Objective To explore the possible therapeutic mechanism of Gastrodin Injection combined with ganglioside in the adjuvant treatment of spinal cord injury(SCI)based on NOD-like receptor thermal protein domain associated protein 3(NLRP3)signaling pathway.Methods A total of 108 patients with SCI were randomly divided into an observation group and a control group,with 54 cases in each group.Both groups were given routine rehabilitation training.Additionally,the control group was treated with intravenous drip of ganglioside,and the observation group was treated with intravenous drip of Gastrodin Injection combined with ganglioside.A course of treatment covered 30 days and the two groups were treated for 2 continuous courses.The time for the recovery of muscle strength,time to leave a sickbed for walking and time to stay in hospital for observation were compared between the two groups.The American Spinal Injury Association(ASIA)score and the serum levels of brain-derived neurotrophic factor(BDNF),central nervous specific protein(S-100β),interleukin(IL)-1β,IL-18,NLRP3,cystein-containing aspartate specific protease 1(Caspase-1)and apoptosis-associated speck-like protein containing a CARD(ASC)in the two groups were observed before and after treatment.After treatment,the clinical efficacy and safety of the two groups were evaluated.Results(1)After two courses of treatment,the total effective rate of the observation group was 83.33%(45/54),and that of the control group was 66.67%(36/54).The intergroup comparison(tested by chi-square test)showed that the curative effect of the observation group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the time for the recovery of muscle strength,time to leave a sickbed for walking and time to stay in hospital for observation in the observation group were significantly shorter than those in the control group(P＜0.01).(3)After one and 2 courses of treatment,the ASIA scores of pain sense,motor sense and tactile sensation in the two groups were significantly higher than those before treatment(P＜0.05),and the scores after 2 courses of treatment were higher than those after one course of treatment(P＜0.05).The intergroup comparison showed that the increase of ASIA scores of pain sense,motor sense and tactile sensation in the observation group after one and 2 courses of treatment was significantly superior to that in the control group(P＜0.05).(4)After one and 2 courses of treatment,the serum BDNF level in the two groups was higher than that before treatment(P＜0.05)and the levels of NLRP3,ACS,Caspase-1 protein and serum IL-1β,IL-18 and S-100β were lower than those before treatment(P＜0.05),and the changes in the levels of above indicators in the two groups after 2 courses of treatment were more obvious than those after one course of treatment(P＜0.05).The intergroup comparison showed that the increase of serum BDNF level and the decrease of the levels of protein NLRP3,ACS,Caspase-1 and serum IL-1β,IL-18 and S-100β in the observation group were significantly superior to those in the control group(P＜0.05).(5)During the treatment,no drug-related adverse reactions occurred in the two groups.Conclusion Gastrodin Injection combined with ganglioside exerts certain effect for the treatment of SCI patients.The combined therapy is effective on relieving the neuroinflammatory response and promoting the recovery of neurological function by regulating the NLRP3 inflammasomes,and its curative effect is superior to that of ganglioside alone.

PURPOSEWe once reported blast-induced traumatic brain injury (bTBI) in confined space. Here, bTBI was studied again on goats in the open air using 3.0 kg trinitrotoluene.

METHODSThe goats were placed at 2, 4, 6 and 8 m far from explosion center. Trinitrotoluene (TNT) was used as the source of the blast wave and the pressure at each distance was recorded. The systemic physiology, electroencephalogram, serum level of S-100 beta, and neuron specific enolase (NSE) were determined pre and post the exposure. Neuroanatomy and neuropathology were observed 4 h after the exposure.

RESULTSSimple blast waveforms were recorded with parameters of 702.8 kPa-0.442 ms, 148.4 kPa-2.503 ms, 73.9 kPa-3.233 ms, and 41.9 kPa-5.898 ms at 2, 4, 6 and 8 m respectively. Encephalic blast overpressure was on the first time recorded in the literature by us at 104.2 kPa-0.60 ms at 2 m, where mortality and burn rate were 44% and 44%. Gross examination showed that bTBI was mainly manifested as congestive expansion of blood vessels and subarachnoid hemorrhage, which had a total incidence of 25% and 19% in 36 goats. Microscopical observation found that the main pathohistological changes were enlarged perivascular space (21/36, 58%), small hemorrhages (9/36, 25%), vascular dilatation and congestion (8/36, 22%), and less subarachnoid hemorrhage (2/36, 6%). After explosion, serum levels of S-100b and NSE were elevated, and EEG changed into slow frequency with declined amplitude. The results indicated that severity and incidence of bTBI is related to the intensity of blast overpressure.

