Objective:To investigate the safety and efficacy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm (IVADA).Methods:A retrospective analysis was performed; 25 patients with ruptured IVADA (25 aneurysms) admitted to Department of Neurosurgery, First Affiliated Hospital of University of Science and Technology of China from January 2020 to June 2023, were chosen. Aneurysm and parent artery occlusion or stent-assisted spring coil embolization were performed according to location of the aneurysms, degrees of aneurysm immediate embolization were evaluated by Raymond grading, and perioperative adverse events were recorded. The patients were followed up for 6-48 months, and aneurysm recurrence was determined according to DSA results; prognoses were assessed by modified Rankin Scale (mRS), with scores of 0-2 as good prognosis and scores of 3-6 as poor prognosis.Results:All 25 patients had unilateral ruptured IVADA, 10 (40%) received aneurysm and parent artery occlusion (occlusion of dissection segment) and 15 (60%) received stent-assisted embolization. Immediately after surgery, 19 patients (76%) had grading I embolization, 4 (16%) grading II embolization, and 2 (8%) grading III embolization. No aneurysm rupture or stent related thrombosis was observed during procedure; 3 patients (12%) died after procedure, with postoperative rebleeding in 1, postoperative cerebellar infarction with respiratory failure in 1, and severe pneumonia in 1. In the 22 survivals, 18 had good prognosis and 4 had poor prognosis. In the 5 relapsed patients (all accepted stent-assisted embolization), 4 underwent re-intervention, and one with visualization at aneurysm neck was relatively stable on re-examination and accepted regular follow up.Conclusion:Aneurysm and parent artery occlusion can be used for non-dominant vertebral artery aneurysms not involving posterior inferior cerebellar artery, whose recurrence rate is lower than that of stent-assisted coil embolization.

Objective:To observe the short-term efficacy and complications of intracranial wide-necked aneurysms treated by Neuroform Atlas stent-assisted coil embolization, and preliminary explore its safety and effectiveness.Methods:A retrospective analysis was performed. The clinical data of 33 patients with intracranial wide-necked aneurysms, admitted to our hospital from September 2020 to August 2021, were collected. All patients underwent Neuroform Atlas stent -assisted coil embolization, including 28 patients with single stent assisted coil embolization and 5 with double stent assisted embolization. Raymond grading was used to evaluate the degrees of immediate postoperative aneurysm embolization. Modified Rankin scale (mRS) was used to assess the prognoses 3-6 months after surgery. DSA was performed to recheck the recurrence of aneurysms and the patency of the parent artery.Results:DSA immediately after surgery showed that all aneurysms were tightly embolized (Raymond grading I). One patient developed intraoperative thrombosis, and blood flow was restored after tirofiban thrombolytic therapy, without new neurological dysfunction after surgery. Three-6 months after surgery, all patients had a good prognosis; DSA recheck was completed in 21 patients (63.6%), and no stenosis or thrombosis were found in the parent artery and no aneurysm recurrence was noted.Conclusion:The Neuroform Atlas stent-assisted coil embolization in treatment of intracranial wide-necked aneurysms has good efficacy and high safety.

