患者男，37岁。因右眼视物模糊3个月，于2022年7月31日就诊于吉林大学第二医院眼科。否认头痛、头晕、耳鸣等其他全身症状。吸烟史十余年，约10支/d。既往身体健康。否认家族遗传史及类似病史。眼部检查：右眼、左眼最佳矫正视力（BCVA）分别为0.3、1.0。右眼、左眼眼压分别为14、13 mm Hg（1 mm Hg=0.133 kPa）。双眼眼前节未见明显异常。眼底检查，右眼颞侧部分神经纤维层缺失，视盘颞侧略苍白，其余无异常（图1A，1B）。视野检查，右眼下方视野缺损（图1C）。左眼上述检查均无异常。视神经核磁共振成像平扫+增强检查，右侧颈内动脉末端多发动脉瘤，与右侧颅内段视神经紧密接触（图2A）。进一步行头颈部CT血管成像（CTA）检查，右侧颈内动脉C1、C4~C6段，左侧颈内动脉C1、C4段可见多发瘤样扩张；与右侧视神经接触的C6段动脉瘤直径约为6.4 mm×7.6 mm（图2B、2C）。眼科诊断：右眼压迫性视神经病变继发视神经萎缩。

目的 探讨复合手术解决复杂缺血性血管病的诊疗策略.方法 回顾性分析1例右侧颈动脉全程闭塞病人的临床资料,采用血管介入技术加传统外科手术开通颈动脉,一期行复合手术开通闭塞颈动脉,二期行颈动脉支架植入术,结合治疗中的问题分析诊疗策略.结果 一期复合手术顺利开通颈动脉,取出大量血栓性物质,残留有颈动脉狭窄.二期支架植入后病人精神状态佳、肢体肌力恢复正常;颈部血管彩超显示颈动脉畅通;病人临床治愈出院.术后1个月电话随访病人情况良好.结论 颈动脉全程闭塞为罕见病例,其血管闭塞范围大,传统颈动脉内膜剥脱术或介入支架取栓均无法解决;复合手术可取得良好疗效.

Objectives. The optimal treatment choice of chronic carotid artery occlusion (CAO) remains inconclusive. This study was aimed at exploring the safety and effectiveness of hybrid surgery in the treatment of CAO and at determining predictors for successful recanalization. Methods. In this study, we enrolled 37 patients with CAO who underwent hybrid surgical treatment during the period 2016-2018. We extracted and analyzed patients' demographic data, disease characteristics, surgical success rates, perioperative complications, and prognosis. Results. A total of 37 patients with symptomatic CAO underwent hybrid surgical treatment. Thirty cases (81.1%) were successfully recanalized, while seven were not. Blood reflux after carotid endarterectomy occurred in 18 patients (60%) of the success group and 1 (14.3%) of the failure group (OR, 9.0; 95% CI, 0.95-54.5; P=0.042). The rate of distal ICA reconstruction below the clinoid segment was 20 (66.7%) in the success group and 1 (14.3%) in the failure group (OR, 12.0; 95% CI, 1.3-113.7; P=0.029). In patients with successful recanalization, no ischemic events occurred after surgery and during follow-up, but restenosis of >50% was found in one case. In the failure group, two patients experienced recurrent ischemic events during follow-up. Perfusion imaging in successful recanalization cases is significantly improved, preoperative I/C ratio was 1.44 (IQR 1.27-1.55), and postoperative 1.12 (IQR 1.05-1.23). National Institutes of Health Stroke Scale (NIHSS) score of successful recanalization cases was 5.35 (2.26) before surgery and 2.03 (1.40) at 6 months (P<0.01). Conclusion. Hybrid surgery might be a safe and effective way to treat CAO. Distal internal carotid artery reconstruction to below the clinoid segment and blood reflux after carotid endarterectomy are predictors of successful recanalization.

