Objective To evaluate the risk factors for interventional treatment of neurological complications in elderly patients with rupture intracranial aneurysms.Methods Form December 2004 to December 2014,520 consecutive old patients (≥ 60 years) with ruptured intracranial aneurysm treated at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled retrospectively.The imaging and clinical follow-up results at day 30 after procedure were documented.According to whether the occurrence of interventional therapy-related neurological complications (including intraoperative aneurysm rupture,interventional therapy-related thromboembolic events,early postoperative aneurysm rebleeding,new postoperative subdural hemorrhage or intraparenchymal hemorrhage),they were divided into a complication group (n =68) and a non-complication group (n =452).Univariate statistical analysis and multivariate Logistic regression analysis were used to screen the independent risk factors for the occurrence of neurologic complications after interventional therapy.Results The incidence of neurological complications in 520 patients with aneurysm was 13.1％ (n =68).Multivariate Logistic regression analysis showed that the history of hypertension (OR,2.207,95 ％ CI 1.149-4.240,P ＜ 0.05),Hunt-Hess grade Ⅳ-Ⅴ (OR,4.287,95％ CI 2.048-8.971,P ＜ 0.01),Fisher grade Ⅲ-Ⅳ (OR,2.686,95％ CI 1.483-4.865,P ＜ 0.01),wide-neeked aneurysm (OR,2.884,95 ％ CI 1.511-5.505,P ＜ 0.01),aneurysm bleb (OR,4.560,95 ％ CI 2.500-8.321,P ＜ 0.01),and aneurysm ＜ 3 mm (OR,5.748,95 ％ CI 2.122-15.570,P ＜ 0.01) were the independent risk factors for treatment-related neurological complications in the interventional treatment of intracranial ruptured aneurysms in the elderly.Conclusion The history of hypertension,high Hunt-Hess grade,high Fisher grade,wide-neck aneurysm,aneurysm bleb,and micro-aneurysm are the independent risk factors for treatment-related neurological complications in interventional treatment of intracranial ruptured aneurysms in the elderly.

Objective To investigate the regulation mechanism of estrogen on the free calcium of smooth muscle cells at the endometrial-myometrial interface (EMI) in uteri with adenomyosis. Methods From September 2011 to November 2012, 59 uterine myometrial specimens were obtained from 59 cases underwent hysterectomy, including 28 adenomyosis patients as adenomyosis (ADS) group and 31 patients with cervical intraepithelial neoplasia Ⅲ as control group. EMI smooth muscle cells were cultured and loaded with calcium ion fluorescent probe fluo-4/AM. After treated with trisphosphate (IP3) receptor antagonist, blocker of sarcoplasmic reticulum calcium-adenosine triphosphate (ATP), depleted agent of the ryanodine receptor-operated Ca2+, inhibitor of L-type calcium channel, inhibitor of Na+-Ca2+exchanger, the labeled cells were stimulated with estrogen. The changes of intracellular Ca2+fluorescence intensity were detected by laser scanning microscopy. The changes of intracellular Ca2+concentration was indicated byΔF[Ca2+]i. Results (1) Under normal calcium conditions, after the stimulation of estrogen, intracellular Ca2+fluorescence intensity in ADS group and control group both increased than those without estrogen. TheΔF[Ca2+]i in ADS group was 384±26, and in the control groupΔF[Ca2+]i was 235±20. TheΔF[Ca2+]i in ADS group was higher than that in the control (P<0.01). Without calcium conditions, theΔF[Ca2+]i in ADS group was 207 ± 17, and in the control group ΔF[Ca2+]i was 221 ± 19. TheΔF[Ca2+]i in ADS group was almost the same with the increase in the control (P=0.731). The ΔF[Ca2+]i in ADS group was significantly decreased compared with the calcium condition (P<0.01). However, there was no significant difference in the control between with and without calcium conditions (P=0.060). (2) After treated with IP3 receptor antagonist, blocker of sarcoplasmic reticulum calcium-ATP, depleted agent of the ryanodine receptor-operated Ca2+, theΔF[Ca2+]i in both groups were significantly reduced (P<0.05), the increase in ADS group was significantly higher than that in the control (P<0.05). (3)After treated with inhibitor of L-type calcium channel, theΔF[Ca2+]i in ADS group was 211 ± 19, while in the control group ΔF[Ca2+]i was 203 ± 16, and there was no significantly increased intracellular Ca2 +in both groups (P>0.05). But, the ΔF[Ca2 +]i in ADS group was significantly reduced after treatment compared to before treatment, (211 ± 19 vs 384 ± 28; P=0.001). The increase in control group was almost the same with before (203±16 vs 234±22, P=0.141). (4) After treated with inhibitor of Na+-Ca2+exchanger, theΔF[Ca2+]i in ADS group was 357 ± 24 and in the controlΔF[Ca2+]i was 209±19. The increase in ADS group was significant higher than that in the control (P=0.000). Compared withΔF[Ca2+]i on the condition without treating with inhibitor of Na+-Ca2+exchanger,ΔF[Ca2+]i was 363±21 in ADS group andΔF[Ca2+]i was 237±20 in control group after treatment. When compared with before treatment, there was no significant difference in both groups (P>0.05). Conclusions The increase of intracellular Ca2+induced by estrogen at EMI smooth muscle cells in adenomyosis patients was mostly from the release of arcoplasmic reticulum, and also from the Ca2+influx controlled by L-type calcium channel. The increase of Ca2+inducing abnormal contraction of EMI muscle may have relationship with the development of adenomyosis.

