Objective:To investigate the feasibility and clinical efficacy of side-to-side anastomosis of superficial temporal artery (STA) and middle cerebral artery (MCA) bypass using in-situ intravascular suture technique.Methods:A retrospective analysis was conducted on the clinical data of 10 adult patients who were treated with side-to-side microvascular anastomosis of STA-MCA bypass to improve intracranial blood supply, between February 2024 and September 2024 in the Department of Neurosurgery of the Fourth Affiliated Hospital of Soochow University. Among the patients, 2 were of symptomatic MCA occlusion and 8 of Moyamoya disease. Diameter of STA and MCA, length of anastomosis and blocking time of MCA were recorded. Indocyanine green video angiography (ICG-VA) was performed to evaluate the immediate patency of the STA-MCA side-to-side anastomosis. Digital subtracted angiography (DSA) was performed at 1 week after the surgery to evaluate the patency of the STA-MCA bypass anastomosis, then follow-up DSA was performed at 1, 3 and 6 months after surgery to further evaluate the postoperative anastomotic patency. Neurological function was evaluated regularly with the modified Rankin Scale (mRS).Results:All of the 10 side-to-side STA-MCA bypass anastomoses were successfully performed using in-situ intravascular suture technique. The scalps of all patients healed well. The diameters of STA and MCA were 1.4-2.0 (1.76±0.27) mm and 0.8-1.4 (0.98±0.20) mm, respectively. The average length of the anastomoses was 3.5-5.0 (4.45±0.60) mm. The blocking time of MCA was 12.0-29.0 (21.50±6.62) min. A 100% vessel patency rate was achieved immediately after vessel anastomosis and at 1 month after surgery. DSA examinations were performed at 3 months after surgery on 6 patients and at 6 months after surgery on 1 patient, and all the anastomoses were found in full patency. All patients were included in the postoperative follow-up that lasted for 3 to 7 months. All patients recovered well without new neurological dysfunction. The mRS of 8 patients remained at 0 point before and after surgery. Two patients had improved postoperative mRS of 1 point from that of 2 points before surgery.Conclusion:STA-MCA side-to-side microvascular bypass anastomosis can be performed safely and efficiently using in-situ intravascular suture technique. It could efficiently reduce the incidence of perioperative complications. Meanwhile, it can self-regulate the blood flow and maximise the potential capability of STA.

Objective To investigate the relationship between the expression of serum solute carrier family member 11 (SLC7A11) and acyl CoA synthase long-chain family member 4 (ACSL4) and the degree of neurological impairment and prognosis in patients with acute cerebral infarction (ACI). Methods 60 ACI patients admitted to the Department of Neurology,Suzhou Jiulong Hospital,School of Medicine,Shanghai Jiaotong University from October 2019 to December 2022 were selected as the ACI group,and 60 healthy people in the same period were taken as a control group. Serum SLC7A11 and ACSL4 levels were detected by enzyme-linked immunosorbent assay(ELISA). According to the degree of neurological impairment[assessed by the National Institutes of Health Stroke Scale (NIHSS)],60 patients with ACI were divided into a mild group(n=41) and a severe group (n=19). According to the prognosis of patients 3 months after discharge[assessed by the modified Rankin scale (mRS) score],60 patients with ACI were divided into good group(n=47) and bad group(n=13),and the serum SLC7A11 and ACSL4 levels of ACI patients in different groups were compared. Pearson correlation was used to analyze the correlation between serum SLC7A11 and ACSL4 levels and the degree of neurological impairment and prognosis,and receiver operating characteristic(ROC) curve was used to analyze the value of serum SLC7A11 and ACSL4 levels in predicting poor prognosis of ACI patients.Results The serum SLC7A11 (16.88±3.19ng/ml)level in ACI group was lower than that in the control group(25.13±5.61ng/ml),and the ACSL4(40.01±4.23ng/ml)level was higher than that in the control group(23.29±5.72ng/ml),with statistical significance (t=9.902,18.205,all P<0.05).Serum SLC7A11(15.16±3.91ng/ml)level in ACI patients in the severe group was lower than that in the mild group(17.68±2.41ng/ml),and ACSL4 (42.08±5.02ng/ml) level was higher than that in a mild group(39.05±3.40ng/ml),the serum SLC7A11(14.25±2.95 ng/ml)level of ACI patients in the bad group was lower than that in the good group(17.61±2.85 ng/ml),and the ACSL4 (43.54±3.87 ng/ml)level was higher than that in the good group(39.03±3.78 ng/ml),and the differences were statistical significance (t=3.070,2.747;3.735,3.789,all P<0.05). Pearson correlation analysis showed that serum SLC7A11 level was negatively correlated with NISS and mRS scores of ACI patients (r=-0.416,-0.378,all P<0.05). The serum ACSL4 level was positively correlated with NISS and mRS scores (r=0.351,0.415,all P<0.05). The AUC (95％ CI) of serum SLC7A11 and ACSL4 in predicting the poor prognosis of ACI patients was 0.810 (0.688～0.900),and the sensitivity and specificity were 68.09％ and 92.31％,respectively,which were better than those of individual detection (Z=2.176,1.977,P=0.030,0.048). Conclusion The combination of serum SLC7A11 and ACSL4 has a high predictive efficiency for the poor prognosis of ACI patients.

