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Objective To report 4 cases of intracranial arterial stenosis stenting via radial artery approach and summarize the experience of treatment. Methods and Results The clinical data and treatment process of 4 patients with ischemic stroke treated by intracranial arterial stenosis stenting via radial artery approach in The Affiliated Hospital of Qingdao University were reviewed in 2022. The stenoses were located in the initial segment of left internal carotid artery (ICA), the initial segment of right vertebral artery (VA), the V4 segment of left VA, and the junction of V4 segment of left VA and the basilar artery, respectively. All the 4 patients underwent transradial approach stenting for ICA stenosis. The surgery was successful and the stenoses were recanalized. No adverse reactions were observed during and after the surgery. Conclusions Intracranial arterial stenosis stenting via radial artery approach is safe and effective in the treatment of ischemic stroke.

Objective To compare the effects of stent combined with drug therapy and aggressive drug therapy alone on cognitive function for patients with symptomatic severe intracranial vertebrobasilar artery stenosis and cognitive dysfunction. Methods A total of 53 patients from October 2016 to March 2019 with symptomatic severe intracranial vertebrobasilar artery stenosis and cognitive dysfunction were collected. Patients were divided into 2 groups [stent combined with drugs group (n = 31) and aggressive drugs alone group (n = 22)] based on patients' informed consent. Perioperative status of stent combined with drugs group and incidence of adverse events in both groups were analyzed. Montreal Congnitive Assessment (MoCA) scores were compared in hospitalization period, 1 month and 6 months at follow-up in order to evaluate the improvement of cognition. Then subgroup analysis of different collateral circulation status before stent combined with drugs group was conducted. Results There were 2 cases of perioperative complication in stent combined with drugs group, and there was no statistical difference in cumulative incidence of adverse events and ischemic stroke between 2 groups. According to the comparion that MoCA scores in hospitalization, 1 month and 6 months at follow-up in two different therapy groups, the score of delayed recall had statistical significance (P = 0.005), which indicted stent group had advantages in delayed recall over drugs group. The scores of total MoCA (P = 0.000), line connection test (P = 0.028), drawing clock (P = 0.006), attention (P = 0.001) and delayed recall (P = 0.000) had statistical significance in different follow-up time points and were significantly improved in stent group. In stent group, the scores of total MoCA (P = 0.000, 0.000, 0.009) and attention (P = 0.000, 0.000, 0.030) improved in succession in the time of before treatment, 1 month and 6 months at follow-up. However, the scores of line connection test (P = 0.001, 0.000), drawing clock (P = 0.006, 0.000), and delayed recall (P = 0.000, 0.000) improved mainly within first month at discharge. As to the scores of MoCA in different preoperative collateral circulation status groups, sentence repetition only had statistical significance (P = 0.021). The scores of total MoCA (P = 0.000), line connection test (P = 0.000), drawing clock (P = 0.002), attention (P = 0.000) and delayed recall (P = 0.000) had statistical significance in different follow-up time points. In further comparion of changes of MoCA scores at different time points in 2 preoperative collateral circulation status groups, scores of total MoCA (P = 0.006, 0.006) and attention (P = 0.005, 0.002) were higher at follow-up of 6 month than these in hospitalization and 1 month follow-up in good collateral group, which suggested the scores above improved mainly between 1 month and 6 month at discharge. The score of delayed recall at discharge after 6 month was higher than it in hospitalization. The scores of total MoCA (P = 0.000, 0.000), line connection test (P = 0.003, 0.001), drawing clock (P = 0.004, 0.001), attention (P = 0.000, 0.000) and delayed recall (P = 0.000, 0.000) were higher at follow-up of 1 month and 6 month than these in hospitalization in poor collateral group, which suggested the scores above improved mainly within first month at discharge. Conclusions As to the patients with symptomatic severe vertebrobasilar artery stenosis and cognitive dysfunction, the improvement in multiple cognitive domains of stent combined with drugs therapy and the advantage over aggressive drugs alone group were observed. Meanwhile, the time of cognitive benefit was earlier in poor preoperative collateral circulation status groups than in good collateral group. [ABSTRACT FROM AUTHOR]

