Objective To explore and evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB Revascularization Device in acute basilar artery occlusion.Methods Nine patients with basilar artery occlusion were treated with direct thrombectomy by using Solitaire AB stent retrievers between August 2010 and October 2012.Stent angioplasty was performed for patients with serious residual stenosis.Neurologic status was evaluated before and after treatment according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scales (mRs).Neurologic status was evaluated after treatment according to the NIHSS and mRs 6 months after stent placement.Stent patency at follow-up was assessed by MR angiography,or DSA 6 months after stent placement.Results Successful revascularization was achieved in all patients.Stenting and angioplasty were performed in 6 patients with serious residual stenosis.The complication of cerebral hemorrhage did not occur in any patient.Acute thrombosis happened in one patient one day after procedure.Emergent angiography showed re-occlusion of basilar artery.Intraarterial thrombolytic therapy was given,and reperfusion was achieved,but the patient died 6 days later.One patient developed coma at 4th month of follow-up.MRA showed acute basilar artery occlusion again and magnetic resonance imaging showed extensive ischemic damage of the brainstem.The patient died during the conservative treatment period.The mean NIHSS scores were 2.4 ± 1.2 at discharge.The mRs scores were 0 in 2 patients,1 in 4 patients,2 in one patient,and 3 in 1 patient at discharge.Conclusion Mechanical thrombectomy with the Solitaire AB stent in acute basilar artery occlusion is relatively safe and effective.

Objective To evaluate the safety and feasibility of Wingspan stent for patients with symptomatic M1 stenosis of middle cerebral artery (MCA). Methods Thirty-two cases with recurrent symptomatic MCA stenosis resistant to medical therapy treated by self-expanding stent were reviewed retrospectively [average (49±19) years old, 13 women]. All patients underwent angioplasty and stenting with the Gateway balloon-Wingspan stent system. After 6 months, all patients were followed up by telephone or clinic, and advised followed up with DSA or TCD. Results Thirty-two patients were successfully stented during the first treatment session. The mean degree of stenosis reduced from (76.5±15.4)% to (19.3±9.2)%. The number of complicating subarachnoid hemorrhage was one, and occlusion occurred on one patients related to balloon angioplasty. During a follow-up of 6 months, there was no recurrence of transient ischemic attack or stroke in 32 available patients. Cerebral hemodynamics using transcranial Doppler monitoring were normal in 19 follow-up patients. Six-month angiographic follow-up was obtained in 5 patients, demonstrating good patency in 5 stenting vessels. The other patients refused to perform TCD or DSA. Conclusions Wingspan stent for symptomatic stenosis of middle cerebral artery appears to be a safe and feasible under strict control of periperformeral project. However further study is needed to evaluate the long-term effect.

Objective To investigate the clinical significance of circumferential aneurysmal wall enhancement (CAWE)in high-resolution magnetic resonance imaging. Methods The imaging and clinical data of 41 patients with intracranial aneurysm underwent gadolinium-enhanced 3. 0 T HR-MRI from October 2014 to July 2015 were analyzed retrospectively. Two experienced neurovascular radiologists read the vascular neuroimagings independently and determined whether the intracranial aneurysm walls of the patents had CAWE. Twenty-five patients had unstable intracranial aneurysms and 16 had stable intracranial aneurysms. The consistency of the diagnostic results of the 2 radiologists was evaluated by the Kappa test. The CAWE,number,location,size and the imaging features of intracranial aneurysms,as well as gender,age, smoking history,drinking history,hypertension and diabetes of clinical risk factors of the patients in both groups were compared. The comparison between groups was conducted by using the chi-square test. Results A total of 47 intracranial aneurysms were detected in 41 patients,including 29 unstable intracranial aneurysms (a unstable aneurysm group)and 18 stable intracranial aneurysms (a stable aneurysm group). The consistency of CAWE results diagnosed by 2 experienced neurovascular radiologists was better (κ =0. 828;95%CI 0. 668 -0. 989). CAWE of the unstable intracranial aneurysms was significantly more than those of the stable intracranial aneurysms. There was significant difference (75. 9%[22 / 29]vs. 33. 33%[6 / 18];χ2 = 8. 341,P = 0. 004). The age of the patients with unstable intracranial aneurysm was younger than 60 years;it was more than those with stable intracranial aneurysm. There was significant difference (68%[17/ 25]vs. 31. 25%[5/ 16];χ2 = 5. 299,P = 0. 021),while there were no significant differences in the imaging features,including the number,location,size,as well as the clinical risk factors,including gender, smoking history,drinking history,hypertension,and diabetes between the 2 groups (P > 0. 05). Conclusion CAWE is significantly more common in unstable intracranial aneurysms. It can differentiate the symptomatic,morphological changes of ruptured intracranial aneurysms between the stable intracranial aneurysms.

