The relationship between statin therapy and clinical outcomes after intracerebral hemorrhage (ICH) remains uncertain. Therefore, we performed a post-hoc analysis of the third intensive care bundle with blood pressure reduction in acute cerebral haemorrhage trial study to evaluate the associations of pre-ICH and post-ICH statin use with clinical outcomes. The primary outcome was death or dependency (modified Rankin Scale [mRS] 3–6) at 6 months. Secondary outcomes included death, dependency, hematoma expansion, serious adverse events (SAEs), and cerebral hemorrhagic events. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were estimated. Analysis was performed using generalized linear mixed model. We further examined whether post-ICH statin therapy modified outcomes within the care bundle group. Overall, a total of 7035 patients were included in the study. Pre-ICH (aOR 0.93, 95% CI 0.61–1.42) or post-ICH statin use (aOR 0.97, 95% CI 0.72–1.29) was not associated with death or dependency. However, pre-ICH statin use was associated with lower 6-month mortality (aOR 0.46, 95% CI 0.26–0.80) and a reduced incidence of cerebral hemorrhage (aOR 0.45, 95% CI 0.21–0.97). In stratified analyses, post-ICH statin use was associated with lower odds of 6-month mortality or disability among care bundle recipients (aOR 0.66, 95% CI 0.44–0.99; P = 0.046), with significant effect modification by intervention allocation (P for interaction = 0.019). In summary, statin therapy before or after ICH onset appeared to be safe, without increased risk of SAEs and hematoma expansion. Besides, among patients receiving the care bundle intervention, post-ICH statin use showed a potential association with improved functional outcomes. These exploratory findings require confirmation in future studies.

临床上恶性肿瘤的垂体转移常见，但转移至垂体柄则较为罕见，目前国内外报道的病例数较少。成都市第二人民医院神经外科于2022年4月收治1例以催乳素水平增高为主要表现的肺癌垂体柄转移患者，行开颅手术切除病变。术后患者的电解质紊乱得以纠正，激素水平恢复至正常。

血管内淋巴瘤(IVL)是弥漫性大B细胞淋巴瘤的罕见亚型,侵袭性强,临床表现、实验室和影像学检查均缺乏特异性,误诊率高,临床预后差.成都市第二人民医院神经外科收治1例以颈髓内出血为表现的IVL患者.术前考虑为脊髓海绵状血管畸形导致的自发性颈髓内出血,术后经病理学诊断为IVL.术后20 d因病情进展而死亡.

Objective:To investigate the clinical characteristics, laboratory findings, diagnosis and treatment of patients with central nervous system (CNS)-intravascular lymphoma (IVL), and review the related literature.Methods:On December 19, 2021, a case of a 54 year-old male patient with CNS-IVL admitted to Neurosurgery Department of Chengdu Second People′s Hospital was selected as the study subject. A retrospective analysis method was used to analyze the patient′s clinical data such as medical history, clinical manifestations, laboratory tests, imaging examinations, metagenomic next-generation sequencing (mNGS) results. Diagnose and treatment of this patient based on clinical manifestations and related examination results. China National Knowledge Infrastructure database, Wanfang Data Knowledge Service Platform and PubMed database were searched using " intravascular lymphoma", " diffuse large B-cell lymphoma", " intraspinal hemorrhage", " central nervous system", " spinal cord" as Chinese and English keywords. Diagnosis and treatment data of CNS-IVL involving spinal cord was summarized. The time for literature retrieval was from inception of the database to March 1, 2022. Procedure followed in this study was in line with requirements of the World Medical Association Declaration of Helsinki revised in 2013, and informed consent of clinical research was signed with the patient and his family members. Results:① This patient was admitted due to " numbness and weakness in the left upper limb for 10 d". Previous history of the patient included tuberculous meningitis, viral meningitis, liver dysfunction, severe pneumonia and erythroderma. ② At the time of admission, blood routine test results of this patient showed that white blood cell count (WBC), neutrophil percentage, red blood cell count, hemoglobin (Hb) value, platelet count were 5.4 × 10 9/L, 72.5%, 3.02×10 12/L, 87 g/L, 49 × 10 9/L, respectively. Abdominal color Doppler ultrasound shows mild enlargement of the spleen. Results of cranial MRI, magnetic resonance angiography (MRA), and susceptibility weighted imaging (SWI) showed lacunar cerebral infarction and ischemic focus in the bilateral frontal lobe, left parietal lobe, basal ganglia, and cerebral atrophy, demyelination of white matter. Intracranial artery runs and collateral circulation is normal. A few micro hemorrhage foci were near the right temporal lobe and lateral ventricles. MRI results of spine showed significant swelling of the cervical spinal cord with abnormal signals, indicating consideration of intramedullary hemorrhage. This patient underwent a intramedullary lesion resection, lamina reduction and internal fixation of cervical spine through whole lamina approach. Biopsy of pathological tissue after operation showed that degenerated and necrotic tissue, accompanied by hemorrhage, lymphoma cells infiltrated into the vascular cavity, and some of them gathered around the vascular wall and in blood clots. Immunohistochemical results showed that B cell antigens CD20 (+ ), CD79a (+ ), paired box protein (PAX)-5 (+ ), and vascular endothelial CD34 (+ ). Epstein-Barr virus-encoded small RNA (EBER) in situ hybridization was positive with about 90%. ③ According to clinical features and related examination result, the final diagnosis was CNS-IVL. Due to severe multisystem damage in medical history, the patient did not receive specialized treatment, such as chemotherapy. Due to the deterioration of CNS-IVL condition, the patient died on January 14, 2022. ④ According to the literature retrieval strategy set in this study, a total of 10 articles were included, involving 11 patients with CNS-IVL involving spinal cord included this case in this study. CNS-IVL patients involving the spinal cord in this group are easily misdiagnosed as myelitis or spinal cord infarction in the early stage. Among them, 3 cases were confirmed by lesion biopsy, 4 cases were confirmed by skin biopsy, and 4 cases were confirmed by autopsy. Improving the early diagnosis rate and followed by either a regimen with cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) or R-CHOP (rituximab+ CHOP) will be beneficial for improving the prognosis of patients. Conclusions:CNS-IVL with meningitis onset and progressive involvement of the spinal cord is relatively rare. Patients with Epstein-Barr virus (EBV) positive cerebrospinal fluid should be test for CNS-IVL.