Objective A recent randomized controlled trial suggested that aggressive medical management was superior to angioplasty for symptomatic intracranial artery stenosis. But it still had its flaws. This study investigated the perioperative safety of balloon angioplasty for symptomatic intracranial artery stenosis. Methods Twenty-eight patients with severe symptomatic intracranial artery stenosis were treated by balloon dilatation alone from May 2016 to May 2019. The success rate, complications, modified Rankin scale (mRS) and follow-up data were evaluated. Results Twenty-six of 28 patients underwent balloon angioplasty successfully with a success rate of 92.86%. Immediate distal stenosis perfusion was more than Modified Thrombdysis in Cerebral Infarction (mTICI) grade 2b. Stent-assisted angioplasty was used in the other 2 cases. No complications related to worsening clinical symptoms occurred in 28 patients after operation and 30 d of follow-up. There were 10 patients whose modified Rankin Scale (mRS) score was 1 on the 30th day after operation, and the other 18 patients' mRS score was 0. Conclusions Balloon angioplasty is relatively safe in the perioperative period of symptomatic intracranial artery stenosis. Stent-assisted angioplasty is a technique used when balloon angioplasty is ineffective. [ABSTRACT FROM AUTHOR]

Recently, concerns about cognitive impairment and its association with carotid artery stenosis have been raised up progressively. Carotid artery stenting (CAS) is a well - established method which has been widely applied for ischemic stroke. However, its impact on cognitive function remains controversial. CAS can improve cognitive function by reducing the incidence of ischemic stroke and improving hemodynamic status, while postoperative microembolic events can lead to increased cognitive impairment. In addition, the effect of CAS on cognitive function is also affected by many other factors, including white matter hyperintensity (WMH), cerebral microbleeds (CMBs), depression, advanced age, etc. Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis - Hemodynamics (CREST-H) is expected to provide a clearer understanding of the therapeutic effects of CAS in cognitive function in conclusion. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of location of intracranial arterial stenosis on the safety of intracranial stenting. Methods A total of 73 patients with symptomatic intracranial atherosclerotic stenosis (ICAS) were divided into intracranial internal carotid artery (IICA, N = 18), middle cerebral artery (MCA)-M1 segment (MCA-M1, N = 11), intracranial vertebral artery (IVA, N = 27) and basilar artery (BA, N = 17). All of them underwent intracranial stenting. The improvement of intracranial arterial stenosis, cerebrovascular complications including perforating events, artery dissection, in - stent thrombosis, distal stent arterial embolism and cerebral hyperperfusion, and neurological complications including transient ischemic attack (TIA), ischemic stroke and intracranial hemorrhage were recorded. Modified Rankin Scale (mRS) was used to evaluate the prognosis 30 d after operation. Results A total of 73 stents were implanted in 73 patients (35 Apollo balloon - expandable stents and 38 Wingspan self - expandable stents). Among them, 10 cases (10/18) were treated with Apollo stents and 8 cases (8/18) with Wingspan stents in IICA group, 5 cases (5/11) were treated with Apollo stents and 6 cases (6/11) with Wingspan stents in MCA-M1 group, 16 cases (59.26%, 16/27) were treated with Apollo stents and 11 cases (40.74%, 11/27) with Wingspan stents in IVA group, and 4 cases (4/17) were treated with Apollo stents and 13 cases (13/17) with Wingspan stents in BA group. No significant difference was seen in stent type among 4 groups (χ² = 7.422, P = 0.201). The stenosis rate of IICA group after treatment [(10.94 ± 1.99)%] was significantly improved than before treatment [(90.89 ± 7.71)%; t = 69.545, P = 0.000]. The stenosis rate of MCA - M1 group after treatment [(10.37 ± 2.14)%] was significantly improved than before treatment [(87.64 ± 9.46)%; t = 26.000, P = 0.000]. The stenosis rate of IVA group after treatment [(11.02 ± 1.99)% ] was significantly improved than before treatment [(89.11 ± 7.97)%; t = 50.726, P = 0.000]. The stenosis rate of BA group after treatment [(10.99 ± 3.39)%] was significantly improved than before treatment [(91.35 ± 5.62)%; t = 69.545, P = 0.000]. In 73 patients, cerebrovascular complications occurred in 11 cases (15.07%), including 4 cases of perforating events, 4 cases of artery dissection, one case of in-stent thrombosis and 2 cases of distal stent arterial embolism. There were 3 cases (3/18) in IICA group, including 2 cases of artery dissection and one case of distal stent arterial embolism, and 8 cases (8/17) in BA group, including 4 cases of perforating events, 2 cases of artery dissection, one case of in - stent thrombosis and one case of distal stent arterial embolism. No cerebrovascular complications occurred in MCA-M1 group and IVA group. The difference among 4 groups was statistically significant (H = 63.134, P = 0.000). Neurological complications occurred in 6 cases (8.22%), including 4 cases of TIA and 2 cases of ischemic stroke. There was one case (1/18) of ischemic stroke in IICA group, and 5 cases (5/17) in BA group, including 4 cases of TIA and one case of ischemic stroke. No neurological complications occurred in MCA-M1 group and IVA group. The difference among 4 groups was statistically significant (H = 65.698, P = 0.003). At 30 d after operation, there was one case with mRS 1 score in IICA group and one in BA group. The total rate of good prognosis 30 d after operation was 97.26% (71/73). Conclusions The location of intracranial arterial stenosis have a great influence on the risk of perioperative cerebrovascular and neurological complications in the intracranial stenting, and the overall prognosis is good. [ABSTRACT FROM AUTHOR]

