BACKGROUND: The clinical application of neural stem cells (NSCs) in combination with gene therapy could be used to treat a variety of nervous system hereditary and acquired diseases. However, nervous system diseases are varying. Nerve tissue internal environment of distinctive diseases is also different. All these factors affect the therapeutic effect of NSCs. Moreover, interaction and regulation of a variety of exogenous genes in NSC gene therapy would greatly promote continued regeneration of nerve tissue.OBJECTIVE: To review application of NSCs in the nervous system diseases.METHODS: A computer-based online search of Medline database (2000-01/2009-08) and Tongfang database (2000-01/2009-08) was performed for related articles with key words "neural stem cells, gene, nervous system diseases". RESULTS AND CONCLUSION: A total of 88 English articles were collected. By reading the title and summary, 20 unrelated articles and 28 repetitive articles were excluded. Finally, 40 were reviewed. NSC as a new-type treatment has been used for somatic cell or transgenic vector, and has achieved a certain effect for cerebrovascular disease, brain damage disease, spinal cord injuries, neurodegenerative diseases, brain tumors, and genetic metabolic diseases. However, many key issues such as NSC proliferation, differentiation, migration and control mechanism have not been resolved. In addition, the microenvironment in nerve tissues with different diseases also influences NSC therapy.

AIM: To investigate the PI3K/AKT/GSK-3β signaling pathway involved in the protective effect and mechanism of propofol on the cerebral ischemia-reperfusion injury in rats. METHODS: There were 72 healthy male SD rats. All rats established a model of focal cerebral ischemia-reperfusion injury according to the Zea Longa method and were randomly divided into six groups (n=12), A-sham operation group, B-model group (MCAO), C-Propofol group, D-Propofol+adenosine A1R antagonist group (DPCPX), E-Propofol group+PI3K specific inhibitor (LY294002), F-Propofol+GSK3β inhibitor group (SB216763). The neurological scores of rats 24 h after operation, LDF monitors changes in cerebral blood flow before and after embolization were observed. The TTC staining method was used to detect the cerebral infarction volume of rats in each group; HE staining method was used to observe the morphological changes of the rat brain tissue; Immunohistochemical method was used to detect Bcl-2 positive cells expression; TUNEL was used to detect cerebral cortex ischemia in each group. The percentage of neuronal apoptotic cells. RESULTS: Compared with group A, the behaviors, cerebral infarction volume, apoptosis rate, and Bcl-2 protein expression of rats in groups B, C, D, E, and F all increased (P<0.05); compared with group C, the behavioral scores, cerebral infarction volume and apoptosis rate of rats in groups B, D and E all increased significantly, and the expression of Bcl-2 protein was decreased significantly (P<0.01), but the expression of Bcl-2 protein in group F was increased, cell apoptosis rate decreased (P<0.05), behavior score and infarcts decreased (P<0.05). CONCLUSION: The neuroprotective effect of propofol mediated by adenosine A1R on ischemia-reperfusion injury in rats may be related to the PI3K/AKT/GSK-3β signal transduction pathway.

Marker-free plants have been public concern. Co-transformation and site-specific recombination system are more important methods in self-gene excision. We reviewed the Cre/lox site-specific system and its applications in plants, also, we discussed perspectives of the system in according with our experience.
DNA, Plant ; genetics ; Genes, Plant ; genetics ; Genetic Markers ; Integrases ; Plants, Genetically Modified ; genetics ; Recombination, Genetic

Objective To investigate the effect of using selective indocyanine green videoangiography in the surgical treatment of craniocervical junction dural arteriovenous fistulas.Methods From June 2014to January 2017,the clinical data of 24 patients (26 sides) with craniocervical junction dural arteriovenous fistula treated at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 15 with subarachnoid hemorrhage,8 with venous hypertensive myelopathy,and 1 with medullary compression symptom.The selective indocyanine green fluorescence technique was used to temporarily clip the origin of the arterilized draining vein,and the drainage vein was opened after the indocyanine green fluorescent arterial phase,and thus to determine the sites of arteriovenous fistulas.DSA examination was performed again after the operation,and the clinical efficacy was evaluated with the modified Rankin scale (mRS).Results The dural arteriovenous fistulas of 24 patients (26 sides) were separated from the fistulas during the operation.Intraoperative indocyanine green fluorescence development and postoperative DSA follow-up confirmed that the fistulas were separated.The follow-up time was 4-30 months.The mRS score in 21 patients was 0-1,the Hunt-Hess grade Ⅲ subarachnoid hemorrhage in 2 patients was mRS score 2,and mRS score in 1 patients with preoperative brainstem compression symptom was mRS score 3.Conclusion The selective indocyanine green fluorescence technique is a safe,simple,and effective technique for the treatment of dural arteriovenous fistulas at the junction of craniocervical junction.

