Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes

BACKGROUND

Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC).

OBJECTIVES

This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients.

METHODS

Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT.

RESULTS

DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02).

CONCLUSIONS

About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT.

[Epidemiological characteristics of COVID-19 caused by 2019-nCoV Delta variant in Shangyu district, Shaoxing of Zhejiang province]

Objective: To investigate the epidemiological characteristics of COVID-19 caused by 2019-nCoV Delta variant in Shangyu district, Shaoxing of Zhejiang province in 2021, and provide evidence for the improvement of COVID-19 control and prevention measures. Methods: The incidence data of COVID-19 in Shangyu from December 7 to 21, 2021 was obtained from Shangyu District Center for Disease Control and Prevention. The epidemiological characteristics of the cases, i.e. the population, time and space distributions, were analyzed, and the incubation period and time-varying reproduction numbers (R_t) were calculated. Results: From December 7 to 21, 2021, a total of 380 COVID-19 cases caused by 2019-nCoV Delta variant were detected in Shangyu, the median age of the cases was 52 years, M (Q₁，Q₃: 38, 61). The male to female ratio of the cases was 1∶1.25, and the cases were mainly workers (36.58%) and farmers (27.63%). The epidemic affected 9 townships (or community) of Shangyu, especially Caoe and Baiguan communities with the cases accounting for 57.10% and 31.53% respectively. The median incubation period of cases was 4.00 days, M (Q₁，Q₃: 3.00, 5.75). The basic reproduction number (R₀) was 4.06, and the R_t was 5.62 in early phase of the outbreak (the highest) and continuously decreased to less than 1.00 within 10 days after the detection of the outbreak. The number of COVID-19 cases decreased to 0 within 14 days after the outbreak (December 7-21), and the main detection methods were screening in centralized isolation (55.53%) and home isolation (40.00%). The infection rates of close contacts and secondary close contacts were 2.06% and 0.46% respectively. Conclusion: The epidemic of COVID-19 in Shangyu characterized by short incubation period, large number of infected people, and case clustering, suggesting the strong transmission of Delta variant (B.1.617.2). Comprehensive prevention and control measures, such as management of close contacts and secondary close contacts, and high-risk area, are essential for the rapid control of the epidemic.

[Study on epidemic trend of hemorrhagic fever with renal syndrome in Zhejiang province, 2005-2020]

Objective: To analyze the epidemiological characteristics and spatiotemporal distribution of hemorrhagic fever with renal syndrome (HFRS) in Zhejiang province from 2005 to 2020, and provide scientific information for the precise prevention and control of HFRS. Methods: Data on HFRS cases in Zhejiang province during 2005-2020 were collected from the China National Notifiable Infectious Disease Reporting Information System (NNDS) for a descriptive analysis, and software ArcGIS 10.2 was used for global autocorrelation and local autocorrelation analyses. Spatiotemporal clusters were scanned with SaTScan 9.4.4 and visualized with ArcGIS 10.2. Results: A total of 7 724 HFRS cases were reported in Zhejiang province from 2005 to 2020, including 25 deaths. There were two incidence peaks each year, in late spring and early summer (May-June) and in winter (November-January). The top three areas with high cumulative cases were Ningbo (1 875, 24.27%), Taizhou (1 642, 21.25%), and Shaoxing (1 123, 14.54%). Among the reported cases, with a male to female ratio of 2.73∶1(5 656∶2 068). The majority of HFRS cases were middle-aged and elderly people, with cases aged 41-70 years accounting for 60.95%. Most HFRS cases were farmers, accounting for 69.89% (5 398/7 724). The spatial distribution of HFRS in most years was correlated. SaTScan was used for retrospective spatiotemporal scanning and three clusters were detected: the first type clusters were in 21 counties in eastern Zhejiang province and central Zhejiang province, among which 4 were in Ningbo, Shaoxing and Jinhua, 8 were in Taizhou, and 1 was in Lishui (RR=13.69, LLR=5 522.60, P<0.001); the second type clusters were in Longquan and Qingyuan counties (RR=31.20, LLR=1 232.46, P<0.001); the third types of clusters were in Changxing and Anji counties of Huzhou in northern Zhejiang province (RR=3.42, LLR=23.93, P<0.001). Conclusions: HFRS mainly occurred in middle-aged,elderly and male farmers in Zhejiang province. The incidence was high in late spring, early summer and winter in eastern Zhejiang province. Precise prevention and control measures are needed for populations at high risk before the epidemic season.

Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

BACKGROUND

Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited.

OBJECTIVES

This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT.

METHODS

Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT.

RESULTS

A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors.

CONCLUSIONS

DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.

Successful interruption of seasonal influenza transmission under the COVID-19 rapid response in Zhejiang Province, China

Objectives

The objective of this study was to evaluate whether the non-pharmaceutical interventions (NPIs) introduced to curb the spread of coronavirus disease 2019 (COVID-19) also interrupted the transmission of influenza.

Study design

This is a descriptive epidemiological study.

Methods

Data on changes in the number of reported influenza cases, number of influenza-like illness (ILI) visits, ILI percentage and influenza virus positivity were compared between the first 18 weeks of 2020 and the same period of 2019.

Results

The changes in the weekly average number of influenza cases were statistically significant between 2020 and 2019 (−4319 vs −525 per week; P < 0.05). The slopes of regression lines for the number of ILI visits were also statistically significant between 2020 and 2019 (−911 vs −98 per week; P < 0.05).

Conclusions

This study found that the prevalence of influenza was substantially decreased when NPIs were implemented for the containment of COVID-19.

•

The prevalence of influenza was substantially decreased when non-pharmaceutical interventions were implemented for the containment of coronavirus disease 2019.

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Changes in the weekly average number of influenza cases were statistically significant between 2020 and 2019 (−4319 vs −525 per week; P < 0.05).

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Changes in the number of influenza-like illness visits were also statistically significant between 2020 and 2019 (−911 vs −98 per week; P < 0.05).

Risk of arrhythmic events after alcohol septal ablation for hypertrophic cardiomyopathy using continuous implantable cardiac monitoring

BACKGROUND

Alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM) can lead to heart rhythm disturbances including complete heart block (CHB) and atrial and ventricular arrhythmias.

