Flow-diverting stent that appears in recent years is a new method for the treatment of complex intracranial aneurysms.This article reviews the principles,composition,development,advantages and disadvantages,indications,main complications and some problems of flow-diverting stent.

BACKGROUND: In subjects with different inflammatory and autoimmune diseases, soluble vascular cell adhesion molecule-1 (sVCAM-1) in sera increases, and its change may become an important monitoring index of immunological function, but its change rule has been unclear in acute cerebral infarction.OBJECTIVE: To observe the change of sVCAM-1 in sera of subjects with cerebral infarction and its clinical significance, and compare between the subjects with cerebral hemorrhage and normal population.DESIGN: A case controlled analysis.SETTING: Second Department of Brain, Research Institute of Surgery,Daping Hospital, Third Military Medical University of Chinese PLA.PARTICIPANTS: A total of 132 inpatients were selected from Second Department of Brain, Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA between May 2002 and April 2004. Among them, 89 subjects with cerebral infarction were classified into large infarction group (n=25,＞ 10 cm3), medium infarction group (n=31,4-10 cm3) and small infarction group (n=33, ＜ 4 cm3) respectively according to the size of infarct focus. There were 43 subjects in cerebral hemorrhage group, and 30 healthy persons were as normal control group.METHODS: Blood samples were isolated from subjects with cerebral infarction at hour 24, days 3, 7 and 14 after onset of the disease, while the blood samples were extracted from subjects with cerebral hemorrhage at hour24 and day 14 after the onset of the disease. 4 mL venous blood was obtained from the three groups. The serum concentration of sVCAM-1 was determined with double antibody sandwich method (DASM) in all the examinees.MAIN OUTCOME MEASURES: ①Dynamic change of the serum concentration of sVCAM-1 in the course of acute cerebral infarction, and compared with the other two groups. ②Comparison of the serum concentration of sVCAM-1 in different size of infarct focus. ③Change of the serum concentration of sVCAM-1 in acute cerebral infarction subjects complicated with infection.RESULTS: A total of 162 subjects were involved in the result analysis. ①The serum concentration of sVCAM-1 at the 24th hour after cerebral infarction was significantly higher in subjects with cerebral infarction than in subjects with cerebral hemorrhage group and normal control group [(1 184.5±68.3) ,(693.9±41.7), (576.1±39.8) μg/L,P＜0.01].Serum sVCAM-1 in the cerebral infarction subjects increased from the 24th hour to the 7th day after infarction gradually, while from the 7th day to the 14th day decreased gradually. However, the serum sVCAM-1 in the cerebral infarction subjects at day 14 was still markedly higher than that in the cerebral hemorrhage group and the normal control group (P ＜ 0.01 ). ②The serum concentration of sVCAM-1 was significantly higher in the large cerebral infarction group as compared with medium and small cerebral infarction groups [(1 217.4±59.3) ,(1 132.6±51.9) ,(983.7±54.2) μg/L,P ＜ 0.01]. ③The serum concentration of sVCAM-1 was significantly higher at days 3, 7and 14 in cerebral infarction subjects complicated with infection than in subjects without infection (P ＜ 0.01 ).CONCLUSION: The sVCAM-1 participates pathological change process of cerebral infarction, which can be regarded as monitoring index of cerebral infarction change. To block its production and expression can provide a new approach for improving the prognosis of cerebral infarction.

BACKGROUND: The number of dementia patients ceaselessly increases with the extension of the life expectancy and the ageing of the population; hence the survival rate of patients with post-stroke dementia(PSD) has become an important issue of public health. Although it is generally believed that dementia could shorten human life expectancy, there is rare report regarding the impact of PSD on the survival rate of the patients in developing countries.OBJECTIVE: To investigate the impacts of ischemic dementia on the survival rate of the patients to explore the risk factors that would affect the survival rate of patients after cerebral infarction(CI).DESIGN: A prospective randomized controlled study based on patients.SETTING: The second department of neurology of a field surgery institute in a military university hospital of Chinese PLA.PARTICIPANTS: Totally 619 cases of acute CI including 313 males and 306 females aged between 55 and 85 years old[mean of (70. 3 ±9.5) years old] were selected form the Department of Neurology of the Daping Hospital of the Third Military Medical University of Chinese PLA between 1st May 1998 and 28th December 1999.INTERVENTIONS: Data including human factor, vascular factor and CI characters of 619 cases of ischemic cerebral stroke were collected and they also received neuropsychological test. Dementia was diagnosed in CI patients at admission and 3 months after CI according to DSM-Ⅳ criteria. Two-year follow up was conducted for the analysis of survival rate in PSD patients and survival-correlated predicting factors.and survival rate in CI patientsRESULTS: Totally 146 total patients(23.6% ) were diagnosed as PSD at 3 month after CI, of which 39 cases were pre-stroke dementia and 107 cases were CI-correlated dementia. The survival rate of PSD patients was 49.3%after(19.4 ±8.3) months of follow-up. The survival rate of patients with CI-correlated dementia was 53.7% while the non-dementia patients was 92.0% after(21.3 ± 9.1 ) months of follow-up. There was significant correlation between PSD and survival rate as indicated by multifactor analysis ( RR = 4. 91, 95% CI = 3.85 - 13.49) . The rest predicting factors included age(RR=1. 12, 95% CI=1.06-1.18), BarthelIndex(BI, RR=1.63,95% CI=1.15-2.31), auricular fibrillation(AF, RR=1.47, 95%CI = 1.17 - 1.85) and CI history( RR = 2. 81, 95% CI = 1.53 - 5.16).CONCLUSION: Dementia could reduce the survival rate of CI patients and it could be set as a predicting factor for post-infarction survival rate.

