Volume 94  ·   Issue 11  ·  2014

Parkinson's disease (PD) is a common neurodegenerative disease in middle-aged and elderly people. At present, the etiology and pathogenesis are unknown. The main pathological features were the absence of dopaminergic neurons in the dense part of substantia nigra and the appearance of Lewy bodies in the residual neurons. In the past, it was believed that PD was mainly characterized by motor symptoms such as bradykinesia, resting tremor and myotonia. In recent years, it has been found that some non-motor symptoms such as anosmia, REM sleep behavior disorder (RBD) and constipation also appear more in all stages of PD patients, and these non-motor symptoms are not improved by dopaminergic drugs^[1,2]。 When determining the treatment plan for patients with Parkinson's disease, it is necessary to conduct a comprehensive evaluation of patients in order to facilitate long-term standardized management. To achieve this goal, some new evaluation methods need to be explored.

To explore the effects of nom-motor symptoms (NMS) on health-related quality of life (HRQOL) in Parkinson's disease (PD) patients.

By convenient sampling, 128 PD patients were recruited. NMS was assessed by the non-motor symptoms scale for PD (NMSS) and HRQOL by the 39-item PD Questionnaire (PDQ39).

All PD patients (100%) had NMS with a general score of(124±48). Among these NMS, constipation was ranked the highest and the general level of NMS was significantly positively associated with age (r=0.226, P<0.05), Hoehn-Yahr staging (r=0.442, P<0.05) and disease course (r=0.223, P<0.05). However there was no correlation with gender (r=0.085, P<0.05). For PD patients, HRQOL became impaired with a general score of(44±16). Activities of daily living (60±15), mobility (49±21), emotional well-being (49±28) and stigma (48±46) were the most seriously affected. Females(χ²=-1.821 P<0.05)and senile bereaved patients(χ²=-1.512, P<0.05) had significantly lower HRQOL than that of others. For PD patients, the general level of HRQOL was significantly positively associated with disease course (r=0.260, P<0.05) and severity (r=0.259, P<0.05). The general level of HRQOL was significantly positively associated with the general level of NMS (r=0.686, P<0.01).

Non-motor symptoms (NMS) are quite common in PD patients. For PD patients, NMS has a more negative impact on HRQOL than other symptoms.

To explore the relationship between dopamine β-hydroxylase gene polymorphisms and Parkinson's disease (PD) in Uygurs and Hans populations of Xinjiang.

The polymorphisms of DBH gene were determined by polymerase chain-reaction restriction fragment length polymorphism (PCR-RFLP) in 239 PD patients (including 100 Uygurs and 141 Hans) and 232 health controls (including 103 Uygurs and 129 Hans).

The genotypic or alleleic distribution of DBH gene had significant differences between PD and control groups in both Uygur and Han populations (P<0.05). The genotypic or alleleic frequencies were significantly different between Han PD and control groups (P<0.05). The genotypic or alleleic frequencies in those aged 65 years or above were significantly different from that in others (P<0.05). There was a significant increase of PD in A2 allele carriers (OR=1.965, P<0.05). And the frequencies of A2 allele in female PD patients were higher than those in female controls (P<0.05) and A2 allele carriers had a significant increase of PD (OR=1.696, P<0.05).

Different between Uygurs and Hans of Xinjiang, DBH5 TaqⅠpolymorphisms may be associated with PD in Hans. A2 allele carriers are often found in females and those aged 65 years or above.

To explore the role of serum cystatin C level in Parkinson's disease (PD) and evaluate the relationship between cystatin C level and clinical characteristics and different stages of PD.

A total of 115 PD patients and 110 healthy controls were recruited. The results of such routine laboratory tests as triglyceride, cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), creatinine, urea, uric acid and cystatin C were assessed from fasting blood samples at our clinical laboratory center. They were further divided into subgroups according to Hoehn & Yahr (H&Y) staging. Statistical analysis was performed with SPSS version 17.0 software.

