Objective To evaluate the efficacy of electrocorticographic (ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy.
Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years (mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated.
Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I (75.00%), 5 were class II (13.89%), 2 were class III (5.56%), and 2 were class IV (5.56%), thus the total effective rate (class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes (P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes (P=0.041).
Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes.

The complete genome of encephalomyocarditis virus (EMCV)strain GXLC isolated from swine was sequenced and analyzed. Five overlapped gene fragments covering the entire open reading frame (ORF) were amplified by RT-PCR, and the 3'-untranslated region (UTR) and 5'-UTR were amplified by the 3'-rapid amplification of cDNA ends (RACE) and 5'-RACE method, respectively. The genome sequences of strain GXLC were obtained by assembling the sequences of RT-PCR-generated cDNA fragments. The length of the complete genome was 7 725 nucleotides (nt). The homology comparison and phylogenetic analysis of the nucleotide and deduced amino acid sequences between strain GXLC and other EMCV strains available in GenBank were performed. The results showed that the complete genome identity between GXLC strain and the strains from China, i.e. GX0601, GX0602, BJC3 and HB1 and the strains from other countries, i.e. CBNU, K3, K11, TEL-2887A, EMCV-R and PV21 was over 99%. The phylogenetic trees based on the complete genome, the structural protein or the non-structural protein gene sequences revealed that the tree topology was similar. All the EMCV strains could be divided into two groups: group I and group II, and group I could be subdivided into subgroup Ia and subgroup Ib. The strains from swine belonged to subgroup Ia or Ib, and the strains from mice belonged to subgroup Ia, while the strains from Sus scro fa belonged to group II. Strain GXLC, together with other EMCV isolates from China, belonged to subgroup Ia.
Animals ; Cardiovirus Infections ; veterinary ; virology ; Cell Line ; Encephalomyocarditis virus ; classification ; genetics ; isolation & purification ; Genome, Viral ; Molecular Sequence Data ; Open Reading Frames ; genetics ; Phylogeny ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, DNA ; Species Specificity ; Swine ; Swine Diseases ; virology ; Weaning

Objective To study the surgical treatment and effects of the lesions in the third ventricle. Methods The data of 15 patients with third ventricular lesion, accepted surgical treatment were retrospectively analyzed. The lesions were removed through transcallosal approach in 11 patients, frontal trans-cortical approach in 2 and trans-terminalis approach in 2,respectively. Postoperative radiotherapy was performed in 5 and chemotherapy in 2. VP shunt was performed in 1. Results The lesions were total-resected in 8 (53.3%), subtotal-resected in 5 (33.3%) and partial-resected in 2 (13.3%) with 1 postoperative death. The hydrocephalus were resolved in all cases. With a follow-up of 3 to 12 months, all the 14 patients recovered without obvious neurological deficits. Conclusion Proper microsurgical approach and perfect surgical skills are the keys to high resection and good prognosis. And postoperative radiotherapy or chemotherapy may be helpful in improving the outcome

Objective To investigate the therapeutic effect of surgical management on patients with secondary epilepsy under the monitoring of cortical electrocorticography (ECoG). Methods Eighty-four patients with secondary epilepsy, admitted to our hospital from September 2004 to January 2008, were chosen; intraoperative ECoG monitoring was performed to locate the epileptic foci before the resection of the primary lesion. After the resection of primary lesion, resection of epileptic foci, enlarged resection of epileptic foci, cortical thermocoagulation, anterior temporal lobectomy,amygdalohippocampectomy and anterior callosotomy were performed, respectively, in different patients according to the clinical manifestations of seizures, and the locations of lesions and epileptic waveform discharges detected by intraoperative ECoG monitoring. Results The epileptic waveform discharges in 84 patients were noted before the resection of primary lesion. The epileptic waves were found in 80patients at the peripheral areas of the primary nidus under immediately postoperative ECoG monitoring,with a relevance ratio reaching 95.24%; after the resection of residual cortical zone with epileptic wave discharges, epileptic wave disappeared on immediately postoperative ECoG in 13 patients whose lesion located in nonfunctional area; normal signals were noted in 60 of the 67 patients performed cortical thermocoagulation whose cortical zone with epileptic wave discharges were located or neighbored in functional area, and good outcomes under the immediately postoperative ECoG monitoring were noted in the other 7 patients performed thermocoagulation combined with anterior callosotomy and/or amygdalohippocampectomy. The follow-up studies for 10 months to 4 years showed that grade Ⅰ in 56patients (66.67%), grade Ⅱ in 21 (25.00%), grade Ⅲ in 4 (4.76%) and grade Ⅳ in 3 (3.57%) according to the Engle standard of curative effect were achieved; the total effective rate was 96. 42%. Conclusion ECoG monitoring can significantly improve the efficiency of surgical management of secondary epilepsy.