Objective To investigate the changes in physique and the bone age,and the correlation between the changes in cardiac structure and function and the bone age index (BAI) in atrial septal defect (ASD) children.Methods The experimental group included 48 cases of ASD patients,and 30 cases of healthy children were assigned as the control group;the children of both groups were measured for height and weight.Philips ie33 ultrasonic detector was used to detect the indicators of cardiac structure and function,and Philips digital X-ray machine was used to radiograph the left hand and the wrist.Then the bone age was assessed in order to calculate the BAI.Fourteen cases of ASD patients who underwent repairing surgery were measured for orifice area in surgery.The differences in physique and the bone age between the 2 groups were analyzed,and Pearson correlation analysis method was used to observe the correlation between the cardiac structure and function indicators,defect area and BAI in the experimental group.Results There was no significant difference in the age,height,bone age (t =-0.02,-1.31,-1.69,all P ＞ 0.05),while the weight and BAI were significantly different between the 2 groups (t =-2.28,-9.06,all P ＜ 0.05).The height,weight and BAI were significantly different in different pulmonary artery systolic pressure (PASP) patients (F =27.630,23.537,16.704,all P ＜ 0.01),while the age and weight had no difference (t =-1.218,-0.046,all P ＞ 0.05).The height and BAI were significantly different in patients with different defect size(t =2.561,2.191,all P ＜ 0.05).There was no correlation between the age and the BAI in children with ASD(r =-0.175,P ＞ 0.05).The defect size,defect size/atrial septal stretched diameter,PASP were all negatively correlated with BAI (r =-0.349,P ＜ 0.05 ; r =-0.412,P ＜0.01 ;r =-0.539,P ＜0.01).The defect area was positively related to the defect size in 14 cases of children with ASD underwent surgery (r =0.599,P ＜ 0.05),and the defect area was negatively correlated with BAI (r =-0.655,P ＜ 0.05).Conclusions The physical development in ASD patients evidently lagged behind the healthy children,particularly for weight.The BAI of ASD patients is significantly smaller than that of the healthy children,in other words,the growing speed of bone in ASD patients is significantly slower than that of the healthy children at the same age.The lagging extent of physical development and the bone age are related to the PASP and defect size.PASP has more influence on the height,yet the defect size has influence on height and weight of ASD children.There is no correlation between physical development and the bone age with the course of disease.

The eighteen incompatible medicaments is the incompatibilities in traditional Chinese medicine (TCM). However, in some special occasion, the incompatible medicaments can also be used in one prescription in the clinical applications. In order to reveal the theoretical basis for applications of incompatible medicaments in prescriptions, we analyzed ancient prescriptions and found that there are contrary Chinese herbal nature combina-tions (CHNCs) which have the same meridian tropism as well as the opposite nature and taste in prescriptions. In clinical applications, one of the non-contrary CHNCs was selected as the main response to syndrome differentia-tion. The contrary CHNCs in the same meridian tropism were used to restrict each other and therefore have the protective effects. The features found in this paper will be beneficial to further research on the rational applica-tion of incompatible medicaments.

Gastrodia elatais graded as top medication in theShen Nong’s Herbal Classic. It was mainly distributed in southwest China. Its quality varied with geographical location. And the quality difference between wild and cultivated sample was extreme. Identifications using traditional methods were unable to accurately distinguish the quality ofG. elata. Therefore, near-infrared (NIR) spectroscopy combined with pattern recognition method was used to distinguish the quality ofG. elata from different geographical locations as well as cultivated or wild. The results demonstrated that using NIR spectroscopy combined with multiclass classification algorithm, the geographical location ofG. elata can be accurately distinguished. The prediction accuracy can reach as high as 94.3% and 96.4% for both applications. Besides, the classification model was built without preprocessing; hence, it can be extended to be applied on-site.