Compared to controls (0.96±0.16 mg/L), the mean serum level of cystatin C was significantly higher in PD patients (1.06±0.20 mg/L). Spearman's correlation analyses showed a positive and significant correlation between cystatin C levels and age as well as creatinine levels. Correlation was not found between cystatin C level and triglyceride, cholesterol, LDL, HDL, urea or uric acid. ANOVA analysis showed that cystatin C had a higher level during the middle and late stages of PD than that during the early stage.

Cystatin C level may play an important role in the progression of PD.

To observe the effectiveness of conscious sedation with dexmedetomidine and sufentanil in patients for plastic surgery.

Forty patients scheduled for elective plastic surgery under conscious sedation were infused 1 μg/kg intravenously within 15 minutes as loading dose followed by a continuous infusion of dexmedetomidine(0.5 μg·kg ^-1·h^-1)and sufentanil (0.07 μg·kg ^-1·h^-1)respectively. Sufentanil 0.05 μg/kg and midazolam 0.025 mg/kg were administrated intravenously 5 minutes before local infiltration, and then a bolus of sufentanil or midazolam was given as needed to maintain OAA/S score of 11 during the procedure. The drug infusion was discontinued at 5 to 10 min before the end of the surgical procedure. The complications (i.e. anoxemia, apnea, bradycardia, restlessness, nausea, vomiting, crying and excitation), if any, anesthesia duration and drug consumption were recorded. On the first postoperative day, patients were asked to rate their satisfaction with the anesthetic management and whether they would choose to receive the same sedative analgesic medications and should they require a similar surgical procedure in the future.

The OAA/S score decreased from 20.0±0 to 11.5±2.5 after patients being infused the loading dose of dexmedetomidine, and was maintained 10.5-11.1 during the procedure. At the end of the procedure, the OAA/S score return to 16.1±2.8. The induction of sedation produced a significant decrease in HR (P<0.05) and no significant changes in SBP, DBP and RR values (P>0.05). There were 38 patients completed their procedures under conscious sedation, and there were incident of crying and bradycardia in 5 and 2 patients respectively. The anesthesia duration and consumption of dexmedetomidine, sufentanil and midazolam were (128±47) min, (116±43) μg, (10±5) μg and (2±1)mg respectively. In an interview on the first postoperative day, there were 13 patients complaining no memory, 17 patients complaining fuzzy memory and 8 patients complaining awake during the procedure, respectively. There were 92% of the patients willing to receive the same anesthetic technique again in the future.

Conscious sedation with dexmedetomidine and sufentanil is an effective anesthetic technique in patients for plastic surgery.

To explore the adequacy of the initial ultrasound-guided core needle biopsy (CNB) on the thyroid nodules and the potential factors for predicting the management of the nodules.

Retrospectively collected the subjects who underwent the CNB on the thyroid nodules within one year, with the inclusion criteria: (1) initial CNB on the thyroid nodules, (2) underwent the ultrasound scanning 1 month before the biopsy. The following data were recorded, which were the patient's age, sex, the lesion's sonographic findings (size, number, content, margin, echo, calcification, and internal vascularity), and histopathology. The CNB pathological diagnostic criterion was set up referring to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC).

One hundred and fifty-seven patients with 162 nodules were enrolled, and the adequacy of the CNB was 97.5% (158/162, 95%CI 93.8%-99.3%). Referring to the BSRTC, of all the 153 nodules with determined management, 64(64/153, 41.8%, 95%CI 34.0%-49.6%) were to be followed up only, and 89(89/153, 58.2%, 95%CI 50.4%-66.0%)were to be undergone nodule excision. Three of the sonographic findings, including lesion margin, echogenicity, and internal vascularity, were significantly associated with the management of the nodules (P<0.05), and the internal vascularity and margin were demonstrated as the independent factors for predicting the nodule excision by using the logistic regression model (Odds Ratio=2.942, 2.767,P<0.05). Only one case of moderate localized hematoma was observed in this series.