Objective To investigate the feasibility of the arterial wall imaging technology of high-resolution magnetic resonance imaging ( HR-MRI) in the risk assessment of intracranial aneurysm rupture. Methods Fifty-four patients with 66 intracranial aneurysms underwent 3. 0 T HR-MRI multiple sequences arterial wall imaging from November 2013 to March 2015 were analyzed retrospectively. Five patients with ruptured aneurysm were used as a control group. The characteristic differences of aneurysm lesions between an unruptured intracranial aneurysm ( UIA) wall enhancement group and a non-enhancement group were compared. The risk factors for rupture were analyzed according to the size,location, and basic clinical characteristics of aneurysm. Results (1) HR-MRI revealed that whether the aneurysm walls enhanced or not,there were no significant differences in the location size,wide-necked aneurysm or not,and ratios of aneurysm height and neck width (all P >0. 05). (2) The enhancement rates of the aneurysm volume <2 group and ≥2 group were 20%(8/40) and 61. 9%(13/21) respectively,the incidence of the ruptured aneurysm asci was higher than that of UIA,and there was significant difference ( all P<0. 05). There were no significant differences in neck width,rate of aneurysm volume,ratios of aneurysm height and neck width,and enhancement rates among the groups. Conclusion The preliminary results of this study have showed that there is a related trend between the HR-MRI aneurysm wall enhancement and the risk of rupture,but a further large sample follow-up study is needed.

Objective To investigate the effect and mechanism of estrodial (E2) on intracellular free calcium in the endometrial-myometrial interface (EMI) smooth muscle cells from uteri with adenomyosis.MethodsFrom March 2011 to October 2011,16 uterus specimens were collected from patients with adenomyosis undergoing hysterectomy in Beijing Obstetrics and Gynecology Hospital,which included 9 proliferative endometrium and 7 secretory endometrium.EMI smooth muscle cells from the uterus were cultured and loaded with calcium ion ( Ca2 + ) fluorescent probe fluo-4/AM.The labeled cells were stimulated with the various concentration of E2 ( 1 × 102,1 × 103,1 × 104,1 × 105 pmol/L,respectively),then the changes of intracellular Ca2+ fluorescence intensity were measured by laser scanning microscopy.The most suitable concentration of E2 was selected,and the reaction difference between the EMI smooth muscle cells of two menstrual phases were also investigated; The changes of intracellular Ca2 + fluorescence intensity were detected proliferative and secretory smooth muscle cells in E2 conjugated to bovine serum albumin (17β-E2-BSA) group,cycloheximide (CHX) group,fulvestrant (ICI182780) group and pertussis toxin (PTX) group.Results ( 1 ) The cell viability of primary cultured EMI smooth muscle cells was well at 24 hours culture.(2) 1 × 102 - 1 × 105 pmol/L E2 can rapidly increase the intracellular Ca2+ fluorescence intensity within 1 min ( P ＜ 0.01 ) ;The increased amplitudes caused by 1 × 104 pmol/L and 1 × 105 pmoL/L E2 were the most significant,but there was no significant difference between them (P ＞0.05).1 × 104 pmol/L was the most suitable concentration.( 3 ) With the 1 × 104 pmol/L E2,the Ca2+ fluorescence intensity changes showed no significant difference between the EMI smooth muscle cells from the proliferative phase and secretory phase uterus (P ＞ 0.05 ).The Ca2+ fluorescence intensity changes were 646 ± 32 in 17β-E2-BSA group and 602 ±31 in CHX group,when compared with 513 ±26 and 617 ±35 in respective control group,no significant difference was observed (P ＞ 0.05 ).The increased amplitude of 188 ± 20 in the PTX group and 302 ± 11 in ICI182780 group exhibited significant difference with 632 ± 33 and 635 ± 24 in respective control group ( P ＜ 0.01 ).Conclusion E2 could increase the intracellular Ca2 + of EMI through a membrane receptor dependent and nongenomic mechanism of action.