Objective To investigate the protective effect of recombinant mouse OP 1 (rmOP 1) on renal ischemia reperfusion injury. Methods The full length open reading frame of mouse OP 1 was cloned by RT PCR. The rmOP 1 was prepared and its osteogenesis was assayed in vitro. Thirty Wistar rat models of renal ischemia reperfusion were randomly divided into 3 groups: preventive group, therapeutic group and control group. The former two groups were administered with rmOP 1 (250 ?g/kg) via the superior mesenteric vein at different time points. The renal function and structure were assessed by serum BUN, Cr, histological findings and the modified Miller's scoring. Results rmOP 1 showed osteoinductive activities in vitro. The level of serum BUN, Cr and Miller's scoring were higher in control group than the others ( P 0.05 ). Histological finding showed that rmOP 1 minimized the cell necrosis. Conclusion rmOP 1 has an protective effect on renal function and structure.

Patients with moyamoya disease often have cognitive impairment.The specific mechanisms are unclear.Surgical intervention relieving low perfusion state of cerebral blood flow may be the only effective way in the treatment of moyamoya disease,maintain or improve cognitive function at present; however the related surgical indications,timing of surgery,postoperative hyperperfusion syndrome,as well as long-term efficacy and other issues must be resolved.

Objective To evaluate the complementary value of 11C-choline (CHO) PET/CT to 18F-FDG PET/CT in the staging of locally advanced nasopharyngeal carcinoma (NPC) and diagnosis of HCC.Methods From December 2007 to January 2010,15 patients with locally advanced NPC and 76 patients with HCC were prospectively enrolled into this study.The research was approved by the ethics committee,and all patients signed informed consents.Whole body 18 F-FDG PET/CT scans were performed on all patients and regional 11C-CHO PET/CT was conducted in 43 patients (15 with NPC,28 with HCC).A lesion with increased uptake of either 11 C-CHO or 18F-FDG was considered positive.SUVmax,tumor/brain (T/B) ratio and tumor/liver (T/L) ratio were calculated for semi-quantitative analysis.Two-sample t test,x2 test,Fisher exact test and linear correlation analysis were used for statistical analysis.Results (1) The lesion SUVmax of 18 F-FDG was higher compared to 11C-CHO (12.81 ± 5.00 vs 6.84 ± 2.76 ; t =6.416,P ＜0.01) in NPC patients.However,11C-CHO PET/CT had a much higher T/B ratio than 18F-FDG (18.62 ±7.95 vs 1.38 ±0.59 ; t =8.801,P ＜ 0.01).Significant correlation was found between the 2 tracers with regard to NPC lesion uptake (r =0.712,P ＜0.01).Compared with 18F-FDG PET/CT,11C-CHO PET/CT had better delineation of intracranial invasion in 50.0％ of patients (12/12 vs 6/12; x2 =8.000,P ＜0.05),skull base invasion in 4/14 patients and orbital invasion in 3/3 patients.(2) 18F-FDG PET/CT showed positive findings in 63.1％ (48/76) of HCC patients.In 28 HCC patients with negative findings on 18F-FDG PET/CT,11 C-CHO PET/CT was positive in 71.4％ (20/28) of patients.The dual-tracer PET/CT improved the diagnostic sensitivity (89.5％,68/76) of HCC compared with 18F-FDG PET/CT (63.1％,48/76) alone (x2 =14.559,P ＜0.01).11C-CHO PET/CT was more sensitive than 18F-FDG PET/CT for the detection of well differentiated HCC (6/9 vs 35.7％ (5/14) ; P =0.214).For the detection of moderately differentiated HCC,the sensitivity of 11C-CHO and 18F-FDG PET/CT was similar to each other (6/7vs 72.0％ (18/25),P =0.648).11C-CHO PET/CT was more sensitive than 18F-FDG for the detection of HCC lesions ＜5.0 cm (72.7％ (16/22) vs 42.1％ (16/38) ; x2 =5.249,P ＜0.05),especially for lesions ＜ 2.0 cm (5/7 vs 0/7; P =0.021).Conclusions 11 C-CHO PET/CT could improve the accuracy in T staging of NPC.It might also play a complementary role for 18 F-FDG PET/CT in the detection of HCC.

The application of cerebrovascular intervention brings the diagnosis and treatment of cerebrovascular disease into a brand-new domain. Many neurological physicians have become physicians of cerebrovascular intervention by training. In the big teaching hospitals carrying out cerebrovascular intervention, advanced physicians are the hard strength in the lot of cerebrovascular intervention. The training aiming at cerebrovascular intervention and comprehensive abilities affects both the training results and the therapeutic results of cerebrovascular intervention. Therefore, it is an important issue to explore how to consummate and standard the training methods of advanced physicians studying cerebrovascular intervention.