Objective To explore the association of three single nucleotide polymorphisms (SNPs; rs228942, rs228941 and rs743777) in interleukin-2 receptor β subunit (1L-2Rβ) gene with the susceptibility and severity of myasthenia gravis (MG). Methods There were 480 MG patients and 487 normal controls enrolled in this study, and their three SNPs (rs228942, rs228941 and rs743777) in IL-2Rβ gene were evaluated through SNPscan™ technique. Subgroups were classified by gender, age of onset, anti - acetylcholine receptor antibodies (AChR-Ab), thymus status, maximal involvement after 2 years of onset and maximal Oosterhuis score. Frequencies of alleles and genotypes were compared between MG group and control group, between MG subgroups and control group, and among subgroups under codominant, log - additive and overdominant models. Results The frequency of T allele of rs228942 in MG group was significantly higher than that in control group (χ² = 4.692, P = 0.030, OR = 1.242, 95% CI: 1.021-1.511). There was significant difference in the frequency of rs228942 genotype between MG group and control group under log-additive model (P = 0.036, OR = 1.230, 95% CI: 1.010-1.480). The rs278942/rs228941 GT haplotype frequency in MG group was higher than that in control group (χ² = 4.286, P = 0.038), while GG haplotype frequency in MG group was lower than that in control group (χ² = 5.333, P = 0.021). The frequencies of T allele of rs228942 was significantly higher in MG subgroups of onset age 15-50 years (χ² = 7.474, P = 0.006, OR = 1.380, 95% CI: 1.095-1.740), non-thymoma (χ² = 4.700, P = 0.030, OR = 1.261, 95% CI: 1.022-1.555) and maximal generalized involvement (χ² = 4.715, P = 0.030, OR = 1.287, 95% CI: 1.025-1.617) than those in control group. Multivariate forward Logistic regression analysis found that onset age 15-50 years (OR = 9.026, 95% CI: 4.225-19.284; P = 0.000), onset age > 50 years (OR = 9.956, 95% CI: 4.475-22.149; P = 0.000), thymoma (OR = 2.578, 95% CI: 1.393-4.773; P = 0.003) and positive AChR-Ab (OR = 1.946, 95% CI: 1.179-3.214; P = 0.009) were the independent risk factors for maximal involvement, while genotypes were not. Conclusions The rs228942 polymorphisms of IL-2Rβ gene may be associated with the susceptibility of MG, but not with the severity of MG. The rs228941 and rs743777 polymorphisms were not found to be associated with the susceptibility and severity of MG. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical application and therapeutic effect of percutaneous vertebroplasty(PVP) and open vertebroplasty for metastatic spinal tumor., Methods: The clinical data of 126 patients with metastatic spinal tumor underwent surgery and obtained follow-up from January 2012 to March 2016 were retrospectively analyzed. These 126 cases were divided into two groups according to different operative methods. The metastatic tumor of 43 cases encroached vertebral canal oppressing spinal cord and nerve root, they were treated with open operation(open vertebroplasty group);and other 83 cases without obviously spinal cord or nerve root compression, or unfit for open operation, were treated with PVP (percutaneous vertebroplasty group) . VAS score, ECOG and Frankel grade were used to evaluate the pain and neurofunction in two groups.All out-hospital patients were followed up every 3 months for 1 time. X-ray, CT, MRI were examined in follow-up., Results: A total of 112 vertebrae underwent PVP with the median surgical time of 50 min;VAS scores decreased significantly at 2 days after operation, which maintained till 1 month later; ECOG grade at 1 month decreased significantly;44 of 112 vertebrae suffered from asymptomatic bone cement leakage, no complications such as nerve injury or pulmonary embolism was found; the median survival time was 16 months. While for open vertebroplasty group, the median surgical time was 160 min and blood loss was 1 000 ml; postoperative VAS scores and ECOG grade at 1 month decreased significantly. Postoperative Frankel grade of 36 patients got improvement in 41 patients with spinal cord functional disturbance(87.8%); and 29 of 40 patients with incompleteness out of motor function were full recovery(76.3%); 12 cases (27.9%) occurred complications and the median survival time was 11 months., Conclusions: The different vertebroplasty treatments can be selected for patients with metastatic spinal tumor, which can relieve the pain, improve the nerve function, reconstruct the spinal stabilization, maintain the local control and raise the life quality., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To evaluate the feasibility and clinical results of subsequent retroperitoneoscopic surgery for patients with previous ipsilateral retroperitoneal surgery through frank incision., Methods: A total of 10 patents were selected for subsequent laparoscopic surgery through retroperitoneal approach. Among them, there were recurrent renal cysts (n = 4) including a history of open surgery (n = 1) and retroperitoneal surgery (n = 3) and nonfunctional kidneys (n = 6) including open nephropyelopolasty (n = 3), retroperitoneoscopic nephropyelopolasty (n = 1) and retroperitoneoscopic ureterolithotomy (n = 2). The mean surgical duration was (12-85) 38.6 months. All patients underwent retroperitoneoscopy. Decortication was performed for renal cysts and nephrectomy for nonfunctional kidneys., Results: All operations were successfully performed with a mean surgical duration of 97 (40-185) minutes and a mean volume of blood loss 125 (20-460) ml. Among 4 cases with intraoperative peritoneal rupture, one case had renal cyst on ventral side. After enlargement, the procedure was performed through peritoneal cavity. The mean postoperative hospital stay was 5.6 (3-9) days. Nine patients received a mean follow-up period of 21.5 (3-47) months. All symptoms were relieved without any occurrence of postoperative complications., Conclusion: For patients with previous ipsilateral retroperitoneal surgery, retroperitoneoscopy may be feasible for properly selected cases.

