Objective To summarize treatment experiences of microsurgical clipping for anterior communicating artery aneurysm via pterional approach.Methods Clinical data of 82 cases undergoing microsurgical clipping for anterior communicating artery aneurysm via pterional approach in the first affiliated hospital of Kunming Medical University from October 2008 to December 2014 were collected and retrospectively analyzed.The patients were divided into different groups by Hunt-Hess illness grading scale,with 11 cases for level 0,7 cases for level Ⅰ,30 cases for level Ⅱ,25 cases for level Ⅲ,8 cases for level Ⅳ,and 1 cases for level Ⅴ.Twenty-one patients underwent operation at early stage of SAH (＜3d),15 at late stage of SAH (4d～2W),and 35 at prolonged stage of SAH (＞2W).The prognosis of patients was evaluated according to GOS classification criteria at discharge.Results A total of 85 ACoAA were found in 82 patients and all of them were clipped and,at the same time,3 aneurysms were resected and 11 thrombuses were punctured,cut and removed.In the operation,15 (17.6％) aneurysms ruptured again and temporary blocking happened for 73 times,with the shortest blocking time of 2 rmin,the longest of 40 rmin,and the average of 9.26min.According to GOS score,good recovery rate was 79.3％ (65/82),moderate disability rate was 12.2％ (10/82),severe disability rate was 3.7％ (3/82),vegetative state rate was 0％,and death rate was 4.9％ (4/82).Good recovery rates for the operations at early,late and prolonged stage of SAH were 85.7％,73.3％ and 82.3％ respectively and for level 0 to level Ⅴ were 90.9％,85.6％,86.7％ and 84.0％,25.0％ and 0.0％ respectively.Results of DSA or CTA re-examination upon 55 patients followed-up at discharge or three months after discharge showed that tumor pedicle were clipped and aneurysm disappeared.Fifty cases were followed up from four months to seven years after the operation,with one case of aneurysm recurrence.Another thirty-two cases were lost to follow-up.ConclusiornS Microsurgical techniques and microdissection are keys to successful operation.Pterional approach can guarantee successful clipping of aneurysms with different directions,locations and sizes.It is also an easy,effective and reliable approach with less postoperative complications.Operation for anterior communicating artery aneurysm should be performed as early as possible.

Cell Hypoxia ; Humans ; Misonidazole ; analogs & derivatives ; Neoplasms ; diagnostic imaging ; pathology ; radiotherapy ; Positron-Emission Tomography ; Radiography ; Radiotherapy, Intensity-Modulated

Objective To observe the relationship of awake bispectral index (BISawake) and the postoperative cognitive dysfunction (POCD). Methods 100 patients aged 60~75 years with ASA status Ⅰ~Ⅱ, underwent elective lower abdominal surgery with intravenous anesthesia (propofol, remifentanyl and rocuronium). The BIS was adjusted in 40~60 during the surgery. Their cognitive function was assessed with the neuropsychological test battery commended by International study of postoperative cognitive dysfunction (ISPOCD). Results 8 patients withdrew for unwilling or serious complications. The BISawake was more than 65 in 68 patients (group A), and less than 65 in 24 patients (group B). The difference of the verbal learning immediate and delayed of Hopkins Verbal Learning Test-Revised was more in the group B than in the group A. Conclusion Lower BISawake may be associated with the decline of postoperative cognitive function.