Atherosclerosis (AS) is one of the most common chronic inflammatory diseases and a major cause of morbidity and mortality. However, the underlying molecular mechanisms of the progression of AS are still largely unknown. Increasing evidence has demonstrated that long noncoding RNAs (lncRNAs) play important roles in a variety of biological processes and the physiological and pathological progression of human diseases. In this study, we aimed to explore the role and underlying molecular mechanism of lncRNA MEG3 in Raw264.7 cells treated with oxidized low-density lipoprotein (ox-LDL). First, we found that ox-LDL inhibited the cell viability and proliferation, increased TNFα and IL1β secretion and induced the apoptosis of Raw264.7 cells. Second, we demonstrated that ox-LDL upregulated MEG3 expression and that knockdown of MEG3 inhibited the action of ox-LDL in Raw264.7 cells. Third, we showed that MEG3 sponged miR-204 in Raw264.7 cells treated with ox-LDL. Fourth, we demonstrated that miR-204 regulated the expression of cyclin-dependent kinase inhibitor 2A (CDKN2A) in Raw264.7 cells treated with ox-LDL. Finally, we revealed that MEG3 exerted its function via the regulation of the MEG3/miR-204/CDKN2A regulatory axis in Raw264.7 cells treated with ox-LDL. In summary, our study identified the role of the MEG3/miR-204/CDKN2A pathway in Raw264.7 cells treated with ox-LDL, revealed a novel regulatory pathway in AS and indicated potential novel characteristic biomarkers and therapeutic targets for AS.

Highlights • Dissecting basilar artery aneurysm (DBAA) is relatively rare. • We report the first case of a DBAA manifesting as sudden sensorineural hearing loss. • This case report adds to the symptom spectrum of DBAA.

烟雾病是一种病因不明的慢性进行性脑血管闭塞性疾病,多表现为双侧颈内动脉及主要分支进行性严重狭窄或闭塞,部分患者脉络膜前后动脉代偿性扩张,迂曲,动脉内血流及压力增加,导致脉络膜上动脉瘤形成,也是烟雾病患者脑室出血的主要原因 [1-5] 。动脉瘤的危险在于瘤体破裂,可导致反复脑出血,死亡率高,需要积极治疗。烟雾病合并脉络膜上动脉瘤治疗方法较多,介入治疗是目前首选的治疗手段 [6,7] 。通过闭塞动脉开通治疗动脉瘤报道少见。本病例因

1 病例资料 患者,男,46岁,因嗜睡1 d,言语不清伴右侧肢体活动不灵5 h入院.患者因嗜睡到当地医院就诊,无言语障碍及肢体活动障碍,行头部CT及血化验检查后诊断为"脑梗死、糖尿病",给予胰岛素降糖治疗.次日晨起后发现言语不清及右侧肢体活动不灵而转至我院治疗.

Objective To evaluate the efficacy and safety of mechanical thrombectomy using Solitaire AB stent in acute ischemic cerebral stroke with intravenous thrombolysis taboo.Methods The clinical data of 19 patients with acute ischemic stroke and intravenous thrombolysis taboo,treated with the Solitaire AB stent from January 2015 to August 2016 in Department of Neurosurgery,the second hospital of Jilin University,were extracted and retrospectively analyzed.There were 13 male and 6 female patients,aged from 30~82.The related factors of intravenous thrombolysis taboo are were beyond the therapeutic time-window for intravenous thrombolysis(6 hours)and / or a higher score of National Institute of Health Stroke Scale(NIHSS>22).The scale of thrombolysis in cerebral infarction(TICI)before and immdiate after thrombectomy,the score of NIHSS before and 7 days after treatment were compared via t test and the clinical outcomes were assessed by modified Rankin Score(mRS)at 90 days after treatment.Results Of 19 patients,successful and complete recanalization was obtained in 18(94.7%),and one case failed.The time from symptom onset to revascularization was(6.8 ± 1.5)h in the internal carotid artery system and(10.0±2.9)h in the vertebral artery system.The time from puncture to reperfusion was(83.3±39.9)min.The NIHSS score 27.3±9.0,which was significantly decreased compared to the admission NIHSS score 9.71±7.98(P<0.01.At 90 days,11 patients(57.89%)had an mRS score of 2,3 patients died(15.79%).Conclusion Mechanical thrombectomy using Solitaire AB stent for acute ischemic cerebral stroke with intravenous thrombolysis taboo,contributes to a high rate of recanalization,dramatically improves clinical outcome and is safe and effective.

