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As one of the most urgent social and health problems in the world, neurodegenerative diseases have always been of interest to researchers. However, the pathological mechanisms and therapeutic approaches are not achieved. In addition to the established roles of oxidative stress, inflammation and immune response, changes of gut microbiota are also closely related to the pathogenesis of neurodegenerative diseases. Gut microbiota is the central player of the gut–brain axis, the dynamic bidirectional communication pathway between gut microbiota and central nervous system, and emerging insights have confirmed its indispensability in the development of neurodegenerative diseases. In this review, we discuss the complex relationship between gut microbiota and the central nervous system from the perspective of the gut–brain axis; review the mechanism of microbiota for the modulation different neurodegenerative diseases and discuss how different dietary patterns affect neurodegenerative diseases via gut microbiota; and prospect the employment of gut microbiota in the therapeutic approach to those diseases. © 2024 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Primary aldosteronism (PA) is the most common cause of secondary hypertension and one of the few medical diseases that can be cured by surgery. Excessive aldosterone secretion is highly associated with cardiovascular complications. Many studies have shown that patients with unilateral PA treated with surgery have better survival, cardiovascular, clinical, and biochemical outcomes than those who receive medical treatment. Consequently, laparoscopic adrenalectomy is the gold standard for treating unilateral PA. Surgical methods should be individualized according to the patient's tumor size, body shape, surgical history, wound considerations, and surgeon's experience. Surgery can be performed through a transperitoneal or retroperitoneal approach, and via a single-port or multi-port laparoscopic approach. However, total or partial adrenalectomy remains controversial in treating unilateral PA. Partial excision will not completely eradicate the disease and is prone to recurrence. Mineralocorticoid receptor antagonists should be considered for patients with bilateral PA or patients who cannot undergo surgery. There are also emerging alternative interventions, including radiofrequency ablation and transarterial adrenal ablation, for which data on long-term outcomes are currently lacking. The Task Force of Taiwan Society of Aldosteronism developed these clinical practice guidelines with the aim of providing medical professionals with more updated information on the treatment of PA and improving the quality of care. [ABSTRACT FROM AUTHOR]

Peritendinous adhesion is a major cause of limb dysfunction and disability in clinical practice. Numerous studies suggest that activation of nuclear factor-κB (NF-κB) pathway in macrophages could be the pivotal figure in excessive collagen synthesis and thus peritendinous adhesion formation. In this study, we assumed this pathological process could be suppressed by inhibiting NF-κB phosphorylation and nuclear translocation using pyrrolidine dithiocarbamate (PDTC), a specific NF-κB inhibitor with the ability to penetrate cell membranes, in macrophages. Then, we conducted electrospinning process to incorporate PDTC into poly(L-lactic) acid (PLA) electrospinning membranes, that is, the PDTC-PLA membranes. Further, with integral film quality and stable drug release property, the PDTC-PLA membranes were subsequently analyzed in the capability and mechanism of preventing adhesion formation both in vitro and in vivo. Our results showed inhibition of macrophage proliferation as well as NF-κB pathway activation from in vitro assays and outstanding promotion in inhibiting NF-κB p65 phosphorylation and reducing adhesion formation from in vivo assays of PDTC-PLA compared to PLA membranes. In conclusion, our findings suggested that PDTC-PLA as an alternative therapeutic approach alleviated inflammation and peritendinous adhesion formation through NF-κB signaling pathway. Pyrrolidine dithiocarbamate (PDTC) can be blended into poly-L-lactic acid (PLA) fibrous membranes by electrospinning process. This incorporation of PDTC into PLA is an effective way to inhibit proinflammatory activation of macrophages and to achieve advanced anti-adhesion outcome after tendon repair. [Display omitted] [ABSTRACT FROM AUTHOR]

Stroke, a global disease with a high disability rate, has limited options for functional rehabilitation and results in an adverse impact on patients' lives. In recent years, mesenchymal stem cells (MSCs) have become a new focus of treatment owing to their potential for neuroregeneration. MSCs have demonstrated therapeutic efficacy capable of cell migration, angiogenesis, immunomodulation, neuroprotection and neural circuit reconstruction. The paracrine action of MSCs can also exert neurotrophic effects and improve the functional recovery. This review shows the transplantation protocol for MSCs, discusses the potential therapeutic mechanisms, and summarizes clinical trials on MSCs for treating ischemic stroke. The current proofs show that MSC therapy for ischemic stroke is safe and feasible. The timing and optimal dose of MSC administration are the main challenges in its clinical use. Although still under research, MSC therapy has the potential to be a new therapeutic approach for neurological recovery from ischemic stroke in the future. [ABSTRACT FROM AUTHOR]

Brain arteriovenous malformations (AVMs) near/within eloquent areas are challenging to treat surgically. The insufficient lesion-to-eloquence distance (LED) is related to poor neurological outcomes. This paper reports the use of in situ embolization combined with surgical resection in a one-staged hybrid operation for eloquent area protection. Nine patients who underwent one-staged in situ embolization combined with surgical resection were selected from the database of a prospective clinical trial (NCT03774017). Nidus got partial in situ embolization in the parts located near/within the eloquence. The rest of nidus was removed via a microsurgical procedure in the same operation. The in situ embolization ensured a sufficient LED to prevent eloquent areas and tracts from being damaged in the subsequent resection. All of the patients achieved complete obliteration with no neurological deficits or complications. One-staged hybrid operation initiates closer cooperation between surgical and endovascular treatments and proposes an integrative therapeutic mode for AVMs. The in situ embolization combined with surgical resection is safe and effective for improving the functional outcome of AVMs with eloquence and tracts involved. The clinical trial is registered at ClinicalTrials.gov (NCT03774017, https://clinicaltrials.gov/ct2/show/NCT03774017). [ABSTRACT FROM AUTHOR]

Background and Objective: Aneurysm rebleeding after rupture can result in a catastrophic outcome with high mortality and morbidity. In this study, we evaluated the correlation of IARS (intracranial aneurysm rupture score) and aneurysm rebleeding. The aim of this study was to explore the clinical utility of IARS for better clinical decision-making.Method: The patients with ruptured intracranial aneurysms between January 2017 and September 2018 were reviewed. Propensity scoring match was performed to construct a cohort. The morphological and hemodynamic parameters were obtained. The difference between stable aneurysms and rebleeding aneurysms was compared. Subsequently, the correlation of IARS and aneurysm rebleeding was studied.Results: The matching process constructed a cohort, including 5 rebleeding aneurysms and 15 stable aneurysms. By comparing the difference between stable aneurysms and rebleeding aneurysms, the statistical significance was found in diameter of neck (p = 0.036), aspect ratio (p = 0.004) and size ratio (p = 0.029), normalized wall shear stress average (p = 0.026), low shear area ratio (p = 0.028), oscillatory shear index (OSI) (p = 0.031), and deviated angle (p = 0.025). The IARS here had a strong correlation with the aneurysm rebleeding, and the interval from the first bleeding to the rebleeding tended to shorten with the increase of IARS (R = 0.715, p = 0.027). IARS had a good predicting value for the aneurysm rebleeding (area under the curve = 0.756, p < 0.001).Conclusion: Based on this preliminary study, intracranial aneurysm rupture score may correlate to the rebleeding in ruptured aneurysms. For ruptured aneurysms with high IARS scores, surgery should be given priority, and medical treatment is not recommended. [ABSTRACT FROM AUTHOR]