As long as the specification of biopsy operation and pathology interpretation, the procedure of CNB on the thyroid nodules is safe with high adequacy as well. The sonographic margin and internal vascularity of the lesion are the independent factors for predicting the nodule excision.

To summarize the clinical features, electrophysiological and neuropathological characteristics of peripheral nerves in patients with primary Sjögren's syndrome (SS).

We retrospectively analyzed the clinical, electrophysiological and neuropathological characteristics of 5 female SS patients with neuropathy complications undergoing electrophysiology and sural nerve biopsy at our department from January 2011 to June 2013.

They had an age range of 20-75 years. The course of peripheral neuropathy ranged 0.5-60 months and the whole course 12-240 months. pSS-associated neuropathy included multiple mononeuropathy (n=1), symmetrical axonal sensorimotor polyneuropathy (n=1) and sensory ganglioneuronopathy (n=3). All biopsies showed varying degrees of myelinated fiber loss. Three biopsies had axonal degeneration associated with demyelination. However, there was no formation of onion bulb regeneration or plexus. Necrotizing vasculitis was diagnosed in 2 cases.

The manifestations of peripheral nerve n pSS include multiple mononeuropathy, axonal symmetric sensorimotor polyneuropathy and sensory gangioneuronopathy. Sural biopsy shows typical necrotizing vasculitis in some cases and myelinated fiber loss and axonal degeneration in others. The pathogenic mechanisms of neurological involvement in pSS remain unknown. However, vasculitis, ischemic and immunological insults resulting in sensory gangioneuronopathy have been described.

To explore the feasibility, advantages and clinical value of gasless abdominal-wall lifting laparoscopic myomectomy with 5 mm laparoscope and 2 abdominal holes (1.5-hole-gasless-laparoscopic myomectomy).

A total of 90 cases of uterine fibroids were randomly divided into 2 groups. Lifting gasless group (n=46) underwent gasless abdominal-wall lifting laparoscopic myomectomy with 5 mm laparoscope and 2 abdominal holes, and pneumoperitoneum group (n=44) pneumoperitoneum laparoscopic myomectomy. The operative duration, blood loss volume, average time of single-myoma-removal, intestinal function recovery and hospital stay of both groups were compared.

The operative duration, blood loss volume and average time of single-myoma-removal of lifting gasless group were respectively significantly less than those of pneumoperitoneum group(P<0.01). The postoperative intestinal function recovery and postoperative hospital stay had no significant difference between two groups (P>0.05). Three cases of pneumoperitoneum group were converted successfully into myomectomy with traditional 3-hole gasless abdominal wall lifting laparoscopy because of large fibroids in uterine isthmus. A total of 12 newly discovered myomas, not pre-detected ultrasonically, were removed in 10 cases of lifting gasless group.

1.5-hole-gasless-laparoscipic myomectomy, like traditional gasless laparoscopy, may avoid the complications of laparoscopic CO₂ pneumoperitoneum. The smaller laparoscope-hole and sole operating hole make this maneuver a safe, easy and mini-invasive procedure. It is more suitable for clinical application and popularity in primary care.

To evaluate the cause of infertility and tubal abnormality in women of tubal pregnancy after conservative treatment with laparotomy or laparoscopy through a combination of laparoscopy, hysteroscopic tubal catheterization and hydrotubation.

Laparoscopy was performed to observe pelvic adhesions, tube shape, fimbriated extremity of fallopian and other factors related with infertility for 37 inpatients with infertility after tubal pregnancy and undergoing conservative surgery during December 2008 and October 2010. Meanwhile, hysteroscopic tubal catheterization and hydrotubation were performed with laparoscopy to examine tube patency.