Objective To analyze the etiology of cerebral ischemic complications occurring in perioperative period of interventional therapy for intracranial aneurysms,and to discuss its prevention and treatment.Methods From January 2011 to March 2015,a total of 1106 patients with intracranial aneurysms underwent interventional therapy at the First Affiliated Hospital of Zhengzhou University,China.Among the 1106 patients,48 patients developed cerebral ischemic complications;their clinical data and the imaging materials were retrospectively analyzed.The factors associated with complications,the effective therapeutic scheme and the clinical preventive methods were discussed.Three months after the treatment,the recovery of neurological function was assessed with modified Rankin Scale (mRS).Results The causes of ischemic complications were,in order of decreasing frequency,cerebral vasospasm/unable elimination of microemboli (n=19),thrombus (n=16),impaired blood flow of adjacent perforating or distal vascular branches caused by embolization (n=6),intra-procedural hypotension (n=4) and cerebral edema (n=3).Combined treatments,including integrated anticoagulation,anti-platelet aggregation,anti-vasospasm,medication of elevating blood pressure,endovascular intervention,etc.were adopted.The patients were followed up for 3 months.Thirty-four patients (70.8％) obtained a mRS of ≤2 (no serious sequelae),and mRS＞2 (poor prognosis) was seen in 14 patients (29.2％).Conclusion The etiology of cerebral ischemia occurring during interventional treatment of intracranial aneurysms is complicated.It is necessary to take useful measures such as individualized anticoagulation,anti-platelet aggregation,anti-vasospasm,etc.during perioperative period of interventional therapy.The procedure-related complications can be effectively treated with interventional therapy and reliably prevented by careful and skilled surgical manipulation.

Cerebral venous and sinus Thrombosis (CVST) is a rare ischemic cerebrovascular disease,the lesions of 60% patients are involved in multiple venous sinus,of which the superior sagittal sinus thrombosis is most common.The pathogenesis and pathophysiology of CVST has not yet been fully elucidated,and the establishment of stable and ideal animal models can provide a basis for the study of its development,prognosis and efficacy assessment.This article summarizes the characteristics and advantages of several available CVST models,but each method has its own limitations.Therefore,the establishment of a more ideal animal model will help to fully understand the pathogenesis and pathological process of CVST.

OBJECTIVETo characterize the expressions of peroxiredoxin 1 (Prx1), peroxiredoxin 6 (Prx6) and glial fibrillary acidic protein (GFAP) in human brain astrocytoma and explore their clinical significance.

METHODSThe protein and mRNA expression levels of Prx1, Prx6 and GFAP in human brain astrocytoma and normal brain tissue specimens were determined by Western blotting, RT-PCR and immunohistochemistry.

RESULTSThe protein and mRNA expressions of Prx1 and Prx6 increased significantly in the order of normal brain tissue, grade II astrocytoma, grade III astrocytoma and grade IV astrocytoma (P<0.05). The protein and mRNA expressions of GFAP decreased significantly in grade III and IV astrocytoma compared with those in grade II astrocytoma and normal brain tissues (P<0.05).

CONCLUSIONPrx1 and Prx6 may play important roles in the invasion and malignant development of human brain astrocytoma, and may serve as biomarkers for evaluating the invasiveness, malignancy and prognosis of the tumor as well as potential molecular targets in astrocytoma therapy.

Adolescent ; Adult ; Aged ; Astrocytoma ; metabolism ; pathology ; Brain Neoplasms ; metabolism ; pathology ; Child ; Child, Preschool ; Female ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Male ; Middle Aged ; Peroxiredoxin VI ; metabolism ; Peroxiredoxins ; metabolism ; Young Adult

The Yellow Fever (YF) vaccine, an attenuated yellow fever 17D (YF-17D) live vaccine, is one of the most effective and safest vaccines in the world and is regarded as one of the best candidates for viral expression vector. We here first reported in China the construction and characterization of the recombinant expression vector of yellow fever 17D which contained the proteinase 2A fragment of foot-and-mouth disease virus (FMDV). Three cDNA fragments representing the full-length YF-17D genome, named 5'-end cDNA (A), 3'-end cDNA (B) and middle cDNA (C), were obtained by reverse transcription polymerase chain reaction (RT-PCR), together with the introduction of SP6 enhancer, necessary restriction sites and overlaps for homologous recombination in yeast. Fragment A and B were then introduced into pRS424 in turn by DNA recombination, followed by transfection of fragment C and the recombinant pRS424 containing A and B (pRS-A-B) into yeast. A recombinant vector containing full length cDNA of YF-17D (pRS-YF) was obtained by screening on medium lack of tryptophan and uracil. A recombinant YF-17D expression vector containing FMDV-2A gene fragment (pRS-YF-2A1) was then constructed by methods of DNA recombination and homologous recombination in yeast described above. In vitro transcription of the recombinant vector pRS-YF-2A1 was then carried out and introduced into BHK-21 cells by electroporation. Results of indirect immunofluorescence assay (IFA) and titer determination showed a stable infectious recombinant virus was gotten, whose features such as growth curve were similar to those of the parental YF-17D. The results suggest that the recombinant vector pRS-YF-2A1, by introduction of heterogenous genes via 2A region, is potential to be an effective live vaccine expression vector.
Animals ; Cell Line ; Cloning, Molecular ; Cricetinae ; Epitopes ; immunology ; Foot-and-Mouth Disease ; prevention & control ; Foot-and-Mouth Disease Virus ; genetics ; immunology ; Genetic Engineering ; Genetic Vectors ; Recombination, Genetic ; Saccharomyces cerevisiae ; genetics ; metabolism ; Vaccines, Attenuated ; Viral Vaccines ; genetics ; immunology ; Yellow fever virus ; genetics ; immunology