Objective To evaluate the damage to the brochial plexus produced by pulsed radiofrequency (PRF)and radiofrequency thermocoagulation(RFTC).Methods Fifty-five male Wistar rats weighing 250-300 g were randomly divided into 3 groups:groupⅠPRF(n=25):groupⅡRFTC(n=25)and groupⅢnormal control(n=5).The animals were anesthetized with intraperitoneal chloral hydrate.The left brochial plexus was exposed and PRF or RFTC was applied to the left brochial plexus.The voltage and current of the minimal stimulation which elecited muscle twitching and the impedance before and after operation were recorded in group PRF and RFTC.The nerve function was scored according to Tarloo(0=flaccid paresis,5=normal gait)before and at 3d after operation.The animals were killed and the left brachial plexus was removed immediately and at 1, 7,14,30 d after operation(n=5 at each time point)for determination of histopathological changes using microscope.Results The impedance and Tarlov score were significantly decreased after operation as compared to the baseline values before operation in group RFTC and were also significantly lower than in group PRF. Microscopic examination showed that the myelinated nerve fibers exhibited Wallerian degeneration and axon regeneration and the cytochondria in cylindraxile were severely injured or disappeared in group RFTC.The myelinated nerve fibers and the cytochondria in cylindraxile were significantly less injured after operation in group PRF than in group RFTC and returned to normal at 7 d and 30 d respectively.Conclusion The injury to brachial plexus produced by PRF is slighter than that produced by RFTC.

Objective To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary diseases in children. Methods Data of 9 patients younger than 14 years who underwent ERCP at between November 2004 and May 2010 were indentified through a computer database search. Therapeutic methods, success rate and procedure-related complications were evaluated.Results A total of 9 patients underwent 17 ERCP procedures under anesthesia, including 16 therapeutic and 1 diagnostic procedure. The success rate was 94. 1% (16/17) and the complication rate was 11.8%(2/17), including 1 mild pancreatitis and 1 peri-pancreatic infection. Conclusion ERCP is an important tool with high safety and efficacy for diagnosis and treatment of pancreaticobiliary diseases in children.

Pregnancy ; Humans ; Female ; Cesarean Section/adverse effects* ; Abdominal Cavity ; Neoplasms

Objective To study whether ferulic acid can promote healing on chronic ischemic wounds and its possible mechanisms.Methods 40 male New Zealand white rabbits were randomly divided into 4 groups:vaseline group,ischemic control group,5％ ferulic acid group and recombinant bovine basic fibroblast growth factor for external use (rb-bFGF) group.Gross wounds were carefully observed and HE staining was used to observe the wound healing and immumohistochemical staining to observe the expression of the VEGF and CD31.The RNA was extracted to detect the expression of VEGF and HIF-1a by real-time PCR.Results The general observation and the HE staining of each specimen 11 days after operation all indicated that the duration of wound healing of the 5 ％ ferulic acid group was similar to that of the rb-bFGF group and markedly shorter than the ischemic control group and the vaseline smear group.The result of the immunohistochemical staining indicated that the content of the VEGF and CD31 expression of the 5 ％ ferulic acid groups and the rb-bFGF group made lit tle difference,but there was markedly less VEGF and CD31 in ischemic control group and the vaseline smear group.The result of the PCR showed that expression level of VEGF and HIF-1α in the 5 ％ fer ulic acid group was similar to that in the rb bFGF group and the vaseline smear group,but was obviously more than that of the ischemic control group and the vaseline smear group (P ＜ 0.05).Conclusions Ferulic acid can promote angiogenesis by increasing VEGF and HIF-1α which are closely related to angiogenesis and then promote the healing of chronic wounds.

