Cerebral vasospasm (CVS) is one of the main causes resulting in death and disability in patients with aneurysmal subarachnoid hemorrhage (SAH). Although CVS has been studied extensively after SAH, its pathogenesis remains uncertain. Decomposed product of erythrocytes, vascular endothelium dysfunction and inflammatory reaction play important roles in it. Cerebrovascular angiography remains the gold standard for diagnosing CVS; however, with the development of neuroimaging technology, the status of some non-invasive methods such as transcranial Doppler, CT and MRI, are more and more important in the diagnosis of SAH and CVS. The management of CVS includes the following 5 aspects: (1) the prevention of CVS should be as early as possible after SAH; (2) arterial stenosis should be corrected after the onset of CVS; (3) arterial stenosis caused cerebral ischemia should be prevented; (4) arterial stenosis caused cerebral ischemia should be treated, and (5) brain tissue should be protected from ischemic injury.

Objective To retrospectively analysis our experience of embolization of ruptured intracranial aneurysms during the period of cerebral vasospasm (CVS). Methods Thirty-seven patients with ruptured intracranial aneurysms were embolized with electrolytic detachable coils during the period of CVS (days 4 to 14). Group A included the 14 patients with angiographic CVS and group B included 23 patients without angiographic CVS. All except 2 patients were transferred to our department during the CVS period. Results Twelve patients in group A were successfully received the aneurysms embolization and treatment of the CVS with intraarterial papaverine injection and balloon angioplasty. The Glasgow Outcome Scales (GOS) in 3 months were good recovery in 7 patients, moderate disability in 2, severe disability in 1 and dead in 2. Two patients failed the embolization because the microcatheters can't pass the spasmatic parent arteries. All the aneurysms in group B were successfully embolized. The GOS were good recovery in 18 patients, moderate disability in 2, severe disability in 2 and dead in 1. There was no intraprocedural aneurysmal rupture but with 2 thromboembolic events. No rebleeding occurred during the mean 11 months follow-up.Conclusions The so-called “the period of CVS” isn't always associated with CVS in angiograpy. Embolization of ruptured intracranial aneurysms during the period of pure CVS doesn't carry an increased risk. Both the aneurysms and CVS can be treated during the single procedure. It can reduce the rebleeding rate in hospital and improved the prognosis of the patients with CVS.

Objective The Neuroform stent is the first self-expandable intracranial stent designed for the treatment of wide-necked intracranial aneurysms. We report the results of our preliminary experience in combination of this stent and detachable coils to treat patients with wide-necked intracranial aneurysms. Methods From August 2003 to August 2004, 22 patients with 24 wide-necked intracranial aneurysms were treated with combination of Neuroform stents and detachable coils. There are 19 acutely ruptured aneurysms and 5 unruptured aneurysms. Results Twenty-three aneurysms were successfully treated by combination of stents and detachable coils. In one patients with multiple aneurysms, an unruptured small wide-necked aneurysm was successfully treated with the stent deployment but failed coiling. All stents were deployed successfully. Mild stent displacement was found in one patient. Intraaneurysmal contrast media stagnation was not seen immediately after the stents deployment. Total (100%) obliteration of the aneurysm was achieved in 18 aneurysms, and subtotal (more than 90%) obliteration was achieved in 5 aneurysms. All the parent arteries were patency after treatment. In 2 aneurysms, some small coil loops were herniated into the parent artery from the stent struts but did not affect the blood flow within parent artery. No symptomatic brain ischemia was found in perioperative period. Seventeen patients were received a mean of 3 months follow-up and control angiography. No recurrence was found in 16 patients. Recanalization was found in one patient, he received a second embolization and the aneurysm was totally oberliterazation.Conclusions The Neuroform stent is a very safe and effective intracranial stent for treatment of wide-necked intracranial aneurysm. It is very suitable for wide-necked intracranial aneurysm with severely tortuous parent artery. Due to lack of significant radial strength of the stent, the stent can be shifted by a microguidewire or microcatheter when performed superselective catheterization. Because the big struts of this stent, the change of intraaneurysmal hemodynamics after stent deployment was notevident as coronary stent. So dense packing the aneurysm is advocated. Care must be taken when packing the detachable coils after the stent deployment. The administration of dual anti-platelet drug to prevent stent-related thromboembolic complications in the perioperative period is important. Although a good angiographic result is achieved, long-term angiographic follow-up is still necessary.