Objective:To explore the influencing factors for pulmonary complications of patients with Parkinson's disease (PD) after deep brain stimulation (DBS), and to construct a nomogram model for predicting pulmonary complications after DBS.Methods:Two hundred and seventy-two patients with PD accepted DBS, admitted to our hospital from March 2015 to December 2019, were chosen in our study; they were divided into pulmonary complication group ( n=56) and non-pulmonary complication group ( n=216). The clinical data of patients from the two groups were compared retrospectively. Multivariate Logistic regression was used to analyze the risk factors for pulmonary complications of patients with PD after DBS, and a nomogram model was established to predict the risk of pulmonary complications; receiver operating characteristic (ROC) curve was used to analyze the prediction performance of the model. Results:As compared with non-pulmonary complication group, the pulmonary complication group had significantly higher percentages of patients with history of pulmonary disease, preoperative albumin<35 g/L, preoperative forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)<60%, operation time≥180 min, and age≥70 years, and significantly lower Parkinson's disease sleep scale (PDSS) scores, unified Parkinson's disease rating scale Ⅲ (UPDRS Ⅲ) scores, and preoperative albumin level, and statistically longer postoperative hospital stays ( P<0.05). Multivariate Logistic regression analysis results showed that history of pulmonary disease ( OR=4.230, 95%CI: 2.035-8.207), preoperative albumin<35 g/L ( OR=6.159, 95%CI: 2.570-5.091), preoperative FEV1/FVC<60% ( OR=31.771, 95%CI: 6.702-66.412), operation time≥180 min ( OR=3.550, 95%CI: 2.261-10.065), age≥70 years ( OR=3.714, 95%CI: 1.451-4.827), and PDSS scores ( OR=1.017, 95%CI: 1.351-13.880) were the independent risk factors for pulmonary complications of patients with PD after DBS. Nomogram model established by using the above indicators showed that area under the curve for predicting pulmonary complications of patients with PD after DBS was 0.841 ( 95%CI: 0.774-0.904, P=0.000), with sensitivity of 84.03% and specificity of 75.06%. Conclusion:PD patients with history of pulmonary disease, preoperative albumin<35 g/L, preoperative FEV1/FVC<60%, operation time≥180 min, age≥70 years, and low PDSS scores are trend to have pulmonary complications after DBS; the nomogram model based on the above variables is highly effective in predicting the risk of postoperative pulmonary complications.

Objective:To investigate the application value of electroencephalogram (EEG) combined with regional cerebral oxygen saturation (rSO 2) in monitoring cerebral perfusion during carotid endarterectomy (CEA). Methods:A retrospective analysis of clinical data of 42 patients with atherosclerotic carotid artery stenosis admitted to and accepted CEA in our hospital from January 2018 to December 2019 was performed. CEA was performed under EEG combined with rSO 2 monitoring. The efficacy and safety of EEG combined with rSO 2 in monitoring cerebral perfusion abnormalities during CEA were analyzed. Results:After carotid artery occlusion, 24 patients (57.1%) had normal EEG and rSO 2; 15 (35.7%) had abnormal changes of EEG, among whom 13 (31.0%) were accompanied by rSO 2 anomaly; 16 (38.1%) had abnormal rSO 2, among whom 13 (31.0%) were accompanied by EEG anomaly. Of these 18 patients with abnormal EEG and/or rSO 2 monitoring, 17 patients recovered after increasing their blood pressure and 1 patient recovered after diverter tube usage. Intraoperative EEG and rSO 2 monitoring results were consistent (Kappa=0.745, P=0.000). The positive rates of combined monitoring, EEG alone or rSO 2 alone were 42.9%, 35.7% and 38.1%, respectively. All patients were evaluated clinically and radiologically before discharge, and no new ischemic lesions or clinical symptoms were found. Conclusions:EEG and rSO 2 monitoring are well consistent in CEA; the combined monitoring can make up for the deficiency of single monitoring to increase surgical safety.

Objective:To observe the short-term efficacy and complications of flow diverter device Tubridge in the treatment of complex intracranial aneurysms, and to summarize the indications and experience of Tubridge in treatment of complex intracranial aneurysms.Methods:Thirty-one patients with complex intracranial aneurysms accepted treatment with assistance of Tubridge in our hospital from January 2020 to December 2020 were enrolled. Raymond grading was used to evaluate the degrees of aneurysm embolization immediately after surgery. Modified Rankin scale (mRS) was used to evaluate the prognoses 6 months after surgery. The embolization of aneurysms was determined in these patients by DSA 6 and 12 months after surgery.Results:Thirty-seven aneurysms were noted in these 31 patients. A total of 32 diverters (Turbridge) were implanted into these 37 aneurysms, and all of which were successfully delivered and released. Thirteen aneurysms were filled with spring coils (8 with Raymond grading I, 2 with Raymond grading II, 3 with Raymond grading III by DSA immediately after surgery), and 24 aneurysms were not filled with spring coils. Postoperative ischemic complications occurred in 1 patient, and no hemorrhagic complications or death were noted. All 31 patients had good prognosis at follow-up. Six months after surgery, DSA re-examination in 24 patients (77.4%) showed that complete occlusion of aneurysms was achieved in 17 patients (70.8%). DSA re-examination 12 months after surgery showed complete occlusion of aneurysms in 19 of the 25 patients (76%).Conclusion:The new domestic flow diverter device Tubridge has a high success rate, less perioperative complications, high safety, and good recovery in the treatment of complex intracranial aneurysm.