Objective To observe effects of electro-acupuncture (EA) on the expression of apoptosis related protein B-cell lymphoma/leukemia gene 2 (Bcl-2) and Bcl-associated protein X (Bax) in the hippoeampal CA1 region of rats with cerebral infarction,and on their behavior. MethodsAn animal model of cerebral ischemia was established by right side middle cerebral artery occlusion using thread in 48 male,adult Wistar rats,who were then randomly divided equally into an EA group and a control group.Both groups were sub-divided into 1 week,2 weeks and 3 weeks subgroups.The EA group began receiving EA 24h after the occlusion,applied at the Baihui (DU20) and Dazhui (BU14) points,once daily,for one,two or three weeks.The control group was reared conventionally and was not given any special treatment.The rats'learning and memory,motion and neural function were evaluated.The expression of Bcl-2 and Bax in the CA1 region of the hippocampus on the infarcted side and changes of apoptosis indexes were detected using immunohistochemical techniques.ResultsThe learning,memory,motion and neural function of the EA group rats were better on average than those of the control group at all observation time points.The expression of Bcl-2 protein increased along with reduced expression of Bax protein in the EA group significantly more than among the controls.TUNEL positive cells in the CA1 region of the hippocampus were reduced significantly in the EA group compared with the control group.ConclusionsBehavioral ability after cerebral infarction can be improved by EA at the Baihui (DU20) and Dazhui (BU14) points.EA can up-regulate the expression of Bcl-2 and down-regulate the expression of Bax and reduce TUNEL positive cells in the CA1 region of the hippocampus after cerebral infarction,which might be the mechanism of its neuroprotection.

Objectives To isolate the cardiogenic fraction, which can enhance cardiogenic differentiation of bone marrow-derived mesenchymal stem cells(MSC)from Geum iaponicum.The therapeutic effeet of the isolated cardiogenic fraction was further tested in a rat myocardial infaretion (MI)model.Method Bioassay guided fractionation method was used for the isolation of the cardiogenic fraction,named as heart repair fraction(HRF).MI was induced by a permanent ligation of left anterior descending coronary artery.The rats exhibiting similarly decreased values of left ventricle ejection fraction(LVEF) and fraction shortening(LVFS)were used.The rats in test group(n=10)were subject to HRF treatment(20 mg·kg-1·d-1)through gastric gavage daily for 4 weeks.Water alone(2 ml/d) was given through gastric gavage to rats in the control group(n=10).The cardiac function was assessed by echocardiography at different time points.Masson trichrome staining was used for evaluation of the infarct size.Morphological and immunohistochemical studies were performed to investigate the HRF mediated myocardial regeneration.Results LVEF(66.2%±6.9%)and LVFS(46.8%±5.8%)were significantly increased two weeks post HRF treatment compared with the values(LVEF:55.7%±6.0%and LVES:36.4%±5.2%)in control rats(a11 P<0.01).The improved heart function was further restored 4 weeks post HRF treatment(P<0.01).Furthermore,the treatment of acute MI with this HRF significantly reduced the infarct size(19.0%±6.1%)compared with that(31.1%±8.6%)in control rats(P<0.01).Substantial regeneration of cardiomyoeytes in infarcted region of the HRF treated heart was also observed that replaced a considerable part of the infarcted heart tissues resulting in remarkable reduction of the infarct size.Conclusion The properties of this HRF isolated from Geum japonicum in stimulating substantial regeneration of myocardium in infarct region with consequently improved cardiac function appear to be new and represent a new approach for the treatment of MI.

Objective To investigate the actual situation of implementation of the project to reduce water arsenic in endemic arsenic poisoning areas in Shanxi province,and to provide a scientific basis for prevention and control of the disease.Methods In June 2011,a questionnaire survey of 151 arsenic endemic villages was carried out in Shanxi province.The actual situation of implementation of the project to reduce water arsenic was investigated.Water samples were collected and arsenic level was determined by atomic fluorescence spectrometry.Results In the 151 arsenic poisoning villages 126 villages had changed the water,and the rate was 83.44％.In these villages,22 villages did not use the water improvement utilities properly.Of the 33 water improvement projects to reduce arsenic,23 operated normally.The projects covered 110 villages,beneficiary population of 97 920 people,accounting for 46.9％(97 920/208 736) of the total population.Water arsenic exceeded the national standards(≤0.05 mg/L) in 10 of the water improvement projects which covered 31 villages,including 15 nonendemic villages and 16 diseased villages.There were a population of 24 764 people in the diseased villages.Conclusions In Shanxi endemic arsenic poisoning areas,water improvement efforts need to be strengthened; the quality of water improvement project needs to be improved,and the project's later management and maintenance also need to be further strengthened.