Volume 85  ·   Issue 32  ·  2005

Intracranial posterior circulation aneurysms are aneurysms occurring in the basilar artery, the intracranial segment of the vertebral artery and the branches of the vertebral-basilar artery. Posterior circulation aneurysms account for about 15% of intracranial aneurysms, among which aneurysms in the bifurcation of the basilar artery and the main branches of the posterior cerebral artery and the superior cerebellar artery are the most common, accounting for about 50% of posterior circulation aneurysms [1].

At present, cerebrovascular diseases are the first cause of death in the population. Compared with cardiovascular diseases and malignant tumors, the disability rate of surviving patients with cerebrovascular diseases is higher. The incidence of stroke in China is as high as 250/100,000, ranking second in the World. Evidence-based medicine research on prevention and treatment of cerebrovascular diseases has been listed as an important research topic in the country. Surgical treatment of cerebrovascular diseases is an important field of neurosurgery. Among more than 1000 papers in the 13th World Congress of Neurological Surgery held in June this year, about 1/5 papers involved in the field of cerebrovascular Surgery. The conference organized more than a dozen special presentations, and carried out in-depth discussions in the fields of cerebral aneurysm, cerebral arteriovenous malformation, cavernous hemangioma, moyamoya disease, hypertensive cerebral hemorrhage and cerebrovascular interventional therapy. Since the "Seventh Five-Year Plan", China has made some achievements in the surgical diagnosis and treatment of cerebrovascular diseases, which has reduced the mortality and disability rate of cerebrovascular diseases. However, compared with western developed countries, For example, the annual incidence rate of subarachnoid hemorrhage is 6/100,000~9/100,000, and 51% are caused by rupture of intracranial aneurysm, and even as high as 83.4% are reported. However, there are no more than 5,000 cases of aneurysm patients treated in China every year. A large number of patients cannot get timely and correct treatment because they have not undergone or unconditionally undergone etiological examination such as cerebral angiography, and as a result, they die due to re-bleeding. This not only wastes a lot of medical resources, but also causes economic burden to families and society.

Objective to investigate the significance of local angiotensinogen mRNA expression and nuclear factor-κ B (NF-κ B) activation in patients with cirrhotic portal hypertension (PHT). Methods Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of local angiotensinogen mRNA in splenic arteriovenous tissues and normal blood vessels of patients with cirrhotic portal hypertension. Results the local angiotensinogen mRNA in splenic artery and vein tissues of the control group were 0.23±0.12 and 0.18±0.10, respectively, which were significantly lower than those in splenic artery and splenic vein tissues of the cirrhotic portal hypertension group (0.48±0.21 and 0.43±0.16) (P<0.05); No significant activity of NF-κ B was detected in the splenic artery and vein of the control group, but significant activity of NF-κ B was detected in the cirrhotic portal hypertension group (P<0.05). Conclusion the enhanced expression of local angiotensinogen mRNA and the activation of NF-κ B in patients with cirrhotic portal hypertension may be one of the causes of the formation and development of visceral vascular lesions in patients with cirrhotic portal hypertension.

Objective to investigate the surgical timing, surgical methods and curative effect of Marfan's syndrome complicated with aortic root tumor. Methods 84 cases of Marfan's syndrome with aortic root tumor were operated from February 1995 to October 2004, including 41 cases of aortic dissection (32 cases of Debakey type Ⅰ, 9 cases of Debakey type Ⅱ), 52 cases of root tumor complicated with moderate to severe aortic insufficiency, and the average diameter of root tumor was 68 mm ± 14 mm; There were 43 cases of preoperative cardiac function (NYHA) grade Ⅰ ~ Ⅱ, 30 cases of grade Ⅲ, 11 cases of grade Ⅳ. 68 cases of Bentall operation, 6 cases of Wheat operation, 5 cases of Cabrol operation, 5 cases of aortic valve replacement plus ascending aortoplasty, 28 cases of emergency operation, 56 cases of elective operation, 3 cases of mitral valve replacement and 3 cases of mitral valve replacement at the same time. Results 3 cases died after operation, the mortality rate was 3.57%. 5 cases were lost to follow-up, and 76 cases were followed up for 3~117 months (mean 55 months ± 31 months). 74 cases of cardiac function grade Ⅰ ~ Ⅱ, 2 cases of grade Ⅲ. Conclusion Bentall operation is the first choice method for the treatment of root tumor in Marfan syndrome, and the long-term follow-up effect is good.