OBJECTIVE

We aimed to evaluate the utility of long-term arrhythmia monitoring with an implantable cardiac monitor (ICM) after ASA.

METHODS

Between February 2014 and March 2019, 56 patients with HCM undergoing ASA were enrolled in a prospective study and underwent ICM implantation. Kaplan-Meier survival analysis was used to assess the rate of ICM-detected arrhythmic events.

RESULTS

The mean age was 59 ± 11 years, and 20 (36%) were women. The median (25th, 75th percentile) resting left ventricular outflow tract gradient obtained by echocardiography was 43 (22, 81) mm Hg. Greater than 1 septal perforating artery was injected in 48 patients (86%). The Kaplan-Meier cumulative rate of ICM-detected arrhythmic events at 18 months of follow-up was 71%, with an event rate of 43% occurring within 3 months of ASA. The cumulative rate of the ICM-detected first atrial fibrillation event at 18 months was 37%, and the corresponding rate of CHB was 19%. All atrial fibrillation and CHB events were actionable, leading to the initiation of anticoagulation and pacemaker implantation, respectively. No baseline demographic or procedural variables were identified as independent predictors of an increased risk of developing ICM-detected arrhythmic events.

CONCLUSION

After ASA, ICM is effective in capturing clinically actionable arrhythmic events in patients with HCM regardless of patient's baseline risk factors.

STIL is upregulated in nasopharyngeal carcinoma tissues and promotes nasopharyngeal carcinoma proliferation, migration and invasion

Nasopharyngeal carcinoma (NPC) is the most common primary malignancy that originates from the nasopharynx. Some regulatory networks involved in nasopharyngeal carcinoma have been reported, but the relevant genes have not been fully identified. We have used mRNA microarray to identify differential expression genes between NPC tissues and adjacent normal tissues. Then high-content shRNA screening was carried out to screen the genes that may control proliferation in nasopharyngeal carcinoma. Cell proliferation was monitored by MTT assays and Celigo image cytometry in vitro and subcutaneous transplantation model in vivo. Flow cytometric analysis was carried out to detect the distribution of cell cycle stages and apoptosis. Transwell assay was performed to measure the migratory and invasive capacities of NPC cells. We identified 20 genes that potentially play an important role in the proliferation of nasopharyngeal carcinoma by mRNA microarray and functional analysis. The result of high-content shRNA screening indicated that STIL had the greatest effect on reducing the proliferation rate of NPC cells. The analysis of The Cancer Genome Atlas (TCGA) data showed that STIL was upregulated in several human cancer tissues, and higher STIL expression level was correlated with shorter survival time. STIL knockdown also inhibited NPC cell migration and invasion, promoted G1/S phase transition and apoptosis. Three genes including ITGA2, SMAD2, JAK1, associated with molecular mechanisms of cancer were influenced by downregulating STIL. Our study confirmed STIL as a key regulator that promotes the proliferation of NPC, providing insight into the molecular mechanisms of nasopharyngeal carcinoma and suggesting a novel therapeutic strategy.

Comparison of air exhausts for surgical body suits (space suits) and the potential for periprosthetic joint infection

BACKGROUND

Periprosthetic joint infection is a major complication of total joint replacement surgery and is associated with significant morbidity, mortality and financial burden. Surgical body suits (space suits), originally designed to reduce the incidence of infection, have paradoxically been implicated in increased periprosthetic joint infection rates recently. Air exhausted from space suits may contribute to this increased rate of periprosthetic joint infection.

AIM

To investigate the flow of air exhausted from space suits commonly used in modern operating theatres.

METHODS

The exhaust airflow patterns of four commercially available space suit systems were compared using a fog machine and serial still photographs.

FINDINGS

The space suit systems tested all air exhausted into the operating room. The single fan systems with a standard surgical gown exhausted air laterally from the posterior gown fold at approximately the level of the surgical field. The single fan system with a dedicated zippered suit exhausted air at a level below the surgical field. The dual fan system exhausted air out of the top of the helmet at a level above the surgical field.

CONCLUSIONS

Space suit systems currently in use in joint replacement surgery differ significantly from traditional body exhaust systems; rather than removing contaminated air from the operating environment, modern systems exhaust this air into the operating room, in some cases potentially towards the sterile instrument tray and the surgical field.

Sensory trait variation contributes to biased dispersal of threespine stickleback in flowing water

Gene flow is widely thought to homogenize spatially separate populations, eroding effects of divergent selection. The resulting theory of 'migration-selection balance' is predicated on a common assumption that all genotypes are equally prone to dispersal. If instead certain genotypes are disproportionately likely to disperse, then migration can actually promote population divergence. For example, previous work has shown that threespine stickleback (Gasterosteus aculeatus) differ in their propensity to move up- or downstream ('rheotactic response'), which may facilitate genetic divergence between adjoining lake and stream populations of stickleback. Here, we demonstrate that intraspecific variation in a sensory system (superficial neuromast lines) contributes to this variation in swimming behaviour in stickleback. First, we show that intact neuromasts are necessary for a typical rheotactic response. Next, we showed that there is heritable variation in the number of neuromasts and that stickleback with more neuromasts are more likely to move downstream. Variation in pectoral fin shape contributes to additional variation in rheotactic response. These results illustrate how within-population quantitative variation in sensory and locomotor traits can influence dispersal behaviour, thereby biasing dispersal between habitats and favouring population divergence.

Comparison of 3 Different Types of Spinal Arteriovenous Shunts below the Conus in Clinical Presentation, Radiologic Findings, and Outcomes

BACKGROUND AND PURPOSE

Spinal arteriovenous shunts below the conus constitute 3 types of lesions, which have previously been mainly described in case reports, given their rarity, and are sometimes misdiagnosed. The purpose of this study was to describe the features of each type and compare these types as to epidemiologic features, clinical and radiologic presentations, treatment, and outcomes in a consecutive series of 48 cases.

MATERIALS AND METHODS

The prospectively collected data bases of 2 referral centers for spinal vascular lesions were retrospectively reviewed. Spinal arteriovenous shunts below the conus were defined as all dural and intradural shunts below the conus medullaris. Clinical features, radiologic findings, treatment results, and clinical outcomes were assessed.

