Moyamoya disease is a cerebrovascular disease characterized by progressive stenosis of the distal end of the internal carotid artery, followed by the formation of an abnormal vascular network in the skull base. At present, the main treatment approach is to perform superficial temporal artery to middle cerebral artery bypass grafting to increase cerebral blood flow and improve the symptoms of patients. Cerebral hyperperfusion syndrome (CHS) is a common complication after revascularization, which can lead to more severe complications such as transient neurological events and intracranial hemorrhage. Therefore, predicting the occurrence of CHS through multimodal intraoperative monitoring is crucial for improving the outcomes of patients. This article reviews various common intraoperative monitoring techniques for predicting CHS.

Objective:To investigate the application value of indocyanine green videoangiography (ICG-VA) in microsurgical clipping of ruptured posterior communicating artery aneurysms (PCoAA).Methods:Patients with ruptured PCoAA underwent microsurgical clipping and intraoperative ICG-VA at the Department of Neurosurgery, Lianyungang First People's Hospital from January 2020 to July 2022 were included retrospectively. Head CT was reviewed 3 days after operation to determine perioperative complications. CT angiography (CTA) or digital subtraction angiography (DSA) were used to evaluate the monitoring effect of ICG-VA. Glasgow Outcome Scale (GOS) was used to evaluate the clinical outcomes.Results:Thirty-two patients with ruptured PCoAA (a total of 38 aneurysms) were enrolled, including 7 males (21.9%), aged 57.97±8.91 years (range, 40~73). Twenty-seven patients (84.4%) had single aneurysm and 5 (15.6%) had multiple aneurysms (4 patients with 2 aneurysms and 1 with 3 aneurysms). Twenty-four patients (75.0%) had no or mild consciousness disorder, and 8 (25.0%) had moderate to severe consciousness disorder. The aneurysms of all patients were successfully clipped and ICG-VA was performed for a total of 40 times. Five patients with multiple aneurysms underwent precise localization of the parent artery and aneurysmal body using ICG-VA before clipping. After initial clipping, ICG-VA found 3 cases of residual aneurysms. After adjusting or adding aneurismal clips, ICG-VA showed that the residues were eliminated. Three days after the surgery, CT scan showed that 1 patient had right subdural effusion with periventricular infarction, and 1 had subdural effusion. At the final follow-up, CTA or DSA showed no residual aneurysms; the GOS score of 18 patients (56.3%) were 5, 5 patients (15.6%) were 4, and 9 (28.1%) were 3. There were no cases of vegetative state or death.Conclusion:ICG-VA assisted microsurgical clipping of ruptured PCoAA can effectively avoid residual aneurysms and the clinical application value is significant.

Objective:To investigate the treatment and prognosis of acute carotid artery occlusion during perioperative period of carotid endarterectomy (CEA).Methods:The clinical data of 112 carotid artery stenosis patients who underwent CEA from January 2017 to December 2021 in Lianyungang Hospital Affiliated to Xuzhou Medical University were retrospectively analyzed. The patients were followed up at 6 to 9 months after surgery, the clinical prognosis was evaluated by Glasgow outcome score (GOS), and the head and neck CT angiography (CTA) was performed.Results:Among the 112 patients, 5 patients underwent acute carotid artery occlusion during the perioperative period, including 1 case of intraoperative acute occlusion of internal carotid artery and 1 case of intraoperative internal carotid artery combined with external carotid artery cute occlusion, both of them were re-sutured, and multi-mode monitoring showed that each carotid artery was unobstructed; 2 cases of intraoperative external carotid artery occlusion, no re-suture was performed during the operation; 1 case of intraoperative monitoring showed no obvious abnormality, and the contralateral limb hemiplegia was observed after surgery, and the muscle strength was grade 1, the carotid color Doppler ultrasound showed the occlusion of the internal carotid artery on the operation side. The CT and CTA examination showed focal infarction and common carotid artery on the operation side, and drugs and conservative treatment were given. The follow-up result: GOS 5 scores was in 4 cases, and 4 scores in 1 case; the muscle strength of hemiplegia patient recovered to grade 4; head and neck CTA examination, except for 1 case of common arterial occlusion, the other 4 cases showed no special abnormality.Conclusions:Intraoperative acute carotid artery occlusion can be detected timely by intraoperative multi-mode hemodynamic monitoring during CEA. Vascular recanalization after acute occlusion is possible by adopting active and effective treatment methods, the occurrence of postoperative ischemic stroke can be effectively prevented and the prognosis of patients can be improved.