Background: Tai Chi that originated in China as a martial art is an aerobic exercise with low-to-moderate intensity and may play a role in cardiac rehabilitation. Aim: To systematically reviewthe effect of Tai Chi on cardiorespiratory fitness for coronary disease rehabilitation. Methods: We performed a search for Chinese and English studies in the following databases: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China Knowledge Resource Integrated Database, Wanfang Data, and China Science and Technology Journal Database. The search strategy included terms relating to or describing Tai Chi and coronary disease, and there were no exclusion criteria for other types of diseases or disorders. Further, bibliographies of the related published systematic reviews were also reviewed. The searches, data extraction, and risk of bias (ROB) assessments were conducted by two independent investigators. Differences were resolved by consensus. RevMan 5.3.0 was used to analyze the study results. We used quantitative synthesis if the included studies were sufficiently homogeneous and performed subgroup analyses for studies with different control groups. To minimize bias in our findings, we used GRADEpro to grade the available evidence. Results: Five studies were enrolled--two randomized controlled trials (RCTs) and three nonrandomized controlled trials (N-RCTs)--that included 291 patients. All patients had coronary disease. ROB assessments showed a relatively high selection and detection bias. Meta-analyses showed that compared to other types of low- or moderate-intensity exercise, Tai Chi could significantly improve VO2max [MD = 4.71, 95% CI (3.58, 5.84), P < 0.00001], but it seemed less effective at improving VO2max as compared to high-intensity exercise. This difference, however, was not statistically significant [MD = -1.10, 95% CI (-2.46, 0.26), P = 0.11]. The GRADEpro showed a low level of the available evidence. Conclusion: Compared to no exercise or other types of exercise with low-to-moderate intensity, Tai Chi seems a good choice for coronary disease rehabilitation in improving cardiorespiratory fitness. However, owing to the poor methodology quality, more clinical trials with large sample size, strict randomization, and clear description about detection and reporting processes are needed to further verify the evidence. [ABSTRACT FROM AUTHOR]

The treatment of brain arteriovenous malformations supplied by deep perforating arteries (PA) (P-BAVM) remains challenging. The aims of this study were to determine the outcomes after surgical treatment in patients with P-BAVMs and to identify the risk factors associated with postoperative neurological deficits. We retrospectively reviewed the medical charts and imaging records of 228 consecutive patients with BAVMs who underwent microsurgical resection of their BAVMs at Beijing Tiantan Hospital between September 2012 and March 2016. Patients were included if the BAVMs were totally or partially supplied by PA. All patients had undergone preoperative diffusion tensor imaging (DTI), MRI, 3D time-of-flight MRA (3D TOF-MRA) and digital subtraction angiography (DSA) followed by resection. Both functional and angioarchitectural factors were analysed with respect to the postoperative neurological deficits, including motor deficits, visual field deficits and aphasia. Statistical analysis was performed using the statistical package SPSS (version 20.0.0, IBM Corp.). Fifty-nine patients with P-BAVMs were enrolled. Radical obliteration was achieved in all P-BAVMs according to postoperative DSA. Forty-five (76.3%) patients obtained neurological deficits 1 week after surgery. At a mean follow-up of 14.7 ± 9.4 (3-30) months after surgery, 34 patients (57.6%) had long-term neurological deficits. Multivariable logistic regression analyses showed that a shorter lesion-to-eloquent fibre tracts distance (LFD) was an independent risk factor for short- ( P = 0.014) and long-term ( P = 0.013) neurological deficits. The cut-off point of LFD for long-term neurological deficits was 5.20 mm. The predominant supply of the PA ( P = 0.008) was an independent risk factor for long-term neurological deficits. This study identified a high risk of surgical morbidity for P-BAVMs. The predominant supply of the PA and a shorter LFD are crucial risk factors for postoperative neurological deficits in patients with P-BAVMs. [ABSTRACT FROM AUTHOR]

Background: This study aimed to elucidate the clinical features, surgical treatment and long-term outcomes of adolescent patients with moyamoya disease. Methods: We reviewed consecutive patients with moyamoya vasculopathy who were admitted to our hospital from 2009 to 2015 to identify adolescent patients with moyamoya disease. Clinical features, surgical treatment and long-term outcomes were analyzed. Follow-up was performed by face-to-face or structured telephone interviews. Outcome measures were future stroke events. We performed univariate and multivariate time-to-event analyses to identify risk factors associated with future stroke events. Results: A total of 95 adolescent patients with moyamoya disease (age at onset, 13.1 ± 2.3 years) were included in this study. During follow-up, 12 patients (12.6%) had stroke events. We found that the patients who underwent direct/combined bypass had a significantly lower risk of future strokes [hazard ratio (HR), 0.16; 95% confidence interval (CI), 0.03-0.74; P = 0.019] compared to patients who underwent indirect bypass. Conclusions: Our results demonstrate that direct/combined bypass can be more effective in preventing future strokes than indirect bypass in adolescent patients with moyamoya disease. [ABSTRACT FROM AUTHOR]

Objective: Previous studies demonstrated a role of variations in sterol regulatory element binding protein (SREBP) cleavage-activating protein (SCAP) in obesity and blood lipids. But the associations between SCAP polymorphisms and blood pressure (BP) are not clear. This study aimed to investigate the relationship between genetic variations in SCAP and BP phenotypes in a Chinese pediatric population. Methods: A case-control study on 702 high blood pressure (HBP) children and 1319 controls was conducted to explore the correlation between single nucleotide polymorphism markers (rs12487736 and rs12490383) of SCAP and BP phenotypes. The associations with continuous and categorical variables were examined by linear regression and logistic regression models under a dominant genetic model for the minor rs12487736 A allele and rs12490383 T allele. Results: The rs12487736 polymorphism was significantly associated with systolic BP (SBP) (β = 1.66, P = 0.003) and diastolic BP (DBP) (β = 1.35, P = 0.024) with age, age-squared, sex, study population and body mass index (BMI) adjusted under the dominant genetic model. The rs12490383 polymorphism was significantly associated with SBP (β = 1.71, P = 0.004) and SHBP (OR = 1.39, 95%CI: 1.04–1.86, P = 0.027). When analyzed by BMI categories, in the normal-weight children, no significant association between the SCAP polymorphisms and BP phenotypes was observed (all P > 0.05). However, in the overweight/obese children, rs12487736 was significantly associated with SBP (β = 1.6, P = 0.019) and SHBP (OR = 1.36, 95%CI: 1.02–1.82; P = 0.037), rs12490383 was associated with SBP (β = 2.04, P = 0.004) and SHBP (OR = 1.50, 95%CI: 1.10–2.05; P = 0.01). Conclusions: This study demonstrated that SCAP rs12487736 and rs12490383 were significantly associated with SBP and SHBP in overweight/obese Chinese children. It provided the evidence for association of SCAP with SBP. [ABSTRACT FROM AUTHOR]

The “linear parametric neurotransmitter PET” (lp-ntPET) model was introduced to capture the time course of transient endogenous neurotransmitter response to drug stimulus from dynamic PET data. We previously used this novel analysis tool to probe the short-lived dopamine (DA) response induced by cigarette smoking in the PET scanner. It allowed us to find a sex difference in the DA signature of cigarette smoking. To make best use of this tool to characterize neurotransmitter response to drug stimulus, the sensitivity of lp-ntPET to detect such responses must be maximized. We designed a series of simulation studies to examine the impact of the following factors on the sensitivity of lp-ntPET using smoking-induced DA release as an example application: tracer delivery protocol, pre-processing for image denoising, timing of the smoking task, duration of the PET scan, and dose of the radiotracer. Our results suggest that a Bolus paradigm could replace a more difficult B/I paradigm without sacrificing the sensitivity of the method. Pre-processing the PET data with the de-noising algorithm HYPR could improve the sensitivity. The optimal timing to start the smoking task is 45min in a 90min scan and 35min in a 75min scan. A mild shortening of the scan time from 90mCi to 75min should be acceptable without loss of sensitivity. We suggest a lower dose limit of a bolus injection at 16mCi to limit underestimation of DA activation. This study established the framework to optimize the experimental design for reaching the full potential of lp-ntPET to detect neurotransmitter responses to drugs or even behavioral tasks. [ABSTRACT FROM AUTHOR]