RESULTS

There were filum terminale arteriovenous fistulas in 11 patients (22.9%), radicular arteriovenous shunts in 7 patients (14.6%), and spinal dural arteriovenous fistulas in 30 patients (62.5%). Radicular arteriovenous shunts presented at a younger age (P = .017) and with a higher incidence of back pain symptoms (P = .037). A tethered spinal cord was found in 54.5% of patients with filum terminale arteriovenous fistulas and 23.3% of patients with spinal dural arteriovenous fistulas. After treatment, the angiographic complete obliteration rate was 89.4% and spinal function was improved significantly (P < .001).

CONCLUSIONS

Three groups of spinal arteriovenous shunts below the conus can be differentiated according to clinical and radiologic features. Filum terminale arteriovenous fistulas are frequently associated with dysraphic malformations, which may suggest a particular embryologic origin.

Antibacterial efficacy and pharmacokinetic evaluation of sanguinarine in common carp (Cyprinus carpio) following a single intraperitoneal administration

Sanguinarine (SA), with antimicrobial and antiparasitic activities against fish pathogens, exhibits great potential commercial use in aquaculture. However, little information on pharmacokinetics of SA restricts further application in aquaculture. In this study, pharmacokinetics of SA in common carp (Cyprinus carpio) following a single intraperitoneal administration [10 mg kg(-1) BW (body weight)] was evaluated by high-performance liquid chromatography (HPLC). The peak concentration (Cmax ) of SA in kidney was 11.8 μg g(-1) , which was higher than in other tissues and plasma. The terminal half-life in fish tissue and plasma was as follows: 42.3 h (kidney) > 37.2 h (liver) > 20.1 h (gill) > 18.8 h (muscle) > 10.9 h (spleen) > 10.0 h (plasma). Additionally, we determined the bacterial loads in tissues of common carp infected with Aeromonas hydrophila after i.p. administration of SA at 0, 5, 10 and 20 mg kg(-1) BW. The results showed that i.p. administration of SA at 10 mg kg(-1) BW significantly enhanced antibacterial efficacy against A. hydrophila, where the antibacterial ratio in the gill, kidney, spleen and liver on day 5 was 95.13%, 93.33%, 90.09% and 92.82%, respectively. Overall, these results suggested the potential of SA to treat A. hydrophila infection in common carp farming industry.

Identification of five novel MHC class II alleles in cynomolgus macaques of Vietnamese origin

We report here the identification of one Mafa-DPA1 and four Mafa-DQB1 novel alleles of Vietnamese cynomolgus macaques.

Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis

BACKGROUND AND PURPOSE

On the basis of the high 1-month stroke and/or death (14.7%) rates associated with stent placement in the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial, modifications in patient selection and procedural aspects for intracranial stent placement have been recommended. We performed a multicenter prospective single-arm trial to determine whether such modifications would result in lower rates of periprocedural stroke and/or death.

MATERIALS AND METHODS

The study enrolled patients with recent transient ischemic attack or ischemic stroke (excluding perforator ischemic events) related to high-grade (70%-99% in severity) stenosis of a major intracranial artery. Patients were treated by using angioplasty and self-expanding stents 3 weeks after the index ischemic event at 1 of the 10 high-volume centers in China. An independent neurologist ascertained the occurrence of any stroke and/or death within 1 month after the procedure.

RESULTS

A total of 100 consecutive patients were recruited. The target lesions were located in the middle cerebral artery (M1) (n = 38, 38%), intracranial internal carotid artery (n = 17, 17%), intradural vertebral artery (n = 18, 18%), and basilar artery (n = 27, 27%). The technical success rate of stent deployment with residual stenosis of <50% was 100%. The overall 1-month stroke and/or death rate was 2% (95% confidence interval, 0.2%-7.0%). Two ischemic strokes occurred in the pontine region (perforator distribution) in patients following angioplasty and stent placement for basilar artery stenosis.

CONCLUSIONS

The results of this prospective multicenter study demonstrated that modifications in patient selection and procedural aspects can substantially reduce the 1-month stroke and/or death rate following intracranial stent placement.

Ten novel MHC class II alleles identified in cynomolgus macaques of Vietnamese origin

Five Mafa-DPB1, two Mafa-DQB1 and three Mafa-DRB novel alleles are identified in Vietnamese cynomolgus macaques.

Probable aerosol transmission of severe fever with thrombocytopenia syndrome virus in southeastern China

Some clusters of severe fever with thrombocytopenia syndrome virus (SFTSV) infection were reported in China as of 2010. However, to date, there has been no epidemiologic evidence of aerosol transmission of SFTSV. Epidemiologic investigations were conducted after a cluster of 13 cases of SFTSV in May 2014. A total of 13 cases, including 11 confirmed cases and one clinically diagnosed case, were identified besides the case of the index patient. The index patient experienced onset of SFTSV on 23 April and died on 1 May. The patients with secondary cases had onset from 10 to 16 May, peaking on 13 May. Moreover, eight secondary cases occurred in family members of the index patient, and the other five cases occurred in neighbors of the index patient. According to epidemiologic investigations, patients 1, 3, 4, 5, 6, 7, 9 and 12 contracted the disease through contact with blood of the index patient. Notably, patients 8 and 10 did not have a history of contact with the blood of the index patient, but they stayed in the mourning hall for hours. SFTSV could be transmitted from person to person by direct contact and/or aerosol transmission, and it is important to consider aerosol transmission as a possible transmission route.

Hypothesis on the source, transmission and characteristics of infection of avian influenza A (H7N9) virus--based on analysis of field epidemiological investigation and gene sequence analysis

On 31 March 2013, the National Health and Family Planning Commission announced that human infections with influenza A (H7N9) virus had occurred in Shanghai and Anhui provinces, China. H7N9 cases were later detected in Jiangsu and Zhejiang provinces. It was estimated that the virus first spread northward along the route taken by migratory birds and then spread to neighbouring provinces with the sale of poultry. Epidemiological studies were carried out on samples from the external environment of infected cases, transmission routes, farmers markets and live poultry markets. Phylogenetic study of viral sequences from human and avian infections in Zhejiang showed that those from Shanghai and Jiangsu provinces along Taihu Lake were highly homologous with those from the external environment. This suggests that avian viruses carried by waterfowl combined with the virus carried by migratory birds, giving rise to avian influenza virus H7N9, which is highly pathogenic to humans. It is possible that the virus was transmitted by local wildfowl to domestic poultry and then to humans, or spread further by means of trading in wholesale poultry markets. As the weather has turned warm, and with measures adopted to terminate poultry trade and facilitate health communication, the epidemic in the first half of the year has been kept under control. However, the infection source in the triangular area around Taihu Lake still remains. The H7N9 epidemic will probably hit the area later in the year and next spring when the migratory birds return and may even spread to other areas. Great importance should therefore be attached to the wildfowl in Taihu Lake as the repository and disseminator of the virus: investigation and study of this population is essential.