Objective to find polysomnography (PSG) indexes that can more comprehensively reflect the degree of pathological damage in obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Severe patients were divided into groups with appropriate apnea hypopnea index (AHI) to reflect the difference between the severity of the disease. The results of subjective symptom assessment scale and polysomnography monitoring indexes of 621 patients were analyzed. Results There were significant correlations between AHI, apnea hypopnea time index (AHTI), minimum blood oxygen saturation and ESS total score (ESS7), dry mouth in the morning, daytime energy and sleepiness (P<0.01), and there was a significant correlation with acid reflux and heartburn symptoms (all P<0.05). AHTI, AHI correlated with ESS7 (r =0.344, 0.317); It was associated with morning dry mouth (r =0.261, 0.239); There were significant differences in morning dry mouth, acid reflux, heartburn symptoms and ESS7 between severe and extremely severe patients with AHI ≥70 times/h (all P<Conclusion Apnea and hypopnea time index AHTI is closely related to AHI, and can more comprehensively reflect the severity of pathological damage in OSAHS. There is a difference in the severity of the disease between severe patients, and the difference between severe and extremely severe is significant when AHI ≥70 times/h.

Objective to investigate the expression and functionality of toll-like receptor (TLR) 1~9 in human corneal epithelium and epithelial cell lines. Methods Twenty healthy young corneal epithelial specimens and cultured immortalized human corneal epithelial cell line (THCE) cells were collected from healthy human peripheral blood mononuclear cells (PBMC) as positive control. Western blot was used to detect the protein expression of TLR2 and 4; Compared with PBMC, human corneal epithelium expressed strongly TLR1,2,3,5,6,9,weakly TLR8,weakly TLR4,1 negative TLR3,4,6,8 and 1 weakly TLR5 in 20 corneal epithelial specimens, TLR3,4,6,8 negative TLR,8 negative TLR,8 negative TLR,5 weakly TLR5 negative TLR,5 negative TLR,5 negative TLR,5 negative TLR,5 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative TLR,6 negative Human corneal epithelium expressed TLR2, 4 at protein level; THCE cells had similar TLR expression profiles to human corneal epithelium; The IL-8 secretion increased after 1, 4 and 8 h stimulation by LPS and PolyI:C, and reached 10 and 7 times that of the control group at 8 h, respectively (all P<Conclusion Human corneal epithelium expresses TLR1~9, but the expression levels of different TLRs are different. THCE is a good cell line to study the expression and function of TLR in human corneal epithelium.

Objective to simulate and investigate the expression of monocyte chemotactic protein-1 (MCP-1) and interleukin-8 (IL-8) in cultured human retinal pigment epithelial cells (hRPE), which may play a role in the early stage of primary retinal detachment.Methods Collagen-coated magnetic bead suspension was added to cultured hRPE cells, and the unbound magnetic beads were incubated and washed away. The mRNA levels of MCP-1 and IL-8 and the protein levels in culture supernatant of hRPE cells were measured by reverse transcription-polymerase chain reaction and enzyme-linked immunoassay, respectively, under the vertical force of magnetic field and after cytochalasin D treatment. Results the expression of MCP-1 and IL-8 in hRPE without magnetic field was very low. Under the action of pulling force, the expression of MCP-1 and IL-8 had two peaks. The first peak of mRNA appeared within 0.5 h, reaching 3.30 ng/L ± 0.12 ng/L and 1.88 ng/L ± 0.08 ng/L, respectively. The first peak of protein levels was 552.05 ng/L ± 7.64 ng/L and 236.67 ng/L ± 14.30 ng/L within 1 h, respectively, and the second peak was about 4 h. The expression and secretion of the two factors were significantly reduced after cytochalasin D pretreatment, which were 2.36 ng/L ± 0.27 ng/L and 1.64 ng/L ± 0.08 ng/L, and 353.80 ng/L ± 16.68 ng/L and 101.86 ng/L ± 15.92 ng/L, respectively. Conclusion Mechanical pulling force can induce the expression of MCP-1 and IL-8 in hRPE cells, and this effect is partially inhibited after cytochalasin D pretreatment, suggesting that the influence of these two inflammatory factors is involved in the cytoskeleton, and these two inflammatory factors play a certain role in the initial stage of retinal detachment.