Objective To investigate the relationship between the expression of serum solute carrier family member 11 (SLC7A11) and acyl CoA synthase long-chain family member 4 (ACSL4) and the degree of neurological impairment and prognosis in patients with acute cerebral infarction (ACI). Methods 60 ACI patients admitted to the Department of Neurology,Suzhou Jiulong Hospital,School of Medicine,Shanghai Jiaotong University from October 2019 to December 2022 were selected as the ACI group,and 60 healthy people in the same period were taken as a control group. Serum SLC7A11 and ACSL4 levels were detected by enzyme-linked immunosorbent assay(ELISA). According to the degree of neurological impairment[assessed by the National Institutes of Health Stroke Scale (NIHSS)],60 patients with ACI were divided into a mild group(n=41) and a severe group (n=19). According to the prognosis of patients 3 months after discharge[assessed by the modified Rankin scale (mRS) score],60 patients with ACI were divided into good group(n=47) and bad group(n=13),and the serum SLC7A11 and ACSL4 levels of ACI patients in different groups were compared. Pearson correlation was used to analyze the correlation between serum SLC7A11 and ACSL4 levels and the degree of neurological impairment and prognosis,and receiver operating characteristic(ROC) curve was used to analyze the value of serum SLC7A11 and ACSL4 levels in predicting poor prognosis of ACI patients.Results The serum SLC7A11 (16.88±3.19ng/ml)level in ACI group was lower than that in the control group(25.13±5.61ng/ml),and the ACSL4(40.01±4.23ng/ml)level was higher than that in the control group(23.29±5.72ng/ml),with statistical significance (t=9.902,18.205,all P<0.05).Serum SLC7A11(15.16±3.91ng/ml)level in ACI patients in the severe group was lower than that in the mild group(17.68±2.41ng/ml),and ACSL4 (42.08±5.02ng/ml) level was higher than that in a mild group(39.05±3.40ng/ml),the serum SLC7A11(14.25±2.95 ng/ml)level of ACI patients in the bad group was lower than that in the good group(17.61±2.85 ng/ml),and the ACSL4 (43.54±3.87 ng/ml)level was higher than that in the good group(39.03±3.78 ng/ml),and the differences were statistical significance (t=3.070,2.747;3.735,3.789,all P<0.05). Pearson correlation analysis showed that serum SLC7A11 level was negatively correlated with NISS and mRS scores of ACI patients (r=-0.416,-0.378,all P<0.05). The serum ACSL4 level was positively correlated with NISS and mRS scores (r=0.351,0.415,all P<0.05). The AUC (95％ CI) of serum SLC7A11 and ACSL4 in predicting the poor prognosis of ACI patients was 0.810 (0.688～0.900),and the sensitivity and specificity were 68.09％ and 92.31％,respectively,which were better than those of individual detection (Z=2.176,1.977,P=0.030,0.048). Conclusion The combination of serum SLC7A11 and ACSL4 has a high predictive efficiency for the poor prognosis of ACI patients.