Cortical glutamate levels decrease in a non-human primate model of dopamine deficiency

While Parkinson's disease is the result of dopaminergic dysfunction of the nigrostriatal system, the clinical manifestations of Parkinson's disease are brought about by alterations in multiple neural components, including cortical areas. We examined how 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) administration affected extracellular cortical glutamate levels by comparing glutamate levels in normal and MPTP-lesioned nonhuman primates (Macaca mulatta). Extracellular glutamate levels were measured using glutamate microelectrode biosensors. Unilateral MPTP-administration rendered the animals with hemiparkinsonian symptoms, including dopaminergic deficiencies in the substantia nigra and the premotor and motor cortices, and with statistically significant decreases in basal glutamate levels in the primary motor cortex on the side ipsilateral to the MPTP-lesion. These results suggest that the functional changes of the glutamatergic system, especially in the motor cortex, in models of Parkinson's disease could provide important insights into the mechanisms of this disease.

Characterization of the major histocompatibility complex class I A alleles in cynomolgus macaques of Vietnamese origin

Cynomolgus macaques (Macaca fascicularis, Mafa) have emerged as an important animal model for infectious disease and transplantation research. Extensive characterization of their major histocompatibility complex (MHC) polymorphism regions therefore becomes urgently required. In this study, we identified 41 MHC class I A nucleotide sequences in 34 unrelated cynomolgus macaques of Vietnamese origin farmed in Southern China, including eight novel Mafa-A sequences. We found two sequences with perfect identity and six sequences with close similarity to previously defined MHC class I alleles from other populations, especially from Indonesian-origin macaques. We also found three Vietnamese-origin cynomolgus macaque MHC class I sequences for which the predicted protein sequences identical throughout their B and F binding pockets to Mamu-A1*001:01 and Mamu-A3*13:03, respectively. This is important because Mamu-A1*001:01 and Mamu-A3*13:03 are associated with longer survival and lower set-point viral load in simian immunodeficiency virus (SIV)-infected rhesus monkeys. These findings have implications for the evolutionary history of Vietnamese-origin cynomolgus macaque as well as for the use of this model in SIV/SHIV (a virus combining parts of the HIV and SIV genomes) research.

Cavernous Angioma of the Cauda Equina: A Case Report and Systematic Review of the Literature

Cavernous angioma is an uncommon vascular malformation of the central nervous system with a tumoural aspect. Spinal cavernous angioma mainly occurs within vertebral bodies; only 3 - 5% of tumours are located entirely in the vertebral canal. This case report describes a case of cavernous angioma, originating from the nerve roots of the cauda equina at the L1 level, in a 57-year-old woman presenting with acute lower back pain. The lesion was surgically resected 6 months after symptom onset and the structural integrity of the nerve root was maintained. Histopathological examination confirmed the diagnosis of cavernous angioma. The patient experienced no postoperative neurological deficit or recurrence. The diagnosis, histopatho -logical features and surgical treatment of this case are presented, together with a literature review of clinical details and surgical procedures undertaken in cases of cavernous angioma of the cauda equina.

Insight into the periprocedural embolic events of internal carotid artery angioplasty. A report of four cases and literature review

Thromboembolism is a major risk of carotid angioplasty and stenting (CAS). Although the incidence of distal embolism has been documented by MRI and TCD studies, the mechanisms and management of this complication are rarely reported. Here we describe four patients with periprocedural embolic events to demonstrate the mechanisms of thromboembolism in CAS. Different remedies were applied to these patients according to the underlying mechanisms of thromboembolism and good clinical outcomes were achieved.

Eighteen novel MHC class I A alleles identified in Vietnamese-origin cynomolgus macaques

We report herein the identification of 18 novel Mafa-A alleles in cynomolgus macaques of Vietnamese origin.

Twenty-three novel major histocompatibility complex class I B alleles identified in cynomolgus macaques of Vietnamese origin

We report herein the identification of 23 novel Mafa-B alleles in cynomolgus macaques of Vietnamese origin.

Outcome in acute stroke with different intra-arterial infusion rate of urokinase on thrombolysis

Intra-arterial infusion of urokinase (UK) has been widely used. However, the optimal infusion rate of the reagent has never been determined. This was investigated in the acute stage of middle cerebral artery (MCA) embolism in the present study. Sprague Dawley male rats (n=43) were randomly divided into sham-operation and five ischemic groups with urokinase administration at different infusion rates or without urokinase administration. Ischemia was induced with MCA embolism. Two hours after embolism, total urokinase (urokinase, 170,000U/kg) was given in groups A,B,C and D (n=8 each) at different rates: 1,000 U (0.03 ml/min) per minute, 4,000U (0.12 ml/min), 10,000U (0.30 ml/min), and 16,000U (0.48 ml/min), respectively. Group E received normal saline at a rate of 0.48 ml/min. The sham-operation group (no embolism) received urokinase at (170,000U/kg, 1.5 ml, 16,000 U/min). During ischemia and thrombolysis, regional cerebral blood flow (CBF) was monitored by laser Doppler flowmetry. The neurological deficits, infarct volumes and mortalities in each group were determined. The CBF in ischemic hemisphere were significantly (p<0.05) decreased after embolism in groups A∼E at similar levels (27.32±8.20% to 34.71±6.84%). After different treatments, in group B 4,000U/min infusion of UK induced the best reperfusion, the least neurological deficits and infarct volume, as well as the least mortality and lowest incidence of hemorrhage. The effect of intra-artery thrombolysis of urokinase was related to the infusion rate. Our study demonstrated an optimal infusion rate at 4,000U/min, suggesting relatively low levels of infusion are better able to improve brain reperfusion and reduce brain injury after stroke.