Background: Clozapine, an atypical antipsychotic medication, has been effectively used to treat refractory schizophrenia. However, the clinical usage of clozapine is limited due to a high incidence of neutropenia or agranulocytosis. We previously reported that clozapine protected dopaminergic neurons through inhibition of microglial activation. The purpose of this study was to explore the neuroprotective effects of clozapine metabolites clozapine N-oxide (CNO) and N-desmethylclozapine (NDC), as well as their propensity to cause neutropenia.Methods: The primary midbrain neuron-glia culture was applied to detect the neuroprotective and anti-inflammatory effect of clozapine and its metabolites in lipopolysaccharide (LPS) and MPP(+)-induced toxicity. And the subsequent mechanism was demonstrated by gp91 (phox) mutant cell cultures as well as microgliosis cell lines. In vivo, to confirm the neuroprotective effect of clozapine and CNO, we measured the dopaminergic neuronal loss and rotarod motor deficits in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-generated mouse Parkinson's disease (PD) model. The neutropenia or agranulocytosis of clozapine and its metabolites was illustrated by white blood cell count of the treated mice.Results: We found that, in midbrain neuron-glia cultures, CNO and NDC were more potent than clozapine in protecting dopaminergic neurons against LPS and MPP(+)-induced toxicity. CNO and NDC-afforded neuroprotection was linked to inhibition of microglia-mediated neuroinflammation, as demonstrated by abolished neuroprotection in microglia-depleted cultures and their capacity of inhibiting LPS-induced release of proinflammatory factors from activated microglia. NADPH oxidase (NOX2) was subsequently recognized as the main target of CNO and NDC since genetic ablation of gp91 (phox) , the catalytic subunit of NOX2, abolished their neuroprotective effects. CNO and NDC inhibited NOX2 activation through interfering with the membrane translocation of the NOX2 cytosolic subunit, p47 (phox) . The neuroprotective effects of CNO were further verified in vivo as shown by attenuation of dopaminergic neurodegeneration, motor deficits, and reactive microgliosis in MPTP-generated mouse PD model. More importantly, unlike clozapine, CNO did not lower the white blood cell count.Conclusions: Altogether, our results show that clozapine metabolites elicited neuroprotection through inactivation of microglia by inhibiting NOX2. The robust neuroprotective effects and lack of neutropenia suggest that clozapine metabolites may be promising candidates for potential therapy for neurodegenerative diseases. [ABSTRACT FROM AUTHOR]

An effective biotin–streptavidin-amplified enzyme-linked immunosorbent assay (BA-ELISA) to rapidly detect metolcarb (MTMC) residues is reported. Nonspecific adsorption was minimized by using 0.5% skimmed milk powder as a blocking buffer and 0.5% bovine serum albumin/phosphate-buffered saline (PBS) as a buffer for streptavidin–horse radish peroxidase conjugates. The established method is four times sensitive than direct competitive enzyme-linked immunosorbent assay, with the IC50of 10.0 ng mL−1. The samples were prepared from mustard, cucumber and mushroom with simple extraction and dilution methods, including use of PBS without concentration or cleanup steps. The samples prepared from spinach and shiitake were quantified after 2-fold methanol extraction and 20-fold dilution with 2.0% fish glutin/PBS. Good accuracy and precision were obtained with mean recoveries between 80.0% and 95.6%, and mean coefficients of variation below 12.1%. A good correlation (R2 = 0.9931) between the BA-ELISA and high-performance liquid chromatography was observed for MTMC analysis in different samples. This method could be potentially useful for high-throughput food inspection. [ABSTRACT FROM PUBLISHER]

Cardiac troponin (cTn) is currently considered the gold standard biomarker for detection of myocardial necrosis. Patients with supraventricular tachycardia (SVT) often present with symptoms resulting in cTn assessment; however, there are no data on the results of such testing in childhood. We hypothesized that cTn elevation would be common in the pediatric SVT population and would portend a benign prognosis. A retrospective review of all pediatric patients (≤21 years) presenting with SVT was performed. Clinical and electrocardiographic variables from the emergency department (ED) presentation were reviewed and clinical outcomes during subsequent follow-up assessed. Of 128 patients seen in the ED for SVT, cTn was assessed in 48 (38 %). Of patients with cTn assessment, 14 (29 %) patients demonstrated cTn elevation. Univariate predictors of cTn elevation included presentation with respiratory or gastrointestinal symptoms (50 vs 12 % and 42 vs 9 %; p = 0.008 and p = 0.01, respectively), lower mean arterial blood pressure (73 vs 85 mm Hg, p = 0.009), higher age-adjusted tachycardia rate ( z score 9.3 vs 7.2, p < 0.001), and longer tachycardia duration (4.2 vs 1.0 h, p = 0.02). Multivariate logistic regression confirmed the association of age-adjusted tachycardia rate (odds ratio [OR] 3.8 per heart rate z score, confidence interval [CI] 1.9-11.8, p = 0.003) and duration (OR 1.5 per hour, CI 1.1-2.5, p = 0.03). Clinical outcome was excellent with no adverse sequelae during a median of 2.9 years of follow-up. Cardiac Tn elevation is common in the pediatric population presenting with SVT. Episode severity, characterized by respiratory or gastrointestinal symptoms, lower mean blood pressure, and increased tachycardia rate and duration are predictive. Clinical follow-up is favorable. [ABSTRACT FROM AUTHOR]

Background: Ureteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA) in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort. Methods: Cancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated. Results: A total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50) of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42) of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001), and 50% (25/50) of the Resonance stents exhibited a significant increase in functional duration (more than 3 months). Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration. Conclusions: Resonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure. Resonance stents can provide a longer functional duration than polymeric stents and should be offered as an option for internal drainage. [ABSTRACT FROM AUTHOR]

To find a more efficient solution for chemolysis of urinary calculi, several organic acids were chosen to form solutions by consulting the composition of a classic solution, Suby G. The solutions together with Renacidin, another classic solution, were designed to react with the 4 phosphate components of urinary stone. The processes were real-time measured and analysed by a focused beam reflectance measurement, and the efficiency factors were investigated and discussed in detail. The results show that several organic acids, e.g. hydroxyacetic acid, lactic acid and α-ketoglutaric acid, are more efficient than citric acid in dissolving urinary phosphate calculus. The new solutions containing the organic acids are promising for improving chemolysis treatment. [ABSTRACT FROM AUTHOR]

Background and objective: Sylvian fissure arteriovenous malformations (AVMs) are among the most challenging AVMs to manage surgically. The estimates of their risk factors and prediction of their long-term prognosis are crucial for clinical decision-making. The authors conducted a retrospective review to patients with sylvian AVMs treated microsurgically to evaluate the risk factors associated with long-term prognosis. Methods: Forty-one patients with sylvian fissure AVMs treated microsurgically between June 2009 and December 2011 were retrospectively reviewed with a mean follow-up time of 23 months (range 6-35 months). Chi-square test was utilized to compare proportions and rank-sum test to compare ordinal materials. Odds ratios (ORs) were used to assess risk factors associated with postoperative short-term outcome and long-term adverse outcome (mRS scores 3-6). Results: One patient died in 1 month after surgery. Eighteen (43.9 %) patients had postoperative transient neurological deterioration. Good outcomes (mRS scores 0-2) were observed in 29 (72.5 %) patients in the follow-up. From the multiple logistic regression, a history of AVM bleeding and deep venous drainage increase the risk of postoperative transient neurological deterioration, with OR = 8.211 and OR = 4.869, respectively. A history of AVM bleeding was a risk factor for long-term adverse outcome, with OR = 7. Conclusions: Despite different Sugita classification subtypes, sylvian fissure AVMs' long-term results with microsurgical resection are better than expected; a history of AVM bleeding is a risk factor for postoperative temporary neurological deterioration and for long-term adverse outcome, while the AVM deep venous drainage is a risk factor only for temporary neurological deterioration. [ABSTRACT FROM AUTHOR]

