Global Burden of Disease ; Risk Factors ; Quality-Adjusted Life Years

Brain Ischemia ; Cerebral Infarction ; Humans ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial/etiology*

Objective:To analyze the clinical, imaging and pathological characteristics of pleomorphic xanthoastrocytoma (PXA), and to explore the effective treatment of PXA.Methods:A total of 25 patients with PXA admitted to our hospital from July 1, 2012 to December 1, 2019 were chosen in our study. Their clinical manifestations, imageology features, pathology features, treatments, and prognoses were retrospectively analyzed.Results:Headache ( n=12) and epilepsy ( n=8) were the most common first symptoms in 25 patients. The tumors in 8 patients were located in the parietal lobe, 6 were in the temporal lobe, and 6 were in the frontal lobe. Among the pathological results, the average positive rate of cell proliferation antigen Ki-67 and P53 in patients with WHO grading II was 6.4% and 21.2%, respectively; the average positive rate of Ki-67 and P53 in patients with WHO grading III was 22.2% and 48.3%, respectively. Synaptophysin protein was confirmed in 12 of the 15 patients. Twenty patients were followed up for 31 months after surgery; 19 survived; 9 had no tumor recurrence or residue, including 8 with WHO grading II and one with WHO grading III. Conclusion:Pathological result play an important role in PXA diagnosis; the prognosis of patients with WHO grading II is obviously better than that of patients with WHO grading III.

Objective:To explore the surgical outcomes of focal cortical dysplasia (FCD) patients with "difficult to locate" intractable epilepsy and their influencing factors.Methods:Thirty-five FCD patients with "difficult to locate" intractable epilepsy, underwent surgical treatment after intracranial electroencephalogram (iEEG) evaluation in our hospital from January 2011 to December 2018, were chosen in our study. Engel grading was used to evaluate the surgical efficacies of these patients, and they were divided into a satisfied efficacy group (Engel grading I) and an incomplete satisfied efficacy group (Engel grading II-IV). The clinical data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was performed to explore the influencing factors for surgical outcomes of FCD patients with "difficult to locate" intractable epilepsy.Results:Of these 35 patients, 26 patients (74.3%) achieved satisfied efficacy, and 4 had incomplete satisfied efficacy. As compared with those in the satisfied efficacy group, patients in the incomplete satisfied efficacy group had significantly lower total resection rate of epileptogenic foci ( P<0.05). Multivariate Logistic regression analysis showed that incomplete resection of epileptogenic foci was the influencing factor for surgical outcomes of FCD patients with "difficult to locate" intractable epilepsy ( P=0.014, OR=0.050, 95%CI: 0.005-0.547). Conclusion:The FCD patients with "difficult to locate" intractable epilepsy can achieve satisfactory results by surgical resection of epileptogenic zones after iEEG monitoring; these FCD patients with "difficult to locate" intractable epilepsy with incomplete resection of epileptogenic foci often have poor surgical outcomes.

Objective:To investigate the prevalence and prognosis of non-alcoholic fatty liver disease (NAFLD) complicated with coronary vulnerable plaque (VP).Method:Consecutive patients were included who had undergone coronary artery CT angiography (CCTA) from January 1, 2011 to January 30, 2015 at the First People′s Hospital of Neijiang. NAFLD was diagnosed according to the liver imaging findings (liver/spleen CT ratio≤1.0) and clinical data. Baseline data, diagnosis, vulnerable plaque were recorded and followed up. The end points included all-cause death rate, cardiac death rate, non-fatal myocardial infarction rate, and elective coronary revascularization rate.Result:A total of 1 069 patients were eventually recruited in this study, including 316 (29.6%) cases diagnosed as NAFLD. In patients with NAFLD, 130 (41.1%) cases had vulnerable plaque, which was significantly higher than 217 of 753 non-NAFLD patients (28.8%) ( P<0.01). The percentages of spotty calcification, low attenuation plaque, positive remodeling and napkin ring sign in NAFLD cohort were 36.5%, 14.2%, 17.6% and 6.8% respectively, while those corresponding in non-NAFLD cohort were 18.4%, 6.3%, 5.8% and 3.2% respectively. The proportion of each vulnerable feature in NAFLD cohort was significantly higher than that in the non-NAFLD cohort, with P values of 0.016, 0.028, 0.019 and 0.042, respectively. The cardiac mortality rate in NAFLD group was significantly higher than and that of non-NAFLD group (7.0% vs. 3.6%, P=0.044). Multivariate Cox analysis suggested that NAFLD was not an independent risk factor for cardiac death. NAFLD subgroup ( n=316) was divided into VP positive group (NAFLD+VP+, n=130) and VP negative group (NAFLD+VP-, n=186). The mean follow-up time was 4.6±1.3 years. All-cause mortality rate, cardiac death rate, elective coronary artery reconstruction rate, non-fatal myocardial infarction rate in NAFLD+VP+group were 20.8%, 12.3%, 25.4%, 13.8% respectively, which were significantly higher than those corresponding rates in NAFLD+VP-group (5.9%, 3.2%, 8.6%, 6.5%) ( P<0.01, 0.002,<0.01, and 0.032 respectively). Conclusion:The incidences of cardiac mortality, elective coronary revascularization, and non-fatal myocardial infarction are significantly higher in patients with NAFLD than those without. NAFLD combined with vulnerable plaque of coronary arteries predicts worse prognosis.