Treatment and outcome of intracranial hemorrhage after carotid artery stenting. A ten year single center experience

SUMMARY

Intracranial hemorrhage following carotid artery stenting (CAS) is a rare but potentially devastating complication. The present study reviewed intracranial hemorrhage cases from patients undergoing CAS in ten years to find the methods to rescue patients from this fatal complication. Patients with postoperative intracranial hemorrhage following CAS were retrospectively selected, and clinical features, treatments and outcomes were studied. Ten patients with intracranial hemorrhage were identified. The mean onset time of hemorrhage was 6.1-/+7.1h. Intracerebral hemorrhage occurred in eight patients and SAH in two patients. The patients were treated by stopping anti-platelet and anticoagulant for at least three days, and surgical drainage of the hematoma/ventricle drainage or conservative treatment. Six patients survived, two had left moderate paralysis, four had a good recovery at four week follow-up, and four patients died. No patients underwent thrombosis in stent after withdrawing of antiplatelet and anticoagulant. Intracranial hemorrhage after CAS occurs usually in a few hours and leads to catastrophic results. Once patients have intracranial hemorrhage, good neurocritical care may help to save them. Stopping antiplatelet and anticoagulant for at least three days may avoid thrombosis in the stenting site.

Intra-arterial thrombolysis for acute central retinal artery occlusion

OBJECTIVE

In this study, we aimed at exploring the effect and safety of local intra-arterial thrombolysis on acute central retinal artery occlusion.

METHODS

Retrospective data analysis of 49 consecutive acute central retinal occlusion patients was performed. All the patients were treated with urokinase perfusion through the ophthalmology artery within the first 6 hours after central retinal artery occlusion attack. Conventional treatments including intra-ocular pressure decreasing, microcirculation improvement, neuroprotection and antiplatelet aggregation were conducted. The visual acuity (with International Snellen Chart) and field of vision were detected after thrombolysis. The complications and adverse events were observed.

RESULTS

Recanalization was found in 71% of patients. The visual acuity improvement was greater in the recanalization group (n=35) than in the non-recanalization group (n=14). The averaged visual acuity was 0.15+/-0.02, 0.25+/-0.03 and 0.4+/-0.05 after 2, 28 days and 6 months, respectively. Of the patients, 24.5% regained >0.6 of visual acuity, and the visual field deficit was less than 30% in 34.7% of patients after 28 days. Six months later, 36.7% patients regained visual acuity of >0.6, and the field deficit was less than 30% in 44.9% of patients. The difference between visual acuity in recanalization (0.6+/-0.04) and non-recanalization (0.002+/-0.0012) patients after 6 months after thrombolysis was significant (p>0.05).

CONCLUSIONS

Intra-arterial thrombolysis could obviously improve the short- and long-term visual function for patients with acute central retinal artery occlusion within 6 hours of symptom onset.

Comparative trial of the canine parvovirus, canine distemper virus and canine adenovirus type 2 fractions of two commercially available modified live vaccines

The results of vaccinating two groups of puppies with commercial vaccines, both of which claimed to provide adequate protection with a final vaccination at 10 weeks of age, were compared. Groups of 19 and 20 puppies with similar titres of maternally derived antibodies against canine parvovirus (cpv), canine distemper virus (cdv) and canine adenovirus type 2 (cav-2) at four weeks of age were vaccinated at six and 10 weeks of age and their responses to each vaccination were measured by comparing the titres against cpv, cdv and cav-2 in the serum samples taken immediately before the vaccination and four weeks later. After the vaccination at six weeks of age, all 19 of the puppies in group 1 had responded to cpv and cdv, and 14 had responded to cav-2; in group 2, 17 of the 20 had responded to cpv, 19 to cdv and 15 to cav-2. In both groups the puppies that did not respond to the first vaccination had responded serologically to cpv, cdv and cav-2 at 10 weeks of age.

Multiple intracranial aneurysms as delayed complication of atrial myxoma. Case report and literature review

SUMMARY

We report a case of multiple intracranial aneurysms as delayed complication of atrial myxoma.We reviewed the literature of intracranial myxomal aneurysms, and trying to find reasonable therapy methods, but got the conclusion that neurosurgery and interventional treatment were not helpful, chemotherapy and radiotherapy maybe useful in the treatment of such cases.

Carotid artery stenting: experience of a single institute in china

SUMMARY

Concern regarding the safety of Carotid angioplasty and stenting (CAS) exists because of the risk of cerebral embolization during the procedure. The purpose of this article is to discuss that technology modification may improve the outcomes of this procedure. Between October 1997 and October 2004, 439 consecutive patients with 478 stenotic carotid arteries were treated. 284 vessels were stented without the use of embolic protection devices and 194 vessels with protection. Among cases not using protection device, 201 arteries were stented with predilation alone, 63 with postdilation alone, six with both pre- and post-dilation, two with neither and twelve were stented with balloon expandable stents. The technical success of 100%.The combined stroke and death rate during the procedure and the 30-day follow-up at 30 days was 1.67% overall. Three (0.63%) deaths occurred; one was due to a major infarction secondary to stent breakage, and two died of massive reperfusion intracerebral haemorrhage. There were total six ischemic stroke, of the five ischemic strokes wich developed in nonprotection group, two were among 201 cases with predilation alone (0.99%), which developed after stent deployment and postprocedure, and three among 63 cases with postdilation alone (4.76%), which developed immediately after postdilation. The incidence of ischemic stroke was lower among those who were stented with predilation alone than among those who were stented with postdilation alone. This likely results from reduced intimal injury and decreased risk of embolic complications.

[Classification of intracranial dural arteriovenous fistula and its clinical signification]

OBJECTIVE

To develop a practical imaging calssification of intracranial dural arteriovenous fistula (DAVF) based on imaging and its clinical significance.

METHOD

The lesion positions and drainage patterns of vein in 110 patients with 121 dural arteriovenous fistulas hospitalized in Xuanwu Hospital were analyzed and a new type of classification of DAVF was developed.