Objective To investigate the therapic efficiency of early one-stage ventriculo-peritoneal shunt and cranioplasty on patients with skull deficit,hydrocephalus and hernia in the cerebral tissue of deficited skull after large flap decompression.Methods Thirty-eight patients with skull deficit,hydrocephalus and hernia in the cerebral tissue of deficited skull after large flap decompression,admitted to our hospital from June 2009 to December 2010,were chosen in our study;early (within two months of onset) one-stage ventriculo-peritoneal shunt and cranioplasty were performed on these patients; follow up was performed for 6-24 months.Results Postoperative CT scan 10 days after the surgery showed that hydrocephlus disappeared in 31 patients and significantly alleviated in 7; the midline located on the middle of the brain,and the titanium structure in the skull deficit was good.The follow-up of 6-24 months (mean 13 months) indicated that hydrocephlus disappeared in 30 patients,significantly alleviated in 6,and recurred in 2 patients under CT scan; recurred hydrocephalus disappeared after a new re-operation of ventriculo-peritoneal shunt.Conslusion The early one-stage ventriculo-peritoneal shunt and cranioplasty could achieve favorable outcome for patients with skull deficit,hydrocephalus and hernia in the cerebral tissue of deficited skull after large flap decompression.

Objective To explore the operative techniques for minimally invasive resection of extradural and intradural extramedullary space-occupying lesions and their values.Methods Twenty-six consecutive patients with intraspinal extramedullary lesions,admitted to and underwent modified unilateral hemilaminectomy in our hospital from August 2008 August 2012,were chosen in our study; there were 5 cases of extradural lesions,and 21 patients with intradural extramedullary lesions;their clinical data and treatment efficacy of these patients were retrospectively analyzed.Results Histologically,eleven lesions were determined to be sehwannomas,four spinal meningiomas,three enterogenous cysts,three herniated discs,two extradural ruptured and bleeding vascular malformations,one sub-adventitial hematoma of nerve root,one capillary hemangioma,and one metastatic neoplasm.All of 26 lesions were completely excised via the limited bone window following unilateral hemilaminectomy.Four spinal meningiomas of resections were assisted with contact laser systems; three enterogenous cysts of resections were assisted with endoscope.With respect to neurological status,all of 26 patients were markedly improved.There were no complications associated with this surgical technique.At the median 9.8-month-follow-up (3-36 months),21 of 26 patients returned to normal life and work.None of the subjects showed spinal deformity or instability and recurrence of the lesions by the evaluation of postoperative MRI and CT.Conclusion By preserving the musculoligamentous attachments and posterior bony elements of spine as much as possible,most of intraspinal lesions could be safely and effectively excised with the modified minimally invasive techniques; with assistance of contact laser system and endoscope,the total resection rate of intraspinal lesions and their outcomes would be improved.

