influenza virus: postmortem study of a case].

OBJECTIVE: To report the postmortem findings of a case of highly pathogenic H5N1 avian influenza virus occurring in human beings. METHODS: Postmortem examination was carried out in a deceased caused by highly pathogenic H5N1 avian influenza virus. Detailed light microscopy of major organs, including heart, lungs, liver, spleen, kidneys and brain, was performed. The lung tissue was further investigated by histochemistry, immunohistochemistry and electron microscopy. RESULTS: Major histopathologic changes in lungs secondary to highly pathogenic H5N1 avian influenza virus included diffuse alveolar damage, hyaline membrane formation and focal hemorrhage. Some of the alveolar spaces contained lightly eosinophilic liquid, lymphocytes, macrophages, plasma cells and small number of neutrophils. Congested capillaries were commonly seen in the alveolar septa which were focally rimmed by hyaline membrane. Immunohistochemical study showed that the lymphocytes were mainly of T lineage and macrophages were also demonstrated. CONCLUSIONS: Highly pathogenic H5N1 avian influenza virus causes pathologic changes mostly in lungs, including diffuse alveolar damage and acute exudative changes (involving mainly T lymphocytes and macrophages). The resulting parenchymal destruction, consolidation, pulmonary edema and hemorrhage eventually lead to respiratory distress and death.

Association of CYP2C19 Polymorphisms with the Clinical Efficacy of Clopidogrel Therapy in Patients Undergoing Carotid Artery Stenting in Asia.

The CYP2C19 gene plays a detrimental role in the metabolism of clopidogrel. This study aimed to investigate the association between CYP2C19 polymorphisms and the clinical efficacy of clopidogrel therapy in patients who have undergone carotid artery stenting (CAS). CYP2C19 genotype screening was performed on 959 ischemic stroke patients. Of these patients, 241 who had undergone CAS were enrolled in the study. They were all followed up for 1 year after stent surgery, and the primary clinical end-points were ischemic events. The frequencies of the CYP2C19*2 and *3 alleles among the 959 patients were 31.80% and 5.06%, respectively. Regarding the 241 participants who had undergone CAS, multivariate Cox regression analysis showed that the CYP2C19 loss-of-function (LOF) alleles (*2 and *3) were risk factors for post-CAS prognosis. Within 1 year of follow-up, the patients carrying the CYP2C19 LOF alleles were more likely to experience ischemic events than those carrying none. The occurrence of ischemic events did not significantly differ between the *2 and *3 allele carriers. Our results suggest that CYP2C19 LOF alleles (*2 and *3) significantly impact the prognosis of patients on clopidogrel therapy after CAS and that the CYP2C19*2 and CYP2C19*3 alleles have the same effects on prognosis.

[Prediction of the spatial distribution of Oncomelania snails in marshland of Jiangning County using the Ordinary Kriging].

OBJECTIVE: To explore the methods to predict the distribution of Oncomelania hupensis in the marshland of Jiangning County. METHODS: Semi-variogram was used to analyze the spatial autocorrelation of snails' distribution in the marshland of Jiangning using the Arcview8.1. A prediction map for the snails' distribution was established using the Ordinary Kriging and evaluated using the cross-validation. RESULTS: Analysis showed that the distribution of alive snails in the marshland of Jiangning in the year 2000 was auto-correlated in spatial. The semi-variogram model which was spherical demonstrated that the variation of alive snails in spatial were related with distance apart when the distance was less than 0.0301. The prediction map of the snail distribution in the marshland of Jiangning was established based on the semi-variogram using the Ordinary Kriging. The cross-validation showed that the prediction map could estimate the distribution of snails in the marshland of Jiangning correctly. And the determinant coefficient for the prediction model was 0.973. CONCLUSION: It is feasible to predict the snail distribution in the marshland of Jiangning County by using Ordinary Kringing and data from the surveillance spot.

Effects of ultrasound-combined microbubbles on hippocampal AchE fibers in rats.

OBJECTIVE: To investigate the protective effect of ultrasound-combined microbubbles on hippocampal acetylcholinesterase (AchE) fibers in rats. METHODS: According to random digits table, 60 SD rats were divided into two groups, marrow stromal cells (MSCs) intracranial transplantation group and MSCs intracranial transplantation + ultrasonic microbubbles group. Marrow stromal cells were cultivated and isolated in vitro; 12 weeks after transplantation, spatial learning and memorizing abilities of rats were assessed by Morris water maze; AchE staining method was used to observe changes in density and appearance of AchE staining positive fibers in hippocampal CA1 region. RESULTS: There was a significant increase in spatial learning and memorizing abilities of rats in MSCs intracranial transplantation + ultrasonic microbubbles group. Hippocampal AchE staining suggested an increase in the density of AchE staining positive fibers in MSCs intracranial transplantation group; the fibers were regular, intact and dense. Density of hippocampal AchE positive fibers was negatively correlated with the escape latent period and was positively correlated with percentage of the time needed to cross each platform quadrant. CONCLUSIONS: Better promotion of spatial learning and memorizing abilities of rats in MSCs intracranial transplantation + ultrasonic microbubbles group may be related with the protective effect of ultrasound-combined microbubbles on hippocampal acetylcholine fibers.

Serum 25-hydroxyvitamin D levels in Chinese children with autism spectrum disorders.