Objective: To investigate the long term outcomes after conservative and surgical treatment for haemorrhagic moyamoya disease. Methods: 97 consecutive patients with haemorrhagic moyamoya disease from 1997 to 2009 were enrolled in this study (mean age 31±10 years; range 5-56 years). We reviewed the clinical charts and radiographs of patients at the first bleeding episode. Follow-up was obtained prospectively by questionnaires and radiographic examinations. Outcomes were compared based on initial treatment (conservative vs surgical). Results: After a median follow-up of 7.1 years, 21 of the 97 (21.7%) patients developed a second episode of bleeding, and six patients (6.2%) died of intracranial rebleeding. The median interval from initial episode to subsequent rebleeding was 9.1 years (0.1-23.2 years). 17 of 43 (37.1%) conservatively treated patients and four of 54 (7.4%) surgically treated patients experienced a rebleeding event (OR 8.1; 95% CI 2.4 to 26.8; p<0.001). There was a difference in the KaplaneMeier curve of rebleeding between the two groups (Breslow test p=0.047; log rank test p=0.05). The rebleeding ratio in patients who underwent direct bypass was lower than that in patients treated with indirect bypass alone (0% vs 28.5%, 95% CI 1.0 to 1.9; p=0.002). No significant correlation was found between rebleeding and the patient's age, sex, location of haemorrhage, hypertension status or presence of cerebral aneurysm (p>0.05). Conclusions: There is a high risk of rebleeding after the first haemorrhagic episode in Chinese patients with haemorrhagic moyamoya disease. Revascularisation surgery can improve regional blood flow and have greater efficacy at preventing rebleeding than conservative treatment. [ABSTRACT FROM AUTHOR]

Background: This report aims to describe the authors' initial experience with laparoendoscopic single-site (LESS) totally extraperitoneal (TEP) inguinal hernia repair in 100 patients. Methods: Patients who underwent an elective LESS TEP inguinal hernia repair between December 2008 and September 2010 in a single center were enrolled prospectively in this study. Patient demographic data, hernia characteristics, and operative and postoperative outcomes were analyzed. An Alexis wound retractor was placed through the 2-cm subumbilical incision as a homemade transumbilical access platform after the preperitoneal space was created by a balloon dissector. Standard procedures of TEP all were finished using conventional straight laparoscopic instruments. Results: Of the 100 patients in this study, 2 underwent conversion to LESS transabdominal preperitoneal (TAPP) repair. The remaining 98 patients received successful LESS TEP inguinal hernia repair by a single surgeon. No patient required open or conventional laparoscopic conversion. However, one patient did experience recurrence. The mean operative time was 64.2 min, and the hospital stay was 1.54 days. One patient with a history of bladder surgery had a minor intraoperative bladder injury. No major postoperative complication occurred, but 11 patients had seroma or hematoma, 2 had epididymitis, 2 had urinary tract infection, 1 had wound dehiscence, 1 had wound infection, and 1 had urinary retention. This single-arm observational study was limited by the absence of a control cohort. Conclusions: Based on our experience, in the hands of experienced laparoscopic surgeons, LESS TEP repair for adult inguinal hernia using the homemade port as an access platform is feasible and safe and provides acceptable operative outcomes. [ABSTRACT FROM AUTHOR]

The expression of TfR/CD71 in T-cell surface plays a pivotal role in T-cell activation and proliferation. Anti-human-TfR monoclonal antibody could be used as an immunosuppressant in transplant therapy because of their potential to suppress T-cell responses to alloantigens. We therefore examined the feasibility of an anti-human-TfR chimeric antibody (D2C) in suppression of T-cell activation in vitro and graft-versus-host reaction (GVHR) in animals. D2C is a chimeric antibody produced by introducing the human Fc fragment. This antibody showed low antigenicity but high suppressive effect manifested by high potency to block the activation and proliferation of lymphocytes in response to alloantigens. D2C also showed capability to mediate complement-dependent cytotoxicity, which could be correlated with TfR expression in peripheral blood mononuclear cells (PBMCs). Importantly, administration of D2C significantly prolonged survival time of nude mice transplanted with human PBMCs when compared with that of control IgG-treated animals (61.2 ± 4.46 vs. 22.1 ± 5.5 days), which is associated with inhibited GVHR characterized by decreased interleukin-1 and tumor necrosis factor α production derived from transplanted PBMCs. Human-TfR chimeric antibody such as D2C could be a valuable option for the treatment of acute form of graft-versus-host disease. [ABSTRACT FROM AUTHOR]

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To investigate the effect of renal function on the stone-free rate (SFR) of proximal ureteric stones (PUS) after extracorporeal shock wave lithotripsy (ESWL), as urinary obstruction caused by PUS can impair renal function, and elevated serum creatinine levels are associated with decreased ureteric stone passage. PATIENTS AND METHODS From January 2005 to December 2007, 1534 patients had ESWL for urolithiasis, 319 having ESWL in situ for PUS; they were reviewed retrospectively. Patients requiring simultaneous treatment of kidney stones, placement of a double pigtail stent, or percutaneous pigtail nephrostomy tube were excluded. We divided patients into groups by chronic kidney disease (CKD) stage according to the estimated glomerular filtration rate (eGFR) of ≥60 and <60 mL/min/1.73 m2. Stone-free status was defined as no visible stone fragments on a plain abdominal film at 3 months after ESWL. A logistic regression model was used to evaluate the possible significant factors that influenced the SFR of PUS after ESWL, and to develop a prediction model. RESULTS The overall SFR of PUS (276/319 patients) was 86.5%; the SFR was 93% in patients with an eGFR of ≥60 and 50% in those with an eGFR of <60 ( P < 0.001). After univariate and multivariate analysis, the three significant factors affecting SFR were an eGFR of ≥60, stone width, and gender, with odds ratios (95% confidence intervals) of 19.54 (8.25–46.30) ( P < 0.001), 0.67 (0.55–0.82) ( P < 0.001) and 0.16 (0.05–0.50 ( P = 0.002), respectively. A logistic regression model was developed to estimate the probability of SFR after ESWL, the equation being 1/(1 + exp [−(3.8137 − 0.3967 × (stone width) + 2.9724 × eGFR − 1.8120 × Male)]), where stone width is the observed value (mm), eGFR = 1 for eGFR ≥60 and 0 for <60, and male = 1 for male, 0 for female. CONCLUSIONS Gender, eGFR ≥60 and a stone width of >7 mm were significant predictors affecting the SFR after one session of ESWL for PUS. [ABSTRACT FROM AUTHOR]

Abstract: Waltonitone, a new ursane-type pentacyclic triterpene isolated from Gentian waltonii Burkill significantly inhibited human hepatocellular carcinoma BEL-7402 cells growth. Apoptosis induced by waltonitone was characterized by AO/EB staining and flow cytometric analysis. Apoptosis microarray assay results showed BCL-2 family genes might especially play an important role in waltonitone-induced apoptosis. RT-PCR and Western blotting analysis showed that waltonitone could induce tumor cell apoptosis via both death receptor and mitochondria pathways. Meanwhile, the inhibitory effect of waltonitone was examined in vivo using BEL-7402 tumor cells xenografted into athymic mice model. In summary, these studies demonstrated that waltonitone might inhibit hepatocellular carcinoma cells growth and induce apoptosis in vitro and in vivo. [Copyright &y& Elsevier]

