Objective To summarize the experiences of microsurgery for treatment of middle cerebral artery aneurysms (MCAA). Methods The clinical data of 35 patients with MCAA treated by microsurgery in General Hospital of PLA from 2004 to 2008 were retrospectively reviewed. Of them there were 20 males and 15 females, aged 18 to 72 years with a mean of 40 years. Of the 35 patients, subarachnoid hemorrhage occurred formerly in 22, intracerebral hemorrhage occurred in 11 and subdural hematoma in one patient. The MCAA located in the middle cerebral artery trunk in 10 patients, at the bifurcation in 20 patients (including one patient with 2 MCAAs), and in the distal segment in 5 patients. MCAA located on the left side in 13 and on right side in 22 patients. There were 7 patients with giant aneurysms, 11 with large aneurysms and 17 with small aneurysms. Microneurosurgery was performed in all cases, and different approaches were taken according to the locations of aneurysms. Superior temporal gyrus approach was conducted in 3 patients with giant intracerebral hematoma. Bypass of superficial temporal artery to middle cerebral artery was performed before occlusion of the afferent artery in one patient with giant aneurysm. Bypass with saphenous vein to middle cerebral artery was performed in another patient with giant aneurysm. Results The giant and large MCAAs consisted of 51.4% of all cases. Excellent outcomes were achieved in 20 patients, no marked change in 12 patients, and post-operative complications were observed in 3 patients. No perioperative death occurred. Conclusions Giant and large aneurysms are more common in middle cerebral artery aneurysms. Proper surgical approaches based on different situations during operation should be considered to achieve satisfactory outcome.

Life-limiting fetal condition (LLFC) is a devastating event for the entire family, and it can also cause work distress and negative emotions for healthcare workers. The implementation of high-quality perinatal palliative care (PPC) can help pregnant women and families cope with the pain caused by trauma and maximize the quality of life and comfort of the fetus. Perinatal palliative care knowledge, skills, and attitudes of health care workers are closely related to the quality of palliative care services and maternal and infant outcomes. This article summarizes the knowledge, skills, and attitude assessment tools of perinatal palliative care of health care workers, in order to provide a reference for the development of perinatal palliative care assessment tools suitable for China.

To investigate the mutation site of pathogenic gene in patients with hypertrophic cardiomyopathy (HCM) and to analyze the relationship between the genotype and clinical phenotype. Methods: Targeted exon capture sequencing was conducted in a HCM proband for 30 coding exons related HCM gene by all exon amplification and high-throughput sequencing. Furthermore, Sanger sequencing was performed in other family member and in 200 healthy volunteers for verification. The familial investigation included in clinical presentation, physical examination, electrocardiogram and echocardiography. Results: There were 3/6 blood relatives carrying cardiac myosin-binding protein gene MyBPC3 G772A heterozygous mutation, the mutation site was at 258 amino acid of MyBPC3 as glutamic acid (Glu) was substitute to lysine (Lys), such mutation was not found in rest of family member and not in healthy volunteers. The onset of proband and her daughter was rather late, they had palpitation and chest tightness; echocardiography showed interventricular septum basal segment thickening (16-18) mm. Proband was complicating paroxysmal ventricular tachycardia, malignant arrhythmia and heart failure, the maximum pressure gradient of left ventricular outflow was 56 mmHg, which with the high risk for sudden death. Conclusion: Comprehensive gene test has been helpful for clinical stratification, early diagnosis and treatment. MYBPC3 site mutation c.G772A might be the pathogenic mutation in that specific HCM family.