In recent years, increasing evidence has shown that children with autism spectrum disorders (ASDs) have lower levels of 25-hydroxyvitamin D [25(OH) D] relative to healthy controls. The purpose of this study was to evaluate the serum 25(OH) D levels in Chinese children with ASD. From January 2012 to December 2012, consecutive patients with ASD admitted to the Department of Neurology were identified. Clinical information was collected. Serum levels of 25(OH) D were measured at baseline. ASD severity was assessed at admission using the Childhood Autism Rating Scale total score. The results indicated that the mean serum 25(OH) D levels were significantly lower in autistic children as compared with normal cases (P=0.002). There was a significant negative relationship between circulating serum 25(OH) D levels and the severity of autism evaluated according to Childhood Autism Rating Scale Scores (P=0.000), after adjustment for the possible covariates such as age, sex, BMI, serum levels of calcium, phosphate, and magnesium, and seasons. After adjusting for all other possible covariates, 25(OH) D levels that remained can be seen as an independent predictor of ASD with an adjusted odds ratio of 1.23 (95% confidence interval, 1.10-1.37). These results indicate that lower 25(OH) D levels may be independently associated with severity of ASD among Chinese patients, and lower serum 25(OH) D levels could be considered as an independent risk factor for ASD.

[Observation of pathological morphology on nervous system of rat with maximum dose sophoridine in chronic toxic test].

BACKGROUND & OBJECTIVE: Sophoridine is a new anticancer drug with noticeable antitumor action and lower toxicity. No marked influence on bone marrow was found till now. The main toxicity is presented in nervous system. This study was to observe the morphological changes of the nervous system of the rats, which were treated with maximum dose of sorphoridine for a long time. METHODS: 30 rats,half of male when and half of female, were randomly divided into experimental group and control group. In the experimental group,rats were treated with maximum dose of sorphoridine [32 mg x(kg x d)(-1) ip, qd] for 60 days. In control group, rats were treated with the same volume of saline everyday for 60 days. The rats in both groups were killed at 20 d, 40 d, 60 d, and 75 d, respectively. The brain and spinal cord were taken out and made into pathological slices, which were stained by HE stain and special stain, sach as Nissel's body stain, glial fibrillary stain and myelin sheath stain. The differences in morphology between the two groups was observed. RESULTS: No pathological change was found in rats' cerebral cortex,internal capsul, striated body, hippocampus, substantia nigra,and spinal cord when the rats' were treated with sophoridine 32 mg x(kg x d)(-1) ip for 20 d, 40 d, 60 d. In the rats who had presented nervous system syndrome repeatedly or died for convulsion, or the rats who were killed in convalescence period (15 d after final administration), there was no pathological change either. CONCLUSION: No pathological changes and delayed changes in the nervous tissues were found when the rats were given maximum dose of Sophoridine continuously for 60 d. Our study showed that the syndrome of nervous system caused by Sophoridine is functional and stimulational, and can be recovered,and there is no any delayed change and sequela.

[Application of satellite image for surveillance of vegetation landscapes of Oncomelenia-snail habitats in marshland using unsupervised classification].

OBJECTIVE: To explore the vegetation landscapes in marshland snail habitats using satellite image. METHODS: The false-color composition image from band 2, 3 and 4 of LANDSAT ETM + images was classified in the ERDAS IMAGINE 8.5 to analyze the vegetation types in the marshland of Jiangning county, using the unsupervised classification. The efficiency of classification was evaluated by the transformed divergence. The overlaid layers of the classified vegetation image and the vector layer of snail habitats distribution were used to analyze the relationship between the snail distribution and the landscape types. RESULTS: The land-cover of marshland in LANDSAT ETM234 image in Jiangning county could be classified into 10 types, including water, bare soil, sandy and other landscapes while the transformed divergence analysis showed that there were misclassified pixes between some types especially for the non-continuous types. The study indicated that through adding the NDVI image in the process of classification efficiency of classification and eliminate misclassification in the non-continuous type could be improved. Analysis on the overlaid layer of the vector of snail distribution and the classified image proved that the vegetation covers in marshland snail habitats in Jiangning mainly belonged to type 3, 5 and 6, that responded to the beach with sparse vegetation, exuberant weed and bulrush respectively. The density of snails in the bulrush was higher than that in other 2 landscapes. CONCLUSION: The vegetation type in the marshland snail habitats could be distinguished from the satellite image, which was helpful for the surveillance of snail habitat in marshland and for the prevention of schistosomiasis.

[Study on the relationship between Terra-MODIS image and the snail distribution in marshland of Jiangning county, Jiangsu province].

OBJECTIVE: To analyze the relationship between the normalized difference vegetation index (NDVI) and the snail distribution in marshland of Jiangning county in Jiangsu province, and to explore the utility of Terra-MODIS image map in the small scale snail habitats surveillance. METHODS: NDVI were extracted from MODIS image by vector chart of the snail distribution using ArcView 8.1 and ERDAS 8.5 software. The relationship between NDVI and the snail distribution were Investigated using Bivariate correlations and stepwise linear regression. RESULTS: The snail density on marshland was positively correlated with the mean NDVI in the first ten-day of May and the maximum NDVI (N(20max)) in the last ten-day of May. Incidence of pixel with the live snail on marshland was positively correlated with the mean NDVI (N(2mean)) in the first ten-day of May. An equation Y(1) = 0.009 47 x N(20max) (R(2) = 0.73), Y(2) = 0.018 6 x N(2mean) (R(2) = 0.906) was established. CONCLUSION: This study showed that the Terra-MODIS satellite images reflecting the status of the vegetation on marshland in Jiangning county could be applied to the study to supervise the snail habitat. The results suggested that MODIS images could be used to survey the small scale snail habitats on marshland.