Among them, 97.3% had tube infertility caused by tube abnormality and adhesions, or tube obstruction alone or concurrently. For all tubes, tube obstruction accounted for 79.7%(59/74), fimrial occlusion of fallopian tube 54.1%(40/74)and tube abnormality 52.7%(39/74). Pelvic adhesion occurred at a rate of 89.2% and there were Ⅰ degree (21.6%), Ⅱ degree (32.4%), Ⅲ degree (35.1%) and Ⅳ degree (0). For tubes with pregnancy history, 48.6% showed tube abnormality, 45.9% fimrial occlusion of fallopian tube and 75.7%(28/37)tube obstruction. Comparatively, for the tubes without pregnancy history, 56.8%showed tube abnormality, 62.2%fimbrial occlusion of fallopian tube and 86.5%tube obstruction. No significant difference existed in tube shape, umbrella end and tube obstruction between the tubes with pregnancy history and those without pregnancy history. Neither statistically significant difference was found in adhesion degree, tube shape, umbrella end and tube obstruction of diseased and normal tubes between laparotomy and laparoscopy groups.

Infertility of women after tubal pregnancy and conservative surgery is mainly caused by abnormal tube including pelvic adhesion, tube morphological abnormality and tube obstruction. No marked inter-group difference exists in fertility damage after conservative surgery with laparotomy or laparoscopy.

To explore the clinical characteristics of multiple primary lung cancer (MPLC) and provide potential clues to the early diagnosis and treatment selection of MPLC patients.

The clinical data of 21 patients with MPLC confirmed by postoperative histopathology were analyzed retrospectively.

All the 21 patients received surgery (pulmonary lobectomy or pulmonary wedge resection), and 49 intrapulmonary tumors were resected. The histopathological examination demonstrated that all the 21 cases were MPLC. Among the 21 patients, 10 had bilateral lesions in lung and 11 had unilateral lesions; 17 suffered synchronous and 4 suffered metachronous tumors; 14 had double two primary tumors, 6 had three primary tumors and 1 had four primary tumors. In these patients, 2 had various histological subtypes among their multiple lesions and 19 had same histological subtypes among their multiple tumors; 14 cases with stage Ⅰ disease, stage Ⅱ 2 cases, stage Ⅲ 5 cases.

For the patients who were detected as MPLC by diagnostic imaging examination, more positive therapeutic decision, such as surgery, could be suggested. The molecular markers should be developed for assisting diagnosis of MPLC.

To evaluate the surgical efficacy and significance of pedicle drill template navigation technology for severe complicated scoliosis.

Retrospective analyses were performed for 8 patients with complicated spinal scoliosis during 2010-2013. There were 5 males and 3 females with an average age of 18 (9-23) years. There were congenital (n=5) and idiopathic (n=3) scoliosis. A three-dimensional spinal computed tomography (CT) scan was performed. And the data were acquired and transferred via a DICOM network to a computer workstation. Three-dimensional reconstruction and rapid prototype were obtained. The navigation drill template was manufactured by rapid prototyping for clinical operation. Eight matched patients without navigation drill template were selected into a control group.

Eight patients were successfully operated as planned without any complication of spinal cord, nerve or blood vessel injury. And their post-operative outcomes were satisfactory. The intra-operative findings were the same as pre-operative impressions and measurements by digital spinal three dimensional reconstructions. The results of pedicle drill template navigation were excellent and the position of pedicle screws was accurate as evaluated by postoperative radiology and CT scan. The correction rate of scoliosis was 60%. Navigation drill template group: the average operating duration was 186 min, average volume of blood loss 460 ml and frequency of radiation by C arm 4 times. Control group: the average operating duration was 225 min, average volume of blood loss 550 ml and frequency of radiation by C arm 30 times. The average operative duration between two groups was statistically significant (P<0.01,t-test). And so were average volume of blood loss and frequency of radiation.