Objective:To investigate the feasibility and clinical efficacy of side-to-side anastomosis of superficial temporal artery (STA) and middle cerebral artery (MCA) bypass using in-situ intravascular suture technique.Methods:A retrospective analysis was conducted on the clinical data of 10 adult patients who were treated with side-to-side microvascular anastomosis of STA-MCA bypass to improve intracranial blood supply, between February 2024 and September 2024 in the Department of Neurosurgery of the Fourth Affiliated Hospital of Soochow University. Among the patients, 2 were of symptomatic MCA occlusion and 8 of Moyamoya disease. Diameter of STA and MCA, length of anastomosis and blocking time of MCA were recorded. Indocyanine green video angiography (ICG-VA) was performed to evaluate the immediate patency of the STA-MCA side-to-side anastomosis. Digital subtracted angiography (DSA) was performed at 1 week after the surgery to evaluate the patency of the STA-MCA bypass anastomosis, then follow-up DSA was performed at 1, 3 and 6 months after surgery to further evaluate the postoperative anastomotic patency. Neurological function was evaluated regularly with the modified Rankin Scale (mRS).Results:All of the 10 side-to-side STA-MCA bypass anastomoses were successfully performed using in-situ intravascular suture technique. The scalps of all patients healed well. The diameters of STA and MCA were 1.4-2.0 (1.76±0.27) mm and 0.8-1.4 (0.98±0.20) mm, respectively. The average length of the anastomoses was 3.5-5.0 (4.45±0.60) mm. The blocking time of MCA was 12.0-29.0 (21.50±6.62) min. A 100% vessel patency rate was achieved immediately after vessel anastomosis and at 1 month after surgery. DSA examinations were performed at 3 months after surgery on 6 patients and at 6 months after surgery on 1 patient, and all the anastomoses were found in full patency. All patients were included in the postoperative follow-up that lasted for 3 to 7 months. All patients recovered well without new neurological dysfunction. The mRS of 8 patients remained at 0 point before and after surgery. Two patients had improved postoperative mRS of 1 point from that of 2 points before surgery.Conclusion:STA-MCA side-to-side microvascular bypass anastomosis can be performed safely and efficiently using in-situ intravascular suture technique. It could efficiently reduce the incidence of perioperative complications. Meanwhile, it can self-regulate the blood flow and maximise the potential capability of STA.

Objective To discuss the relationship between serum lipoprotein-associated phospholipase A2(Lp-PLA2),low-density lipoprotein(LDL),amyloid beta 1-42(Aβ1-42)and soluble intercellular adhesion molecule-1(sICAM-1)levels,the National Institutes of Health Stroke Scale(NIHSS)score and prognosis in patients with acute ischemic stroke(AIS).Methods A total of 106 patients with AIS who underwent intravenous thrombolysis(the thrombolysis group),30 AIS patients without thrombolysis(the non-thrombolysis group)and 95 healthy individuals(the control group)were included in the study.The thrombolysis group was divided into the recanalization group(n=41)and the non-recanalization group(n=65)according to whether the vein was recanalized after thrombolysis.Patients were divided into the mild group(n=45),the moderate group(n=36)and the severe group(n=25)based on the NIHSS score.They were divided into the good prognosis group(n=65)and the poor prognosis group(n=41)based on the modified Rankin Scale(mRS)score.Serum levels of four indexes in different groups were compared.Their relationship with the NIHSS score and the prognosis was analyzed.Results The vein recanalization rate in 106 patients with thrombolysis was 38.68%(41/106).Serum Lp-PLA2,LDL,Aβ1-42 and sICAM-1 levels were lower in the recanalization group than those in the non-canalization group(P＜0.05).Serum Lp-PLA2,LDL,Aβ1-42 and sICAM-1 levels increased successively in the control group,the thrombolysis group and the non-thrombolysis group(P＜0.05).The 4 serum indexes increased with the aggravation of disease condition,and were positively correlated with NIHSS score(P＜0.05).High serum levels of Lp-PLA2,LDL,Aβ1-42 and sICAM-1 were risk factors for poor prognosis of patients with thrombolysis(P＜0.05).The area under the curve(AUC)and specificity of the combination of 4 serum indexes for predicting poor prognosis of patients with thrombolysis were higher than those of prediction with single index(P＜0.05).Conclusion The expression levels of serum Lp-PLA2,LDL,Aβ1-42 and sICAM-1 in patients with AIS are high.They can be used as important reference indexes for disease condition monitoring and prognosis evaluation.

Objective To evaluate the effectiveness and safety of mouse nerve growth factor in treating dysphagia in patients with nasopharyngeal carcinoma after radiotherapy.Methods Fifty-eight post-radiotherapy nasopharyngeal carcinoma patients with dysphagia were randomly divided into an observation group and a control group.Both groups received routine treatment,but the observation group was additionally injected with mouse nerve growth factor intramuscularly every day for four weeks.Before and after the 4 weeks of treatment,both groups were evaluated using Kubota's water drinking test,videofluoroscopy and the brief version of the WHO's Quality of Life scale.Results After 4 weeks,the patients in the observation group displayed significantly greater improvement in swallowing compared with the control group.There was a significant difference in the groups' average scores on the drinking water test and in the videofluoroscopy results.Moreover,the patients in the observation group had significantly higher quality of life scores than those in the control group,on average.Conclusions Mouse nerve growth factor may have a rapid and safe therapeutic effect on dysphagia induced by radiation.No obvious adverse reactions were observed.