Objective: To explore the expressions of urokinase-type plasminogen activator (uPA) and its receptor (uPAR) in vulvar tissues and elucidate the patterns., Methods: Thirty cases of vulvar neoplasms, 30 vulvar intraepithelial neoplasia (VIN) and 30 cases of normal epithelial tissue were harvested. And the expressions of uPA and uPAR in paraffin-embedded tissues were detected by immunohistochemistry. And the differential expressions of various vulvar tissues were observed. And the differences were compared in clinical stage and lymph node metastasis., Results: (1) The expressions of uPA and uPAR in normal tissues (0.422 ± 0.022, 0.431 ± 0.027), vulvar intraepithelial neoplasia (VIN) (0.462 ± 0.018, 0.467 ± 0.015) and vulvar neoplasms (0.508 ± 0.020, 0.510 ± 0.020) were significantly different (P < 0.01). (2) The expressions of uPA and uPAR in vulvar tissue significantly increased with a rising stage-level (P < 0.05). (3) Compared with those without lymph node metastasis, the patients with lymph node metastasis had significantly higher expressions of uPA and uPAR in vulvar tissue (P < 0.05)., Conclusion: Thus uPA and uPAR play an important role in the development process of vulvar neoplasms with an elevated expression in normal vulvar tissue, VIN and vulvar neoplasms. The invasiveness and prognosis of vulvar neoplasms may be evaluated through detecting the tissue expressions of uPA and uPAR.

Objective: To compare the clinical efficacy and safety of nephrectomy versus radical nephrectomy for renal cell carcinoma (RCC)., Methods: A total of 134 patients with renal carcinoma without metastasis in lymphatic system and distant sites were recruited. In random, 69 cases of renal cell carcinoma were elected for nephrectomy and the others radical nephrectomy. The operating time, blood loss, fasting time, postoperative hospital stay, information of tumor recurrence and metastasis, survival time without tumor, survival rate and perioperative complication were compared between two groups., Results: In cases of nephrectomy, the operating time ranged from 60 - 135 minutes and blood loss 70 - 100 ml. In 4 cases, membrana pleuro-peritonealis was damaged. The fasting time ranged from 6 - 24 hours and postoperative hospital stay 5 - 8 days; the staging of all 69 cases was detected; follow-up studies ranged from 5 - 15 years, finding 1 case tumor metastasis in adrenal body and 1 case recurrent tumor in cases of radical nephrectomy, operating time ranged from 105 - 185 minutes and blood loss 150 - 2000 ml. Membrana pleuro-peritonealis was breached in 3 cases. The fasting time ranged from 12 - 90 hours and postoperative hospital stay 8 - 12 days. The staging of all 65 cases was detected. Follow-up studies of 5 - 15 years revealed 1 case of tumor metastasis in brain and 1 case of recurrent tumor. There was no significant difference in perioperative complication, tumor recurrence, tumor metastasis and survival time without tumor between those two groups (P > 0.05). The blood loss, operating time, fasting and postoperative hospital stay were less than that in radical nephrectomy group (P < 0.05)., Conclusion: In patients without metastasis in lymphatic system and distant sites, nephrectomy is both effective and safe. It has the advantages of a short operating time, a short postoperative hospital stay and less damage and blood loss than radical nephrectomy.