The rapid prototyping of pedicle drill template navigation technology is a new method for accurate intra-operative insertion of pedicle screws. It has a high surgical accuracy and safety for spinal scoliosis. The application of pedicle drill template navigation is simple without special experience requirements for operators. It can shorten the operative duration and reduce blood lose. The exposure of operators to radiation may be reduced or avoided during fluoroscopy.

To assess the efficacies of proximal femoral nail antirotation (PFNA) versus dynamic hip screw (DHS) for intertrochanteric fracture in elders.

The databases of PubMed, Embase, CENTRAL, CBM, CNKI and WANFANG were searched for the relevant randomized controlled trials (RCTs) up to May 18, 2013. After quality evaluation and data extraction by two authors independently, meta-analyses were performed with the RevMan5.1 software. And the levels of evidence were evaluated by the GRADEprofile 3.6 software.

A total of 17 studies (n=1 344) were included and there were 656 patients in PFNA group and 688 in DHS respectively. Meta-analyses showed that, as compared with DHS, PFNA could significantly decrease fixation failure rate (odds ratio (OR)=0.26, 95% confidence interval (CI)=[0.12,0.57], P=0.0008), reduce average fracture healing time (weighted mean difference (WMD)=-15.11, 95%CI=[-24.36,-5.85], P=0.001), improve excellent and good rate for Harris score (OR=0.29, 95%CI=[0.15,0.56], P=0.0002), yield a higher Harris score (WMD=6.88, 95%CI=[0.96,12.80], P=0.02) and reduce the rate of coxa vara (OR=0.40, 95%CI=[0.18,0.92], P=0.03). However, there was no statistical significance in 1-year mortality, postoperative nonunion and delayed union, postoperative femoral head necrosis, postoperative femoral fractures or femoral head necrosis. The importance of outcomes was "critical". And the level of evidences based on the GRADE approach was from "very low" to "low".

PFNA is superior to DHS. Due to the limitations of the included studies, more large-sample and high-quality RCTs are required. And subgroup analysis based on fracture types should be performed.

To evaluate the values of radiology, computed tomography (CT) and magnetic resonance imaging (MRI) in assessing symptomatic osteoporosis vertebral compression fractures in vertebroplasty and kyphoplasty.

Retrospective reviews were conducted for 41 osteoporotic vertebral compression fractures patients with preoperative CT (with 3D reconstruction)/MRI (with fat saturation sequence) and preoperative and postoperative radiological imaging data. All patients underwent percutaneous vertebroplasty (PVP) or balloon kyphoplasty (BKP) when conservative treatment failed to offer pain relief.

CT scan showed 52 vertebral fractures while MRI detected a total of 70 lesions of vertebral body, including 44 new fractures, 8 old fractures and 18 bone bruises. Eight old fractures and 2 mild bone bruises were treated conservatively. In conjunctions with MRI, especially fat saturation sequence, 60 therapeutic vertebral bodies were visualized. It was superior to CT. As demonstrated by preoperative and postoperative radiology, vertebral body height improved and Cobb Angle slightly decreased for 60 lesions.

For vertebral compression fractures in osteoporosis patients, preoperative CT and MRI examinations have important clinical significance in providing treatment guidance and assessing postoperative outcomes.

To analyze the diagnosis, treatment and prognosis of the malignant carotid body tumor.

The data of pathology, diagnosis, therapy and follow-up of seven patients with malignant carotid body tumor in Peking Union Medical College Hospital from Dec 1949 to Dec 2012 were analyzed retrospectively.