clinical decision is the most complicated and carefully practiced process, which relates to human health and life. From the perspective of information management, clinical decision is essentially a process of medical information exchange. Successful clinical decision is a very complicated chain process consisting of information acquisition, information evaluation and information utilization. First, decision makers must obtain information from different sources, including patients' clinical data (medical history, physical examination, laboratory data), patients' requirements, values, expectations, doctors' clinical experience, external regulations and restrictions, and scientific evidence, etc. Then, they should carefully evaluate the value of various information, and finally make decisions through multi-party agreement.

Objective to investigate the formation process and mechanism of pseudoaneurysm after rupture of common carotid artery (CCA) aneurysm. Methods Twenty dogs with pseudoaneurysm (T + F) model after rupture and hemorrhage of true aneurysm (AN) were made by trauma and microsurgical technique. Color Doppler ultrasound, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) were performed at 1, 2, 3, 4 and 8 weeks after operation. The pathological changes of true and pseudoaneurysm were observed by light and electron microscope. The distribution of blood flow velocity, pressure and shear stress in true and pseudoaneurysm were analyzed by computational fluid dynamics (CFD). Results The T + F model of 11 rats was successfully established. Three had occlusion of common carotid artery, two had occlusion of true AN, and four had true AN but no pseudoaneurysm. The blood flow velocity in pseudoaneurysms is very slow, and the shear stress at the distal bottom edge of the tumor mouth of the true aneurysm is the highest, but the shear stress at the junction between the true aneurysm and the pseudoaneurysm is not high. Conclusion The pathophysiological process of T + F formation is verified, which suggests that the formation and growth of pseudoaneurysm may be related to the pressure in it. Because of the formation of pseudoaneurysm, T + F is more likely to rupture and bleed under the influence of hemodynamics, and definitive surgical treatment should be performed actively.

Objective to investigate the mutation of CCM1 gene in patients with intracranial cavernous malformation (ICM). Methods Twenty-five patients with ICM confirmed by operation and pathology were collected, all of them were Han nationality, including 7 cases with familial ICM, and 30 normal healthy subjects were taken as the control group. Genomic DNA was extracted from the venous blood of the two subjects, PCR was used to amplify exons 8, 9, 11, 12, 13, 15, 16, 17 and 18 of CCM1 gene and some adjacent introns on both sides, and DNA sequencing was compared with GenBank. Results Seven new CCM1 gene mutations were detected in 11 patients with ICM, and the mutation rate was 44% (11/25). Among them, 3 were missense mutations: exon 12, 1160A→C (Q387P), 1172C→T (S391F); Exon 13, 1405A→C (N469H), 2 insertion mutations: Exon 8, 704insT (K246stop); Exon 18, 2138insG (T733stop), one intron mutation: IVS12-4C → T, and one synonymous mutation: exon 17, 1875C → T (F625F). Except for the synonymous mutation of 1875C → T, which may be gene polymorphism, all other mutations in CCM1 gene found caused the change of encoding KRIT protein. No abnormality was detected in CCM1 gene in control group. The mutation rate of CCM1 gene in familial ICM was higher than that in sporadic ICM, and the difference between the two was statistically significant (P<0.05). Conclusion The mutation of CCM1 gene also exists in Chinese ICM patients, which leads to the functional change or deletion of the encoded KRIT1 protein, which is related to the pathogenesis of ICM and is the genetic basis of ICM.