CONCLUSIONBlast wave can pass through the skull to directly injure brain tissue.

Animals ; Blast Injuries ; complications ; Brain ; pathology ; Brain Injuries, Traumatic ; etiology ; pathology ; Electroencephalography ; Goats ; Male ; Phosphopyruvate Hydratase ; blood ; S100 Calcium Binding Protein beta Subunit ; blood

Objective To explore the clinical characteristics and treatment of cerebral arteriovenous malformations (AVMs) in elderly patients to improve their prognoses.Methods Such clinical data as clinical manifestations,angioarchitecture features,location and therapy of 28 elderly patients (≥60 years old) with AVMs,admitted to our hospital from January 2000 to December 2011,were retrospectively analyzed.Results The elderly patients had 5.4％ (28/511) morbidity of AVMs,with mean age of (62.25±3.46) years; the male patients were slightly more than the female patients.The clinical presentations included hemorrhage in 20 patients,seizure in 4,headache in 2,facial tic in 1 and tinnitus in 1.Supratentorial and infratentorial lesions were noted in 22 and 6,respectively.The maximum diameter of AVMs was smaller than 3 centimeters in 11 patients,ranged from 3 to 6 centimeters in 16,and larger than 6 centimeters in 1.Twenty-one AVMs were located in the functional areas and 7 in non-functional areas.Deep vein drainage was noted in 15,two-way drainage in 1 and superficial drainage in 11.Spetzeler-Martin grading showed grade Ⅰ in 1,grade Ⅱ in 7,grade Ⅲ in 13,grade Ⅳ in 6 and grade V in 1.After operation,endovascular embolization,27 patients had significantly improved symptoms; one patient had no effect on any treatments.Conclusion The elderly patients with cAVMs have low morbidity with hemorrhage as its most common symptom; and the lesions mostly locate in the supratentorial region; active intervention therapy (resection,endovascular embolization and radiotherapy)can obviously improve the prognosis and quality of lives.

Objective To observe the expression of growth factors (vascular endothelial growth factor [VEGF],stromal cell-derived factor-1 [SDF-1 ],basic fibroblast growth factor [bFGF],insulin-like growth factor [IGF-1],transforming growth factor-β [TGF-β],platelet-derived growth factor [PDGF],brain derived neurotrophic factor [BDNF],glial cell line-derived neurotrophic factor [GDNF] and nerve growth factor [NGF]) in rat ischemic brain tissues after intravenous implantation of bone marrow stromal cells (BMSCs) and/or endothelial progenitor cells (EPCs). Methods Healthy adult Wistar rats were randomly divided into 4 groups:vehicle group,BMSCs transplantation group,EPCs transplantation group and BMSCs combined with EPCs transplantation group (n=20). The rats were subjected to middle cerebral artery occlusion (MCAO),and 24 h after that,they were intravenously transplanted with either 3×106 BMSCs,EPCs,BMSCs/EPCs or 1 mL physiological saline.Seven d after transplantation,real time-PCR and Western blotting were employed to detect the expressions of VEGF,SDF-1,bFGF,IGF-1,TGF-β,PDGF-BB,BDNF,GDNF and NGF. Results The mRNA expressions of bFGF,VEGF and BNDF in the BMSCs/EPCs transplantation group were significantly higher as compared with those in the other groups (P＜0.05).BMSCs transplantation group enjoyed the highest mRNA levels of NGF,GDNF and TGF-β among all the groups, significantly higher as compared with those in the other groups (P＜0.05),followed by BMSCs/EPCs transplantation group.EPCs transplantation group enjoyed the highest mRNA levels of PDGF,IGF-1 and SDF-1,significantly higher as compared with those in the other groups (P＜ 0.05), followed by BMSCs/EPCs transplantation group. Conclusion BMSCs combined with EPCs implantation can promote the functional rehabilitation in rats after focal cerebral ischemia, which provides new way for improving the transplantation success rate.

OBJECTIVETo observe the effect of electro-needling at acupoints of the yangming meridian on the expression of platelet associated complement-1 (PAC-1) and lower limb functions in acute cerebral infarction (ACI) patients.