Objective To evaluate the effect of surgical therapy for hepatolithiasis by hepatectomy and choledochofiberscopy. Method We retrospectively analyzed hepatolithiasis patients in our hospital during the past 5 years, comparing the therapeutic effect of different surgical modality. Data were analyzed by chi-square test. Result A total of 469 patients underwent surgical treatment, 412(87.85%) cases were followed up for an average of 3 years and 6 months. The residual calculus rate was 5. 14% and 14. 81% (x2 =9.32,P

Objective: To explore the clinical features and genetic characteristics of myoclonic-atonic epilepsy (MAE) caused by SLC6A1 gene mutation. Methods: The clinical data of a patient with SLC6A1 gene mutation from Xiangya Hospital of Central South University was collected. The related literatures were reviewed from Wanfang Data, China National Knowledge Infrastructure, PubMed (until July 2019) by using keywords " SLC6A1" and " myoclonic-atonic epilepsy" . The characteristics of SLC6A1 gene mutation and the clinical phenotype of children with myoclonic-atonic epilepsy were summarized. Results: A 8 year and 8 months old girl was enrolled in the study. Her first attack happened at the age of 19 months, and multiple seizure types including myoclonic-atonic, atonic and absence were observed. The seizures were well controlled by valproate (VPA), but she has mild-moderate intellectual disability. Whole exome-sequencing study identified a de novo nonsense variant of c. 46G>T(p.Glu16*)in SLC6A1 gene. A total of 27 cases including the present case with SLC6A1 gene mutation were analyzed. 22 mutations were identified, including 11 missense mutations, 5 nonsense mutations, 3 frameshift mutations, 2 splicing mutation and 1 with chromosome microdeletion. Among them 26 patients had more one type of seizures, 20 cases had absence seizures, 17 cases had atonic seizures, 14 cases had myoclonic seizures, 11 cases had myoclonic-atonic seizures, 4 cases had generalized tonic-clonic seizures, 3 cases had eyelid myoclonias, 2 cases had nonconvulsive status epilepticus and 2 cases had tonic seizure. 24 patients had described intelligence assessment. Among them, 18 had developmental delay before epilepsy onset, 11 had developmental regression after onset. There were 9 cases with autistic features, 4 cases with attention deficit hyperactivity disorder and 3 cases with ataxia. The seizures of 17 cases were controlled, 4 cases had partial seizure control, 3 cases had no significant improvement, and other 3 cases were unclear. Conclusions The main clinical feature of MAE patients with SLC6A1 gene mutations is absence and atonic seizures, cognition before epilepsy onset can be impaired, and some patients had behavioral problems, such as autistic features or attention deficit hyperactivity disorders. VPA is recommend as first-line treatment.

Objective:To investigate the mental health status of postgraduates in a medical university in southwest China and analyze its influencing factors.Methods:A total of 622 clinical medical postgraduates from a medical university were investigated by basic information questionnaire and symptom Checklist-90 (SCL-90). Logistic regression was performed for data analysis. Excel 2010 was used for data entry, and SPSS 22.0 was used for statistical analysis.Results:The scores of each factor were as follows: somatization=1.24±0.44, compulsion=1.62±0.64, interpersonal sensitivity=1.4±0.54, depression=1.45± 0.64, anxiety=1.37±0.56, hostility=1.31±0.50, fear=1.18±0.42, paranoia=1.27±0.51, psychosis=1.25± 0.46, others=1.36±0.53. Besides, 169 (27.2%) people had positive mental health symptoms, and the top three symptoms were compulsion, depression and interpersonal sensitivity. The results of multivariate logistic regression analysis showed that grade, professional satisfaction, postgraduate study motivation and family education style were the influencing factors of mental health status of postgraduates in medical colleges and universities.Conclusion:The mental health status of postgraduates in medical colleges is worse than before. According to the influencing factors, targeted measures should be taken to improve the mental health level of postgraduates.