85%) in 18 patients (21.4%) and a partial resection (

Objective To evaluate double microcatheter technique for detachable coil treatment of wide-necked intracranial aneurysms. Methods Routine endovascular coil occlusion was not achieved in 6 cases of wide-necked intracranial aneurysms. A second femoral arterial sheath was inserted on the opposite side . A second microcatheter was positioned within the aneurysm. The detachable coils were introduced via double microcatheter simultaneously or successively till the aneurysm were compactly embolized. The coils were detached after satisfactorily positioned. Results Total 6 cases of wide-necked aneurysms were successfully embolized with detachable coil. Aneurysmal sacs were 100% embolized in 2 cases, over 90% in 4 cases. 1 case suffered moderate disablement as a result of complication of. Angiographic follow-up in 5 cases revealed no recurrent or rerupture.Conclusions The double microcathter technique may be an optional method during embolization of some complicated wide-necked aneurysms.

Objective To retrospectively analyze our experience of embolization of ruptured intracranial aneurysms during the period of cerebral vasospasm (CVS). Methods Thirty-seven patients with ruptured intracranial aneurysms were embolized with electrolytic detachable coils during the period of CVS (days 4 to 14). Group A included the 14 patients with angiographic CVS and group B included 23 patients without angiographic CVS. All except 2 patients were transferred to our department during the CVS period. Glasgow outcome score (GOS) was evaluated 3 months after the treatment. Results Twelve patients in group A successfully received the aneurysm embolization and treatment of the CVS with intraarterial papaverine injection and balloon angioplasty. GOS in 3 months was good recovery in 7 patients, moderate disability in 2, severe disability in 1, and dead in 2, respectively. Embolization failed in 2 patients because the microcatheters could't pass the spasmodic parent arteries. All the aneurysms in group B were successfully embolized. GOS were good recovery in 18 patients, moderate disability in 2, severe disability in 2, and dead in 1, respectively. There was no intraprocedural aneurysmal rupture but with 2 thromboembolic events. No rebleeding occurred during the mean 11 months follow-up. Conclusions The so-called “period of CVS” isn′t always associated with CVS in angiograpy. Embolization of ruptured intracranial aneurysms during the period of pure CVS doesn′t carry an increased risk. Both the aneurysms and CVS can be treated during the single procedure. It can reduce the rebleeding rate in hospital and improve the prognosis of the patients with CVS.

Objective To investigate the methods of diagnosis and treatment of pediatric and hebetic adrenocorticotropic hormone ( ACTH) secreting pituitary microadenoma. Methods The data of 10 patients with ACTH secreting pituitary microadenoma were retrospectively analysed. ACTH secreting pituitary microadenoma was diagnosed by clinical manifestations, biochemical and imaging findings, and 5 patients underwent bilateral inferior petrosal sinus sampling ( BIPSS). Transsphenoidal surgery was performed on all the patients under microscope, and the tumor specimens were detected by immunohistochemistry. Results Immunohistochemical examination revealed that ACTH was positive in 8 cases and negative in 2 cases. Patients were followed up for 12 to 63 months, 7 cases (70%) were cured, one (10%) achieved remission, and the other two (20%) experienced recurrence. Conclusion BIPSS is helpful in the diagnosis and localization of pediatric and hebetic ACTH pituitary microadenoma, and transsphenoidal surgery is the optimal choice of treatment.

Objective To evaluate urinary β2-microglobulin (β2-MG) and retinoid binging protein (RBP) in monitoring of early renal impairment in chronic hepatitis B (CHB) patients with long-term adefovir dipivoxil (ADV) treatment. Methods Three hundred and fifty five with CHB admitted in Shaoxing Municipal Hospital from June 2009 to June 2011 were enrolled in the study, among whom 180 cases study group) were treated with ADV monotherapy (n=100) or ADV + lamivudine (LAM) combination therapy (n=80); and 175 cases (control group) were treated with entecavir (ETV). Serum creatinine, urinary β2-MG, RBP and creatinine were measured and glomerular tration rate (eGFR) was estimated regularly during 5-year follow up. Kaplan-Meier method was used to calculate the cumulative incidence of changes in urinary β2-MG and RBP. Results Five-year follow-up results showed that in study group 2, 6, 10, 14 and 24 cases developed urinary β2-MG abnormality in year 1, 2, 3, 4 and 5 of treatment, respectively; and 2, 7, 11, 16 and 20 cases developed urinary RBP abnormality in year 1, 2, 3, 4 and 5 of treatment, respectively; eGFR decreased 20%-30% from baseline in 20 cases, 30%-50% in 13 cases and >50% in 2 cases. The decrease of eGFR ≥30% in 5 years was significantly correlated with urinary RBP and β2-GM abnormality. However, both serum creatinine and eGFR remained stable during the 5 years of follow-up in control group; only 2 cases developed urinary β2-MG abnormality and 3 cases developed urinary RBP abnormality. Conclusions Urinary RBP and β2-MG are sensitive biomarkers of early renal injury during long-term ADV treatment in CHB patients, and ADV should not be used as first-line treatment for CHB.