Bypass surgery ( BSX ) and endovascular therapy ( EVT ) are the most important therapeutic method to critical limb ischemia?EVT has potential advantages in reducing surgical trauma and early postoperative complications, shortening hospital stay and so on? Concerning long?term results, BSX is better in reducing long?term mortality and improving long?term patency than EVT group? Therefore, control indications reasonably and select individualized methods, avoid the abuse of EVT are more meaningful for patients.

Bypass surgery ( BSX ) and endovascular therapy ( EVT ) are the most important therapeutic method to critical limb ischemia?EVT has potential advantages in reducing surgical trauma and early postoperative complications, shortening hospital stay and so on? Concerning long?term results, BSX is better in reducing long?term mortality and improving long?term patency than EVT group? Therefore, control indications reasonably and select individualized methods, avoid the abuse of EVT are more meaningful for patients.

Objective To evaluate the effect of propofol preconditioning on endoplasmic reticulum stress induced by hypoxia-reoxygenation (H/R) in HEPG2 cells.Methods HEPG2 cells were randomly divided into 4 groups using a random number table:control group (group C),propofol group (group P),H/R group and H/R + propofol preconditioning group (group PP).In group C,the cells were cultured routinely for 42 h.In group H/R,after being cultured routinely for 6 h,the cells were exposed to 1％ O2 + 5％ CO2 + 94％ N2 for 12 h followed by 12 h reoxygenation.In group PP,the cells were cultured for 6 h in the culture medium containing propofol 10 μmol/L (final concentration),and then H/R was induced.The cell viability was detected by MTT assay.The expression of immunoglobulin heavy chain-binding protein (BIP),C/EBP homologous protein (CHOP) and activated caspase-3 was determined by Western blot.The expression of BIP,CHOP and caspase-3 mRNA was determined by RT-PCR.Results Compared with group C,the cell viability was significantly decreased,and the expression of BIP,CHOP and activated caspase-3 protein and mRNA was up-regnlated in H/R and PP groups,and no significant changes were found in the parameters mentioned above in group P.Compared with group H/R,the cell viability was significantly increased,and the expression of BIP,CHOP and activated caspase-3 protein and mRNA was down-regulated in PP group.Conclusion Propofol preconditioning can promote the cell proliferation and attenuate H/R injury to HEPG2 cells through inhibiting endoplasmic reticulum stress.

Objective To evaluate the effect of propofol on the endoplasmic reticulum stress-mediated apoptosis during focal cerebral ischemia-reperfusion (I/R) in rats.Methods Eighty adult male Sprague-Dawley rats,weighing 240-280 g,were randomly divided into 4 groups (n =20 each):shame operation group (group S) ; focal cerebral I/R group (group FCIR); propofol pretreatment group (group P); intralipid pretreatment group (group Ⅰ).Focal cerebral I/R was induced by 4 h middle cerebral artery occlusion followed by reperfusion.Propofol was infused at a rate of 12 mg· kg-1 · h-1 starting from 30 min before ischemia until 15 min of ischemia in group P,while intralipid was given instead of propofol in group I.Neurological deficit scores (NDSs) were measured at 6 h of reperfusion in 10 rats chosen from each group and the rats were then sacrificed.Their left brains were removed for determination of brain water content.The left 10 rats were sacrificed and their brains were immediately removed for determination of the expression of C/EBP homologous protein (CHOP),Bcl-2,and activated caspase-3 in the left hippocampi by Western blot.Results Compared with group S,NDSs and brain water content were significantly increased,the expression of CHOP and activated caspase-3 was up-regulated,and the expression of Bcl-2 was down-regulated in group FCIR,NDSs was increased in group P (P ＜ 0.05).Compared with group FCIR,NDSs and brain water content were significantly decreased,the expression of CHOP and activated caspase-3 was down-regulated,and the expression of Bcl-2 was up-regulated in group P,and no significant change was found in each parameter in group Ⅰ (P ＞ 0.05).Conclusion Propofol can reduce focal cerebral I/R injury through inhibition of the endoplasmic reticulum stress-mediated apoptosis in rats.