Objective To evaluate the effectiveness of VEGF-transfected neural stem cells (NSCs) transplantation to striatum for amelioration of neural damage induced by cerebral ischemia.Methods Temporary middle cerebral artery occlusion (tMCAO) models were established and randomly divided into control group, PBS transplantation group, NSCs transplantation group (n=10) and VEGF-secreting NSCs transplantation group (n=20). The grafts in each group were transplanted into right striatum respectively 3 days after tMCAO model established. NSS was checked in all groups 2, 4, 6, 8, 10, 12 weeks respectively after transplantation. By using immunofluorescent staining, VEGF expression in transfected NSCs was detected 7 days after transplantation. Differentiation of transplanted NSCs was investigated 12 weeks after transplantation. Endothelial cells around the transplantation area were semi-quantitated by using immunohistochemistry staining.Results NSS in VEGF-secreting NSCs transplantation group was lower than in other three groups from 2-12 weeks. There was significant difference in NSS among the groups 12 weeks after transplantation (P

Along with the continuous publication of a series of large-scale clinical trials results,endovascular thrombolytic therapy (or combined with intravenous thrombolysis) has been recommended as the treatment of first choice for acute ischemic stroke caused by large intracranial artery occlusion.Nevertheless,there are a variety of factors that may affect the clinical outcome of endovascular recanalization procedure.This article aims to make a comprehensive review about the factors that may affect the prognosis of patients with acute ischemic stroke who are receiving endovascular treatment.

Objective To evaluate the possibility of keyhole approaches for surgical treatment of petroclival meningiomas. Methods We retrospectively analyzed our experience in 14 cases with petroclival meningiomas surgically treated from May 2003 to January 2004. Eight tumors involved the upper and middle clivus.five tumors were attached to the entire width of clivus and one tumor involved the middle and lower cilvus. The tumors infiltrated into parasella regions or cavernous sinus in six cases simultaneously. Retrosigmoidal keyhole approach was selected to remove the tumors in 6 cases, and subtemporal keyhole approach was selected in 2 cases,while the combined retrosigmoidal and subtemporal keyhole approaches were applied in other six cases. Results Gross total resections of the tumors were achieved in 8 cases, subtotal resections in 4 cases, large resection in two cases who had recurrent tumors. Postoperatively, neurological intact or unchanged were found in 8 cases. The main surgical complications were mild facial palsy (4 cases) , abducent dificits (3 cases) ,temporary oculomotor nerve dificits (2 cases),and lower cranial nerve palsy (1 case). One patient died from disseminated intravascular coagulation (DIC) two weeks after surgey. There were no CSF leakage and infections after surgery in all cases 11 to 19 months follow-up studies demonstrated the great improvement of the Ⅲ and Ⅶ nerve deficits,but minor improvement in the Ⅵ nerve deficits. Conclusion According to the location and extension of the tumors, retrosigmoidal or subtemporal keyhole approaches or their combined can be selected for surgical treatment. These keyhole approaches can expose sufficiently the petroclival region, shorten the surgical time, and minimize the complications. Combined usage of minimally invasive techniques including the keyhole approach and radiosurgey in the treatment of the petroclival meningiomas is suggested.

Objective To evaluate the feasibility,efficacy and complication of early middle cerebral artery(MCA) mechanical recanalization(MER) for treatment of acute ischemic stroke.Methods Seven cases undergone MER of MCA for the treatment of acute cerebral infarct were retrospectively reviewed and analyzed,including the etiology,mechanism,Qureshi grading scale,location and size of infarcts,NIHSS score of pre and post procedure,endovascular technique and complications.Referring to the literature,the indications of MCA recanalization were further identified.Results A total of 7 cases with mean age of 48 yrs were reviewed,which included 3 cases of atherosclerotic thrombosis and 4 embolic cases with pre NIHSS score ranging from 3 to 22.Mechanical recanalization succeeded in 6 cases,but 2 cases of cardiogenic embolism died of intrac ranial hemorrhage postoperatively.Favorable clinical outcomes were achieved in 4 cases whereas 1 deteriorated.Overall complications seemed to be consistent with literatures reviewed.Conclusions Early MER of MCA may benefit to a certain subset of acute ischemia stroke patients,however,embolic cases,elder patients and those with severe neurologic deficits are often accompanied by higher complications and unfavorable outcome.

