Objective To summarize surgical strategies and skills against aneurysms of posterior circulation .Methods Twenty-one cases of posterior circulation aneurysms who had undergone microsurgery between March 2008 and March 2013 were analyzed retrospectively .Two of these cases had their basilar artery aneurysms clipped via the pterion approach and five through the subtemporal approach .Five posterior cerebral artery aneurysms were clipped via the subtemporal approach , two anterior inferior cerebellar artery aneurysms were clipped via the retrosigmoid approach , three posterior inferior cerebel-lar artery aneurysms were clipped through the far lateral approach , and two vertebral artery aneurysms were clipped similar-ly approach.Results All the aneurysms were clipped successfully .According to Glasgow Outcome Scale (GOS), the cura-tive effect was poor in 3 cases(GOS 2-3 points), good in 16 cases(GOS 4-5 points) and 2 patients died(GOS 1 point). Conclusion Aneurysms of posterior circulation can be treated through microsurgery .Proper surgical strategies , operative ap-proach and delicate surgical skills are critical to the success of surgeries and curative effects .

PurposeVon Hippel-Lindau (VHL) syndrome is a rare autosomal dominant diseases involved multiple organs. This paper aims to explore the clinical and imaging features of VHL syndrome for the improvement of early diagnosis and treatment of this disease.Materials and Methods The clinical and imaging data, as well as their history of 5 patients with VHL syndrome were retrospectively studied. Follow-up was performed and the related literature was also reviewed.Results Among the 5 patients, 4 were found with angioreticulomas. One out of four patients simultaneously suffered from multiple angioreticulomas in brainstem, and another one had multiple cervical cord angioreticulomas. The typical MRI showed multiple cystic and solid mass with mixed intense signals, and the enhanced MRI displayed obvious enhancement in the solid part of the mass. Three patients were diagnosed with renal clear cell carcinomas. The typical CT scan showed equidensity or slightly low density signals, and the enhanced CT scan noted heterogeneous enhancement. Besides, bilateral epididymis cystadenoma occurred in one case. The ultrasonography presented heterogeneous echo and rich blood vessels. The follow-ups had been conducted till January 2015. According to the Glasgow outcome scale, three patients were in good conditions, while the other two died from renal clear cell carcinomas.Conclusion Patients with VHL syndrome usually have an unsatisfactory prognosis and most may die from renal carcinoma. Genetic test and investigation of family history should be performed as early as possible on patients with highly suspected or confirmed VHL Early treatment, life-long follow-up and periodic imaging examinations may be helpful in the prognosis.

Objective To investigate the operative techniques of microsurgery treatment of M1 segment of middle cerebral artery (MCA) aneurysms via pterional approach in 132 cases.Methods Retrospectively analyzed the clinical manifestation,angiograms,and surgical operation data of 132 patients with M1 segment of MCA aneurysms who underwent microsurgery through pterional approach.Results Preoperative digital subtraction angiography (DSA) was conducted in 121 cases to identify the size,shape,orientation and relationship with blood vessels around the MCA aneurysms.The other 11 cases underwent emergency operation.Among the 132 cases,72 patients were discharged in good condition according to Glasgow Outcome Scale; 41 patients were in poor condition; 19 cases were dead or in predying state.Postoperative CT showed that49 cases occurred new infarction and 7 cases developed hydrocephalus or enlargement of ventricles.Ventriculoperitoneal shunt was conducted in 2 cases.Intraoperation rupture and bleeding of aneurysms occurred in 17 cases.Conclusion The aneurysms in M1 segment of the middle cerebral artery are mostly located in the bifurcation of M1 segment.Most branches and perforating arteries stem from middle cerebral artery trunk.Patients with Hunt-hess grade Ⅰ-Ⅲ MCA aneurysms or with Hunt-hess grade Ⅳ,Ⅴ should be treated with microsurgery as soon as possible.Inside Sylvian fissure approach is the most frequently adopted in microsurgery via pterional approach.It is key for the success of the operation to preoperatively understand the anatomy surrounding the aneurysms,have good microsurgical skills and employ correct methods of preventing and managing of rupture of aneurysm.It can relieve the secondary cerebral vasospasm to clear up hematocele in the cisterns or to wash the cisterns or use adhesive wound dressing on blood vessels during operation using papaverine.

Objective:To investigate the expressions and significance of tyrosine kinase receptor EphA2 and its ligand ephrinA1 in human malignant gliomas and their correlation with tumor angiogenesis. Methods:The expressions of EphA2, ephrinA1, and CD105-stained microvessel density (MVD) were detected via immunohistochemical assay in 62 glioma tissues and 8 normal brain tissues. The correlation between EphA2 and ephrinA1 expression and microvessel counts in the glioma tissues were assessed. Results:Immunohistochemical staining results revealed that variable levels of EphA2 and MVD expression were significantly higher than that of the normal brain samples. Statistical difference was observed in EphA2 and MVD expressions between human gliomas and normal brain samples (P<0.01). The positive rate of EphA2 and MVD expressions was significantly higher in high-grade gliomas (WHO III-IV) than that in low-grade gliomas (WHO I-II) (P<0.01). EphrinA1 was expressed at low levels in most malignant gliomas, and the increased ephrinA1 expression was associated with lower-grade histology. MVD was significantly positively correlated with EphA2 expression (r=0.713, P<0.01) and significantly negatively correlated with ephrinA1 expression (r=-0. 772, P<0.01). EphA2 was significantly negatively correlated with ephrinA1 expression (r=-0.912, P<0.01). Conclusion:Specifically over-expressed EphA2 and its low-expressed ligand ephrinA1 in malignant gliomas may be closely correlated with the invasion and malignant degree of gliomas. Cooperation is involved in the angiogenesis and has an important function in the initiation and progression of gliomas.

Objective To summarize the experience of surgical strategies and operational skills on multiple intracranial aneurysms of anterior circulation.Methods The clinical data of 85 patients with multiple intracranial aneurysms of anterior circulation,admitted to our hospital from October 2010 to March 2011,and the surgical strategies and operational skills on the aneurysms were retrospectively analyzed.According to Glasgow outcome scale (GOS) scores,the curative effects in these patients were rated.Results One-stage surgery was performed in all aneurysms of 79 patients and staged surgeries in 6 patients.Bilateral aneurysms were treated through unilateral craniotomy in 7 patients and bilateral craniotomy in 26 patients.One hundred and eighty-three aneurysms were clipped and 5 were wrapped.According to GOS scores,the curative effects were poor in 7 patients (GOS 2-3) and good in 76 (GOS 4-5),and 2 patients died.Conclusions Multiple intracranial aneurysms of anterior circulation should be treated as soon as possible.The reasonable surgical strategies and delicate surgical skills are critical to the success of surgeries.

Objective To explore the construct validity of the competency assessment questionnaire for junior registered nurses and offer evidence for further tool developments. Methods A total of 603 junior registered nurses from eight level three class A hospitals in Beijing were included and investigated by the competency assessment questionnaire. Exploratory factor analysis was used to analyze the data. According to the results and the experts panel discussion, the items were selected and adjusted. Results The final questionnaire consisted of 4 factors with 23 items and the accumulating explanatory rate of the 4 factors was 61. 785%. The Cronbach′s α coefficient was 0. 787. Conclusions The competency assessment questionnaire for junior registered nurses can evaluate the competency of nurses from 4 aspects, and can also help to guide the improvement of following standardized training.