Objective:To investigate the clinical and genetic characteristics of a male carrier of exceptional complex chromo-some rearrangement(CCR)and the outcome of preimplantation genetic testing for chromosomal structural rearrangement(PGT-SR).Methods:Using the modified high resolution G banding technique and whole-genome low-coverage sequencing(WGLCS),we analyzed the cellular karyotype and molecular karyotype of a male carrier of CCR,performed an analysis of the single-sperm chromosome copy number and conducted PGT-SR for the patient by next-generation sequencing(NGS).In addition,we reviewed the literature on repor-ted male carriers of CCRs and summarized their normal/balanced sperm ratios and PGT-SR outcomes.Results:The karyotype of the patient was 46,XY,der(5)inv(5)(q14.3q23.2)t(5;14;11)(q23.2;q31.1;q21),der(11)t(5;14;11);der(14)t(5;14;11),with the translocation breakpoints located in the intergenic region.Single-sperm sequencing revealed 20.0%(7/35)of normal haploids in the male's spermatozoa,and the results PGT-SR showed a proportion of 25.0%(4/16)of normal/balanced embryos.After thawing and transferring of 2 euploid blastocysts,a healthy male infant was successfully delivered.Conclusion:The proportion of normal hap-loids in the spermatozoa of male CCR carriers may be higher than theoretically predicted,and PGT-SR can effectively improve the preg-nancy outcome in male CCR carriers and provide valuable data for genetic counseling.

OBJECTIVE: To retrospectively compare treatment of hepatocellular carcinoma (HCC) with transarterial chemoembolization (TACE) using gelatin sponges or microspheres plus lipiodol-doxorubicin vs. doxorubicin-loaded drug-eluting beads (DEB). MATERIALS AND METHODS: A total of 158 patients with HCC received TACE from November 2010 to November 2011 were enrolled in this study, including 64 (40.5%) received TACE with lipiodol-doxorubicin and gelatin sponges (group A), 41 (25.9%) received TACE with lipiodol-doxorubicin and microspheres (group B), and 53 (33.5%) received TACE with doxorubicin-loaded DEB (group C). Tumor response and adverse events (AEs) were evaluated. RESULTS: No significant difference was found at baseline among the three groups. The doxorubicin dosage in group C was significantly (p < 0.001) higher compared to the dose used in groups A or B (median, 50 mg vs. 31 mg or 25 mg). Significantly (p < 0.001) more patients in group C achieved complete response compared to those in groups A or B (32.1% vs. 6.3% or 2.4%). Significantly (p < 0.001) less patients in group C had progressive disease compared to those in groups A or B (34.0% vs. 57.8% or 68.3%). Minor AEs were more common in groups A and B compared to group C, with rates of 54.7%, 34.1%, and 5.7%, respectively. CONCLUSION: In patients with HCC, TACE with DEB offers better safety and efficacy profiles compared to either TACE with gelatin sponges or TACE with microspheres.
Abdominal Pain/etiology ; Adult ; Aged ; Antibiotics, Antineoplastic/*administration & dosage/adverse effects ; Carcinoma, Hepatocellular/*drug therapy/mortality ; Chemoembolization, Therapeutic ; Disease-Free Survival ; Doxorubicin/*administration & dosage/adverse effects ; Drug Carriers/*chemistry ; Ethiodized Oil/chemistry ; Female ; Fever/etiology ; Follow-Up Studies ; Gelatin/chemistry ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/*drug therapy/mortality ; Male ; Microspheres ; Middle Aged ; Retrospective Studies