Objective: To investigate the clinical efficacy of combined acupuncture and herbal medicine based on Prof. QIN Liang-fu's experience in treating chronic gastritis. Methods: Ninety chronic gastritis patients were randomly divided into acupuncture, herbal medicine and acupuncture plus herbal medicine groups. The clinical effects were evaluated after 6 months. Results: After 6months, the clinical effect was better in the acupuncture plus herbal medicine group than in the acupuncture group and in the herbal medicine group(P＜ 0.05). Conclusion:The curative effect on chronic gastritis was better in the acupuncture plus herbal medicine group than in the acupuncture group and in the herbal medicine group.

BACKGROUND: Exogenous neural stem cells (NSCs) can repair nerve and promote recovery of neurofunction following cerebral hemorrhage.OBJECTIVE: To observe the growth and development of NSCs in vitro, to evaluate the survival, migration and differentiation of transplanted NSCs surrounding hematoma and the possible recovery function of NSCs, and to investigate the repairing effect of NSCs on damaged neurofunction in cerebral hemorrhage model rats.DESIGN: Completely randomized grouping design and controlled animal study,SETTING: Department of Neurosurgery, Huashan Hospital, Fudan University.MATERIALS: Eighteen adult healthy male SD rats weighing 280-320 g were provided by Shanghai Animal Center of Chinese Science Academy. BrdU was provided by Neomarkers Company; rat-anti-glial fibrillary acidic protein (GFAP) and rabbit-anti-microtubule-associated protein-2 (MAP-2) by Chemicon Company.METHODS: This study was performed at the Laboratory of Anatomy and Histology & Embryology, Shanghai Medical College,Fudan University from February to December 2006. The NSCs was isolated, cultured, and evaluated from hippocampus of day E14fetal SD rats. Eighteen rats were randomly divided into control group, PBS group and NSC transplantation group. Cerebralhemorrhage rat models were established via injection of autoiogous arterial blood in caudate nucleus. Thirty minutes after model establishment, 5 μ L NSC suspension with the concentration of 2×1011 L-1 was transplanted at four points surrounding hematoma cavity in the NSC transplantation group. Transplantation of PBS and NSCs was the same as autoblood transplantation. Thirty minutes after model establishment, injuries at the four points were performed, and nothing was injected in the control group.MAIN OUTCOME MEASURES: Neurofunction was evaluated with forward limb scale and turning scale just soon after transplantation and at 1, 3, 5, 14, and 28 days after transplantation. Brain was colleted by anesthesia 28 days after model establishment.Differentiation of transplanted NSCs was detected through testing GFAP, MAP-2, and BrdU by using immunohistochemistry.RESULTS: ①Neurofunction scores: There was no significant difference 5 days after model establishment (P＞0.05). However, the scores were significantly improved in the NSC transplantation group 14-28 days after model establishment (P＜0.05).②lmmunofluorescent double labeling: Apoptosis ceils around hemotoma in the NSC transplantation group were less than those in the PBS group. BrdU and MAP-2 or GFAP-positive ceils were observed in cerebral tissue sections, and this suggested that NSCs could survive, migrate and differentiate in host brain and differentiate into neurons or astrocytes.CONCLUSION: NSC Transplantation contributes to the recovery of neurofunction in cerebral hemorrhage rats through differentiation into neurons or astrocytes.

Objective To evaluate the technical feasibility,safety and mid-term effect of endovascular revascularization of nonacute intracranial vertebrobasilar artery occlusion.Methods Consecutive data of patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization,were retrospectively collected and analyzed.Complications and recurrent events during the follow-up period were recorded.The modified Rankin scale (mRS) scores were used to compare the symptoms before and after the procedure.Results All 27 patients but 1 (96.3％) obtained successful recanalization.After the procedure,13 patients showed improvements,11 were stable,and 3 worse.The decline of median mRS scores,which was 4 [interquarter range(IR),2-5) preoperatively and 3 (IR,1-5) on discharge,showed significant statistical difference (Z =3.116,P =0.002).Five patients had procedural complications,namely 2 dissection,1 in-stent thrombosis during the operation,1 thrombus disruption and translocation during the operation and 1 acute reocclusion after operation.During the follow-up period with the median of 21 months,3 death,1 stroke and 2 transient ischemic attack occurred.The latest median mRS scores were 1 (IR,0-3).The ratio of patients with mRS ≤ 2 increased from 25.9％ (7/27) before operation to 63.0％ (17/27) at the follow up.Seventeen patients received imaging follow-up during the 9 months,with restenosis in 6 and symptom in 3 of them.Subgroup analyses revealed better functional recovery (lower mRS) both in patients with vertebral artery occlusion (Z =2.111,P =0.035) and those with basilar artery occlusion (Z =2.333,P =0.020).Conclusions Endovascular revascularization for the nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours is technically feasible,and improves disability recovery.However,the rates of procedural complication and restenosis are high.

