Objective To explore the related risk factors of rupture of very small intracranial aneurysms(VSIA),and to provide guidance for the clinical management of unruptured intracranial microaneurysms.Methods A total of 99 patients of single very small intracranial aneurysms at Calmette Hospital Affiliated to Kunming Medical University from January 2016 to November 2021 were continuously included in the study.They were divided into ruptured group(n=48)and non-ruptured group(n=51)according to whether or not they ruptured.The clinical features,tumor location,shape and morphological parameters of the patients were retrospectively analyzed.Independent sample t test orx2test was used to analyze the significance of these factors.Multivariate logistic regression analysis was further performed on the statistically significant factors in the univariate analysis.The receiver operating characteristic curve was used to analyze the optimal threshold of each parameter to predict the rupture of microaneurysms.Results There were significant differences in aneurysm location,morphology,inflow angle,aneurysm angle,aspect ratio,volume to neck ratio,diameter-width ratio,size ratio,hypertension history and smoking history between the ruptured group and the non-ruptured group(P＜0.05).Multivariate Logistic regression analysis showed that smoking history,inflow angle,diameter-width ratio,volume to neck ratio and shape were independent risk factors for rupture of microaneurysms(P＜0.05).The ROC curve showed that the maximum area under the curve of the inflow angle was 0.864,which was the most accurate to evaluate whether the VSIA was ruptured.Conclusion Very small intracranial aneurysm with large inflow angles,diameter-width ratio,volume to neck ratio,irregularities in the aneurysm,and location in the anterior communicating artery are considered to be at high risk of rupture,and aggressive surgical intervention is recommended if conditions warrant.For patients with a history of hypertension and smoking,it is recommended to control blood pressure well,quit smoking,undergo regular digital subtraction angiography review,and timely surgical intervention if aneurysm morphology changes.

随着医学诊疗技术的迅速发展,造影剂被越来越广泛使用,其副反应如过敏反应、肾功能损害及造影剂脑病(contrast-induced encephalopathy,CIE)等也随之增多.造影剂对神经系统的副反应的患病率约为1％～2％[1].CIE是一种使用造影剂后出现短暂性、可逆性的神经功能障碍和CT扫描异常的罕见疾病,大部分预后良好,但仍有极少数患者出现严重神经功能障碍,甚至死亡.大部分致死性CIE病例均因为使用高渗性造影剂,对于非离子单体低渗造影剂诱发的致死性CIE报道极为少见.本文报道1例使用碘普罗胺造影剂的颅内动脉瘤栓塞术后发生致死性CIE的临床表现、病因、诊治经过,旨在提高对CIE的认识.

目的 探讨LVIS支架辅助弹簧圈栓塞治疗颈内动脉床突上段夹层动脉瘤(DA-SICA)的可行性、有效性.方法 回顾性分析2015年1月至2020年7月运用LVIS支架辅助弹簧圈栓塞治疗的28例DA-SICA的临床资料.结果 双LVIS支架辅助栓塞13例,术后即刻造影显示Raymond分级Ⅰ级10例,Ⅱ级3例;单LVIS支架辅助栓塞15例,术后即刻造影显示均为Raymond分级Ⅰ级.术中动脉瘤破裂出血2例.围手术期死亡3例,其中2例死于恶性脑肿胀,1例死于再出血.存活25例术后随访3～49个月,平均(26.5±2.5)个月;2例术后复发,再次使用LVIS支架辅助弹簧圈栓塞治愈;其余23例术后3个月复查DSA无动脉瘤复发及载流动脉狭窄.结论 LVIS支架辅助弹簧圈栓塞治疗DA-SICA,是一种有效、可行的选择,使用支架的数目应根据术中具体情况决定,术后应制定个体化的抗血小板治疗方案.

目的 比较单纯抗凝与联合血管内治疗重症颅内静脉窦血栓形成(CVST)患者的结局.方法 回顾性分析2013年1月～2019年6月昆明医科大学附属甘美医院收治的39例CVST患者的临床资料.根据治疗方式不同分为单纯抗凝治疗组(保守组)19例与抗凝联合血管内治疗组(手术组)20例.比较两组患者不良反应发生率、血管再通率、结局良好率、格拉斯哥昏迷指数(GCS)、改良Rankin量表(mRS)的差异.结果 两组患者出院GCS评分均显著高于入院GCS评分(P＜0.05);手术组血管再通率显著高于保守组(P＜0.05);两组不良反应发生率比较差异无统计学意义(P＞0.05);手术组结局良好率显著高于保守组(P＜0.05);手术组出院时、出院3月、出院6月mRS评分显著低于单纯抗凝组(P＜0.05).结论 抗凝联合血管内治疗重症颅内静脉窦血栓形成患者出院后预后较好的可能性更大,可作为单纯治疗后效果不佳患者的备用方法.