Objective:To analyze the clinical features and reflectance confocal microscopy (RCM) characteristics of vulvar lichen sclerosus (VLS).Methods:RCM examination was carried out in 34 patients who were preliminarily diagnosed as VLS in People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to June 2019, the results of the various indicators were recorded, and then a histopathological examination was performed at the same site.The RCM image characteristics were analyzed against histopathological manifestations, after that the results were compared and calculated the consistency rate of these image features.Results:The RCM image features of 28 patients with VLS were as follows: the thickness of spinous layer of lesion was thinner than that of surrounding normal skin (epidermis atrophy) in 21 cases (75%); hyper reflectance in basal layer was decreased in 21 cases (75%); In 16 (57.14%)cases, the basal cell ring was absent at the junction of the epidermis, the boundary was blurred, and the infiltration of mononuclear cells and scattered round like large cells in the superficial dermis (liquefaction and degeneration of basal cells); 28 cases (100%) had increased refractive index of superficial dermis (collagen homogenization). The coincidence rates with histopathological examination were 89.29%, 92.86%, 85.71% and 100%, respectively. The sensitivity and specificity of the increase of refractive index in the superficial dermis were the highest, reaching 96.53% and 62.35%. The highest specificity was 92.82% in the presence of epidermal atrophy and the increase of refractive index of superficial dermis.Conclusions:The RCM images of VLS were highly consistent with the histopathological examination.It also has high sensitivity and specificity.Combined with clinical manifestations, it can provide effective help for the diagnosis of vulvar lichen sclerosus and the judgment of therapeutic efficacy.

OBJECTIVE: To evaluate the feasibility of applying intracranial lead reconstruction in deep brain stimulation (DBS) therapy for Parkinsonism. METHODS: We retrospectively collected the clinical data from 27 patients with Parkinson's disease (PD), who received bilateral subthalamic nucleus (STN) DBS therapy between January, 2016 and December, 2017. According to the position of the selected optimal stimulating contact of the implanted leads, the patients were divided into group A with the stimulating contacts of the bilateral leads in the STN, group B with unilateral stimulating contacts in the STN, and group C with bilateral stimulating contacts outside the STN. All the patients were assessed for improvement using Hoehn-Yahr stage, the third part of United Parkinson's Disease Rating Scale (UPDRS Ⅲ), Schwab and England Activities of Daily Living (SE-ADL), and L-dopa equivalent daily dose (LEDD). The consistency between the optimal stimulating contact selected by lead reconstruction and that by standard postoperative programming procedure was also evaluated. RESULTS: The patients in all the 3 groups showed postoperative improvements in Hoehn-Yahr stage, UPDRS Ⅲ score, SE-ADL score, and LEDD in the medication-off state. But at 12 months of the follow-up, such improvements were maintained only in the patients of group A. The optimal stimulating contacts selected by lead reconstruction and standard postoperative programming procedure had a matching rate of up to 77.78% (42/54), and the coordinates of the optimal contacts selected by the two methods showed no significant difference. CONCLUSIONS Intracranial lead reconstruction facilitates the study of the association between the implant site of the leads and the clinical outcome of DBS therapy for PD and allows the precise selection of the optimal contact of the implanted leads in postoperative programming of DBS.
Activities of Daily Living ; Deep Brain Stimulation ; Humans ; Parkinson Disease ; Retrospective Studies ; Treatment Outcome