Objective To evaluate the mid-and long-term follow-up outcome of revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion. Methods Consecutive data of 27 patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization, were retrospectively collected and analyzed. Complications and recurrent ischemic events during the follow-up period were recorded. The modified Rankin scale(mRS) scores were used and compared between pre-and postoperation. Results All 27 patients except one(96.3%) obtained successful recanalization. After the procedure, 13 patients showed improvement, 11 were stable, and 3 worse. The decline of median mRS scores, which was 4(interquarter range-IR, 2-5) preoperatively and 3(IR, 1-5) on discharge. Five patients suffered from procedural complications and three of them resulted in aggravation. Nineteen patients received imaging follow-up during the median 10 months, 6 restenosis occurred and 3 of them were symptomatic. During median 55 months clinical follow-up after operation, 2 ipsilateral stroke and 2 ipsilateral transient ischemic attack occurred. The mRS scores decreased significantly in the first one year after procedure. Conclusions Revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion can prevent recurrent ipsilateral ischemic event and improve disability recovery in the first one year.

Objective To retrospectively evaluate the cerebrovascular complications from stenting for symptomatic intracranial stenosis and to detect the factors associated with complications.Methods Medical records of Wingspan stenting were reviewed for 306 cases with symptomatic intracranial stenosis from July 2007 to February 2012,including transient ischemic attack,ischemic stroke,death and intracranial hemorrhage as clinical in-hospital complications.The location of lesions included middle cerebral artery level M1 (114 lesions),intracranial portion of the internal carotid artery (50 lesions),vertebral artery 4(75 lesions),venebro-basilar artery (14 lesions),basilar artery (76 lesions).Complications were evaluated and analyzed to find out whether they were associated with patient-or stenosis-related risk factors using x2test.Results The technical success rate was 99％ (303/306).Cerebrovascular complications rate was 6.9％ (21/303),with 1.6％ (14/303) of disabling stroke events and 0.7％ (2/303) of deaths.Hemorrhagic events were consisted of procedure-related events (3 cases),hyperperfusion (3 cases),ischemic events of perforator stroke (8 cases),transient ischemic attack (3 cases),embolization (2 cases),thrombosis in stent (2 cases).Hemorrhagic events were associated with significantly higher morbidity and mortality rates(x2 =2.908,P ＜ 0.05) and occurred more frequently after treatment of middle cerebral artery stenosis than other lesions(x2 =1.168,P ＜ 0.05).Perforating branches were detected to be affected mainly in the basilar artery than other locations (x2 =4.263,P ＜ 0.05).Conclusion The complication rates in the study are preliminary consistent with the previously published data.Hemorrhagic events are prone to occur in the treatment of middle cerebral artery stenosis,while perforating branches are affected mainly in the basilar artery.

Objective To evaluate the technical feasibility,safety and treatment effect of endovascular revascularization of symptomatic sub-acute and chronic intracranial vertebrobasilar artery occlusion.Methods Twenty-one consecutive patients with symptomatic sub-acute and chronic intracranial vertebrobasilar occlusion underwent endovascular revascularization.Perioperative complications and recurrent events during the follow-up period were recorded. The modified Rankin scale ( mRS ) scores and blood stream thrombolysis in myocardial infarction (TIMI) scores for all patients preoperatively,postoperatively and at follow-up were evaluated.The results were analyzed using Wilcoxon rank sum test and Fisher exact test.Results All 21 patients but 1 (95.2％,20/21 ) obtained successful recanalization. After the procedure,9 patients showed improvements,10 were stable,and 2 worse. The decline of median mRS scores,which was 4 preoperatively [ inter-quartile range ( IR ) 2.5-5.0 ] and 4 ( IR 1.0-5.0 ) on discharge from the hospital respectively,showed significant statistical difference (Z =2.810,P ＜ 0.01 ).Three ( 14.3％ ) patients suffered periprocedural complications,namely basal arterial dissection,intra-stent thrombosis and postoperatively acute occlusion in each one.There was no death,stoke or recurrent transient ischemic attack (TIA) occurring 30 days after the procedure. During the 7 months after operation,which was the mean clinical follow-up duration,TIA and recurrent stoke occurred in one patient respectively,and two patients died of systemic complications. The median mRS scores were 2.0 (IR 1.0-4.0 )in all 21 patients and 1 ( IR 1.0-4.0) in the surviving subjects.Conclusions Endovascular revascularization for the recanalization of symptomatic sub-acute and chronic vertebrobasilar artery occlusion is technically feasible,and helps to prevent ischemic events and improve disability recovery. However,its exact effect needs further verification by future random controlled studies.