Unlabelled: The objective of this prospective study was to evaluate both thyroid function in children with Hashimoto's thyroiditis and the necessity of lifetime thyroxine replacement therapy. A total of 47 patients with goiter and positive thyroid auto-antibodies participated in the study. Serum thyroxine and thyrotropin levels and titers of thyroid auto-antibodies were checked regularly throughout the follow-up period. At the beginning of the study, 25 patients were diagnosed as euthyroid, but at the end of the study, 22 patients initially diagnosed with euthyroidism remained euthyroid, while eight patients with subclinical hypothyroidism and three patients with overt hypothyroidism had become euthyroid. Thus, of the 22 patients with thyroid dysfunction at diagnosis, subclinical or overt, 11 became euthyroid during the follow-up period. The effect of thyroxine treatment on thyroid auto-antibody titers was not significant.Conclusion: Our data shows that Hashimoto's thyroiditis in children has a benign course and that thyroid function in one half of the patients with thyroid dysfunction at diagnosis reverts to normal. Careful follow-up of thyroid function is important in order to determine the necessity and timing of thyroxine replacement therapy. [ABSTRACT FROM AUTHOR]

Abstract: Background: It is an occasional giant case we came to recently. The young patient had no special presentation except for transient epilepsy. It was difficult to get the first impression with either CT or MRI because the mass was huge that it was difficult to locate where its root was. A careful DSA examination further gave us a probable diagnosis—AVF, which was identified through surgery. According to our literature work on PUBMED, few cases have ever been reported with such giant size. Case Description: A 23-year-old man presented with transient epilepsy, and routine computer topography scan only showed a giant mass with clear rounding edge, about 9 cm in diameter, significantly enhanced with contract. The radiologist''s diagnosis was an intracranial aneurysm. A draining vein connecting to the superior sagittal sinus was discovered on DSA, which further confirmed the AVF. A tough yet successful operation was performed to totally remove the intracranial mass, and the patient recovered to normal. Conclusion: The widely accepted treatment of AVF includes endovascular coiling, surgical resection, burning or blockage of the fistulae, or the combination of endovascular and surgical treatments. Comparing to general cases, the size of the AVF in our case is rare. We successfully surgically removed the giant mass, and the patient has totally recovered. [Copyright &y& Elsevier]

Abstract: Objective: To compare the efficacy of nifekalant and amiodarone in the treatment of cardiac arrest in a porcine model. Methods: After 4min of untreated ventricular fibrillation, animals were randomly treated with nifekalant (2mgkg−1), amiodarone (5mgkg−1) or saline placebo (n =12 pigs per group). Precordial compression and ventilation were initiated after drug administration and defibrillation was attempted 2min later. Hemodynamics were continuously measured for 6h after successful resuscitation. Results: Compared with saline, nifekalant and amiodarone equally decreased the number of electric shocks, defibrillation energy, epinephrine dose, and duration of cardiopulmonary resuscitation required for successful resuscitation (P <0.01). The incidence of restoration of spontaneous circulation (ROSC) and the 24-h survival rate were higher in both antiarrhythmic drug groups (P <0.05) vs. the saline group. Furthermore, post-resuscitation myocardial dysfunction at 4–6h after successful resuscitation was improved in animals given antiarrhythmic drugs as compared with the saline group (P <0.05). There were no differences between nifekalant and amiodarone for any of these parameters. Conclusion: The effect of nifekalant was similar to that of amiodarone for improving defibrillation efficacy and for the treatment of cardiac arrest. Administration of either nifekalant or amiodarone before defibrillation increased the ROSC and 24-h survival rates and improved post-resuscitation cardiac function in this porcine model. [Copyright &y& Elsevier]

As a recognized risk factor for cardiovascular disease (CVD), hyperlipidemia (HLP) has developed into a high incidence disease that seriously threatens human health. Finding a new target for effective treatment of HLP will be a powerful way to reduce the incidence of CVD. The purpose of this study was to find potential biomarkers in urine of HLP patients and analyze their metabolic pathways to study the pathogenesis of HLP. An UPLC-Q-TOF/MS technology was used to detect the metabolites in urine of 60 HLP patients and 60 normal controls. Based on PLS-DA pattern recognition, potential biomarkers related to HLP were screened out. 22 potential biomarkers related to HLP were identified, which involved amino acid metabolism, fatty acid metabolism, nucleotide metabolism, steroid hormone metabolism and intestinal flora metabolism, and their possible pathogenesis was found to be related to inflammatory reaction and oxidative stress. The non-targeted metabolomic method based on UPLC-Q-TOF/MS technology can effectively identify potential biomarkers in the urine of HLP patients and explore the possible pathogenesis. Our research will lay a foundation for finding new targets for the treatment of HLP and provide a basis for clinical research on the treatment of HLP. • Non-targeted metabolomics based on UPLC-Q-TOF/MS has been used and analyzed in positive and negative ionization modes. • The urine of 60 patients with hyperlipidemia and 60 normal controls has been studied. • To explore the pathogenesis and find new targets for treatment of hyperlipidemia by finding metabolic profiling. [ABSTRACT FROM AUTHOR]

Abstract Background Cardiac hypertrophy is a serious factor underlying heart failure. Although a large number of pathogenic genes have been identified, the underlying molecular mechanisms of cardiac hypertrophy are still poorly understood. MicroRNAs are a class of small non-coding RNAs which regulate their target genes at the post-transcriptional level. L-type calcium channels play important role in hypertrophic signaling pathways, and CACNA1C is encoded by L-type calcium channels. Here, we hypothesize that the overexpression of miR-135b can attenuate hypertrophy by targeting CACNA1C. Methods We test the functional involvement of miR-135b in cardiac hypertrophy model. In order to evaluate the effect of miR-135b in cardiac hypertrophy, miR-135b mimic, miR-135b agomir and α-MHC-miR-135b transgenic mice were used for the overexpression of miR-135b. Luciferase reporter assays were used to testify the binding of miR-135b to the CACNA1C 3′UTR. Results Our results revealed that in a pathological cardiac hypertrophy model, the expression of miR-135b was clearly downregulated. Hypertrophic marker genes were upregulated after the knockdown of miR-135b in vitro , while the overexpression of miR-135b attenuated hypertrophy. These results suggested that miR-135b may weaken hypertrophic signals. We then explored the mechanism of miR-135b in hypertrophy and identified that CACNA1C was a target gene for miR-135b. The overexpression of miR-135b attenuated cardiac hypertrophy by targeting CACNA1C. Conclusions Our studies revealed that miR-135b is a critical regulator of cardiomyocyte hypertrophy. Our findings may provide a novel strategy for the treatment of cardiac hypertrophy. Highlights • Loss expression of miR-135b was found in pathological cardiac hypertrophy models both in vivo and in vitro. • CACNA1C was a direct target gene of miR-135b. • The overexpression of miR-135b could attenuate pathological cardiac hypertrophy by targeting CACNA1C. [ABSTRACT FROM AUTHOR]

Objective: To present an original technique of robotic-assisted urethra-sparing simple prostatectomy (RAUSP) for treating patients with benign prostatic hyperplasia.Materials and Methods: From April 2015 to December 2016, 27 patients underwent RAUSP via an extraperitoneal approach. Baseline patient characteristics, perioperative outcomes, pathologic outcomes, postoperative Clavien complications, International Prostate Symptom Score, International Index of Erectile Function, and ejaculatory function were assessed.Results: Twenty-six patients (96.3%) successfully underwent RAUSP, one patient (3.7%) was converted to simple prostatectomy. Median operative time was 169 minutes (interquartile range: 150-185); median estimated blood loss was 235 mL (interquartile range: 180-300). Seven cases (26.9%) required urethral repair secondary to inadvertent urethrotomy. Mean catheterization time was 1.6 days (range 1-5). Clavien complications were reported, 6 being low grade (grade 1 or 2) with a single 3a complication (gross hematuria requiring bladder irrigation). Mean follow-up duration was 16.4 months (range 9-30). Postoperative questionnaire demonstrated that international prostate symptom score (P < .001) and quality of life score (P < .001) were significantly improved postoperatively. A total of 14 patients reported erectile function, 13 of which had normal ejaculation, only 1 complained retrograde ejaculation.Conclusion: RAUSP is technically feasible for patients with benign prostatic hyperplasia. Our data indicate that patients have short catheterization time, an acceptable risk profile, significant improvements of voiding function and maintaining antegrade ejaculation following this urethral-sparing technique. [ABSTRACT FROM AUTHOR]