2 cases without the tumor resection. 5 cases were treated with surgical methods, 4 cases with tumor resection and external carotid artery ligation, 1 case with tumor resection and reconstruction of internal carotid artery with saphenous vein. Cranial nerve palsy occurred in 5 cases, of which 3 occurred hypogiossal nerve damage, 2 cases occurred vagus damage, 1 case with hypogiossal, vagus and sympathetic nerve damage. Follow-up was from 2 to 12 years. local tumor recurrence happened in 2-year postoperation and got remote bone and pancreas metastasis in 5-year postoperation in one case, and finally died in 7-year postoperation. 1 case had the internal carotid artery restenosis severely in 1-year postoperation, then performed the stent treatment. 2 cases without operation were still alive. Interestingly, the tumor after radiotherapy was steady in one case. The other received the tumor resection because of the severe syndrome after 8 years.

the diagnosis of malignant carotid body tumor should base on occurring extensive invasion of adjacent organs, metastasis and pathology. Early stage surgical excision can reduce the recurrence and complication. Radiotherapy can effectively control local size and distant metastasis.

A 51-year-old female was diagnosed with Raynaud's disease in Jiaxing No.1 Hospital because her hands were pale and painful for 7 years after being cold. Had been treated with radiofrequency thermal ablation of the thoracic sympathetic nerve and had a recurrence 6 months later. This time, thoracic sympathetectomy is proposed under thoracoscope. Examination at admission: General condition is good, blood pressure, heart rate, respiration and oxygen saturation are in the normal range. Chest auscultation can hear a systolic murmur of grade 2 to 3 at the left margin of the sternum. The abdomen was flat and soft, without tenderness and mass. Examination of limbs and nervous system was normal. Hands are cold, and the end of the left middle finger is black and painful. Color ultrasound showed atrial septal defect and pulmonary hypertension. Improve all preoperative examinations and preparations. The patient was routinely performed right internal jugular vein puncture and catheterization (ARROW single-lumen catheter) before anesthesia induction. The operation went smoothly. Hands warm after surgery. On the 5th postoperative day, the internal central jugular vein catheter was proposed to be removed. The patient took the recumbent position, routinely disinfected the local area, removed the sutures, and slowly removed the internal jugular vein catheter. When the end of the catheter left the skin, the puncture port was pressed with gauze for 1 min, then fixed with ordinary adhesive tape, and the patient was instructed to lie down. Three minutes later, the patient suddenly suffered from confusion, inability to respond to calls, shortness of breath, and convulsions, which could palpate the pulsation of the great arteries. Endotracheal intubation was performed after the mask was pressurized and oxygenated. Blood pressure was 158/108 mmHg (1 mmHg =0.133 kPa), heart rate was 119 beats/min, both pupils were equal size and round, and right side light response was slow. Emergency CT of the head showed intracranial air embolism (Figure 1)。 After being transferred to ICU for 3 hours, the tracheal intubation was removed and hyperbaric oxygen therapy was performed. The next day, the patient became conscious, hoarse, left hemiplegic, and muscle strength of upper and lower limbs grade 0; Right lower limb muscle strength level 4. Hyperbaric oxygen therapy was administered twice daily for 1 week and then changed to once daily. After 1 week, he was transferred to the neurology department and 2 weeks later to the rehabilitation department. He had hoarseness, left hemiplegia, left lower limb muscle strength grade 1 and left upper limb muscle strength grade 0. Right lower limb muscle strength level 4. The hoarseness disappeared after 30 days, and the muscle strength of the patient's left upper limb was grade 4, and the muscle strength of both lower limbs was grade 5. After 35 days, the patient was able to walk independently.

