Objective To observe the changes of inflammatory cytokines in brain protective methods, study the inflammatory mechanism during cerebral protection tissues in different cerebral Methods Eighteen healthy adult dogs were randomly divided into three groups （6 dogs in each group）： normothermic cardiopulmonary bypass （NCPB group）, deep hypothermic circulatory arrest （DHCA group）, and intermittent selective antegrade cerebral perfusion （ISACP） during DHCA（DHCA＋ISACP group）. After operation the water contents in brain tissue were measured ,the hippocampus were removed, and radio-immunity analysis （RIA） was used to measure the content of interleukin-1β（IL-1β） and tumor necrosis factor-alpha （TNF-α） of the hippocampus tissue. The morphology of the hippocampus were examined by transmission electron （TE） microscopy. Results The contents of IL-1β and TNF-α of DHCA group was higher significantly than those of NCPB group and DHCA＋ISACP group （P〈0.01）, there was no significant difference between NCPB group and DHCA＋ISACP group （P〉0.05）. And the contents of TNF-α and IL-1β were positive linear correlated with degree of edema of brain tissues （r = 0. 987, 0.942; P〈 0.01）. TE examination revealed that the damage of the uhrastructure in the DHCA group was more severe than that in NCPB group and DHCA＋ISACP group. Conclusions This experiment revealed that long duration DHCA can bring some damages to the brain and that ISACP during long-term DHCA has brain protective effects to some extent. IL-1β and TNF-α play an effective role in the brain damage of long-term DHCA.
Objective To compare the outcome of patients with the strategy of conventional and steady cooling ＆ rewarming and cold reperfusion , who suffered from DeBakey type Ⅰ aortic dissection or aortic arch aneurysm and underwent the total aortic arch replacement. Methods Thirty-two patients who underwent total arch replacement were randomly allocated to one of two strategies of temperature management in cardiopulmonary bypass （CPB）, conventional group （group C, 16 cases） and steady cooling ＆. rewarming and cold reperfusion group （group S, 16 cases）. The jugular bulb venous oxygenation saturation （SjvO2）, jugular bulb venous oxygen tension （PivO2） and jugular bulb venous blood temperature （JVBT） were tested or monitored during the operation. Preoperative and postoperative neurological examinations and brain computerized tomography scan were performed. Results All patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 2 patients of the group S and 3 patients of the groupC. The “cooling ＆ rewarming blanket-impress puple” occurred in 4 cases of the group C. The SjvO2, PjvO2, lowest nasopharyngeal temperature and the post operative nasopharyngeal temperature of the patients in group S were significantly higher than those of the patients in group C （SjvO2 0.85±0. 11 vs. 0. 74±0.23, PjvO2 36. 9± 15.6mmHg vs. 24.5±7.7mmHg, P（ 0.01 ）. While the highest brain temperature, wake time and ICU stay in group S were remarkably lower than those in group C （P 〈0. 01,0. 05）. Conclusion With less postbypass afterdrop and satisfactory clinical outcome, the strategy of steady cooling ＆ rewarming and cold reperfusion can effectively avoid brain hyperthermia and mismatch of cerebral blood flow metabolism in the surgery of total aortic arch replacement.
Abstract： Objective To investigate the cerebral protective effects of hyperoxia management during deep hypothermia circulatory arrest（DHCA） rabbit by the blood gas indexes, superoxide dismutase（ SOD） activity and malondialdehyde （MDA） levels of brain, and ratio of water to brain. Methods A DHCA and antegrade selective cerebral perfusion （ASCP） rabbit model was established. Twenty-four 11-13 week-old male New Zealand rabbits（ weighing 2.7 to 3.4 kg） were assigned to three groups with a random number table: a sham operation group （Sham group）, an ASCP group （S group）, and an ASCP ＋ hyperoxia management group （SH group）. There were eight rabbits in each group. We recorded the intraoperative values for arterial oxygen pressure （PaO2）, arterial oxygen saturation （SaO2）, jugular venous oxygen pressure（PjvO2）, jugular venous oxygen saturation（ SjvO2） and blood lactate level. The brain SOD activity, MDA levels, and ratio of water to brain were measured after the operation. Results Before initiating circulatory arrest, before initiating reperfusion and five minutes of reperfusion, levels of PaO2 , PjvO2 , and SjvO2 in the SH group were significantly higher than those of the S group and Sham group. SOD activity in the SH group was not significantly different from that of the S group[（213.53±33.52） U/mg. prot vs. （193.02±27.67） U/mg. prot] and Sham group[（213.53±33.52） U/mg. prot vs.（244.38±35.02）U/mg. prot], but the SOD activity in the S group was lower than that in the Sham group（ P ＜ 0.05）. MDA levels in the SH group were lower than that in the S group[（1.42±0.30） nmol/mg. prot vs. （2.37±0.55） nmol/mg. prot, P ＜ 0.05]. Conclusion Our data show that hyperoxia management during DHCA＋ASCP improves rabbits’PjvO2 and SjvO2, maintains brain SOD activity, and decreases brain MDA levels, demonstrating the neuroprotective effects of hyperoxia mangagement.