Objective to investigate the surgical technique and therapeutic effect of microbone window approach (keyhole approach) in the treatment of intracranial aneurysm. Methods 56 cases of 58 intracranial aneurysms were directly clipped by microbone window approach. Among 56 cases, 23 cases were anterior communicating artery aneurysm, 29 cases were internal-posterior carotid communicating artery aneurysm (2 cases were bilateral aneurysm), and 4 cases were internal carotid aneurysm. 22 cases were operated by supraorbital approach, 18 cases were pterional approach, and 16 cases were operated by eyebrow arch incision through orbital approach. 33 patients were treated with neuroendoscopic assisted surgery. Results 58 aneurysms were successfully clipped in 56 cases of aneurysm. 2 cases of bilateral posterior communicating artery aneurysm were clipped once by one side approach. After operation, 37 patients were confirmed by cerebral angiography, and the aneurysm disappeared. There were no surgical deaths. No complications related to surgical approach occurred. Conclusion Microbone window approach is technically feasible for craniotomy in the treatment of intracranial aneurysm.

Objective to investigate the diagnosis and treatment of intracranial hemangiopericytoma. Methods The clinical manifestations, imaging manifestations, pathological examination and treatment of 63 cases of intracranial hemangiopericytoma admitted to the neurosurgery department of Huashan Hospital from January 1993 to June 2004 were retrospectively analyzed. Results Among 63 cases, 58 cases received total tumor resection, 5 cases received subtotal tumor resection, 56 cases had improved or unchanged symptoms, 6 cases had aggravated symptoms, and 1 case died of complications after operation. 38 cases were followed up after operation, of which 34 cases received radiotherapy, the follow-up period was 3 to 84 months, with an average of 25 months. 30 cases recovered well, 2 cases had distant metastasis (to lumbosacral vertebra), and 6 cases had recurrence (all underwent reoperation, 3 cases recovered well, 2 cases had aggravated symptoms, and 1 case died of postoperative intracranial infection and other complications). Conclusion Intracranial hemangiopericytoma is a type of tumor with abundant blood supply. Although it grows slowly, it has the characteristics of recurrence and metastasis. Therefore, the tumor should be completely removed by operation, and sufficient blood source should be prepared during operation. Embolization of partial blood supply artery before operation is helpful to reduce intraoperative hemorrhage and remove the tumor safely. At the same time, postoperative radiotherapy can delay the recurrence and prolong the survival time of patients.

Objective to explore the reliability of different judgment criteria of balloon occlusion test (BOT) and the strategy of reducing complications. Methods BOT was performed in 86 patients with cerebrovascular disease, and the prognosis of 38 patients undergoing arterial occlusion was analyzed. Results the positive rate of conventional BOT was 10.47% (9/86), and the negative rate was 89.53% (77/86); The positive rate of combined cross-filling test was 36.05% (31/86), the negative rate was 63.95% (55/86), the incidence of cerebral ischemia after arterial occlusion treatment was 8.33% (3/36), and the incidence of technical complications was 3.49% (3/86). Conclusion (1) At present, BOT can provide basically accurate evaluation results. (2) Cross-filling test and hypotension test can effectively improve the specificity of BOT. (3) Combining traditional methods with new imaging technology, finding objective and quantitative indexes as judgment criteria is the direction of BOT improvement in the future.