METHODS58 ACI patients were randomly assigned to the treatment group and the control group. Conventional therapies were given to all patients. Additionally, the electro-needling at acupoints of the yangming meridian was given to patients in the treatment group. Changes of PAC-1 were detected using flow cytometry. Effect of lower limbs functions of ACI patients before and after electro-needling was assessed using Fugl-Meyer Index. Meanwhile, 20 healthy subjects were selected for reference value.

RESULTSIn the acute stage, the PAC-1 level in ACI patients were significantly higher than that in healthy subjects (P<0.05). The PAC-1 level in the electro-needling group was obviously lowered after treatment (P<0.01). There was no significant difference in the control group between before and after treatment. Significant difference was found in Fugl-Meyer index in the same group between before and after two-week treatment (P<0.05). It was higher in the electro-needling group than in the control group, showing significant difference (P<0.01).

CONCLUSIONSPlatelet activation exists in the acute stage of ACI. Electro-needling at acupoints of the yangming meridian showed obvious inhibition on PAC-1 levels, could improve lower limbs functions of ACI patients. It was inferred that electro-needling at acupoints of the yangming meridian promoted the recovery of paralyzed lower limbs at the early stage mainly by regulating PAC-1 levels, thus postponing the progress of ACI.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Cerebral Infarction ; metabolism ; rehabilitation ; therapy ; Electroacupuncture ; Female ; Humans ; Lower Extremity ; Male ; Middle Aged ; Platelet Membrane Glycoproteins ; metabolism ; Recovery of Function ; Stroke Rehabilitation ; Treatment Outcome

Objective To explore the clinical skills and curative efficacy of endovascular embolization on dural arteriovenous fistula (DAVF). Methods A total of 50 patients with DAVF,admitted to our hospital from 2000 to 2009, underwent endovascular embolization with different materials through a microcatheter under DSA. After embolization, imaging examination was applied and clinical manifestations were noted during the clinical follow-up to evaluate the clinical efficacies.Results Immediate postoperative angiography indicated that the fistulas were totally occluded in 43patients, occluded evidently in 6 and occluded partially in 1. The 6-84 months follow-up found that clinical symptoms of 34 patients disappeared, 6 alleviated evidently, 7 relapsed, and 3 worsened; no complications were noted. Conclusion The endovascular embolization for DAVF is effective; and choosing the right embolic approach and material and improving the technology are the keys of successful treatment.

Objective To explore the influencing factors of bleeding in patients with cerebral arteriovenous malformation (AVM) through observing the angioarchitecture of AVM with cerebral DSA.Methods The clinical and imaging data of 199 patients with AVM, including 107 with bleeding and 92without bleeding, were retrospectively analyzed. The relationships between bleeding and such factors as the site and size of masses, the type and site of supplying arteries, the number and pathway of venous drainage, having vascular tumor-like changes or not, the relation between AVM and aneurysm in terms of location, and the number and size of concurrent aneurysms were determined by univariate analyses and Binary logistic regression with SPSS13.0. Results Univariate analysis indicated that such factors as micro-sized (0.5-1.0 cra) and small-sized (1.0-2.0 cra) masses ofAVM, AVM underdeep location,having exclusively deep draining veins, fewer draining veins and deep feeding arteries, concurrent small aneurysms (＜5 mm), aneurysms at the end of the blood-supply artery were positively correlated to hemorrhagic presentation. The number of feeding arteries and the number of concurrent aneurysms were not correlated with hemorrhagic presentation. Having vascular tumor-like changes can decreased the risk of bleeding. When stepwise multiple logistic regression analysis was employed, only micro-sized and small-sized masses of AVM, having deep feeding arteries, and aneurysms at the end of the blood-supply artery were dependent predictors of hemorrhagic presentation. Conclusion Micro-sized and small-sized masses of AVM, having deep draining veins and aneurysms at the end of the blood-supply artery are the most powerful risk predictors for hemorrhagic AVM presentation.