Objective: To discuss the causes of common complications of ureteroscopy and how to prevent them., Methods: A total of 768 cases of common complications of ureteroscopy were retrospectively analyzed from February 2004 to February 2009., Results: The intra-operative complications were failed entry (n = 6, 0.78%), ureterostoma injury and ureterostoma submucosa pseudocana (n = 12, 1.56%), ureteral perforation (n = 16, 2.08%), stone displacement (n = 13, 1.87%) and ureteral mucosa evulsion (n = 3, 0.39%). And the post-operative complications were lumbago or renal colic (n = 11, 1.43%), infection (n = 9, 1.17%)and severe hematuria (n = 5, 0.65%)., Conclusion: Skillful operative techniques and strict indications are key to reducing complications of ureteroscopy.

Objective: To explore if PPARgamma agonist rosiglitazone could enhance the anti-atherosclerotic effects of mouse peroxisome proliferator-activated receptor gamma1 (PPARgamma1) gene transfer in apolipoprotein-knock out mice., Methods: Adult ApoE-knock out mice were fed a Western-diet for 20-weeks and then injected with PBS, Ad. PPARgamma1 (5 x 10(8)pfu) or Ad. GFP (5 x 10(8)pfu) via jugular vein. Another group of mice were intervened with rosiglitazone (dissolved in 0.5% cellulose acetate, 4 mg.kg(-1).d(-1), per gavage) 1 week before Ad. PPARgamma1 injection (n = 10, each group). Two weeks later, the lipid core and plaque composition were characterized with oil red O staining and Movat method respectively. The expression of PPARgamma, SM-actin, MOMA-2, MMP-9/TIMP-1, CD40/CD40L and TF antigens in aortic roots and plaques among four groups were compared semi-quantitatively using immunohistochemical technology., Results: All parameters were similar between AdGFP and PBS groups (P > 0.05). The area of plaque were significantly decreased and oil red O staining area significantly increased in AdPPARgamma1 [(0.86 +/- 0.12) mm(2), (150 +/- 35) x 10(3) microm(2)] and AdPPARgamma1 + RO [(0.79 +/- 0.15) mm(2), (270 +/- 49) x 10(3) microm(2)] treated mice compared with AdGFP group [(0.98 +/- 0.17) mm(2), (80 +/- 21) x 10(3) microm(2)] all P < 0.05. Elastic fiber, collagen and proteoglycan in plaques were also significantly increased in AdPPARgamma1 and AdPPARgamma1 + RO groups. Upregulation of PPARgamma, SM-actin, TIMP-1 antigen activity and downregulation of MOMA-2, MMP-9, CD40/CD40L and TF antigen activity in AdPPARgamma1 and most significantly in AdPPARgamma1 + RO group were observed (P < 0.05)., Conclusion: Anti-atherosclerotic effects of PPARgamma1 gene transfer in ApoE-knock out mice could be enhanced by PPARgamma agonist rosiglitazone.

Objective: To investigate the effect of PPARgamma1 gene overexpression on caveolin-1 mRNA and protein expressions in a murine macrophage cell line Raw264.7., Methods: Replication-deficient recombinant adenovirus expression vector of PPARgamma1 was constructed using the AdEasy system. Raw264.7 cells were randomly treated as follows: P group (PPARgamma1 gene overexpression), T group (Troglitazone 40 micromol/L in DMSO), PT group (PPARgamma1 gene overexpression and Troglitazone) and control group. Changes of PPARgamma1 and caveolin-1 at mRNA and protein levels were investigated., Results: Caveolin-1 expression can be detected by RT-PCR in Raw264.7, by immunocytochemistry method in cell and nuclear membrane but not by immunoblotting at protein level. Caveolin-1 expression at mRNA and protein levels in Raw264.7 were significantly higher in P, T and PT groups compared to control group and the expression was also significantly higher in PT group than that in P group and T group (P < 0.05). PPARgamma expression was significantly increased in PT group and P group where remained unchanged in T group compared to control group., Conclusion: PPARgamma1 overexpression can upregulate caveolin-1 expression in macrophages. Troglitazone upregulated caveolin-1 expression in the absence of increased PPARgamma1 expressions at mRNA and protein levels.