Objective To summarize the single-center experience with indirect surgery(cerebrovascular bypass)for the treatment of giant internal carotid aneurysms(GICAs).Methods A retrospective analysis was conducted on the clinical outcomes of patients with GICAs treated using indirect surgical techniques at our center from May 2016 to May 2023.For patients who tested negative in the balloon occlusion test(BOT),internal carotid artery(ICA)constriction was performed with or without low-flow bypass from the superficial temporal artery(STA)to the middle cerebral artery(MCA).For patients who tested positive in the BOT,ICA ligation was combined with high-flow bypass(external carotid artery-radial artery-M2).Preoperative and postoperative O'Kelly-Marotta(OKM)grading and changes in the maximum diameter of the aneurysm were examined through cerebral angiography.The preoperative and postoperative modified Rankin Scale(mRS)scores and changes in clinical symptoms were followed up to evaluate the safety and efficacy of the indirect surgery.Results A total of 22 patients were included in this study.Sixteen patients underwent ICA constriction with or without STA-MCA bypass,while six patients underwent ICA ligation combined with high-flow bypass.Postoperative OKM grades reached C/D in 50% (11/22)of the patients,showing a statistically significant improvement compared to preoperative grades(P<0.0001).Postoperative or final imaging follow-up showed that the size of aneurysms was decreased in 19 patients,remained unchanged in 2 patients,and increased in 1 patient,which reached a statistically significant difference compared to preoperative measurements(t=5.439,P<0.001).Follow-up results indicated that the mRS scores of the 22 patients decreased significantly compared to preoperative scores(t=2.531,P=0.019).Conclusion In the era of neurointervention,indirect surgical techniques remain an important complementary approach for the treatment of refractory or recurrent GICAs.

Objective:To evaluate the effect of remimazolam combined with remifentanil used for painless gastroscopy.Methods:A total of 150 patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective painless gastroscopy, were divided into 3 groups ( n=50 each) using a random number table method: propofol combined with remifentanil group (group P), remimazolam 0.3 mg/kg combined with remifentanil group (group R1) and remimazolam 12 mg combined with remifentanil group (group R2). Drugs were administrated according to body weight, and calculation was carried out according to ideal body weight.Remifentanil 0.25 μg/kg was injected intravenously, propofol 1.5 mg/kg was then injected intravenously in group P, remimazolam 0.3 mg/kg was injected intravenously in group R1, and remimazolam 12 mg was injected intravenously in group R2.When Modified Observer′s Assessment/Alertness and Sedation (MOAA/S) score was≤3, gastroscopy was performed.It was defined as sedation failure when MOAA/S score was still ≥4 at 3 min after administration of propofol or remimazolam.When intraoperative body movement occurred, 1/4 of the initial dose of propofol was injected intravenously in group P, 1/4 of the initial dose of remimazolam was injected intravenously in group R1, and remimazolam 2.5 mg was injected intravenously in group R2 to maintain MOAA/S score ≤3.It was defined as sedation failure when sufficient sedation was not maintained after the additional drugs were given more than 3 times within 15 min.The success of sedation, time for gastroscopy, emergence time and discharge time were recorded.The occurrence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was recorded. Results:Compared with group P, no significant change was found in the success rate of sedation ( P>0.05), and the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was decreased in group R1, and the success rate of sedation was significantly decreased, the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, coughing and injection pain was decreased, and the incidence of hiccup was increased in group R2 ( P<0.05). Compared with group R2, the success rate of sedation was significantly increased, and the incidence of intraoperative body movement, coughing and hiccup was decreased in group R1 ( P<0.05). Conclusion:Remimazolam 0.3 mg/kg combined with remifentanil can be safely and effectively used for painless gastroscopy.

Objective To explore the essence of polycystic ovary syndrome of spleen-kidney yang deficiency,and to investigate the objective standardization of TCM syndrome diagnosis of the disease.Methods Among the 200 PCOS patients,the Chinese medicine syndrome pattern was differentiated as spleen-kidney yangdeficiency type (n=105 )and Non-spleen-kidney yang deficiency type (n=95).To measure and compare their levels ofBMI、WHR、sexual hormones、FINS、2 hINS,and HOMR-IR.Results The levels of BMI (24.4±2.8)、WHR (0.88±0.07)、LH/FSH (2.02±1.06)、E2 (55.84±23.87) pg/ml、HOMR-IR (2.95±1.52)、FINS (15.18±7.64) IU/ml、2hINS ( 59.53 ±40.61 ) IU/ml in the group of spleen-kidney yang deficiency type were obviously higher than those[ (22.2±2.2)、(0.80±0.06)、(3.50± 1.80)、(45.82±21.31) pg/ml、( 1.90± 1.50)、(9.93±6.59) IU/ml、(50.56±41.34) IU/ml respectively] in the group of Non-spleen-kidney yang deficiency type (P＜0.05＝,but T and FSH level showed no significant difference between two groups [FSH the group of spleen-kidney yang deficiency type=(6.46±0.95) IU/L、FSH the group of No-spleen-kidney yang deficiency type=(6.40±1.16) IU/L; T the group of spleen-kidney yang deficiency type=(0.81±0.15) μg/L、T the group of No-spleen-kidney yang deficiency type=(0.72±0.13) μg/L,P＞0.05].Conclusion BMI、WHR、LH/FSH、E2、FINS、2HINS,and HOMR-IR could be used as objective index in identifying the difference in between spleen-kidney yang deficiency type and Non-spleen-kidney yang deficiency type.

Objective:To explore the Th1/Th2 type cytokines expression and its clinical significance in various clinical behaviors of HBV-infected individuals.Methods:The production of IFN-? and IL-4 by CD3+CD8+?CD3+CD8-cells in peripheral blood from normal donor and patients with hepatitis B virus infection were assessed by a four-color flow cytometry.Results:Compared with the healthy control,the percentage of Tc1 cells in AHB group was higher,whereas the percentage of Th1 and Tc1 cells in CHB group were lower,and lower than that of the AHB,but they increased significantly with the chronic hepatic inflammation activity.Conclusion:T-helper 1 type cytokines are predominant in peripheral blood cell of AHB and CHB,but the different percentage of Th1 type cytokines may be one reason of the final outcome of the HBV-infected individuals.