Objective To compare the impact of Telbivudine (LDT) and Entecavir (ETV) administration on estimates of glomerular filtration rate for anti-viral therapy in patients with hepatitis B virus (HBV)-related compensated cirrhosis by an open, prospective randomized controlled study.Methods Patients with HBV-related compensated cirrhosis at clinic or hospitalized in Shaoxing Municipal Hospital from January 2012 to June 2013 were included.A total of 170 patients were randomly divided into LDT (600 mg/d) or ETV (0.5 mg/d) groups at a ratio of 1∶1 according to the random number table method.All patients were treated for more than 36 months.The LDT group was optimized according to the roadmap.Patients with poor response or resistance in both treatment group were added with Adefovir dipivoxil (ADV) 10 mg/d for optimal treatment.The clinical outcome, creatinine (CR), estimated glomerular filtration rate (eGFR) of patients before and after 36 months of treatment were compared between two groups.All categorical data were analyzed using chi-square test and data accorded with normal distribution were compared by t test.Results After 36 months of treatment, the virological and biochemical responses in LDT group and ETV group were similar.The mean CR levels at month 24 and 36 in LDT group were (74.25±22.98) μmol/L and (70.72±24.75) μmol/L, respectively, which were both lower than baseline level ([83.09±17.68] μmol/L, t=2.811 and 3.145, respectively, both P<0.01).The mean CR levels at month 36 between two groups were statistically different (t=3.431, P=0.001).The mean eGFR levels at month 12, 24 and 36 in LDT group were all significantly lower than that at baseline (t=3.976,8.297 and 10.629, respectively, all P<0.01).The mean eGFR levels at month 24 and 36 between two groups were statistically different (t=9.684 and 15.019, respectively, both P<0.01).A total of 64 patients including 34 in LDT group and 30 in ETV group had mild nephritic injury at baseline.The mean eGFR in patients with mild nephritic injury at baseline in LDT group at month 12, 24 and 36 were significantly different compared to baseline (t=6.098,10.191 and 14.378, respectively, all P<0.01).The mean eGFR level at month 36 in ETV group had statistical difference compared to baseline (t=2.058, P<0.05).The mean eGFR levels at months 12, 24 and 36 were all statistical different between two groups (all P<0.01).The mean eGFR levels at month 24 and 36 in the optimized group were superior to ETV group (P<0.01).Conclusions In patients with HBV-related compensated cirrhosis, LDT and ETV treatment have similar clinical efficacy.LDT is more effective in protecting nephritic function than ETV.

Objective:To compare the effects of intensive and standard blood pressure control on the outcomes of patients with acute ischemic stroke in the anterior circulation who have successfully recanalized after endovascular therapy (EVT).Methods:A multicenter, open-label, blinded-endpoint, randomized controlled design was used. Patients with anterior circulation stroke received EVT and successfully recanalized in Nanjing First Hospital, Nanjing Medical University and several branch hospitals from July 2020 to October 2022 were prospectively included. They were randomly divided into the intensive blood pressure control group (target systolic blood pressure [SBP] 100-120 mmHg) or the standard blood pressure control group (target SBP 121-140 mmHg). The blood pressure of both groups needs to achieve the target within 1 h and maintain for 72 h. The primary outcome endpoint was outcome at 90 d, and the good outcome was defined as a score of 0-2 on the modified Rankin Scale. Secondary outcome endpoints included early neurological improvement, symptomatic intracranial hemorrhage (sICH) within 24 h, and death and serious adverse events within 90 d.Results:A total of 120 patients were included, including 63 in the intensive blood pressure control group and 57 in the standard blood pressure control group. There was no statistically significant difference in baseline characteristics between the two groups. The SBP at 72 h after procedure was 122.7±8.1 mmHg in the intensive blood pressure control group and 130.2±7.4 mmHg in the standard blood pressure control group, respectively. There were no significantly differences in the good outcome rate (54.0% vs. 54.4%; χ2=0.002, P=0.963), the early neurological improvement rate (45.2% vs. 34.5%; χ2=1.367, P=0.242), the incidence of sICH (6.3% vs. 3.5%; P=0.682), mortality (7.9% vs. 14.0%; χ2=1.152, P=0.283) and the incidence of serious adverse events (12.7% vs. 15.8%; χ2=0.235, P=0.628) at 90 d between the intensive blood pressure control group and the standard blood pressure control group. Conclusion:In patients with anterior circulation stroke and successful revascularization of EVT, early intensive blood pressure control don’t improve clinical outcomes and reduce the incidence of sICH.