The clinical data of 5 patients with occupational contact dermatitis caused by methyl chlorobutyrate treated in the Affiliated Hospital of Jining Medical College and Mamiao Township Hospital of Jinxiang County from September to October 2021 were retrospectively analyzed. Patients were all males aged 33-47 years with a history of exposure to methyl chlorobutyrate 1 to 4 d before the onset of symptoms. Three patients were hospitalized and 2 patients were treated in outpatient clinic. The clinical manifestations were erythema on the trunk or extremities of varying degrees, scattered with blisters and bullae of different sizes, with thin and clear blisters, local ulceration and exudation; no erosion or ulceration was found in the oral cavity and vulva. All 5 patients had elevated white blood cell counts, and 2 patients had abnormal liver function. All patients received symptomatic treatment with topical drugs. Three hospitalized patients were given methylprednisolone and loratadine; in addition, 1 case also received human immunoglobulin and moxifloxacin hydrochloride injection and 2 cases received hepatoprotective drugs. Two outpatients were given prednisone acetate and loratadine for treatment. Three hospitalized patients were all improved and discharged after 14-30 d of treatment. The rash of 2 outpatients subsided after 14 d of treatment, and there was no recurrence after 1-month follow-up. The occupational contact dermatitis caused by methyl chlorobutyrate is primary irritant contact dermatitis, often manifested as erythema and blisters on the trunk or limbs, and timely anti-allergic treatment can effectively control the disease.

Internal carotid artery bifurcation aneurysm is relatively rare in clinical practice. It locates at the bifurcation of the internal carotid artery, with numerous branches and perforating vessels running through it. Whether endovascular treatment or craniotomy clipping, it is necessary to ensure the patency of the branches and perforating vessels. There are very few systematic reports on internal carotid artery bifurcation aneurysms. This article summarizes its definition, epidemiology, formation and rupture mechanisms, clinical features, and imaging features, with a focus on explaining its classification and treatment.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Carotid artery stenosis is an important cause of ischemic stroke. Carotid endarterectomy and carotid artery stenting are the effective methods for treating carotid artery stenosis, but postoperative restenosis remains a challenge. The pathogenesis of postoperative restenosis is currently not fully understood. However, multiple factors, including biomarkers, imaging features, and surgical related factors, have been proven to be associated with postoperative restenosis and can predict the occurrence of postoperative restenosis. This article reviews the predictors of restenosis after carotid endarterectomy and carotid artery stenting.

Endovascular mechanical thrombectomy (EMT) has become the main treatment of acute ischemic stroke, but the pathological study of thrombi retrieved with EMT is still very limited. This article reviews the routine staining, special components, expression of immune factors, electron microscopic morphology, imaging features of the pathological components of thrombi retrieved with EMT, and their correlation with the etiological differentiation and outcomes of stroke.

Objective:To investigate the efficacy and clinical experiences of fluorescein angiography assisted occlusion via lateral-orbital keyhole approach in internal carotid bifurcation aneurysms. Methods:The clinical data of 16 patients with internal carotid artery bifurcation aneurysms admitted to our hospital from January 2016 to December 2020 were retrospectively analyzed. All patients accepted fluorescein angiography assisted occlusion via lateral-orbital keyhole approach. The patients were followed up at one, 3, and 6 months after surgery by medical imaging. The therapeutic efficacy of these patients was assessed by Glasgow outcome scale (GOS). Results:All aneurysms in these 16 patients were clipped at one-stage operation. Intraoperative fluorescein angiography and FLOW 800 showed that the aneurysms were completely clipped without residual, and the blood flow of the parent artery and perforating arteries was unobstructed. Six months after surgery, 14 patients recovered well (GOS scores of 5), and 3 developed limb hemiplegia (GOS scores of 4).Conclusion:Intraoperative fluorescein angiography assisted occlusion via lateral-orbital keyhole approach is safe and effective in internal carotid bifurcation aneurysms.

China ; Esophageal Neoplasms ; Humans ; Length of Stay ; Malnutrition ; Mass Screening ; Postoperative Complications ; ROC Curve ; Sensitivity and Specificity