目的 探讨脑室腹腔分流术后脑内出血的原因及其发病机制.方法 回顾性分析3例脑室腹腔分流术后脑内出血患者的临床资料,并结合相关文献进行复习.结果 病例1在分流术后第1天发生早期脑内出血,由于出血量大,行颅内血肿清除术,病例2和3分别于分流术后第6、9天发生迟发性脑内出血,出血量较小行保守治疗.结论 分流术后早期脑内出血可能是空心导管直接穿刺损伤微小血管及血管跨壁压增加所致,而迟发性脑内出血则可能是由于各种原因所致的脑组织脆弱性及导管对微小血管的延迟侵蚀作用造成.

According to the American Heart Association, ischemic stroke is the second leading cause of death globally and is responsible for approximately 11% of deaths. Carotid endarterectomy (CEA) is the standard treatment for moderate or severe extracranial internal carotid artery (ICA) stenoses. With the development of materials and technology in neurointervention, the Centers for Medicare and Medicaid Services (CMS) have proposed that carotid artery stenting (CAS) can serve as an alternative treatment for CEA. As CAS is widely used worldwide, comorbidities, especially persistent hemodynamic depression (PHD) and stroke, have attracted public attention. In this review, we summarized the current advances in PHD after CAS. A better understanding of CAS-related PHD may inspire the design of potential prognostic and therapeutic tools.

目的 分析颈动脉支架植入(CAS)术中低血流动力学紊乱(HD)的危险因素.方法 回顾性分析121例接受CAS患者,根据CAS术中血压和心率变化评估有无HD;以单因素及多因素logistic回归分析筛选CAS中发生HD的危险因素.结果 共42例发生HD(HD组),其中27例见于球囊扩张时,14例见于植入支架时,1例见于以封堵器封堵血管时;79例未见HD(非HD组).单因素分析显示,组间患者年龄、颈动脉狭窄程度和部位(有无累及球部或分叉部)、血管斑块性质及球囊后扩张差异均有统计学意义(P均＜0.05);多元logistic回归结果显示,年龄、狭窄部位、血管斑块性质及球囊后扩张均为HD的独立危险因素(P均＜0.05).结论 CAS术中发生HD与患者年龄、颈动脉狭窄部位、血管斑块性质及有无球囊后扩张有关.

目的 总结颅内破裂动脉瘤栓塞术中再出血的治疗经验及原因.方法 回顾性分析2018年1月～2021年12月介入栓塞治疗的9例颅内破裂动脉瘤术中再出血的临床资料.结果 9例中,5例经术中弹簧圈快速填塞止血、鱼精蛋白中和肝素等抢救后好转出院,4例抢救无效死亡.结论 颅内破裂动脉瘤介入术中再出血,致残率、病死率高.病人自身状况、颅内动脉瘤具体情况、介入治疗本身都与病人预后有关,术前做好再出血预案能有效降低病死率.