RESULTS

The dural arteriovenous fistulas in 110 patients were classified accrding to lesion position into DAVF of dural sinus, cavernous sinus, tentorial incisure, venous plexus at skull base, and cerebral falx; or classified according to the pattern of venous drainiage into type I (draining directly into dural vein or dural sinus), type II (directly draining into dural sinus with retrograde venous drainage into cortical vein or spinal vcein), and type III (directly draining into cortical vein or spinal vein). Then, based on a combination of these two criteria, DAVF was claassified into cavernius sinus area type I (38 cases, 69.1%) and type II (17 cases, 30.9%); dural sinus area type I (11 cases, 33.3%), type II (16 cases, 56.4%), and type III (2 cases, 10.3%); and tentorial area (20 cases), skull base vein plexus area (6 cases), and cerebral falx area (1 case), all in type III.

CONCLUSION

The newly developed classification system of intracranial dural arteriovenous fistula helps analyze clinical risk and determine therapeutic procedures.

[3-D angiography in diagnosis and treatment of intracranial aneurysm]

OBJECTIVE

To summarize the results of initial application of three-dimensional angiography (3D-Angio) in diagnosis and treatment of intracranial aneurysms.

METHODS

From August 1999 to January 2001, standard digital subtraction angiography (two-dimensional angiography, 2D-Angio) and 3D-Angio(obtained by reconstruction of rotational angiography) were performed in 65 patients with confirmed or suspected aneurysms.

RESULTS

Sixty-six aneurysms were found in 60 patients and nothing was found in 5. Of 66 the aneurysms (60 cases), 46 (43 cases) were treated by intrasaccule embolizotion with coils, 3 (3 cases) by occluding the parent artery with detachable balloon, 10 (10 cases) by surgery, and 1 (1 case) by combination of extracranial-intracranial bypass and balloon occlusion of parent artery. Six (3 cases) were not treated. Two aneurysms that could not be detected by 2D-Angio were diagnosed by 3D-Angio. Three aneurysms that were difficult or dangerous to embolize by 2D-Angio were embolized successfully with the help of 3D-Angio. Three aneurysms seemed to be embolized on 2D-Angio were proved impossible to be embolized on 3D-Angio. Of the 46 aneurysms embolized intrasaccularly, 38(82.6%) were completely embolized on 2D-Angio. In the 38, 8 had residual aneurysm on 3D-Angio.

CONCLUSION

More accurate diagnosis and secure treatment of intracranial aneurysm can be reached by 3D-Angio.

[Treatment of cerebral dural arteriovenous fistula targetting drainage vein or sinus]

OBJECTIVE

To investigate the efficacy of occluding the drainage veins or sinus in patients with cerebral dural arteriovenous fistulae.

METHODS

Twenty patients with cerebral dural arteriovenous fistulae involving cavernous sinus (8), transverse-sigmoid sinus (6), tentorial sinus (3), superior sagittal (1), Galen (1) and straight sinus (1), were treated by transvenous embolization (14 patients), surgical interruption of venous drainage (5) and sinus isolation (1) respectively.

RESULTS

Clinical cure was obtained in 13 patients, symptoms were relieved in 6 and aggravated in one. Angiographically, complete cure was noted in 11 patients, partial disappearance of fistulas in 9. Sixteen patients were followed up for 1-48 months.

CONCLUSION

Targetting drainage vein or sinus occlusion is effective and safe in the management of patients with cerebral dural arteriovenous fistulae.

Isolation and purification of the ovulation-inducing factor from seminal plasma in the bactrian camel (Camelus bactrianus)

The purpose of this study was to extract, identify and partially characterize a newly found ovulation-inducing factor, and thus gain our understanding of induced ovulation in biology. In our preliminary research, an ovulation-inducing factor (OIF) was isolated and purified from seminal plasma of the bactrian camel by ion-exchange chromatography on DEAE-cellulose, HPLC and reverse-phase HPLC. The OIF is a peptide with 74 residues and GnRH-like bioactivity, which is heat-stable in camel seminal plasma because the OIF is wrapped up in several protein layers with different properties. However, purified OIF is degraded when it is exposed to oxygen or is heated in water. According to the analysis of amino acid components and partial amino acid sequence aminated N-terminus, and its molecular weight, the OIF is completely different from the native-LHRH, LH, HCG, PMSG and PGF-2alpha. The OIF is a novel ovulation hormone in the bactrian camel, but is similar to that reported in the bull.

The role of controlled anticoagulation in balloon occluding vertebral arteries to treat giant fusiform aneurysms of the basilar artery

SUMMARY

We suggest and discuss the role of controlled anticoagulation therapy after the balloon occlusion of vertebral arteries to treat giant fusiform aneurysms in the basilar trunk. Two cases of giant fusiform aneurysms were treated with balloon occlusion of vertebral arteries. Both of these patients suffered severe brain stem ischaemia. Anticoagulants were used to adjust the PTT to 1.5-2.5 times the normal level to control the formation speed of thrombosis inside the aneurysms. Case 1 was obliged to suspend the anticoagulation therapy one week after occlusion because of digestive tract haemorrhage, and died of severe brain stem ischaemia. On autopsy, the sac of the aneurysm was totally occupied by the thrombus. Two perforating arteries feeding the brain stem arising from the wall of the aneurysm and infarction in the brain stem were found. Case 2 was anticoagulated strictly and progressively improved after three weeks. Anticoagulation was terminated after one month. Follow-up MRI showed the aneurysm had disappeared six months later. Giant fusiform aneurysms in the basilar artery trunk can be treated with the balloon occlusion of vertebral arteries which induces thrombosis in the sac of aneurysm. Controlled anticoagulation should be given to slow down the thrombotic obliteration in the perforators arising from the aneurysm wall to the brain stem and give the brain stem have enough time to establish the sufficient collateral circulation.