目的:分析妊娠期及产褥期颅内静脉窦血栓(CVST)患者病例资料,提高对孕产妇并发CVST的认识.方法:回顾性分析2013年1月至2019年1月昆明医科大学附属甘美医院诊断为孕产妇并发CVST患者的一般资料、临床表现、实验室及影像学检查结果、治疗方式与预后情况.结果:13例患者中,处于产褥期者10例,首发症状表现为头痛8例,实验室检查D-二聚体升高者5例,通过CT发现异常者11例.所有患者通过磁共振成像、磁共振静脉成像明确诊断,影像学检查结果示:累及上矢状窦9例,横窦8例,其中累及2个静脉窦及以上者8例.9例患者预后良好,5例手术患者中4例预后良好.结论:孕产妇并发CVST更易发生在产褥期,最常见临床症状为头痛,D-二聚体无异常不能排除CVST可能,CVST最易累及上矢状窦及横窦,尽早诊断、选择合适的治疗方法可使大部分患者取得较好预后.

目的:探讨高血压幕上脑出血在微创治疗中使用有创颅内压监测的临床应用价值.方法:选取昆明医科大学附属甘美医院2017年6月至2019年6月收治的高血压幕上脑出血且接受微创治疗的患者68例,使用随机数字表法分为颅内压监测组及对照组,各34例,颅内压监测组术中、术后持续监测颅内压,对照组术后采用常规监护,比较两组患者病例资料.结果:颅内压监测组术中血肿抽吸量、术后使用甘露醇量、复查CT次数较对照组少;颅内压监测组住院时间、住神经外科重症监护室时间较对照组短;颅内压监测组出院3月后格拉斯哥预后评分预后不良率较对照组低,差异均具有统计学意义(P<0.05).结论:术中、术后持续使用颅内压监测能实时掌握颅内压变化情况,减少复查CT频率,减少住院天数及降低短期预后不良率,值得在临床中推广和应用.

Objective: To explore how miR-124 reduces brain cell apoptosis and provides a neuroprotective effect after intracerebral hemorrhage by activating the STAT3 signaling pathway.Methods: A total of 96 clean-grade healthy male rats were randomly selected and randomly divided into a sham operation group (a craniotomy to expose the coronal skull suture and anterior condyle, with no injection of autologous blood into the putamen), a model group (use brain localizer to inject autologous blood into rat putamen), an miR-124 overexpression group (use a brain localizer to inject autologous blood into the rat putamen and slowly inject diluted miR-124 analogs into the rat lateral ventricle), and an miR-124 low expression group (use a brain localizer to inject autologous blood into the rat putamen and then slowly inject a diluted miR-124 antagonist into the rat lateral ventricle), with 24 rats in each group. The expression of miR-124 in each group was determined by real-time quantitative PCR. The expression of inflammatory cells in the brain tissue of each group was observed by HE staining. TUNEL staining was used to determine the apoptosis of brain tissue cells in each group. Western blot was used to determine the expression of STAT3 in each group.Results: Compared with the sham operation group, the expression levels of miR-124, inflammatory cells, and apoptosis in the tissues surrounding the cerebral hemorrhage in the model group were significantly increased, and the expression level of STAT3 was significantly reduced (P<0.05). Compared with the model group, the miR-124 overexpression group had significantly higher miR-124 expression levels, inflammatory cells, and apoptosis, and significantly reduced STAT3 expression levels. In the miR-124 low expression group, the expression levels of miR-124, inflammatory cells, and apoptosis in the tissues surrounding the cerebral hemorrhage were significantly reduced, and the expression level of STAT3 was significantly increased (P< 0.05).Conclusions: Inhibition of miR-124 expression could activate the STAT3 signaling pathway, significantly reduce brain cell apoptosis and inflammatory cells after cerebral hemorrhage, and thus play a neuroprotective role.