Objective This paper intends to compare the efficacy and safety of high-dose dual regimens containing Vonoprazan and proton pump inhibitor in patients infected with Helicobacter pylori(H.pylori).Methods A prospective randomized controlled study was conducted.According to inclusion and exclusion criteria.,243 patients with H.pylori infection admitted to the Department of Gastroenterology,the First Hospital of Lanzhou University from February 2023 to December 2023 were enrolled as the research objects.They were randomly divided into two groups.The high-dose dual therapy containing Vonoprazan group(VPZ-HDDT group)was given Vonoprazan fumarate tablet 20mg twice daily plus amoxicillin 750 mg four times daily for 14 days and the high-dose combination group containing PPI(PPI-HDDT group)was given esomeprazole 40 mg twice daily plus amoxicillin 750 mg four times daily for 14 days.Patients were followed up and recorded by telephone or WeChat on the 7th and 14th day of starting treatment for drug intake and occurrence of adverse reactions.Patients were instructed to recheck the 13C or 14C urea breath test at least 1 month after the end of medication.Treatment by protocol(PP)analysis,modified intention to treat(mITT)and intention-to-treat(ITT)analysis were used for H.pylori eradication rates in both groups,and compliance and incidence of adverse reactions were compared between the two groups.Results The eradication rates of the VPZ-HDDT group and the PPI-HDDT group in the initial treatment were 94.0％and 88.5％(P=0.209)by PP analysis,and 91.8％and 87.5％(P=0.358)86.7％by mITT analysis,and 81.9％(P=0.377)by ITT analysis,respectively.In the retreated patients,the PP analysis and mITT analysis eradication rates in these two groups were consistent,87.0％and 84.2％(P=0.800),respectively,and 83.3％and 76.2％(P=0.550)by ITT analysis.For the refractory H.pylori patients,the PP analysis and mITT analysis eradication rates in these two groups were also consistent,71.4％and 50.0％(P=0.429),and the eradication rates of ITT analysis were 62.5％and 50.0％(P=0.640),respectively.In different stratifications,the eradication rates of the VPZ-HDDT group were higher than those of the PPI-HDDT group,but the differences were not statistically significant.The incidence of adverse reactions and compliance of the VPZ-HDDT group and the PPI-HDDT group were similar,with no statistically significant differences.Conclusion Both two combination regimens can achieve clinically acceptable eradication rates(＞85％)in the first-time treatment patients.For the retreated and refractory patients,the choice of vonoprazan is more beneficial.

Objective: To evaluate the characteristics of left ventricular structure, function, myocardial mechanics, hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy (HCM) using state-of-the-art echocardiography. Methods: A consecutive series of 85 adult HCM patients who were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected. According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography, the patients were divided into three groups: patients with non-obstructive HCM (n=28), those with labile-obstructive HCM (n=27), and those with obstructive HCM (n=30). In addition, 16 normal family members of HCM patients were included as control group. Two-dimensional speckle tracking imaging, tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states. Results: ①As compared with the control group, left ventricular end-diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups(all P<0.05). Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM, followed by labile-obstructive and non-obstructive HCM, and the lowest in the control group (all P<0.05). ②At rest, the left ventricular global longitudinal, circumferential and radial strain (GLS, GCS and GRS), as well as the twist of obstructive HCM were significantly lower than the other three groups (all P<0.05). As compared with the control group, the GLS and twist decreased in the labile-obstructive and non-obstructive HCM(all P<0.05), but there were no significant changes of GCS and GRS (all P>0.05). The obstructive HCM had the lowest mitral annular plane systolic excursion (MAPSE) and s′, and the longest systolic peaking time standard deviation(Ts-SD) and early diastolic peaking time standard deviation(Te-SD) (all P<0.05). The left ventricular diastolic function of obstructive HCM (e′, the E/e′ ratio and the left atrial volume index) was the worst, labile-obstruction and non-obstructive HCM were better, and the control group was the best (all P<0.001). ③During exercise, the GLS, GCS, GRS, twist of the left ventricle and the MAPSE were the lowest in the obstructive HCM, which increased in the labile-obstructive and non-obstructive HCM, and were best in the control group. The Ts-SD and Te-SD were the shortest in the control group, were prolonged in non-obstructive and labile-obstruction HCM, and were longest in obstructive HCM (all P<0.05). Additionally, the exercise time of the control group was the longest, followed by non-obstructive and labile-obstruction HCM, and the shortest in the obstructive HCM (all P<0.05). The METs of obstructive HCM were significantly lower than the other three groups (all P<0.05). Conclusions In obstructive HCM, the left ventricular systolic strain and synchronization, as well as the MAPSE, are significantly impaired in patients both at rest and during exercise. The patients with labile-obstructive and non-obstructive HCM have reduced left ventricular GLS, twist, and e′, but normal left ventricular GCS, GRS, synchrony, and MAPSE at rest, which are all impaired during exercise.