A role for MHR1, a gene required for mitochondrial genetic recombination, in the repair of damage spontaneously introduced in yeast mtDNA

A nuclear recessive mutant in Saccharomyces cerevisiae, mhr1-1, is defective in mitochondrial genetic recombination at 30 degrees C and shows extensive vegetative petite induction by UV irradiation at 30 degrees C or when cultivated at a higher temperature (37 degrees C). It has been postulated that mitochondrial DNA (mtDNA) is oxidatively damaged by by-products of oxidative respiration. Since genetic recombination plays a critical role in DNA repair in various organisms, we tested the possibility that MHR1 plays a role in the repair of oxidatively damaged mtDNA using an enzyme assay. mtDNA isolated from cells grown under standard (aerobic) conditions contained a much higher level of DNA lesions compared with mtDNA isolated from anaerobically grown cells. Soon after a temperature shift from 30 to 37 degrees C the number of mtDNA lesions increased 2-fold in mhr1-1 mutant cells but not in MHR1 cells. Malonic acid, which decreased the oxidative stress in mitochondria, partially suppressed both petite induction and the temperature-induced increase in the amount of mtDNA damage in mhr1-1 cells at 37 degrees C. Thus, functional mitochondria require active MHR1, which keeps the extent of spontaneous oxidative damage in mtDNA within a tolerable level. These observations are consistent with MHR1 having a possible role in mtDNA repair.

[An occlusive evaluation proposal to intra-saccular embolization of intracranial aneurysm]

OBJECTIVE

To explore the imaging criteria for evaluating intracranial aneurysm embolization.

METHODS

Angiographic occlusive criteria for intracranial aneurysm embolization (aneurysm not opcified angiographically after embolization, 100% occlusion; a little part of aneurysm neck residual, 95%; neck residual, 90%; neck and a little part of aneurysm cavity residual, 80%; some cavity residual, < 80%) were used by 6 specialists to evaluate 121 aneurysms embolized with MDS (mechanical detachable spiral) and/or GDC (guglielmi detachable coil) from March 1995 to July 1999. The rationality, feasibility and limitation of the criteria were discussed.

RESULTS

Among the 121 aneurysms, 100% occlusion was reached in 53 aneurysms (43.8%), 95% in 27 (22.3%), 90% in 16 (13.2%), 80% in 15 (12.4%), and less than 80% in 10 (8.3%) respectively. Good accordance was obtained among different doctors in the occlusive evaluation of aneurysm embolization.

CONCLUSIONS

The suggesting criteria are simple and feasible in clinical practice, although the effect of imaging follow-up of embolized aneurysm is unknown and the numerical value of occlusive percentage is arbitrary.

Tubulocystic ovarian clear cell carcinoma with abundant fibrous stroma: malignant clear cell adenofibroma

We report a case of tubulocystic ovarian clear cell carcinoma (OCCC) with abundant fibrous stroma associated with an endometriotic cyst. Most OCCC show a small amount of fibrous stroma; however, the tumor presented in this case had abundant stroma, that qualifies it as a malignant clear cell adenofibroma. This unusual type of clear cell carcinoma may be misinterpreted as a benign lesion or as metastatic carcinoma on frozen section. In permanent sections, the stromal invasive foci are focal, small and subtle. Therefore, extensive sampling of the specimen to search for evidence of invasion is recommended for a fibrous ovarian tumor that appears benign on gross examination.

[Selective arterial embolization for the treatment of thoracolumbar spinal tumor]

OBJECTIVE

To decrease intraoperative blood loss during tumor resection.

METHODS

Fifteen patients with primary thoraco-lumbar spinal tumor [giant cell tumor (5 patients), malignant nerinoma (2), chordoma (1), fibrous xanthosarcoma (1), malignant fibrohistocytoma (1), osteosarcoma (1), Ewing sarcoma (1), myeloma (1), leimyosarcoma (1), Non-Hodgkin diseases (1)] were treated by means of preoperative selective arterial embolization, tumor resection, and spinal reconstruction. Eight patients were subjected to total spondylectomy in one stage.

RESULTS

Fourteen patients showed satisfactory results after embolization. The volume of intraoperative blood loss ranged from 3,000 ml to 400 ml (average 1,200 ml). Follow up of the patients varied from 8 months to 19 years (average 48.7 months). Local recurrence happened in 3 patients; 3 patients died from metastasis. Three of 4 patients recovered from complete bowel movement and urination. Seven of nine patients had musical strength improved. Six of 8 patients had recovery of the e sensation of the lower limbs.

CONCLUSIONS

Selective arterial embolization before operation followed by operation within 24 hours can reduce intraoperative blood loss, shorten operative time, and provide a clear operative field for tumor resection.

[Refractory carotid-cavernous fistula: causes and countermeasures]

OBJECTIVE

To explore the causes and countermeasures of refractory carotid-cavernous fistula (CCF).

METHODS

Twelve refractory cases from 123 cases of consecutive traumatic CCF during 12 years were reviewed.

RESULTS

The main causes of refractory CCF were: small or large fistula's opening, or constrictive parent artery; inappropriate early treatments such as ligature of internal carotid artery or common carotid artery, balloon detachment of, and non-dense packing of coils inside the cavernous sinus; unexpected deflation or balloon displacement of resulting in fistula recurrence. Anatomical cure was achieved in 11 cases, and clinical care in 1 by using balloon or/and coil or/and NBCA (n-butal 2-cyanoacrylate) through arterial, venous or surgical approach.

CONCLUSIONS

refractory CCF can be treated effectively skilled catheterization and embolization as well as appropriate approach and embolic material according to fistula structure and vascular route.

A mutation in a mitochondrial ABC transporter results in mitochondrial dysfunction through oxidative damage of mitochondrial DNA

We have isolated a Saccharomyces cerevisiae mutant that shows an increased tendency to form cytoplasmic petites (respiration-deficient rho- or rho0 mutants) in response to treatment of cells growing on a solid medium with the DNA-damaging agent methyl methane-sulfonate or ultraviolet light. The mutation in this strain, atm1-1, was found to cause a single amino acid substitution in ATM1, a nuclear gene that encodes the mitochondrial ATP-binding cassette (ABC) transporter. When the mutant cells were grown in liquid glucose medium, they accumulated free iron within the mitochondria and at the same time gave rise to spontaneous cytoplasmic petite mutants, as seen previously in cells carrying a mutation in a gene homologous to the human gene responsible for Friedreich's ataxia. Analysis of the effects of free iron and malonic acid (an inhibitor of oxidative respiration in mitochondria) on the incidence of petites among the mutant cells indicated that spontaneous induction of petites was a consequence of oxidative stress rather than a direct effect of either a defect in the ATM1 gene or the accumulation of free iron. We observed an increase in the incidence of strand breaks in the mitochondrial DNA of the atm1-1 mutant cells. Furthermore, we found that rates of induction of petites and accumulation of strand breaks in mitochondrial DNA were enhanced in the atm1-1 mutant by the introduction of another mutation, mhr1-1, which results in a deficiency in mitochondrial DNA repair. These observations indicate that spontaneous induction of petites in the atm1-1 mutant is a consequence of oxidative damage to mitochondrial DNA mediated by enhanced accumulation of mitochondrial iron.