Objective To explore the related factors affecting postoperative pneumonia in patients with cavernous cerebrovascular malformation (CCM).MethodsClinical data of 151 CCM patients admitted to our hospital from January 2010 to January 2017 were retrospectively collected. Patients were divided into postoperative pneumonia group (n=11) and postoperative non-pneumonia group (n=140) according to the occurrence of postoperative pneumonia. Univariate Logistic regression analysis, multivariate Logistic regression analysis and receiver operating characteristic (ROC) curve were used to screen the relevant factors influencing the occurrence of postoperative pneumonia in CCM patients and evaluate the predictive value of relevant factors in postoperative pneumonia.ResultsAs compared with patients from postoperative non-pneumonia group, patients from postoperative pneumonia group had significantly increased modified Rankin scale (mRS) scores and significantly higher percentage of CCM combined with hemorrhage, and significantly decreased Glasgow coma scale (GCS) scores (P<0.05). Multivariate Logistic regression analysis showed that preoperative GCS scores (OR=4.75, 95％CI: 1.14-19.80,P=0.032) and mRS scores (OR=15.61, 95％CI: 3.22-75.58,P=0.001) were independent factors influencing the occurrence of postoperative pneumonia. ROC curve showed that the sensitivity and specificity of mRS scores≥4 to predict postoperative pneumonia were 45.5％ and 95.7％, respectively, and the sensitivity and specificity of GCS scores≤13 to predict postoperative pneumonia were 54.5％ and 85.7％, respectively.ConclusionFor CCM patients with preoperative GCS scores≤13 or mRS scores≥4, more attention should be paid to perioperative lung management and occurrence of postoperative pneumonia should be vigilant.

Objective The aim of our study was to establish an endoscopic endonasal transsphenoidal surgical training model, and to examine its application value. Methods The endoscopic endonasal transsphenoidal surgical training models were made.After assessments,the models was used for endoscopic operation training for 8 neurosurgeons with no experiences of endoscopic operation. Results The available operating space of this model is similar to the actual operating space in endoscopic endonasal transsphenoidal surgery. The egg fixed on the model has many layers of structure, such as eggshell, shell membrane, egg white and egg yolk, which constituted a good practice object. All students indicated that they could benefit from the training using this model. The skill in grinding the eggshell [(1.07 ± 0.221)cm2/min vs.(1.45±0.27)cm2/min, P<0.001]was significantly improved and the chance for shell membrane rupture (8 vs. 2, P=0.007) was significantly reduced in the last-time practice compared with the first-time practice (P<0.001). Conclusion The endoscopic endonasal transsphenoidal surgical training model is helpful for neurosurgeons to practice the basic operation of endoscopic surgery and to improve their surgical skills,and can be used repeatedly.It can be used in basic operation training before the training using cadaver cranium.

Objective To investigate the distance change of bilateral internal carotid artery in acromegalic patients. Methods Twenty patients with acromegaly were included in this study from August 2016 to March 2018 in Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University. There were 7 males and 13 females with an average age of 40.2±12.6 years (range from 21 to 62 years old). Forty sex and age matched patients with non-functional pituitary adenoma were selected as controls. The 3D printing software was used for reconstructing the internal carotid artery. Distances of the bilateral internal carotid arteries were measured on the reconstructed images. Results The maximum distance between bilateral siphon carotid ectasias (25.1±3.9 mm vs. 23.2±2.9 mm, P=0.041) and distance between bilateral lacerum segments (26.2 ±3.1 mm vs. 23.8 ±4.1 mm, P=0.022) were significantly longer in patients with acromegaly than in those without. Although the distance between bilateral cavernous segments (20.7 ±4.3 mm vs. 22.4 ±3.1 mm, P=0.076) tended to be shorter, the difference was not statistically significant. The distance between bilateral ophthalmic segments was not significantly different between the two groups (15.7±5.1 mm vs. 16.0±2.5 mm, P=0.783). Conclusion The distance of bilateral internal carotid artery of acromegalic patients is different from that of patients with non-functional pituitary adenomas. Patients with acromegaly have significantly longer distance between bilateral siphon carotid ectasias and distance between bilateral lacerum segments compared with the patients with non- functional pituitary adenomas.