Background Seizure is the second-most common presentation in patients with arteriovenous malformations (AVMs) and superimposes a significant burden on pediatric patients. Postoperative seizure risk in unruptured AVMs is underreported in the pediatric AVM literature. We aimed to characterize and identify predictive factors for postoperative seizures in this study. Methods We performed a retrospective review of all surgically treated pediatric patients with unruptured AVM at our institution from 2001 to 2014. Patients younger than 18 years of age were included. Baseline variables was compared against our outcome of interest, which was defined as patients with or without follow-up seizures. Multivariable Cox regression was performed to identify potential predictive factors. Results The average age of all patients was 13.1 years, and 68.2% were male. Nine patients were asymptomatic (13.6%), and seizure presentation occurred in 57.6% ( n = 38). During an average follow-up of 4.2 years, 12 (18.2%) patients experienced postoperative seizures, with 5 (17.9%) of 28 patients with seizures being de novo. In patients with seizure presentation, 81.6% were completely seizure-free throughout follow-up. In multivariable analysis, larger AVM size (hazard ratio [HR] 1.63, P = 0.023) and temporal location (HR 8.35, P = 0.007) were found to increase the risk of follow-up seizures. On the contrary, seizure presentation (HR 1.91, P = 0.369) and postoperative infection (HR 2.37, P = 0.265) were not associated. Conclusions Surgery may eliminate most seizures with low risk of inducing de novo seizures in pediatric patients with unruptured AVM. Predictive factors for postoperative seizures included large AVM size and temporal location. For selected unruptured AVMs with small size and nontemporal location, consideration of surgery as primary treatment for persistent seizures is a reasonable option. [ABSTRACT FROM AUTHOR]

Objective The treatment of brain arteriovenous malformations (BAVMs) supplied by the anterior choroidal artery (AChA), or aBAVMs, remains challenging. The aim of this study was to determine the surgical outcomes and risk factors for worsened muscle strength (MS) after surgery in patients with aBAVMs. Methods We retrospectively reviewed 266 consecutive patients with BAVMs who underwent microsurgical resection of their BAVMs between September 2012 and June 2016. Patients were included if the BAVMs were entirely or partially supplied by the AChA. All patients had undergone preoperative diffusion tensor imaging, magnetic resonance imaging, 3-dimensional time-of-flight magnetic resonance angiography, and digital subtraction angiography followed by resection. Both functional and angioarchitectural factors were analyzed with respect to the change in MS. Results We identified 29 patients with aBAVMs who underwent surgical resection of the nidus. Radical resection was achieved in all patients. Thirteen (44.8%) patients suffered from postoperative short-term and 11 (37.9%) suffered from long-term MS deterioration. A shorter lesion-to-corticospinal tract distance (LCD) ( P = 0.004) was significantly associated with postoperative short-term worsened MS. Shorter LCD ( P = 0.018) and nidus supplied by cisternal segment of AChA ( P = 0.026) were independent risk factors for the long-term MS worsening. The amplitudes and potential changes of intraoperative motor-evoked potential monitoring were consistent with the surgical outcomes. Conclusions Surgical treatment of aBAVMs can cause a high incidence of MS deficits. Niduses supplied by cisternal segment of AChA and shorter LCD were crucial risk factors for postoperative MS worsening. Motor-evoked potential monitoring was an effective intraoperative technique to predict postoperative MS deficits. [ABSTRACT FROM AUTHOR]

Objective Stroke in young adults is uncommon and rarely described. Moyamoya disease is one of the leading causes of stroke in young adults. We aimed to study the prognostic factors for stroke recurrences and functional outcomes in young stroke patients with moyamoya disease after revascularization. Methods We reviewed 696 consecutive patients with moyamoya disease admitted to our hospital from 2009–2015 and identified patients aged 18–45 years with first-ever stroke. Follow-up was conducted via face-to-face or structured telephone interviews. Outcome measures were recurrent stroke events and unfavorable functional outcomes (modified Rankin Scale >2). Results We included 121 young patients with moyamoya disease suffering from stroke (initial presentation age, 35.4 ± 7.5 years). All patients underwent revascularization after the acute phase of initial stroke events as the secondary prevention for recurrences. During follow-up (median, 40 months), 9 patients (7.4%) experienced recurrent strokes and 8 of them (6.6%) suffered unfavorable functional outcomes. In the multivariate analysis, diabetes was an independent predictor for stroke recurrences (hazard ratio 6.76; 95% confidence interval 1.30–35.11; P = 0.02) and was significantly associated with unfavorable functional outcomes (odds ratio 7.87; 95% confidence interval 1.42–38.74; P = 0.01). Conclusions We identified diabetes as an independent risk factor for recurrent strokes and unfavorable functional outcomes after revascularization in young stroke patients with moyamoya disease. [ABSTRACT FROM AUTHOR]

Introduction The rupture rate of unruptured intracranial aneurysms is influenced by certain angioarchitectural and hemodynamic characteristics. Recently the translucent appearance of aneurysms was described as a possible risk factor for aneurysm rupture. In this study, we investigate the intraoperative rupture risk of surgically clipped unruptured translucent aneurysms (TAs). Method Clinical and radiologic data of microsurgically treated unruptured middle cerebral artery (MCA) bifurcation aneurysms between 2013 and 2015 were collected and analyzed. Aneurysms were divided into TA as defined as >90% reddish pigmentation appearance of the aneurysm wall or non-TA (NTA) according to the observation under microscope by a single neurosurgeon. Parameters were analyzed using univariate and multivariate statistical analyses. Result A total of 41 unruptured MCA bifurcation aneurysms were included in the analysis, and 68.2% (28/41) were defined as TA. The univariate analysis showed that aneurysm characteristics (Dmax, Wmax, height, and lower size ratio [SR]) that were small in nature were associated with TAs. TAs were associated with intraoperative rupture (28.6% vs. 0%, P = 0.04). Multivariate logistic regression analysis found that the lower SR is the independent risk factor for TAs. Conclusion The results demonstrate that a lower SR correlates with TA in the MCA bifurcation and the thinner wall of the TA causes intraoperative rupture more likely. These results provide important information on the fragility of TAs and might influence the treatment decisions in unruptured MCA bifurcation aneurysms with lower SRs. [ABSTRACT FROM AUTHOR]

Objective We aimed to describe our single-center experience in treating cerebellar arteriovenous malformations (AVMs) with microsurgical resection. Methods During a 16-year period, 181 patients with cerebellar AVMs were surgically treated at the Department of Neurosurgery in Beijing Tiantan Hospital. Patient functional status was evaluated using modified Rankin Scale (mRS) scores both before treatment and at the last follow-up. The mRS scores at the last follow-up were dichotomized as good outcome (mRS <3) and poor outcome (mRS ≥3). The treatment modalities, post-treatment complications, obliteration rate, and follow-up outcomes were analyzed. Results Of the 181 patients, 172 (95%) patients presented with initial hemorrhage and 62 (34%) patients experienced rehemorrhage before microsurgical treatment. Complete obliteration of the AVMs was achieved in 177 (97.8%) patients. Good functional outcome was achieved in 144 (80%) of the patients. The surgical mortality rate was 4.4% (8/181), and overall mortality rate was 6.6% (12/181). Poor outcome was significantly associated with increasing age ( P = 0.035; odds ratio [OR], 1.030; 95% CI 1.002–1.060), presurgical mRS ≥3 ( P = 0.029; OR, 2.563; 95% CI 1.101–5.968), eloquent AVM location ( P = 0.015; OR, 3.058; 95% CI 1.244–7.516), and presurgical rehemorrhage ( P = 0.008; OR, 3.266; 95% CI 1.358–7.858). Conclusion Good outcome can be achieved by microsurgical resection in most patients with cerebellar AVMs. Increasing age at surgery, poor presurgical functional status, eloquent AVM location, and presurgical rehemorrhage are independent predictors of poor outcomes after AVM resection. We recommend early surgical resection for all surgically accessible cerebellar AVMs to prevent subsequent hemorrhage and resultant poor neurologic outcomes. [ABSTRACT FROM AUTHOR]