Objective:To explore the application effect of self-made urine specimen collector in the collection of urine specimens from patients with Parkinson's disease.Methods:Using the convenience sampling method, 150 patients with Parkinson's disease admitted from August 2018 to February 2020 of the First Affiliated Hospital of University of Science and Technology of China were selected as the experimental group, and 125 patients with Parkinson's disease admitted from August 2017 to July 2018 were selected as the control group. The experimental group used the self-made urine specimen collector to collect urine, and the control group used a disposable plastic urine cup to collect urine. The qualification rate, one-time retention success rate, retention time of urine specimens and patient satisfaction between two groups were compared.Results:The qualification rate, one-time retention success rate of urine samples, and the satisfaction score of experimental group were higher than those of control group. The urine specimen retention time of experimental group was shorter than that of control group. The above differences were statistically significant ( P<0.05) . Conclusions:The self-made urine specimen collector can improve the qualification rate, the success rate of one-time retention of urine specimens and patient satisfaction, shorten the retention time of urine specimens, which can be further promoted and used.

Objective To understand the clinical nutritional status and malnutrition risk factors of Parkinson's disease (PD) patients and construct their risk scoring system.Methods A total of 221 patients with PD admitted to our hospital from January 2015 to January 2019 were enrolled. The nutritional status of the patients was assessed by Mini Nutrition Assessment (MNA), and according to the MNA scores, these patients were divided into well-nourished groups (n=176) and malnourished group (including patients having malnutrition and malnutrition risk,n=45). Single factor analysis and Logistic regression analysis were used to analyze the risk factors; their scoring systems were constructed and Hosmer-Lemeshow goodness of fit test was used. Accuracy and discrimination of evaluation scoring systems were evaluated by area under receiver operating characteristic (ROC) curve.Results A total of 45 patients (20.36％) had malnutrition or risk of malnutrition. Multivariate regression analysis suggested that the course of disease≥9 years, motor symptoms (unified PD rating scale Ⅲ scores≥54), Hoehn-Yahr (H-Y) staging≥4, daily levodopa equivalent dose≥600 mg, scores of non-motor symptom scale (NMSS) scores≥101, and quality of life (39-item PD questionnaire scores≥81) were independent risk factors for malnutrition in PD patients (P<0.05). The constructed risk scoring system scored from 0 to 30, and Hosmer-Lemeshow goodness of fit test were:χ2=6.259,P=0.618; the area under ROC curve was0.830 (95％CI: 0.801-0.860); when the predicted score was 14, Yoden index was the largest (0.517), and the sensitivity and specificity were 75.70％ and 76.00％, respectively.Conclusion sPD patients have a high risk of malnutrition or malnutrition. The risk scoring system based on risk factors has high predictive ability and discriminating ability, and can be used as an important tool for malnutrition risk assessment in PD patients.

Objective To explore the efficacy of moderate dose bromocriptine by one-off oral administration in treatment of patients with non-acute prolactin (PRL) type pituitary adenoma.Methods Forty-three patients with definite diagnosis of non-acute prolactin type pituitary adenoma,admitted to our hospital from January 2016 to December 2017,were chosen in our study.All patients were administrated with 5 mg bromocriptine at 18 pm;the serum PRL levels were examined at 2,3 and 12 h after bromocriptine administration.The curative effects of these patients were judged by decline rate of PRL,and the curative effects of patients with different genders,different initial PRL levels and different ages were compared.Results In these 43 patients,bromocriptine showed excellent effect in 20 patients,obvious effect in 18 and invalid effect in 5.There were statistically significant differences in the efficacy of bromocriptine between different genders (P＜0.05).There were statistically significant differences in efficacy of patients with different genders after taking bromocriptine (P＜0.05).The female patients had obviously higher rate of obvious effect than the male patients.Patients with different initial PRL values had statistically significant differences in efficacy after taking bromocriptine (P＜0.05).Patients with PRL initial value of 40-200 ng/mL had significantly higher rate of obvious effect than patients with PRL initial value of ＞200 ng/mL.There was no significant difference in efficacy between patients ＜ 45 years old and patients＞45 years old (P＞0.05).Conclusion The treatment ofhyperprolactin caused by prolactin type pituitary adenoma with moderate dose bromocriptine by one-off oral administration is effective;female patients have obviously better effect than male patients;and for patients with initial prolactin＞200 ng/mL,the effect is better.