Objective: To explore the potential pathogenicity of epistaxis in routine diagnosis and treatment. Methods: The data of a patient with recurrent epistaxis and fever for more than 5 months were observed. Li Mou, a 21-year-old male patient complained epistaxis after digging his nose and was relieved after self-packing treatment before May. Due to the habit of blowing nose, digging his nose and staying up late in nights for playing games, he did not paid attention to his recurrent epistaxis 3 ~ 5 times a month. He had fever in January and his blood routine examination showed mild anemia. Autoimmune hemolytic anemia was considered after screening for blood system disorders. There was no remission after shock treatment with prednisone tablets, and the degree of anemia increased gradually. Frequent epistaxis did not improve after repeated nasal endoscopy, tamponade, cauterization and other treatment. He was admitted to hospital with severe anemia. After admission, the patient was examined for anemia, pale eyelid and conjunctiva, and it was fixed with oil gauze in both nasal cavities. A systolic murmur was heard in the apical region and the second auscultation area of aortic valve; the respiratory sounds of both lungs were rough, and there were no dry and wet rales. The abdomen was soft, without tenderness, rebound pain and muscle tension; there was no edema in both lower limbs. Two independent blood cultures were examined after admission, which showed defective hypoxic bacteria. Cardiac color Doppler ultrasound showed valve vegetations, perforation and reflux. Diagnosis of infective endocarditis caused by defective hypoxic bacteria was made after examination. Antibiotics combined with valve replacement surgery were performed for the treatment. Results: After one year follow-up, the symptoms of anemia and epistaxis were reveled. Conclusion: Routine diagnosis and treatment of epistaxis may be a potential risk factor for infective endocarditis; the presence of infective endocarditis and bacteremia may increase the frequency of epistaxis, resulting in multiple visits to hospital for treatment of epistaxis; in the diagnosis and treatment of autoimmune hemolytic anemia, it is necessary to screen infective endocarditis to rule out the adequate diagnosis.

Von-Hippel Lindau(VHL)综合征为临床罕见疾病,原发病灶位于胸髓者则更为罕见,目前该病的治疗方法仍以外科手术为主,其中显微镜下行微创手术的治疗效果较好.本研究回顾性分析了1例以胸髓血管母细胞瘤合并脊髓空洞为首发表现的VHL综合征患者的临床资料,以期为该病的诊断与治疗提供参考.

Background: Cavernous hemangioma of the glans penis is a relatively rare disease in clinical practice, caused by congenital dysplasia. Case presentation: A 20-year-old male, found a snake shaped dark purple mass on the glans penis for more than 10 years. During the operation, the tumor was seen to be about 0.5 cm away from the outer urethra. The tumor was broken longitudinally, and the boundary between the tumor and the corpus cavernosum was not clear, and the tumor was bluntly separated until it was completely removed. Postoperative pathological examination revealed a cavernous hemangioma. The patient was discharged without complications such as infection or wound dehiscence. Conclusion: With the increase of sexual demand and to avoid rupture and bleeding of glans penis cavernous hemangioma are recommend early intervention and treatment. Keywords: glans; cavernous hemangioma; treatment methods.

1病例资料 45岁女性,10 d前无明显诱因出现头痛伴恶心、心悸,至所在社区就诊,予以甲钴胺及多巴酚丁胺营养神经、止痛等对症治疗,头痛未见明显好转.3 d前,因头痛伴右侧耳后疼痛于我院神经内科就诊,体格检查发现右耳耳后红肿并可触及耳后肿大淋巴结,右侧外耳道疱疹,右侧周围性面瘫;其余体格检查无特殊.遂以亨特综合征收入神经内科,予以抗病毒、营养神经、改善循环、糖皮质激素、中医针灸理疗等对症支持治疗,自诉头痛及面瘫症状较前明显好转.入院头部MRI示环池左侧结节(血管瘤?脑膜瘤?其他?),双侧额叶少许缺血灶(图1A).转至我科进一步治疗.DSA见左侧小脑上动脉分叉处囊状动脉瘤,大小5 mmX9 mm(图1B、1C).全麻下行动脉瘤介入栓塞术,微导管在0.14微导丝引导下超选进入左侧小脑上动脉动脉瘤瘤颈处,先后释放5枚可电解弹簧圈闭塞载瘤动脉,行左侧椎动脉造影显示基底动脉、大脑后动脉等分支显示可(图1D).术后诉有眩晕、恶心等,复查MRI示环池左侧低信号结节,考虑术后改变;左侧小脑及右侧颞叶异常信号,梗死灶?;双侧额叶少许缺血灶(图1E),予以乙酰谷酰胺营养神经、盐酸地芬尼多片等对症支持治疗,眩晕及呕吐症状好转出院.