Objective Temporo-occipital junction arteriovenous malformations (TOJ-AVMs) do not often involve eloquent brain cortex, but rather exist beside functional fiber tracts. The objective of this study was to determine the outcomes after surgical treatment in patients with TOJ-AVMs and to identify risk factors associated with postoperative neurologic deficits. Methods We retrospectively studied 41 patients with TOJ-AVMs. All patients underwent preoperative diffusion tensor imaging. Every potentially involved function (visual field and language) was studied as an independent function object (FO). The function-related optic radiation or arcuate fasciculus was tracked. Lesion-to-eloquent fiber distances (LFDs) were analyzed in regard to postoperative neurologic deficits. The areas under the receiver operating characteristic curves were compared. Results There were 58 FOs analyzed. Of these, 26 (44.8%) FOs led to short-term neurologic deficits, and 21 (36.2%) FOs resulted in long-term neurologic deficits. LFD was a significant predictor of short-term ( P = 0.002) and long-term ( P = 0.007) neurologic deficits. The Spetzler-Martin (S-M) score was associated with short-term neurologic deficits ( P = 0.045), but it was not associated with long-term neurologic deficits. The area under the receiver operating characteristic curve of LFD was higher than that of the S-M score in predicting short-term neurologic deficits (0.89 vs. 0.72, P = 0.04) and long-term neurologic deficits (0.90 vs. 0.62, P = 0.002). The cutoff point for LFD in predicting long-term neurologic deficits was 3.10 mm. Conclusions Patients with TOJ-AVMs have a high risk of surgical morbidity, although they often have relatively low S-M scores; LFD is a crucial risk factor associated with postoperative neurologic deficits in patients with TOJ-AVMs. [ABSTRACT FROM AUTHOR]

Background Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with increased intracranial pressure, and these patients are unstable with a high risk of rebleeding. Computed tomography angiography (CTA) has been proposed as an examination tool for the rapid detection of ruptured aneurysms. We aimed to determine the safety and efficacy of CTA alone for surgical treatment of poor-grade aSAH compared with digital subtraction angiography (DSA). Methods We conducted a multicenter retrospective analysis of 144 patients with poor-grade aSAH who underwent surgical treatment for 2 different cohorts. Patients were grouped into CTA alone and DSA groups. Baseline characteristics, postoperative complications, and clinical outcomes at discharge and at last follow-up were compared between the 2 groups. Multivariate logistic regression models were used to assess the association between CTA alone and clinical outcomes after we adjusted for potential confounders. Results Of the 116 patients included, 42 (36.2%) patents received CTA alone and 74 patients (63.7%), including 12 patients with CTA and DSA and 62 patients with DSA alone, received DSA before surgical treatment. Patients with larger ruptured aneurysms ( P = 0.006), aneurysm sizes of larger than 5 mm ( P = 0.025), presence of single aneurysms ( P = 0.018), and presence of intraventricular hemorrhage ( P = 0.019) more often received CTA alone. All ruptured aneurysms were clipped successfully during surgery. There were no statistically significant differences in postoperative complications and clinical outcomes between the 2 groups. Conclusions Although CTA alone can be safely and effectively used in most patients requiring surgical treatment, additional DSA may be considered in patients with smaller ruptured aneurysms or in those with multiple aneurysms. [ABSTRACT FROM AUTHOR]

Background Prediction of high-grade meningiomas before surgery is essential to determine optimal treatment strategies; however, the relationship between radiologic features and malignancy of meningiomas in pediatric patients has not been clearly demonstrated. The aim of this study was to identify preoperative magnetic resonance imaging features that are significantly correlated with high risk of high-grade pediatric meningiomas. Methods We retrospectively reviewed preoperative magnetic resonance imaging features and histopathologic diagnosis according to the 2007 World Health Organization classification system for intracranial tumors of 79 pediatric meningiomas from 2005 to 2015. World Health Organization grade II and III meningiomas were defined as high-grade meningiomas. The relationship between the radiologic findings and incidence of high-grade meningiomas was assessed initially with univariate analysis and then corrected by multivariate analysis. Results According to univariate analysis, heterogeneous tumor enhancement, an unclear tumor-brain interface, tumor cyst, type of dural attachment, lateral location, positive capsular enhancement, and irregular shape of tumor were strong predictive factors for high-grade meningiomas. When corrected by multivariate analysis, an unclear tumor-brain interface ( P < 0.001; odds ratio = 10.4; 95% confidence interval, 3.0–37.0), lateral location ( P = 0.014; odds ratio = 4.9; 95% confidence interval, 1.4–17.6), and narrow base ( P = 0.001; odds ratio = 8.3; 95% confidence interval, 2.5–27.1) were strong independent predictive factors for high-grade meningiomas. Conclusions In pediatric patients, meningiomas with an unclear tumor-brain interface, lateral location, and narrow base on preoperative magnetic resonance imaging are more likely to be high-grade meningiomas. Our results may be helpful in decision making regarding therapeutic strategies for pediatric patients with meningiomas. [ABSTRACT FROM AUTHOR]

Objective To explore outcomes after microsurgery of brain arteriovenous malformations (AVMs) that failed to be obliterated by Gamma Knife radiosurgery (GKRS). Methods From January 2000 to January 2014, 42 consecutive patients underwent surgical resection of persistent AVMs after GKRS. These 42 patients with AVMs who underwent radiosurgery (radiosurgery group) were individually matched with 42 patients with AVMs who did not undergo radiosurgery (no radiosurgery group) based on patient and AVM characteristics. The modified Rankin Scale was used to assess neurologic status of patients. The effects of GKRS on AVM resection and surgical outcomes were analyzed. Results After GKRS, the mean AVM volume was significantly reduced by 76.8% ( P < 0.01), the size was reduced by 41% ( P < 0.01), and the Spetzler-Martin grade was reduced in 61.9% of the patients ( P < 0.01). During the time interval from radiosurgery to surgical resection, subsequent hemorrhages led to significant neurologic deterioration ( P = 0.046). Compared with the control group, the frequency of preoperative embolization, operative time, and blood loss were significantly lower in the radiosurgery group (all P < 0.05). The no radiosurgery group had a significantly higher rate of worsening in mRS scores at 6 months after surgery (40.5% vs. 16.7%, P = 0.029). Good neurologic status (mRS score <3) was achieved in 81% of the radiosurgery group and 83% of the no radiosurgery group at the final follow-up evaluation. Conclusions GKRS performed several years before microsurgical resection can facilitate resectability of AVMs and decrease the rate of postoperative neurologic deterioration. For patients with persistent AVMs several years after GKRS, microsurgical resection is recommended to achieve good clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective To identify whether age, sex, and lesion location are associated with initial presentation in patients with brain arteriovenous malformations (AVMs). Methods Collected data of 3299 consecutive patients with AVM treated at Beijing Tiantan Hosptial from January 1980 to January 2015 were analyzed. The variables assessed were age at diagnosis, sex, AVM location, and mode of initial presentation. Results Initial presentation was AVM hemorrhage in 57.9%, seizure in 20.9%, chronic headache in 14.9%, focal neurologic deficit in 5.2%, and incidental in 1.2%. Younger age and female sex were associated with initial hemorrhage (all P < 0.05). Hemorrhage was more likely to occur in patients with AVMs in the basal ganglia, the corpus callosum, the ventricles, the cerebellum, and the brainstem (all P < 0.05). Male sex was associated with initial seizure ( P < 0.05). Initial seizure was more likely to occur in patients with AVMs in the frontal, temporal, parietal, frontotemporal, and frontoparietal lobe (all P < 0.05). Compared with frontal AVMs, temporal AVMs were more likely to present with hemorrhage ( P < 0.05) and less likely to present with seizure ( P < 0.05). AVMs involving the occipital lobe were more likely to present with chronic headaches ( P < 0.05). Conclusions Initial AVM presentation varied with patient age, sex, and AVM locations. Younger age, female sex, and deep and infratentorial locations may be associated with initial hemorrhage. Male sex and frontal, temporal, and parietal AVM locations may be predictors of initial seizure. Chronic headache was more likely to occur in patients with AVMs involving the occipital lobe. [ABSTRACT FROM AUTHOR]