INTRODUCTION:Aneurysmal subarachnoid hemorrhage (aSAH), caused by rupture of an intracranial aneurysm and bleeding into the subarachnoid space, is a life-threatening cerebrovascular disease. Because of improvements in clinical interventions, the mortality rate of aSAH is gradually decreasing. Thus, many survivors recover from aSAH but still have sequelae. Working memory (WM) deficit is one of the most common and severe sequelae after aSAH. Interestingly, the severity of WM deficit is not identical to the extent or localization of brain damage, which implies an underlying mechanism of WM deficit other than direct hemorrhagic brain damage. Previous studies have revealed altered neural activity of several brain regions during stimulus tasks. However, the behaviors and functional organization of these corresponding areas in the resting state remain unclear. Insights into the organization of the WM network could reveal novel information about the mechanism of WM deficits, which will be of great value in developing new therapeutic strategies.METHODS:In this study, we recruited 50 aSAH patients consisting of survivors with either impaired or intact WM (two groups). Independent component analysis was performed on resting state data to extract the WM network. Dynamic causal modeling was then performed to assess the intrinsic coupling between key regions of the WM network. A model describing the neural activity and functional organization of the WM network was established, although some connections were not consistent in the resting state.RESULTS:We found that effective connectivity of the precuneus (PCUN)-middle temporal gyrus (MTG), MTG-PCUN, and middle frontal gyrus-inferior parietal lobule was significantly decreased in the impaired WM group, which suggests a vital and central role of affected regions or connections and provides new targets for brain stimulation.CONCLUSIONS:The results of this study may contribute to new therapeutic or rehabilitation strategies for aSAH patients with WM deficits.

随着医学影像学技术快速发展,对比剂应用日渐广泛,相关不良反应随之增加.对比剂脑病(CIE)是应用对比剂后出现的短暂性、可逆性神经功能障碍性疾病,多预后良好,但少数患者可出现严重神经功能障碍甚至死亡.本文对CIE临床特点、发病机制、高危因素及治疗措施等研究进展进行综述.

目的 分析重症颅内静脉窦血栓(Cerebral Venous Sinus Thrombosis,CVST)患者二种治疗方法的短期预后,探讨重症CVST患者的最佳治疗方法.方法 回顾分析2013年1月至2019年1月昆明市第一人民医院神经外科28例确诊为CVST重症患者,分为单纯抗凝治疗组与抗凝联合血管内治疗组,分析比较二组的短期预后.结果 抗凝联合血管内治疗组的短期预后良好率优于单纯内科抗凝组,差异具有统计学意义(P＜0.05).结论 对于重症CVST抗凝治疗效果差患者,可尝试介入治疗,能有效改善患者短期预后.

目的:分析妊娠并发颅内静脉窦血栓形成患者1例的发病特点、临床特征、治疗方法及预后,并进行相关文献复习.方法:通过对患者进行相关资料收集并对该病的相关知识进行文献复习.结果:患者以头痛并发右侧肢体活动不灵入院,入院予抗凝及血管内介入治疗,术后7d突发呼吸循环衰竭死亡.结论:颅内静脉窦血栓好发于中青年及育龄期女性,多以头痛起病,易累及上矢状窦,其次是横窦、乙状窦,发病尽早诊断及规律治疗,多数患者预后较好.

OBJECTIVE:To investigate the clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) after surgeries in Yunnan Province. METHODS:We retrospectively analyzed the demographic features, vascular risk factors, severity at admission, and aneurysm locations in 85 patients with aSAH receiving surgical interventions in Yunnan Province. All the patients were treated by aneurysm clipping or coiling and followed up for clinical outcomes and recovery of daily activities evaluated by modified Rankin Scale (mRS) and Activities of Daily Living (ADL) scale, respectively. RESULTS:Thirty-four of the patients (40.0%) underwent aneurysm clipping and 51 (60.0%) underwent aneurysm coiling. During a median follow- up period of 66.23 months (IOR, 12.03 months), 84.7% of the patients had low mRS scores, and 78.8% lived independently. The WFNS grade at admission was significantly correlated with the follow-up mRS scores (95%CI: 1.48-19.09, P=0.011) and ADL (95%CI: 2.55-28.77, P < 0.001). Multivariate analysis showed that age (95%CI: 1.02-1.23, P=0.017; 95%CI: 1.00-1.15, P=0.038) and a high WFNS grade at admission (95%CI: 2.19-141.48, P=0.007; 95%CI: 2.84-82.61, P=0.002) were independent predictors of both mRS and ADL scores at follow-up. There was no significant difference in clinical outcomes or the length of hospital stay between the two treatment strategies (P > 0.05), but the cost of hospitalization was significantly higher in coiling group than in the clipping group (P < 0.001). CONCLUSIONS:Both aging and a high WFNS grade at admission are associated with a poor prognosis of aSAH, for which aneurysm clipping and coiling have similar long- term outcomes, but for patients with a high WFNS score, aneurysm clipping is favored over coiling in terms of health economics.