1 病例资料 病例1∶31岁男性,因头痛头晕、眼球发胀伴恶性呕吐3d入院.无明确外伤史.入院体格检查未见明显神经系统阳性体征.头部CT示右侧额颞顶部慢性硬膜下血肿(chronic subdural hematoma.CSDH),右侧额颞部稍高密度占位(最大截面约3.6 cm×5.0 cm),中线向左偏移10 mm(图1A).头部MRI示右侧额颞部硬膜下血肿,右侧颞部见团块状稍短T1、等T2信号,与邻近弧形异常信号分界不清,邻近颅骨受压变薄(图1B～D).在全麻下行右侧额颞部占位切除术合并右侧额颞部慢性硬膜下血肿清除术,术中见硬膜张力高,硬膜下腔大量暗红色陈旧性血液,见硬膜下血肿包膜形成,分离包膜与硬膜及蛛网膜的粘连,见颞部蛛网膜囊肿(intracranial arachnoid cysts,IAC),切除部分蛛网膜囊肿外层囊壁,见囊内为陈旧性血性液,沟通蛛网膜囊肿与蛛网膜下腔.术后病理检查示蛛网膜囊肿伴血肿形成(图1E).术后复查头部CT、MRI示蛛网膜囊肿较术前缩小(图1F、1G).出院后5个月随访复查头部CT示蛛网膜囊肿较明显缩小(图1H).

Background: Glioma is a prevalent disease of the central nervous system with a high incidence and mortality rate. Many long noncoding RNAs (lncRNAs) have been determined to be critical regulators of glioma oncogenesis. However, the function and mechanism of LINC00963 in glioma have not been fully elucidated. Methods: The expression level of RNA was determined by qRT-PCR, and the protein level was determined by Western blot analysis. A luciferase activity assay was conducted to verify the interaction between miRNA and lncRNA or the target gene. The proliferation, cell cycle distribution, invasion, and migration were evaluated by MTT, EdU, flow cytometry, wound-healing and Transwell invasion assays, respectively. In vivo tumor growth was evaluated in a xenograft nude mouse model. Results: We found that LINC00963 was upregulated in glioma cells and tissues and associated with the poor prognosis of patients with glioma. Ectopic expression of LINC00963 promoted cell proliferation, cell cycle progression, migration, and invasion in vitro and tumorigenesis in vivo. Mechanistically, the results of luciferase activity and RNA pulldown assays validated that LINC00963 could act as a molecular sponge of miR-506. Reciprocal repression was found between LINC00963 and miR-506. In addition, BCAT1 was identified as a target of miR-506, and both the mRNA and protein levels of BCAT1 were reduced by miR-506. In tumor tissues, the expression of BCAT1 was negatively and positively correlated with miR-506 and LINC00963 expression, respectively. The reintroduction of BCAT1 in glioma cells abolished the tumor suppressive function of miR-506 by promoting cell viability and motility. The upregulated LINC00963 and BCAT1 were associated with the aggressive phenotypes of tumors. Conclusion: Our data revealed that LINC00963 confers oncogenic function in the progression of glioma and that the LINC00963/miR-506/BCAT1 axis may be a novel mechanism and therapeutic strategy for this disease.

颈动脉狭窄是引起急性缺血性脑血管事件的重要原因.近年随着颈动脉支架材料进步以及脑保护装置出现,颈动脉支架置入术已逐渐成为颈动脉狭窄病患的治疗选择.本文主要对各类颈动脉支架的特点及研究现状进行综述.

Objectives: With the ongoing outbreak of COVID-19 around the world, it has become a worldwide health concern. One previous study reported a family cluster with an asymptomatic transmission of COVID-19. Here, we report another series of cases and further demonstrate the repeatability of the transmission of COVID-19 by pre-symptomatic carriers. Methods: A familial cluster of five patients associated with COVID-19 was enrolled in the hospital. We collected epidemiological and clinical characteristics, laboratory outcomes from electronic medical records, and also verified them with the patients and their families. Results: Among them, three family members (Case 3/4/5) had returned from Wuhan. Additionally, two family members, those who had not traveled to Wuhan, also contracted COVID-19 after contacting with the other three family members. Case 1 developed severe pneumonia and was admitted to the ICU. Case 3 and Case 5 presented fever and cough on days two through three of hospitalization and had ground-glass opacity changes in their lungs. Case 4 presented with diarrhea and pharyngalgia after admission without radiographic abnormalities. Case 2 presented no clinical nor radiographic abnormalities. All five cases had an increasing level of C-reactive protein. Conclusions: Our findings indicate that COVID-19 can be transmitted by asymptomatic carriers during the incubation period.

目的 探讨颅内尤文样肉瘤(ewing-like sarcomas,ELS)的诊断及治疗策略.方法 回顾性分析1例小脑蚓部ELS的临床资料,行枕下后正中入路显微镜下切除.结果 肿瘤达次全切除,术后荧光原位杂交技术(FISH)检测出CIC基因易位,病理证实为ELS.术后10 d发生非交通性脑积水,病人拒绝再次手术,术后22 d死于枕骨大孔疝.结论 颅内ELS病例罕见,确诊需基因检测,手术加放化疗治疗疗效有限,预后差.