Objective To investigate the clinical effect of endovascular interventional treatment of intracranial peripheral aneurysms. Methods From January 2013 to December 2016,the clinical data of 31 patients with intracranial peripheral aneurysm admitted to the Department of Neurosurgery,Anhui Provincial Hospital were analyzed retrospectively.Among them,12 patients had saccular aneurysms,10 had narrow-neck aneurysms,and 2 lacked clear aneurysm necks;19 patients had fusiform aneurysms,they all lacked clear aneurysm necks.Ten patients with narrow-neck saccular aneurysm were treated with coil embolization, of the 2 lacked clear neck saccular aneurysms,1 was treated with stent-assisted coil embolization,1 was treated with coil occlusion of the aneurysm and parent artery;4 patients with fusiform aneurysm were treated with coil occlusion of the aneurysms and parent arteries,11 with fusiform aneurysm were treated with Onyx glue occlusion of the aneurysms and parent arteries,and 4 with fusiform aneurysm were treated with coils in combination with Onyx glue occlusion of the aneurysms and parent arteries.They were followed up for 6 to 36 months after procedure. Results All patients were successfully treated with endovascular intervention,no rebleeding cases were found.Immediate postoperative angiography showed that 11 patients with saccular aneurysm were totally occluded.The aneurysms and parent arteries in 1 patient with saccular aneurysm and 19 with fusiform aneurysm were totally occluded.The aneurysms and parent arteries of 8 patients were occluded with Onyx glue,cranial CT revealed different degrees of cerebral infarction (6 patients without new neurological deficits,2 new neurologic deficits).CT revealed cerebral infarction in 1 patient treated with coils in combination with Onyx glue for occlusion of the aneurysm and parent artery(no new neurologic deficit),other patients did not have cerebral infarction and new neurologic deficits.DSA follow-up revealed aneurysm neck recurrence in 1 patient with saccular aneurysm,no obvious aneurysm recurrence was observed in all other patients. Conclusions Endovascular treatment of intracranial peripheral aneurysms is safe and effective.Choose what specific intervention therapy base on the aneurysm morphology,location, tortuous degree of the parent artery,and the importance of the blood supply area.

Objective To analyze the risk factors related to incidence of shunt dependent hydrocephalus in patients with intracranial aneurysmal subarachnoid hemorrhage so as to provide guidance for clinical diagnosis and treatment.Methods The clinical data were retrospectively analyzed of the 451 patients who had been treated in our hospital for ruptured intracranial aneurysmal subarachnoid hemorrhage from January 2013 to December 2016.Of them,67 were complicated with shunt dependent hydrocephalus and 384 were not.The 2 groups were compared in terms of related clinical variables.Multivariate Logistic regression was conducted to analyze risk factors associated with incidence of shunt dependent hydrocephalus.Results The proportions of patients ＞60 years old,intraventricular hemorrhage,posterior circulation aneurysm,acute hydrocephalus and central nervous system infection were significantly higher in the patients with complicated shunt dependent hydrocephalus than in those without (P＜0.05).There were significant differences between the 2 groups in Hunt-Hess grade and Fisher grade at admission (P＜0.05).Multivariate Logistic regression analysis revealed that posterior circulation aneurysm,acute hydrocephalus and central nervous system infection were independent risk factors for incidence of shunt dependent hydrocephalus in patients with intracranial aneurysmal subarachnoid hemorrhage.Conclusion If the patients with intracranial aneurysmal subarachnoid hemorrhage are complicated with posterior circulation aneurysm,acute hydrocephalus and central nervous system infection,they are more likely to develop shunt dependent hydrocephalus.