A 50-year-old female was transferred from an external hospital due to sting of head and neck by swarm bees for 1 d with hematuria and anuria for 6 h. Being in good health. Admission: Multiple bee sting wounds on the head and face, local skin necrosis. Shortness of breath, wet rales audible in both lungs. Physical examination of nervous system: slightly irritable, bilateral pupils D =3 mm, and normal muscle strength and tone of limbs. After admission, HGB and PLT decreased progressively. Urine analysis showed dark red urine, BLD + + +, PRO +, blood UN 17.18 mmol/L, Cr 273.1 μ mol/L, which was considered to be myolysis and red blood cell destruction caused by bee venom, blockage of renal tubules, leading to renal dysfunction and proteinuria; Coagulation function APTT 163.3 s was significantly prolonged; The myocardial enzyme spectrum of CK 16 435 IU/L, CK-MB 293 IU/L were significantly increased, and the blood BNP was 1 712 ng/L. It was considered that myocardial injury and muscle injury caused by bee sting injury were also considered. After admission, he was given high-dose hormone administration, plasma exchange once, CRRT treatment for 6 days, intermittent component blood transfusion and organ support therapy. After the 5th day, the coagulation function, electrolyte and blood gas analysis were normal, and the liver and kidney functions improved compared with before. However, in the early morning of the 7th day, the patient suddenly experienced a decrease in heart rate and slower breathing, followed by respiratory and cardiac arrest. Immediately, cardiopulmonary resuscitation was performed, and the patient recovered his spontaneous heart rhythm. CT examination of the brain showed hematoma in the right occipital lobe and left parietal lobe (Figure 1), the patient's family gave up treatment, and the patient died.

To discuss the establishment of acute cerebral infarction model in rabbits and evaluate the value of computed tomographic perfusion (CTP) imaging.

A total of 12 healthy adult New Zealand white rabbits were used. The model was established through femoral artery puncture and injecting autoblood clot into internal carotid artery through an inserted micro-catheter to occlude the artery. Digital subtraction angiography(DSA)cerebral angiography and CTP imaging were performed at 2 and 6 hours post-embolization.

Super-selective catheterization of internal carotid artery and an injection of auto-blood clots were successfully accomplished in all rabbits and the success rate was 100%. DSA showed that middle cerebral artery and anterior cerebral artery narrowed. At 2 hours post-embolism, CTP showed cerebral blood flow(CBF)and cerebral blood volume(CBV)decreased and mean transit time(MTT)and time to peak(TTP)increased in cerebral ischemia area. Compared with the contralateral mirror area, CBF and CBV decreased in infarct area and MTT and TTP elongated with significant statistical difference at 2 and 6 hours (P<0.01).

The model of acute cerebral ischemia may be effectively established in rabbits. This micro-invasive technique is easily manipulated with a high success rate. And CTP is an effective way of diagnosing acute cerebral infarction.

To explore new treatment modalities for complex intracranial aneurysms.

Under general anesthesia, intracranial aneurysm parent artery remodeling surgery was performed along with repeated immediate intraoperative cerebral angiogram to verify the effect of revascularization and therefore adjust the operation plan accordingly.

Aneurysm was successfully clipped without injuries of vascular branches. Prognosis was excellent.

Complex hybrid surgery is an ideal option for parent artery remodeling of complicated intracranial aneurysms.

hyperbaric oxygen (HBO) has been widely used clinically to treat a variety of diseases, including cerebral air embolism, decompression sickness, carbon monoxide poisoning, brain injury, crush injury, radiation injury, diabetic foot ulcer, etc. In addition to the therapeutic effect, the study also found that after a certain regimen of hyperbaric oxygen exposure in advance, that is, hyperbaric oxygen preconditioning (HBOPC), the body can produce endogenous protective effect under the subsequent stimulation of some adverse factors. This protective effect exists in various tissues and organs such as brain, spinal cord, myocardium, liver, lung, small intestine and skeletal muscle, and its specific mechanism is not very clear at present.

As a classic drug for the treatment of acute promyelocytic leukemia (APL), arsenic trioxide (As₂O₃) in solid tumors and some autoimmune diseases has attracted much attention. Previous studies have suggested that As₂O₃The mechanisms of action in the treatment of tumor diseases such as leukemia mainly include promoting cell differentiation, inducing apoptosis and inhibiting tumor angiogenesis. It has currently been found that As₂O₃It is not only a cytotoxic anti-tumor drug, but also has an immunomodulatory effect. Now As₂O₃The research progress on immunomodulatory effects is summarized below.