Objective　To explore the creation of intracranial arteriovenous malformation (AVM) animal model and its application in embolization. Methods　Using their rete mirabile (ReM) as nidus of AVM, we selected nine Chinese Experimental Mini-pigs (CEMPs) to create AVM animal models mainly by right carotid-jugular anastomosis (CJA) and ligation of the right external carotid artery. The models were embolized respectively with n-butal 2-cyanoacrylate and embosphere, and the ReM, CJA vessel and brain of the animal were removed for histopathological observation. Angiographies were arranged before and after model creation as well as pre- and post embolization. Combined with angio-images and histopathological findings, the applications of the model, the reason of CJA stoma occlusion, and the possibility of model improvement were discussed. Results　The AVM animal model was successfully created in seven 　CEMPs, which was similar to 　human brain 　AVM in angio-architecture, angiographic-image, embolizing behavior and post embolization pathological findings. Thromboses were found inside the CJA vessels in 4 animals and in the rest 3 the CJA vessels were shrunk without thrombus. The brain histopathological changes of the dead animal after embolization were of ischemic infarction. Conclusions　Although our method is relatively more simple and rather reliable, which is suitable for the embolizing research of embolic agents and for the training of interventional staff, it reaches however an acute (short-term) model and its applications are evidently limit. How to prevent the CJA stoma occlusion and to let animal tolerate the embolization need further studies.

Objective　To explore the creation of intracranial arteriovenous malformation (AVM) animal model and its application in embolization. Methods　Using their rete mirabile (ReM) as nidus of AVM, we selected nine Chinese Experimental Mini-pigs (CEMPs) to create AVM animal models mainly by right carotid-jugular anastomosis (CJA) and ligation of the right external carotid artery. The models were embolized respectively with n-butal 2-cyanoacrylate and embosphere, and the ReM, CJA vessel and brain of the animal were removed for histopathological observation. Angiographies were arranged before and after model creation as well as pre- and post embolization. Combined with angio-images and histopathological findings, the applications of the model, the reason of CJA stoma occlusion, and the possibility of model improvement were discussed. Results　The AVM animal model was successfully created in seven 　CEMPs, which was similar to 　human brain 　AVM in angio-architecture, angiographic-image, embolizing behavior and post embolization pathological findings. Thromboses were found inside the CJA vessels in 4 animals and in the rest 3 the CJA vessels were shrunk without thrombus. The brain histopathological changes of the dead animal after embolization were of ischemic infarction. Conclusions　Although our method is relatively more simple and rather reliable, which is suitable for the embolizing research of embolic agents and for the training of interventional staff, it reaches however an acute (short-term) model and its applications are evidently limit. How to prevent the CJA stoma occlusion and to let animal tolerate the embolization need further studies.

The training of neurocritical care is an important component in standardized training of neurosurgical specialists. As a subspeciality of neurosurgery, as well as with the characteristics of critical care medicine, neurocritical care carries its own discipline features. Based on clinical training and practice experiences, the training mode and practice experience were summarized, including basic requirement, theory training, skill training, research training, humanity accomplishment improvement and evaluation stan-dard, in order to discuss the appropriate training mode of neurocritical care in standardized training of neurosurgical specialists, improve the training methods and advance the training effectiveness, and provide reference for cultivating qualified and comprehensively developed neurosurgical specialists.