Objective to compare the traditional craniotomy, CT-guided hematoma aspiration and micro-bone window approach for hypertensive cerebral hemorrhage, and analyze the curative effects. Methods From September 2001 to November 10, 2003, 2464 cases of hemorrhagic stroke were operated in 135 medical units in China, and the follow-up was completed for 3 months. The multicenter single-blind study was used to compare the curative effects of different surgical methods. Results Among 2464 cases, 639 cases were in the traditional group, 409 cases in the micro-bone window group and 1416 cases in the aspiration group. The cumulative mortality rate at 1 month was 19.3%, and the cumulative mortality rate at 3 months was 21.1%. The mortality rate of 3 months after operation was 4.4 times that of those without complications. The 3-month mortality rate of patients with thalamic hemorrhage was 2.4 times that of patients with cortical hemorrhage. The 3-month mortality rate of the traditional group (24.6%) was higher than that of the micro-bone window group (17.6%) and the aspiration group (20.6%). The postoperative complications between the three groups were significantly different between the traditional group (29.9%) and the aspiration group (24.8%) (P =0.015). Conclusion The mortality, disability and prognosis improvement of the micro-bone window approach and CT-guided aspiration group in the treatment of hypertensive cerebral hemorrhage were better than those of the traditional craniotomy group.

Case 1, male, 52 years old, was admitted to the emergency department for intermittent headache and dizziness, accompanied by palpitations and sweating for 3 years, which aggravated for 1 day. The symptoms lasted for 3 to 5 minutes each time, and their blood pressure was mostly 140-150/69-80 mm Hg (1 mm Hg =0.133 kPa), without regular treatment. After admission, his blood pressure was extremely unstable, rising and falling suddenly, up to 300/160 mm Hg, and symptomatic treatment was performed. On the second day after admission, he suddenly appeared severe pain in his right waist, accompanied by sweating, pale face, cold limbs, unresponsive calls, weak pulse, and blood pressure was 0. After being rescued by the intensive care unit, his blood pressure fluctuated about 170/90 mm Hg. Color ultrasound showed a 10.2 cm ×9.5 cm ×9.0 cm hypoechoic mass at the upper pole of the right kidney, which was irregular and blurry, with uneven internal echoes and fluid dark areas in the abdominal cavity. CT showed a round mass in the right adrenal gland, 10 cm ×9 cm ×8 cm in size, with irregular edges and mixed density. Although the blood pressure was stable, the pain continued to aggravate, CT examination revealed massive and progressive hemorrhage of right retroperitoneum. According to the medical history and auxiliary examination, the patient was suspected to have spontaneous rupture and hemorrhage of pheochromocytoma. Abdominal aortomography was performed in emergency department, and hemorrhage of right adrenal artery was found, and superselective arterial embolization was performed. After embolization, the patient's blood pressure was relatively stable, maintained at about 130~160/90~110 mm Hg. Abdominal pain was still present, but it was significantly reduced compared with that before embolization, and the patient could tolerate it. One week later, the right adrenal tumor was resected under general anesthesia. During the operation, adhesion between the tumor and the surrounding area was found, and the boundary between the tumor and the surrounding area was unclear, and the tumor was resected. Postoperative pathological diagnosis: pheochromocytoma with rupture and hemorrhage. After 10 months follow-up, there was no tumor recurrence, and the patient's blood pressure returned to normal.

For adult mammals, only the neural stem cells in the subventricular zone (SVZ) and the subgranular zone (SGZ) of the hippocampal dentate gyrus can differentiate into neurons in vivo, while the neural stem cells in other regions can only differentiate into glial cells in vivo [1]. However, if the stem cells from the neurogenic region are transplanted into non-neurogenic regions, they can only differentiate into glial cells; However, stem cells from non-neurogenic regions can differentiate into neurons after being transplanted into neurogenic regions; This will undoubtedly make us think that there is some mechanism that regulates the differentiation of neural stem cells in vivo environment.At present, the research on the factors affecting the biological characteristics of neural stem cells is mostly concentrated in the field of some single factors.Although these studies can reflect the pathways of action of some factors,it is still impossible to comprehensively understand the biological characteristics of neural stem cells in the complex environment.The discovery of neural stem cell niche provides a breakthrough point for us to comprehensively understand the biological characteristics of neural stem cells.The neural stem cell niche refers to the surrounding structure that can affect neural stem cells, mainly including nearby supporting cells,extracellular matrix and microvascular network.The influence of neural stem cell niche on the biological characteristics of neural stem cells is regulated by complex microenvironmental signaling, so the concept of this nest is more considered as a biochemical concept than an anatomical concept [2].