Objective To investigate the feasibility and clinical value of combined treatment for lung cancer with cerebral metastasis. Methods From May 1999 to May 2005, twentyone patients diagnosed lung cancer with cerebral metastasis received treatment in our hospital. The management consists of cerebral lesion resection, chemotherapy, lung cancer resection and chemotherapy or radiotherapy. Then evaluate the short-term and long-term outcome. Results No severe complications occurred in hospital. The 1-, 2-, and 3-year survival rates were 75.0%(12/16), 37.5%(6/16), and 12.5%(2/16) respectively. Life quality was promoted significantly. Conclusion Although lung cancer with cerebral metastasis is classified as stage Ⅳ,the effect of combined treatment is favorable because of the special metastatic position. But the choice of the patient is important.
Objective To investigate the association of the polymorphism of the cystathionine β synthase (CBS) T833C, CBS 844ins68 and cerebral arterial thrombosis in Chinese population. Methods We electronically searched CBM, CNKI, Wanfang database, VIP and PubMed from 1999 to February 2010 to collect case studies on CBS polymorphism and cerebral arterial thrombosis of the Chinese. We evaluated the quality of the included studies and the extracted data. RevMan 4.2 was used for meta-analyses. Results We identified 4 case-control studies on association of CBS T833 polymorphism and cerebral arterial thrombosis of the Chinese. In Shandong subgroup, the Chinese people with TC+CC genotypes of T833C had higher risk of cerebral arterial thrombosis at OR 5.01 and 95%CI 2.63 to 9.53 (Plt;0.000 01). In non-Shandong subgroup, higher risk of cerebral arterial thrombosis was found in the Chinese people with genotype of CT+CC at OR 0.95 and 95%CI 0.60 to 1.50 (P=0.82). Meta-analyses of the 4 case studies showed there were no significant differences in the risk of cerebral arterial thrombosis between people with genotype of DI and II and people with genotype of DD at OR 1.20 and 95%CI 0.72 to 1.99 (P=0.49). Conclusion Our findings suggest that in Chinese population, CBS T833C polymorphisms might be associated with cerebral arterial thrombosis in Shandong subgroup; 844ins68 polymorphisms does not increase the risk of cerebral arterial thrombosis for the Chinese.
Long-term chronic internal jugular vein (IJV) insufficiency, originally viewed as a non-pathological finding, may result in cerebral venous outflow disturbance, leading to cerebral venous ischemia and cerebral nervous functional disorders. In this article we discuss probable etiologies, symptoms, diagnosis and treatment of IJV disturbance, so as to provide some insights for clinicians.
Objectives To analyze the effect of sling exercise therapy on the walking ability of children with spastic hemiplegia and cerebral palsy, and to provide a scientific basis for clinical treatment. Methods Children with spastic hemiplegia and cerebral palsy who were treated in the Department of Rehabilitation of Children’s Hospital of Shanghai from July 2018 to July 2019 were selected as the research subjects. The children were divided into conventional treatment group and sling exercise therapy group by random number table method. The routine treatment group was given routine rehabilitation training, and the sling exercise therapy group was given combined sling exercise therapy on the basis of routine treatment. The Gross Motor Function Measure (GMFM)-88-item E functional area score, Clinical Spasticity Index (CSI) and Berg Balance Scale (BBS) score were compared between the two groups. Results A total of 36 children were included, with 18 cases in each group. There was no significant difference in gender, age and hemiplegia side between the two groups (P>0.05). All children completed the trial without adverse reactions. Before treatment, there was no significant difference in BBS, CSI and GMFM-88 E functional area scores between the two groups (P>0.05). After 3 months of treatment, the above scores of the two groups were improved compared with those before treatment (P<0.05). The improvement of the above scores in the sling exercise therapy group after treatment was better than that in the conventional treatment group. The difference of BBS, CSI, and GMFM-88 E functional area scores in the sling exercise therapy group before and after treatment was 8.94±4.15, 2.44±0.71, and 7.28±3.23, respectively, the difference of the above scores before and after treatment in the conventional treatment group was 4.50±4.15, 1.83±0.79, and 2.89±1.64, respectively, and the differences were statistically significant (P<0.05). Conclusion Combined use of sling exercise therapy can better improve the walking ability of children with spastic hemiplegia and cerebral palsy, which is worthy of clinical promotion and application.