Objective To summarize the clinical features of global developmental delay (GDD) children,and to explore the relationship between severity of GDD and social-culture factors.Methods Sign the informed consent before enrollment.Collect clinical data in detail about 100 GDD children (GDD group) and 95 children with normal development (healthy control group),and analyze their regular clinical data,physical examination,intellectual disability test,electroencephalography (EEG) and cranial imaging test.Spearman rank correlation was used to analyze the differences of social and cultural factors between GDD group and healthy control group,such as maternal reproductive age,parental education level and family economic status.At the same time,we compared the lag degree of total developmental quotient and the degree of developmental retardation of five energy areas with the above factors.Results Significant associations were found between GDD and maternal/paternal education,economic level of family,but no sgnificant association was found between maternal age and GDD.And analysis in the relationship between severity of delay in all domains of the child's developmental status about language and social-culture factors,we only obtained the severity of delay in abilities about language is related with maternal education.Spearman rank correlation statistics explains that if there are the lower level of education with mothers,the delay of language domain will more severe (rs =-0.505,P ＜ 0.05).Conclusions Significant associations were found between GDD and maternal/paternal education,economic level of family.The higher maternal education was an important protective factor against risk of GDD.Improving the cognition of parents in child health care,early be diagnosed,early be intervened,is the most important for children with language development.

Objective:To investigate the safety and efficacy of Tubridge flow diverter for the treatment of recurrent internal carotid blood blister-like aneurysms after stent-assisted embolization.Methods:From June 2018 to April 2021, patients with recurrent internal carotid blood blister-like aneurysms treated with Tubridge flow diverter in the Department of Neurosurgery, Changhai Hospital, Naval Medical University were enrolled retrospectively. The perioperative safety, immediate postoperative and follow-up results were analyzed.Results:A total of 6 patients with recurrent internal carotid blood blister-like aneurysm after stent-assisted embolization were enrolled. The time interval from the first stent-assisted embolization to Tubridge placement was 14 to 90 d. Tubridge implantation alone was used in 4 patients, and Tubridge was implanted in the other 2 patients after the coils were packed. There were no complications during the perioperative period, and no rebleeding was observed after clinical follow-up for 5 to 36 months. Five patients were followed up by angiography for 1-3 months, and the aneurysms disappeared completely.Conclusion:Tubridge flow diverter for the treatment of recurrent internal carotid blood blister-like aneurysms is safe and effective.

Objective:To evaluate the changes in vitamins and trace elements in obese patients after laparoscopic sleeve gastrectomy (LSG).Methods:A systematic retrieval of the available literature was performed using Pubmed, Embase, Cochrane library, Web of Science, WanFang data and CNKI databases and studies were selected per predefined eligibility criteria. Statistical analysis was performed using Stata 13.0.Results:A total of 22 studies with 5320 individuals with obesity who underwent LSG were identified as eligible for inclusion. A significant increase was observed in serum 25(OH)D ( SMD = 0.59, 95% CI: 0.16 to 1.03, P = 0.007), phosphorus ( SMD = 0.28, 95% CI: 0.09 to 0.47, P = 0.004) and iron ( SMD = 0.46, 95% CI: 0.31 to 0.61, P < 0.01) after LSG. A significant decrease in serum zinc ( SMD = -0.41, 95% CI: -0.81 to -0.01, P = 0.044) was observed after LSG. But no significant changes in serum calcium ( SMD = 0.11, 95% CI: -0.14 to 0.36, P = 0.385), folate ( SMD = 0.27, 95% CI: -0.08 to 0.62, P = 0.133), vitamin B 12 ( SMD = 0.11, 95% CI: -0.25 to 0.47, P = 0.563) and magnesium ( SMD = 0.53, 95% CI: -0.08 to 1.14, P = 0.09) were observed. Conclusions:The changes of serum nutritional measurements in individuals with obesity who underwent LSG are uncertain. Therefore, it is recommended to monitor the nutritional laboratory values and add supplements when necessary to prevent postoperative malnutrition.