Clinical data An 8-year-old child was admitted to hospital in June 2004 due to 7 months after allogeneic bone marrow transplantation, 3 months of skin rash, 5 days of fever and shortness of breath. He was diagnosed with acute lymphocytic leukemia in October 2003. After bone marrow transplantation, he was treated with chronic graft versus host disease (GVHD) by oral administration of methylprednisolone 12 mg/d and cyclosporine A (CsA) 45 mg/d for a long time. Physical examination at admission: body temperature 39.7℃, pulse 110 beats/min, breathing 48 beats/min, blood pressure 110/70 mm Hg (1 mm Hg =0.133 kPa). Scattered dark red macules on the skin of the whole body, no enlargement of superficial lymph nodes, shortness of breath, a few damp rales at the floor of both lungs, regular heart rhythm. Other tests were negative. Blood image and liver and kidney function tests were normal. Blood cytomegalovirus antigen CMV-pp65 test was negative, and cytomegalovirus antibody CMV-IgG test was negative. Arterial blood gas analysis: pH 7.427, inhaled oxygen concentration (FiO2) 0.4, PaO2 63.1 mm Hg, PaCO239 mm Hg, P (A-a) O Preliminary diagnosis: (1) Acute lymphocytic leukemia, after bone marrow transplantation; (2) chronic GVHD; (3) pulmonary infection; (4) Acute hypoxemic respiratory failure.

The 13th World Congress of Neurological Surgery (13th World Congress of Neurological Surgery) was held in Marrakech, southern Morocco, from June 19 to 24, 2005. The World Congress of Neurological Surgery organized by the World Federation of Neurosurgical Societies was held every four years. More than 1800 papers were received at the conference, and more than 4000 neurosurgeons from nearly 100 countries attended the conference. The Neurosurgery Branch of Chinese Medical Association organized nearly 150 neurosurgeons from China to attend the conference. The discussion contents of the conference involved various fields of neurosurgery, and the main relevant information is introduced as follows.

Radial head fracture is a common clinical injury, which can be divided into Mason Ⅰ-Ⅳ types according to the fracture displacement, involvement range and whether it is combined with elbow dislocation. Among them, type Ⅱ and type Ⅲ fractures are obviously displaced, and there are many controversies in the choice of treatment plan and judgment of results.

Primary gallbladder carcinoma is the most common malignant tumor of the biliary system, and the first correct and rational diagnosis and treatment of this type of patients is the key to improve the prognosis. With the popularization of laparoscopic cholecystectomy and the improper expansion of indications for laparoscopic cholecystectomy, the incidence of accidental gallbladder carcinoma has increased [1]. Exploring a rapid and accurate diagnosis method for suspicious lesions during operation will certainly reduce the irrational treatment of accidental gallbladder carcinoma. It has been reported that molecular vibration spectroscopy, especially Fourier transform infrared spectroscopy (FTIR), can make a rapid and accurate judgment of tissue state at the molecular level, and some preliminary results have been obtained in gastrointestinal tumor tissues [2-4]. In this study, FTIR method was used to study gallbladder carcinoma tissues, which is the experimental basis for the clinical application of this technique.

The first issue of Eye World Asia-Pacific Chinese edition met the vast number of Chinese ophthalmologists in June 2005. It was launched at the time of the 18th annual meeting of the Asia-Pacific Society of Cataract and Refractive Surgery Physicians in Beijing. This is a new effort made by the Ophthalmology Branch of Chinese Medical Association for academic exchange at home and abroad, accelerating the spread of new knowledge and technology of ophthalmology to China, further improving the level of clinical service and scientific research of ophthalmology in China, and will definitely promote the development of ophthalmology in China (especially in the field of cataract and refractive surgery) to a certain extent.

In recent decades, new theories have emerged on the pathogenesis of heart failure. Sutter et al. published in June 2005 in the United States<The diagnostic use and therapeutic effects of natriuretic peptides in heart failure are discussed in Emery Med, 2005, 37 (6): 18-25.