Objective To evaluate the safety and efficacy of the use of Enterprise stent in the treatment of symptomatic intracranial atherosclerotic stenosis (sICAS) . Methods The clinical data of 27 patients with sICAS, who were treated with Enterprise stent implantation at First Affiliated Hospital of Zhengzhou University, China, during the period from January 2012 to December 2017, were retrospectively collected. The patient's basic parameters, characteristics of target lesions, technical success rate, perioperative safety and follow-up results were analyzed. Results A total of 27 patients (28 lesions in total) were enrolled in this study, and a total of 28 Enterprise stents were implanted. The preoperative mean stenosis degree of lesions was (75.7 ±6.7) ％, the postoperative residual stenosis degree was (23.2 ±16.6) ％. The technical success rate was 100％. Postoperative complication of perforating branch events occurred in 2 patients. No severe complications such as hemorrhage, artery dissection, in-stent thrombosis, hyper-perfusion syndrome, or cardiovascular events occurred. All patients were followed up for (10.8±9.1) months, and 3 instent restenosis lesions (≥50％) were detected although the patients had no target lesion-related symptoms, the incidence of in-stent restenosis was 10.7％. No newly-developed stroke caused by responsible blood vessel, bleeding events or death occurred. Conclusion For the treatment of sICAS, balloon dilatation followed by Enterprise stent implantation is technically feasible, and clinically safe and effective. The incidence of perioperative complications is low and the follow-up results are satisfactory. Further randomized controlled trials are still needed before its long-term efficacy is clarified.

Objective To explore the efficacy and safety of venous sinus stenting in the treatment of refractory idiopathic intracranial hypertension (IIH) complicated with venous sinus stenosis. Methods We reviewed our clinical database for 18 patients with resistant or fulminant IIH and cerebral venous sinus stenosis,who underwent placement of venous sinus stents between January 2013 and December 2016. Patients were considered eligible for stenting based on the following criteria: (1) medically refractory IIH;(2)papilledema confirmed by an ophthalmologist;and(3)dural venous sinus stenosis of the dominant venous outflow system with a gradient of ≥10 mmHg(1 mmHg=0.133 kPa). Prior to intervention, diagnostic angiography and venous pressure measurements were performed. Clinical follow-up was available in all patients at 6 to 48 months after stenting.Angiography to evaluate stent patency and restenosis was performed at 6 months after intervention;Relevant clinical, demographic and radiographic data were extracted after review of these records. The paired t test was used to compare the changes before and after the operation. Results The mean lumbar CSF pressure was reduced from (385±72) mmH2O(1 mmH2O=0.009 8 kPa) to (201±24)mmH2O(t=13.02,P<0.05).The mean pressure gradient across the venous stenosis was reduced from(31.5±11.4)mmHg before the procedure to(2.5±2.1)mmHg(t=10.96,P<0.05).Headache in 13 cases,vision in 14 were resolved. Papilledema and pulsatile tinnitus resolved in all patients. There was no instances of restenosis among the 18 patients with follow-up imaging.Conclusion In patients with IIH and documented evidence of venous sinus stenosis with a high pressure gradient,venous sinus senting represents an effective treatment strategy.

Objective To evaluate the clinical safety and efficacy of LVIS stent (a low profile knitting designed self-expandable stent) in assisting endovascular embolization for intracranial saccular aneurysms.Methods A total of 127 patients with intracranial saccular aneurysm,who were admitted to authors' hospital during the period from April 2014 to June 2016 to receive LVIS stent-assisted endovascular embolization,were retrospectively analyzed.The safety of the operation,the immediate postoperative outcomes,the recurrence rate,and the clinical and radiographic follow-up results were analyzed.Results A total of 130 LVIS stents were successfully implanted in the 127 patients with intracranial saccular aneurysm,implantation failure was seen in one patient,the technical success rate was 99.2％.During or after the endovascular embolization process in-stent thrombosis was observed in 7 patients (7/127,5.5％).Neither perioperative bleeding nor death occurred.Immediately after the operation,complete occlusion of the aneurysm was obtained in 112 aneurysms (88.1％) and neck remnant was observed in 15 aneurysms (11.9％).The patients were followed up for a mean period of 8 months.Follow-up angiography was performed in 37 patients,which showed that complete occlusion of the aneurysm was obtained in 33 patients (89.1％),and visualization of the aneurysm was seen in 4 patients (10.9％),including 3 patients who had aneurysm visualization immediately after embolization and one patient who had aneurysm recurrence.No death occurred.Conclusion The use of LVIS stent to assist endovascular embolization for intracranial saccular aneurysms is safe and effective,although its long-term effect needs further observation.