To valuate cerebral protection by retrograde cerebral perfusion (RCP) via superior vena cava,the study results for the last ten years have been reviewed.RCP is regarded as an assistant method in deep hypothermic circulatory arrest(DHCA) in that it provides partial brain blood flow,maintains a low brain temperature,optimizes cerebral metabolic function during DHCA by supplying oxygen and some nutrient and removal of catabolic products;it also reduces the incidence of cerebral embolization by flushing out air...
ObjectiveThe aim was to summarize the seizure and video electroencephalogram (VEEG) characteristics of Dyke-Davidoff-Masson syndrome (DDMS). Methods The case data of four patients with Dyke-Davidoff-Masson syndrome (DDMS) who attended the Epilepsy Center of Hunan Provincial Brain Hospital from March 2022 to March 2023 were retrospectively analyzed to summarize the clinical manifestations of their seizures and the characteristics of their video electroencephalogram (VEEG). Results One case of symptomatic epilepsy with focal seizures; VEEG showed poor background activity alpha rhythmic modulation, amplitude modulation, and increased distribution of slow wave activity in the left frontal and temporal regions; bilateral frontal-central and anterior-temporal regions (more so on the left side), with sharp and slow composite wave issuance.Two cases of symptomatic epilepsy with focal seizures progressing to generalized seizures; in one case, the VEEG showed: background activity α-rhythmic modulation, amplitude modulation is possible, the left frontal, central, anterior temporal region slow wave increase; the left frontal central, parietal anterior temporal region spike-like slow wave activity mixed with spike wave, spike-slow complex wave short-medium-range issuance; the other VEEG showed: background activity α-rhythmic modulation, amplitude modulation is possible, the right frontal central, anterior temporal region slow wave increase; right frontal, central, and anterior temporal region for the famous medium-extremely high-high-amplitude slow wave activity mixed with spike wave, spike-slow complex wave short-medium-range issuance. One case of symptomatic epilepsy with generalized seizures; VEEG showed bilateral occipital alpha rhythm asymmetry, right occipital region <50% of the left side, poor regulation and amplitude modulation; bilateral frontal pole, frontal region, anterior temporal region spike and spiking slow complex wave discharges (right side was prominent), and right pterionic electrodes, anterior temporal and mesial temporal spike and spiking slow wave discharges. Conclusions Epileptic seizures are one of the main clinical manifestations of DDMS and most of them are consulted after a seizure, and their seizure types tend to be focal seizures or progress to generalized seizures, and most of them are drug-refractory epilepsies. The results of VEEG monitoring tend to be characterized by abnormal background activity, increased slow-wave activity, and the site of epileptogenic wave-like discharges tends to be in line with the site of cerebral softening foci or the site of the atrophic side of the brain as shown by cranial MRI.
Cerebral amyloid angiopathy (CAA) is an age-dependent disease affecting older subjects. CAA is characterized by lobar intracerebral hemorrhage (ICH), lobar cerebral microbleeds (CMBs), nontraumatic subarachnoid hemorrhage, and cortical superficial siderosis (cSS), which is the main causes of spontaneous intracranial hemorrhage in the elderly. If a patient had experienced dementia, psychiatric symptoms, recurrent or multiple lobar hemorrhage, the possibility of CAA should be considered. Epilepsy can be associated with CAA. Literature studies had found that CAA-related inflammation are predisposing factors for the development of epilepsy. It is a unique subtype of CAA, which is a form of inflammation and a rare clinical manifestation of sporadic CAA. CAA-ri is a special type of central nervous system vasculitis. Once CAA patients had exhibited atypical clinical manifestations, such as headache, epilepsy, behavioral changes, focal neurological signs, consciousness impairment combined with asymmetric T2 weighted magnetic resonance imaging high signal lesions, clinicians had to consider it maybe CAA-ri. Although CAA- ri is rare, timely diagnosis is important because once seizure had occured, which may indicated the inflammation in CAA patients may had reached a very serious level. Therefore, timely identification and treatment are particularly important. Literature shows that most patients responded well to immunosuppressants. Because of its uncommon, researches on epilepsy in CAA mainly focused on case reports currently, and there were many controversies about its pathological mechanism, treatment and prognosis. This article mainly reviews the incidence rate , pathological mechanism, treatment and prognosis of epilepsy in CAA.