目的 比较并评价神经内镜微创手术与小骨窗开颅术和颅骨钻孔+尿激酶输注+导管引流术对高血压脑出血病人血肿清除的疗效和安全性.方法 采用随机法将90例HICH患者分为3组:小骨窗开颅术(A组),颅骨钻孔+尿激酶输注+导管引流术(B组),神经内镜手术(C组),每组30例.比较3组患者的血肿清除率、死亡率、GCS评分、GOS评分、再出血率、肺炎发生率、颅内感染率等并发症.ELISA方法测量所有脑出血患者外周血IL-4、IL-6、IL-8、IL-10和S100β蛋白水平.结果 成功完成所纳入的各组脑出血患者手术,A组、B组、C组患者血肿清除率分别为74.5％、43.1％、88.2％,差异有统计学意义(P<0.05).C组患者手术时间、再出血率、肺炎发生率、死亡率低于A组和B组(P<0.05).手术6月后GOS评分显示C组患者Ⅰ级和Ⅱ级人数高于A组和B组(P<0.05),而III级、IV级和V级人数分别低于A组和B组(P<0.05).C组患者术后72 h外周血液IL-10水平高于A组和B组(P<0.05),而IL-4、IL-6和IL-8水平低于A组和B组(P<0.05).在术后28 d,C组患者血清S100β蛋白水平低于A组和B组(P<0.05).结论 神经内镜技术的微创、直观、较高的血肿清除率,较低的并发症发生率和明显改善临床预后,可能是治疗高血压脑出血更有前景的手术方法.

目的 分析15例使用LVIS支架辅助弹簧圈栓塞治疗的颈内动脉破裂的血泡样动脉瘤患者的有效性和安全性.方法 15例患者均使用LVIS支架辅助弹簧圈栓塞治疗,其中5例患者行双支架辅助栓塞治疗,分析术中动脉瘤破裂出血、术中血栓形成、术中及术后载瘤动脉分支血管闭塞、支架释放后移位、支架释放后塌陷、弹簧圈逃逸发生率及手术结束前、术后14 d、90 d的Raymond分级、MRS评分.结果 15例患者均行支架辅助弹簧圈栓塞,弹簧圈使用率为100％,共5例采取双支架辅助栓塞,其中3例为双LVIS支架,一例为LVIS支架+Enterprise支架,另一例为SolitaireAB支架+LVIS支架.术中动脉瘤破裂出血一例,手术结束时评估,Raymond分级1级14例(93.3％)0,Raymond分级2级1例(6.7％).术后14d造影复查再评估,14例患者为Raymond分级1级(93.3％),1例患者为Raymond分级2级(6.7％);14例患者mRS评分0分(93.3％),1例患者mRS评分2分(6.7％).术后90 d造影复查再评估,15例患者全部为Raymond分级1级(100％),无复发患者;14例患者mRS评分0分(93.3％),1例患者mRS评分1分(6.7％).结论 LVIS支架辅助栓塞破裂的颈内动脉血泡样动脉瘤具有一定的有效性和安全性,远期疗效仍需多中心、大样本及长时间的随访观察.

BACKGROUND: More than 20 neurotrophic factors have been found. Among them, nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) are the most widely distributed growth factors in the central nervous system, and they are responsible for the growth, development and neuronal plasticity of the central nervous system and even of the entire brain. OBJECTIVE: To fully understand NGF and BDNF, learn more about their role in the repair of nervous system damage, and to review the research progress in NGF and BDNF and their precursors. METHODS: A computer-based online retrieval of PubMed and CNKI databases was performed to search relevant papers about neurotrophic factors, NGF and BDNF. The keywords were “nerve growth factor (NGF), proform of nerve growth factor (proNGF), brain-derived neurotrophic factor (BDNF), precursor for brain-derived neurotrophic factor (proBDNF), neurotrophic factor, neurotrophin receptor” in English and Chinese, respectively. RESULTS AND CONCLUSION: NGF has the biological function of protecting neurons after peripheral nerve injury. The precursor of NGF simultaneously forms trimers of signal transducers with receptors p75 NTR and Sortilin and induces apoptosis and death of nerves post-nerve injury. PDNF preferentially binds to TrkB to produce biological effects that promote synaptic growth or support the survival and differentiation of neurons. The precursor of BDNF preferentially binds p75 NTR and Sortilin to trigger neuronal apoptosis. With the deepening of the research, it has been found that the precursors of NGF and BDNF exhibit the opposite biological effects on the mature NGF and BDNF, but the specific mechanism of action remains unclear. Subject headings: Neurturin; Nerve Growth Factor; Peripheral Nerves; Tissue Engineering Funding: the National Natural Science Foundation of China, No. 31560295; the Basic Applied Research of Yunnan Province (Combined Project of Kunming Medical University), No. 2015FB098; the Health Science and Technology Project of Yunnan Province, No. 2014NS202