颅内动脉瘤（intracranial aneurysm,IAN）是颅内动脉先天发育异常或后天损伤等因素造成局部血管壁受损,在血流的冲击及各种因素的作用下形成的脑血管瘤样突起。研究表明,亚洲人群中颅内动脉瘤患病率约为2.5%-3%。据统计颅内动脉瘤破裂率为3%-6%,约2/3的蛛网膜下腔出血是由IAN破裂造成的[1-3]。IAN破裂出血死亡率和致残率极高,其中,10%-15%尚未来及就医直接死亡。

颅内处动脉粥样硬化性狭窄是脑卒中的主要诱发因素。数字减影全脑血管造影（DSA）是评价脑血管病变的金标准,但该检查方法有侵袭性,费用高,不适用于动脉粥样硬化性病变的筛查。我们通过CTA与DSA对比应用研究来探讨CTA用于临床诊断动脉狭窄及介入治疗前用于疾病评估的可行性。1资料和方法1.1一般资料自2005年09月至2007年4月间,对21例病人进行了CTA及DSA对照检查。男

目的探讨银杏、川芎制剂是否可以使骨髓基质细胞(MSCs)治疗局灶性脑缺血最佳时间窗延后。方法SD大鼠随机分为对照组、MSCs组、MSCs+中药组,每组10只。采用线栓法制备大鼠缺血再灌注模型。MSCs组尾静脉注入MSCs;MSCs+中药组静脉注入银杏、川芎制剂,48h注入MSCs;对照组注入PBS。应用姿势反射实验和肢体不对称应用实验进行神经功能障碍评价,脑组织双免疫荧光组化检测。结果MSCs组、MSCs+中药组神经功能障碍程度明显好于对照组(P<0.05),两治疗组之间无显著差异(P>0.05)。免疫组化显示,MSCs组、MSCs+中药组在梗死灶部位BDNF及GFAP表达显著。结论银杏、川芎制剂可使MSCs治疗时间窗延后,促进MSCs在脑病灶内分布、分化。

Objective:To investigate the role of CTA in the diagnosis of cerebral ischemia disease.Methods:Cerebral ischemia patients were examined with CTA,And the results were compared with DSA.Results:All 198 arteries were inspected,Conincidence of results inspected with DSA and CTA in 195 arterys,discrepancy of diagnosis in 3 arterys.Conclusion:In the diagnosis of cerebral ischemia disease,CTA had high accuracy and repeatability.Make the best of various kinds analysis diagnostic methods,the CTA may substitute to the DSA completely.

Granulocyte colony stimulating factor(G-CSF)can mobilize hemopoietic stem cells(HSCs)from bone marrow to peripheral circulation,stimulating HSCs and marrow stromal cells(MSCs)homing to the lesion of cerebral ischemia,contributing to the interactions of HSCs and MSCs with the cells in ischemic penumbra,and promoting the generation of neurotrophic factors.G-CSF also has antiapoptotic effect on neurons and drives neurogenesis.Mobilizing autologous HSCs and MSCs using G-CSF for the treatment of local cerebral ischemic injury may reduce the volume of cerebral infarction,and improve neurological functional recovery.

骨髓基质细胞(MSC)是指骨髓基质中具有自我复制和多向分化潜能的干细胞,在特定条件下不仅可分化为中胚层细胞,而且也可横向分化为外胚层起源的神经胶质细胞和神经元.缺血性脑损伤时,MSC可向缺血灶迁移并分化为神经细胞,从而减轻神经功能缺损.研究表明,MSC静脉移植促进脑缺血神经功能恢复并非由于移植后新分化的神经元与宿主神经环路发生整合,而是MSC分泌的各种生长因子介导的.MSC并不能取代损伤组织,而是增进其功能,提高残存组织的可塑性.另外,MSC还是外源基因转染和表达的良好载体.MSC具有很强的增殖能力,易于体外培养扩增,通过基因修饰MSC,可提高对缺血性脑损伤的修复作用.因此,MSC有望成为基因治疗的靶细胞,在基因工程方面有着广阔的应用前景.