Objective To study the anatomical features of medial wall of the glomus jugulare to provide the theoretical direction for surgery of the glomus jugulare. Methods Fifteen (30 sides)formalin-fixed adult cadaveric specimens were dissected under the operating microscope, and their structural features of the medial wall of the glomus jugulare and their anastomosis of nerves were observed; and 5 dry skull specimen were also employed to observe the bone landmark of medial wall of the glomus jugulare. Results The medial wall of the glomus jugulare is composed of endocranial opening of the jugular foramen, jugular process of the temporal bone and occipital bone, cerebral dura mater and the Ⅸ, Ⅹ and Ⅺ cranial nerves. A curve line was marked on medial wall of the glomus jugulare, finding that the cranial nerves and the cerebral dura mater are at the anteroinferior position and the posterior-up part is composed of the well of the jugular vein adhered to the petrous bone and cerebral dura mater. Cranial nerve Ⅸ travels at the anterosuperior part of its own fibrous sheath and the inferior petrosal sinus ostium separates it from cranial nerves Ⅹ and Ⅺ; cerebral dura mater separates the cranial nerves Ⅸ and Ⅹ. The cranial nerve Ⅹ and the accessory nerve are closely related. Interval of cerebral dura mater between cranial nerve Ⅸ and Ⅹ is clearly seen in 86.67％ (26/30) patients and illegible in 13.33％ (4/30). Hypoglossal canal travels of the bottom of the medial wall of the glomus jugulare. Conclusion The medial wall of the glomus jugulare is composed of endocranial opening of the jugular foramen,jugular process of the temporal bone and occipital bone, cerebral dura mater and the Ⅸ, Ⅹ and Ⅺ cranial nerves, and this information can help the clinicians during the operations of the jugulare foramen, so that the operation complications can be reduced.

OBJECTIVETo analyze the death-related risk factors of type B aortic dissection treated medically during the acute phase (symptoms presenting within 14 d), and to determine the predictors of surgical indications for acute type B aortic dissection.

METHODSClinical data of 42 patients with acute type B aortic dissection admitted from January 2007 to May 2009 was retrospectively reviewed. There were 33 male and 9 female with a mean age of (50 +/- 12) years old. Therapy included analgesia, controlled hypotension and beta-receptor blocker, the mortality in acute phase was 33.3% (14/42). Univariate and multivariate logistic regression analyses were performed to identify the predictors of the death in acute phase.

RESULTSIn univariate logistic regression analysis, the malperfusion of aortic branches (P = 0.018) and maximum aortic diameter (P = 0.002) were significant predictors of death. In the multivariate logistic regression model, the malperfusion of aortic branches (P = 0.041) and maximum aortic diameter (P = 0.005) were also considered as the significant death-related factors.Risk of death augmented significantly (P = 0.000) when the maximum aortic diameter over 40 mm.

CONCLUSIONMalperfusion of aortic branches and the large maximum aortic diameter (> 40 mm) are the indications of surgery or endovascular therapy for acute type B aortic dissection.

Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting ; drug therapy ; mortality ; Aortic Aneurysm ; drug therapy ; mortality ; Cause of Death ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

OBJECTIVETo study the surgical approach and curative effect of the "interlocking basket" technique in interventional therapy for longitudinal intracranial aneurysm.

METHODSThirty-eight Hunt and Hess Grade I-III patients with longitudinal intracranial aneurysm underwent interventional therapy using the "interlocking basket" technique. During the operation, the aneurysm was divided into two segments based on its length and occluded with two coils. The first coil with a transverse diameter matching that of the aneurysm was deployed to form a "basket", which was densely occluded, and a portion of this coil out of the "basket" was interlocked with the second coil to form another "basket" crossing the aneurysmal neck to prevent the coils from escaping till the neck of the aneurysm was densely occluded.

RESULTSThirty-five aneurysms (92.1%) were completely embolized, and 3 (7.9%) were 95% embolized. No coil escaping from the aneurysm neck or other complications occurred. Twenty-five patients were discharged with a GOS score of 5 (65.8%), 7 (18.4%) with a score of 4, and 6 (15.8%) had a score of 3. In the follow-up for 3-25 months after the embolization, angiography was performed in 28 cases, and recurrence was found in 2 cases (7.14%).

CONCLUSIONThe "interlocking basket" technique can increase the coil stability in longitudinal intracranial aneurysm and allows reliable block of the aneurysm neck and dense embolization of the aneurysm to improve the clinical outcomes of the patients.

Aged ; Embolization, Therapeutic ; methods ; Female ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Treatment Outcome