〔Abstract〕Objective: To investigate the clinical significance of propofol on the treatment of severe traumatic brain injury with continuous invasive intracranial pressure monitoring. Methods: 32 patients were randomly divided into 2 groups with invasive intracranial pressure monitoring. In propofol group, patients were given continuous intravenous pumping of propofol for 1-4 days. Patients in the control group were given a regular treatment of neurosurgery. Close observation of GCS scoring, ICP change rate, total amount of mannitol and complication was carried out. Results:Two groups had no significant difference in GCS scoring in 1 week(P>0.05). On the 3rd day and 4th day, the decrease of ICP of propofol group was greater than that of control group. The total amount of mannitol of experiment group was obviously smaller than that of control group on the 2nd day, the 3rd day and 4th day(P< 0.05). Conclusion:In a certain period of time, propofol would help reduce the ICP, thus decreasing the total amount of mannitol. However, it showed no significance in short-term prognosis.

ObjectiveThis study aimed to investigate the neurobehavioral change in rats subjected traumatic brain injury (TBI) and explore the mechanism involving in the expression of synaptophysin.MethodsSprague Dawley rats were randomly divided into Sham and TBI groups. TBI was induced by modified Feeney’s freefall method. Neurological severity score (NSS) was assessed at 2 days, 4 days and 7 days after operation, and cortex was obtained at 7 days post TBI. Then, Quantitative real‐time polymerase chain reaction and western blot were used to detect the mRNA and protein expression of synaptophysin. Lastly, immunofluorescence staining was conducted to localize synaptophysin.ResultsNSS was significantly aggregated after TBI, compared with the Sham group. The mRNA and protein expressions of synaptophysin were increased in TBI group than that in the Sham group. Synaptophysin‐positive cells were also enhanced in TBI group and mainly expressed in neutrophil.ConclusionThe nerve function change induced by TBI was associated with the upregulation of synaptophysin expression.

BACKGROUND:There are several routes for stem cel transplantation;however, it is stil unable to determine which one is the best. As for the different individuals with brain injury, the type of transplanted cel s, transplantation route and time wil affect the therapeutic effects. <br> OBJECTIVE:To investigate the effect of bone marrow mononuclear cel s transplanted via different approaches on neurological function of rats with traumatic brain injury. <br> METHODS:Bone marrow mononuclear cel s of rats were administered gradient centrifugation with Ficol lymphocyte separation medium, and were labeled with CFDA-SE in vitro as standby. Rat models of traumatic&nbsp;brain injury were established by the method of freefal . After successful establishment of rat models, bone marrow mononuclear cel s labeled with CFDA-SE were immediately transplanted into rats via injured area, lateral ventricle and internal carotid artery. One control group was designated for each transplantation route (bone marrow mononuclear cel s were replaced with the same volume of DMEM). The degree of neurological deficits was evaluated using mNSS scores at different time points after treatment. The brain tissue was harvested after the last neurobehavioral evaluation. The survival and migration of bone marrow mononuclear cel s in the injured area were observed under an inverted fluorescent microscope. <br> RESULTS AND CONCLUSION:At 7, 10, and 14 days after treatment, the mNSS scores of rats in al groups were al lower than those at 1 and 3 days (P<0.05). At 7 and 10 days, the mNSS scores of rats in the internal carotid artery transplantation group were significantly lower than those in the control group (P<0.05). At 14 days after treatment, the number of fluorescence-labeled cel s of rats in the internal carotid artery transplantation group was greater than that in the other groups (P<0.05) and these labeled cel s were widely distributed. The results demonstrate that the neurological function of rats can be improved by transplanting bone marrow mononuclear cel s via the internal carotid artery, and a large number of transplanted cel s can survive and migrate in the injured area.

Endoscopic ultrasonography is a set of medical equipment,ultrasound and endoscopy as a whole article on endoscopic ultrasonography in the diagnosis and treatment of human luminal disease applications.