OBJECTIVE: To evaluate the safety of the balloon occlusion test(BOT) and therapeutic occlusion of the internal carotid artery(ICA). METHODS: The data of 43 patients hospitalized consecutively with traumatic intractable carotid cavernous fistulas (TICCF) were analyzed. Therapeutic occlusion of ICA was performed on 39 cases and BOT was only performed on the remaining 4 cases. Our assessment consisted of: (1) angiographic evaluation of collateral circulation with or without BOT of ICA, and (2) evaluation of clinical tolerance to therapeutic occlusion of ICA with hypotensive challenge for 30 minutes. Complications of BOT and therapeutic occlusion of ICA were also analyzed retrospectively. RESULTS: Complications related to BOT occurred in 1 case (2.3%) without causing permanent deficits. Complications related to therapeutic occlusion of ICA occurred in 4 cases (10%), including 1 technical (2.5%), 2 temporary (5%) and 1 permanent (2.5%) deficit. There was no fistula recurrence or mortality. CONCLUSIONS: BOT of ICA is safe and economical. The reliability of the results is almost the same compared with that of other more complicated methods of assessing therapeutic occlusion of ICA. And it is easy to treat TICCF with therapeutic occlusion of ICA.

The diagnosis and treatment of traumatic brain injury (TBI) are basic skills that should be mastered by neurosurgery specialists during the standardized training. In view of the lack of TBI patients in our center, TBI training was entrusted to a joint base with more TBI patients. Based on clinical training and practice experience of the authors in recent years, including joint base introduction, basic requirement, theory and skill training, research training, humanity accomplishment improvement, inter-base communication and evaluation standard, we discuss the appropriate joint base training mode of TBI in standardized training of neurosurgery specialists, so as to provide reference for cultivating qualified and comprehensively developed neurosurgery specialists.

Objective To analyze the independent risk factors and complications for perioperative hyperbilirubinemia in Stanford type A aortic dissection undergoing operation and investigate the management strategy of perioperative hyperbilirubi-nemia. Methods Between January 2013 and January 2018 from the department of great vessel surgery of heart centre of,290 cases of patients with Stanford type A aortic dissection undergoing operation were collected consecutively,male 210 cases,fe-male 80 cases. The related data and perioperative peak hyperbilirubinemia were recorded. According to the perioperative peak hyperbilirubinemia,patients were divided into 2 groups:≥51. 3 μmol/ L group and < 51. 3 μmol/ L group. Univariate and lo-gistic regression analysis were used to identify the independent risk factors. The perioperative complications were also recorded. Results Preoperative total bilirubin ≥ 17. 1 μmol/ L(OR = 2. 105,95％ CI: 1. 153 - 3. 125,P = 0. 016),cardiopulmonary bypass time > 3. 5 h(OR = 1. 103,95％ CI: 1. 316 - 6. 151,P = 0. 031),a large number of hemolysis(OR = 1. 503,95％CI: 1. 506 - 6. 651,P = 0. 029),the input amount of 24 h allogeneic red blood cell > 2000 ml(OR = 1. 381,95％ CI:0. 956 - 2. 552,P = 0. 036)were the independent risk factors for perioperative hyperbilirubinemia. The incidence rate of post-operative acute hepatic failure(2. 5％ vs. 0,P = 0. 021)and artificial liver therapy(2. 5％ vs. 0,P = 0. 021)in≥51. 3μmol/ L group were significantly increased. The incidence rate of postoperative acute lung injury(37. 5％ vs. 25. 2％,P =0. 039)and acute kidney injury(38. 7％ vs. 19. 5％,P = 0. 035)in 51. 3 μmol/ L group were also significantly increased. The duration of mechanical ventilation[(4. 1 ± 1. 6)days vs. (2. 8 ± 1. 3)days,P < 0. 05]and ICU stay time[(5. 1 ± 2. 3)days vs. (3. 9 ± 1. 8)days,P = 0. 035]and hospitalization time[( 19. 3 ± 3. 1)days vs. ( 17. 3 ± 2. 5)days,P = 0. 035]were sig-nificantly prolonged. Temporary nerve dysfunction(52. 5％ vs. 32. 6％,P = 0. 002)and in-hospital mortality( 17. 5％ vs. 8. 1％,P = 0. 037)were significantly increased. Conclusion Preoperative total bilirubin ≥ 17. 1 μmol/ L,cardiopulmonary bypass time > 3. 5 h,a large number of hemolysis,the input amount of 24 h allogeneic red blood cell > 2000 ml were the in-dependent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection. The perioperative complications in≥51. 3 μmol/ L group were significantly increased. Therefore,more attention should be paid to the independent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection,hyperbilirubinemia and its clearance should be moni-tored more actively and dynamically,the cause should be found more precisely,the treatment be more comprehensive to achieve to control the level of bilirubinemia and improve the prognosis.