Objective To establish the beneficial effects of salvianolic acid and fluoxetine on the improvement of cognitive function and amelioration of depression-like symptoms of rats with chronic stress-induced depression. Methods Ninety-nine male Sprague-Dawley rats were randomly divided into 5 groups—a control group with no stress challenge and 4 chronic stress groups. Rats assigned to chronic stress groups were exposed to stress for 3 weeks, and then were given placebo, fluoxetine (20 mg/kg), salvianolic acid (40 mg/kg), or combined fluoxetine and salvianolic acid. Body weight of each rat was recorded throughout the study. Sucrose preference test and water maze experiment were performed after chronic stress challenge and after drug treatment to assess the effect of drug treatments on depressive-like symptoms and cognitive function. The sucrose preference test was also performed before chronic stress exposure for baseline measurement. Results Exposure of rats to chronic stress for 3 weeks significantly reduced body weight and sucrose preference values compared with the no stress control. The water maze experiment showed that chronic stress impaired the spatial learning of rats as well. Treatment of stress-challenged rats with fluoxetine and fluoxetine combined with salvianolic acid resulted in shorter training latency and longer time spent in the target quadrant during the exploration stage of the water maze experiment compared with placebo treatment. Effect of the combined regimen was found more obvious. Conclusions Combination therapy of salvianolic acid and fluoxetine could alleviate depression-like symptoms and cognitive deficit induced by chronic stress. [ABSTRACT FROM AUTHOR]

Objective We reviewed our prospective study of patients with occipital arteriovenous malformations (AVMs) to assess whether the display of optic radiation diffusion tensor imaging (DTI) during neuronavigation-guided surgery can reduce the severity of postoperative visual field deficits (VFDs) and to evaluate the factors associated with visual field preservation. Methods Forty-six consecutive patients with occipital AVMs were randomized in our study. DTI of the optic radiation was displayed during neuronavigation surgery in 24 patients. The other 22 patients were treated surgically without neuronavigation. Modified Rankin Scale (mRS) scores and visual fields were evaluated preoperatively, immediately after surgery, and at the last follow-up. Results The patients' baseline characteristics and AVM features were statistically similar between the 2 surgical groups. The postoperative obliteration rate was 100%. The postoperative mRS scores did not differ between the 2 groups ( P > 0.05). Preexisting VFDs were more common ( P = 0.00004) in patients who bled than in those with unruptured AVMs. The application of DTI-incorporated neuronavigation reduced the frequency and severity of postoperative VFDs ( P = 0.013 and 0.001, respectively). Visual fields were more likely to be preserved in patients with an AVM >5 mm from the optic radiation ( P = 0.025). Conclusions A history of hemorrhage is an independent risk factor for VFDs associated with occipital AVMs. Although not showing superiority in postoperative mRS, functional MRI navigation-guided surgery may help to radically resect occipital AVMs and preserve patient visual fields. A 5-mm distance from the optic radiation may be a suitable safety margin for visual field preservation. [ABSTRACT FROM AUTHOR]

Objective To report our experience with retroperitoneal laparoscopic pyeloplasty for the management of ureteropelvic junction (UPJ) obstruction in patients with horseshoe kidneys (HSKs). Materials and Methods Between March 2005 and May 2012, 2 boys, 5 men, and 1 woman (mean age, 23.9 years; range, 7-42 years) with HSKs underwent retroperitoneal laparoscopic dismembered pyeloplasties for UPJ obstructions with transections of the isthmuses. One patient had a renal calculus that was extracted during surgery. The follow-up included clinical evaluations, ultrasonography, intravenous urography, and diuretic renography. Results Retroperitoneal laparoscopic dismembered pyeloplasty was feasible in all cases. The median operative time was 192 minutes (range, 148-252 minutes), and there were no perioperative complications. The mean hospital stay was 5.8 days (range, 4-7 days). The mean follow-up time was 45 months (range, 18-96 months). All patients were asymptomatic and exhibited decreased pelvic dilation at follow-up. Conclusion The retroperitoneal laparoscopic approach is feasible and safe for pyeloplasty in UPJ obstruction associated with HSK. Isthmectomy and a fully mobilized kidney offer better surgical exposure during the operation. [ABSTRACT FROM AUTHOR]

Abstract: Kombucha is a health tonic. d-Saccharic acid-1,4-lactone (DSL), a component of kombucha, inhibits the activity of glucuronidase, an enzyme indirectly related with cancers. To date, there is no efficient method to determine the content of DSL in kombucha samples. In this paper, we report a rapid and simple method for the separation and determination of DSL in kombucha samples, using the high-performance capillary electrophoresis (HPCE) method with diode array detection (DAD). With optimized conditions, DSL can be separated in a 50cm length capillary at a separation voltage of 20kV in 40mmol/L borax buffer (pH 6.5) containing 30mmol/L SDS and 15% methanol (v/v). Quantitative evaluation of DSL was determined by ultraviolet absorption at λ =190nm. The relationship between the peak areas and the DSL concentrations, in a specified working range with linear response, was determined by first-order polynomial regression over the range 50–1500μg/mL with a detection limit of 17.5μg/mL. Our method demonstrated excellent reproducibility and accuracy with relative standard deviations (RSD) of less than 5% DSL content (n =5). This is the first report to determine DSL by HPCE. We have successfully applied this method to determine DSL in kombucha samples in various fermented conditions. [Copyright &y& Elsevier]

Objective To gain comprehensive insight into the molecular mechanism of formation and rupture of intracranial aneurysms (IAs). Methods All publicly accessible microarray-based whole-genome gene expression profiles on IAs were retrieved. The significance analysis of microarrays method was applied to identify differentially expressed genes (DEGs). Functional annotation was performed using gene ontology terms and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses. Expression of DEGs was examined using quantitative polymerase chain reaction. Results Six data sets of 3 microarray platforms were qualified and analyzed. Comparing expression profiles between aneurysmal wall and control vessels, 5232 significant DEGs were identified among 3 platforms, and MMP12 was shown to have the largest fold change of upregulation. In all 3 platforms, 46 DEGs were shared, and 1297 DEGs were commonly resolved in at least 2 microarray platforms. Among these 1297 concordant DEGs, the 512 upregulated genes were mainly enriched in inflammatory and immune response processes, whereas the 785 downregulated genes were primarily concentrated in smooth muscle cell contraction and development pathways. Comparison between expression profiles of ruptured and unruptured IAs revealed that a few angiogenic factors, including HIF1A , VEGFA , and ANGPTL4 , were upregulated in ruptured aneurysms. Subsequently, the upregulation of MMP12 , HIF1A , and VEGFA was partially confirmed using quantitative polymerase chain reaction among independent samples. Conclusions Inflammation, immune response, and loss of contractile vascular smooth muscle cells could potentially contribute to the formation of IAs, whereas the role of angiogenesis and vascular remodeling in IA formation and rupture needs further exploration. [ABSTRACT FROM AUTHOR]

Nutcracker syndrome is a rare condition of left renal vein entrapment manifesting with hematuria and flank pain. We report a case of nutcracker syndrome, where a robotic-assisted laparoscopic transposition of the left renal vein was performed. To our knowledge, this is the first case of robotic-assisted laparoscopic surgery of a nutcracker syndrome. [ABSTRACT FROM AUTHOR]