Is premenstrual dysphoric disorder a distinct clinical entity?

Does the evidence now available support the concept of premenstrual dysphoric disorder (PMDD) as a distinct clinical disorder such that the relative safety and efficacy of potential treatment can be evaluated? In a roundtable discussion of this question, a wealth of information was reviewed by a panel of experts. The key characteristics of PMDD, with clear onset and offset of symptoms closely linked to the menstrual cycle and the prominence of symptoms of anger, irritability, and internal tension, were contrasted with those of known mood and anxiety disorders. PMDD displays a distinct clinical picture that, in the absence of treatment, is remarkably stable from cycle to cycle and over time. Effective treatment of PMDD can be accomplished with serotinergic agents. At least 60% of patients respond to selective serotonin reuptake inhibitors (SSRIs). In comparison with other disorders, PMDD symptoms respond to low doses of SSRIs and to intermittent dosing. Normal functioning of the hypothalamic-pituitary-adrenal (HPA) axis, biologic characteristics generally related to the serotonin system, and a genetic component unrelated to major depression are further features of PMDD that separate it from other affective (mood) disorders. Based on this evidence, the consensus of the group was that PMDD is a distinct clinical entity. Potential treatments for this disorder can now be evaluated on this basis to meet the clear need for effective therapy.

[Surgical treatment of spinal dural arteriovenous fistulas]

OBJECTIVE

To discuss the operation modalities of spinal dural arteriovenous fistulae (SDAVFs) and treatment with anticoagulant agents after surgery.

METHOD

The medical records, radiographic studies and operations of 23 patients with SDAVFs were reviewed. Laminectomy was performed at the level of the arterialized venous entry into the subarachnoid space in 18 patients with thoracic and lumbar lever AVFs, followed by coagulation, clipping and division of the vein. In 14 of 18 patients, the arteriovenous nidus in the dura was identified and obliterated by coagulation. The draining veins were interrupted at L(5) - S(1) level in 5 patients with sacral AVFs. Anticoagulant treatment was given in 13 patients.

RESULT

Outcome was good in 20 patients and 2 of the 20 had transient postoperative neurological deterioration that reversed by anticoagulant agents. No changes were seen in 2 patients except one deteriorated.

CONCLUSION

Surgical interruption of arterialized radicular-medullary draining vein of SDAVFs provides lasting occlusion of the fistula, and postoperative anticoagulant therapy can prevent thrombosis of the coronal venous plexus.

Glucose repression on RIM1, a gene encoding a mitochondrial single-stranded DNA-binding protein, in Saccharomyces cerevisiae: a possible regulation at pre-mRNA splicing

The mitochondrial single-stranded DNA-binding protein (SSB) encoded by anuclear gene, RIM1, is a homolog of Escherichia coli SSB. The addition of glucose decreased the amount of RIM1-mRNA in cells growing in a glycerol medium, but increased the amount of the immature RIM1-mRNA. The changes in the amounts of both mature and immature RIM1-mRNAs were dependent on SRN1/REG1/HEX2, a gene relating to pre-mRNA-splicing and glucose repression. These observations suggest that the expression of the mitochondrial SSB is regulated, at least in part, by pre-mRNA splicing under the control of glucose repression.

[Animal experiment and clinical application of self-made mechanically detachable coils]

OBJECTIVE

To evaluate the practical and thrombogenetic characteristics of self-made mechanically detachable coils by the animal experiment and primary clinical application.

METHOD

The bifurcation type of aneurysm model was established on rabbit and embolized with self-made mechanically detachable coils 2 weeks after surgery. 24 coils were used in 5 experimental aneurysms. Control angiography was performed and the rabbits were sacrificed 2 - 3 weeks after the embolization. The embolized aneurysm samples were examined by pathologist. Ten patients were treated with self-made mechanically detachable coils in primary clinical application. They were divided into aneurysms (7 patients), traumatic carotid-carvenous fistulas (2), dural arterio-venous fistula in carvenous sinus region (1). 146 coils were used totally and all were delivered with mechanical detachable system (MDS Balt co. France).

RESULT

Pathologically, the cavities of rabbit aneurysm models were occluded by tungsten coils (2 complete, 3 almost complete). The coils were trapped in granulation tissue which was covered by a thin layer of endothelium on the surface facing the blood flow. In the coils dense packing ones, the aneurysms were completely excluded from the parent circulation by neointimal layers. In the practice procedures, the coils fit MDS (Balt co. France) very well and can be delivered, withdrew and detached smoothly.

CONCLUSION

The self-made mechanically detachable coils have practical reliability and evident thrombogenetic effects.

[Endovascular treatment of intracranial aneurysms with GDC: report of 8 cases]

OBJECTIVE

To assess the usefulness and practical experience in intracranial aneurysm embolization with guglielmi detachable coil (GDC) applied firstly in China.

METHOD

Under general anesthesia and systematic anticoagulation, eight cases of intracranial aneurysms were embolized with GDC which was introduced by tracker micro-catheter, combined remodeling technique (RT) if necessary.

RESULT

100% occlusion was achieved in 5 cases, 95% in 2 and 90% in 1, without any complication. Among these cases, 4 failed in the previous attempts of endovascular treatment with mechanical detachable system (MDS), because MDS could not be safely and totally placed inside the aneurysms and Mag 3F/2F micro-catheter could not be navigated into the aneurysms.

CONCLUSION

Embolization of intracranial aneurysms with GDC is safe, effective and reliable, and it may offer the cure opportunity to those enearysms which are very dangerous to embolize or can not be embolized with MDS.