Objective Further investigate the causing and influential factor of patients who generated cognitive dysfunction in postoperative ruptured aneurysm.Methods 22 operative ruptured aneurysms patients were retrospectively evaluated the relationship of patients' cognitive dysfunction with the preoperative Hunt-Hess grade,SAH Fisher score and the location of aneurysm.MMSE were used to screening and ascertainment cognitive dysfunction.Results Patients manifest with cognitive dysfunction in 8 cases.Anterior communicating aneurysms in 5 cases,posterior communicating aneurysms in 2 cases,Left middle artery in 1 case,and SAH Fisher 3 score in 6 cases and 2 score in 2 cases.8~10 days after operation onset in 5 cases,14~16 days in 2 cases,and 1 cases onset in 18 days after check out.most patients showed mood disturbance,speech nonverbal memory and mental activity speed dysfunction.Conclusions Study showed that cognitive dysfunction were caused by multi factor in postoperative ruptured aneurysm patients.We should highly think of the treatment strategies aimed at reducing cognitive dysfunction early after the operation,cut down patient' permanent mood disturbance,enhance the independence and self-care,the capability of participate to the social activities.

目的 探讨CT血管造影术(CTA)与数字减影血管造影术(DSA)相比在诊断颈动脉狭窄疾病方面的可靠性.方法 选健康成年犬解剖显露颈动脉后用缝合线部分缩窄颈动脉建立颈动脉狭窄动物模型,行CTA和DSA检查并进行比较分析.结果 当颈动脉狭窄率＜95%时CTA与DSA所测量的结果具有一致性,当狭窄率超过≥95%时CTA会夸大狭窄程度.结论 CTA具有微创、安全、费用低、准确、高敏感度等优点,可用于颈动脉狭窄疾病的术前诊断、术后效果评价和随访以及流行病学调查研究.

Objective To research the CTA reliability contrast with DSA on the diagnosis of carotid artery stenosis disease.Methods The contrast study of CTA and DSA to the animal models and clinical patients was performed. Results The two methods had no difference when carotid stenosis rate was less than 95% while CTA magnified the stenosis when the rate was above 95%.Conclusion(1)CTA has less trauma and danger and is more cheaper than DSA.(2)CTA can be used for diagnosis of carotid artery stenosis disease.

Objective Study the role and significance of perfusion weighted MR imagingPWI and DSA in the diagnosis of cerebral ischemic disease. Methods Fifteen cerebral ischemic patients were examined with the PWI and DSA and the results were compared and analyzed. The relation between the clinical manifestations with PWI and DSA were studied. Results The results extent of lesions detected by PWI correlated well with DSA in eleven patients but different in four patients. In eleven cases clinical symptoms presented TIA 4 patients showed stroke symptoms. The rCBF were normal in eight cases and abnormal in seven cases. TTP were normal in five cases delay in ten cases. DSA examination showed that 13 cases had arterial lesions. Seven cases showed collateral circulation. Conclusion TTP is a sensitive method in the evaluation of cerebral ischemic disease. It should combined with DSA and evaluate the cerebral ischemic disease comprehensively.

Recent studies have shown that the endoplasmic reticulum can also be damaged after cerebral ischemia and lead to endoplasmic reticulum response and at last cause neurons apoptosis through various pathways. Among them, the more important one is the caspase-12-mediated apoptosis, and this provides a new train of thought for the transgenic therapy of ischemic stroke. Key words: endoplasmic reticulum; apoptosis; brain ischemia; caspase-12

Objective To evaluate the effect of balloon embolization in the treatment of Traumatic carotid cavernous fistula(TCCF).Methods 12 cases of Traumatic carotid cavernous fistula were examined by transcranial doppler ultrasound(TCD) before and after endovascular treatment, the speed of blood flow, pulse index(PI), pulse-frequency morphology, sound-frequency changes of main artery in the basement of cranium were obtained and analysed. Results Before treatment the blood flow at the siphon segment isnot symmetric, ipsilateral arteries flow were fast and PI were low, Frequency signs were diffuse, accompanied with murmur, flow in superior ophthalmic vein was reversed. abnormal blood flow sign disappeared after balloon placement.Conclusion TCD can provide objective blood flow information of CCF and also an noninvasive method in the diagnosis and follow-up of CCF during pre-postoperation, which is important, and reliable.