Analysis of ischemic cerebral lesions using 3.0-T diffusion-weighted imaging and magnetic resonance angiography after revascularization surgery for ischemic disease

Background

Cerebral revascularization surgery (CRS) is increasingly recognized as an important component in the treatment of complex cerebral vascular disease and tumors. CRS requires that the incidence of perioperative neurological complications should be minimized, because CRS for ischemic disease is often not the goal of treatment, but rather a prophylactic surgery. CRS carries the risk of focal postoperative neurological deficits. Little has been established concerning mechanisms of post-CRS ischemia. We used 3.0-T diffusion-weighted magnetic resonance imaging (DWI) and magnetic resonance angiography (MRA) to analyze the incidence and mechanism of ischemic lesions.

Methods

We studied the anterior circulation territory after 20 CRS procedures involving 33 vascular anastomosis procedures (13 double anastomoses and 7 single anastomoses) in 12 men and 8 women between June 2007 and October 2011. The operations included single or double superficial temporal artery–middle cerebral artery (STA–MCA) anastomosis to treat internal carotid artery/MCA occlusions or severe MCA stenosis. A combined STA–MCA anastomosis and indirect bypass were performed for moyamoya disease. Postoperative DWI and MRA were obtained in all patients between 24 and 96 h after surgery to detect thromboembolism, hypoperfusion, or procedural ischemic complications and vasospasms of the donor STA.

Results

Follow-up DWI and MRA were carried out 1.8 ± 0.6 days after CRS (range, 1–4 days). Temporary occlusion time for anastomoses averaged 18.9 min (range, 16–32 min). Asymptomatic new hyperintensities occurred in the ipsilateral hemisphere of 2 patients on postoperative DWI (10% patients/6.0% anastomoses), and 1 moyamoya patient (5.0% patients/3.0% anastomoses) developed a symptomatic hyperintensity in the ipsilateral occipital lobe in response to the operation. Two abnormal small (<5 mm) cortical DWI lesions were caused by sacrifices of a small branch of the recipient MCA.

Conclusion

This study is the first postoperative 3.0-T DWI study of CRS and related clinical events. The incidence of symptomatic postoperative DWI abnormalities was restricted to 1 moyamoya patient representing 5.0% of total patients and 3.0% anastomoses. Although some postoperative DWI abnormalities occurred, CRS was found to be safe with a low risk of symptomatic ischemia.     

The use angiogenesis stimulators for the treatment of chronic ischemia of lower extremities

We present the results of treatment of chronic ischemia of the lower extremities (distal form) with angiogenesis stimulators, autologous endothelioblast precursors (CD133+) and gene preparation of vascular endothelial growth factor VEGF₁₆₅ (angiostimulin). Good clinical effect was attained in all patients, which was confirmed instrumentally 1, 3, and 6 months after administration of the stimulant: transcutaneous oxygen tension on the foot, index of malleolar pressure, and walking duration increased, parameters of microcirculation improved, the number of newly formed collateral arteries increased (angiography findings), quality of life improved (SF 36 questionnaire), and parameters of coagulogram also improved. The maximum positive dynamics was observed by month 3 of the study. __________ Translated from Kletochnye Tehnologii v Biologii i Medicine, No. 3, pp. 159–164, July, 2007     

盐酸戊乙奎醚对肺叶切除术患者单肺通气时血清炎性因子和气道黏蛋白MUC5AC表达的影响

目的 评估盐酸戊乙奎醚对肺叶切除术患者单肺通气（OLV）时血清炎性因子和气道黏蛋白MUC5AC表达的影响。方法 择期行胸腔镜下肺叶切除术患者48例,男28例,女20例,年龄40~75岁,BMI 18~25 kg/m²,ASA Ⅰ或Ⅱ级,采用随机数字表法分为两组：对照组（C组）和盐酸戊乙奎醚组（P组）,每组24例。P组于麻醉诱导前10 min静脉注射盐酸戊乙奎醚0.01 mg/kg,C组于相同时点静脉注射等容量生理盐水3 ml。分别于OLV前（T1）、OLV 60 min（T2）、术毕（T3）、术后24 h（T4）采集中心静脉血,采用ELISA法测定血清IL-1β、IL-6、TNF-α、NF-κB浓度;肺叶切除后即刻取肺组织,HE染色观察病理学结果;采用Image-Pro Plus图像分析软件进行图像分析,取平均积分光密度值表示气道黏蛋白MUC5AC含量。记录术后72 h内肺炎、肺不张、低氧血症等并发症及住院时间。结果 与T1时比较,T2—T4时两组血清中IL-1β、IL-6、TNF-α、NF-κB浓度明显升高（P＜0.05）。与C组比较,T2—T4时P组血清中IL-1β、IL-6、TNF-α、NF-κB浓度明显降低（P＜0.05）,肺组织病理损伤明显减轻,气道黏蛋白MUC5AC含量明显下降（P＜0.05）。两组术后72 h内肺炎、肺不张、低氧血症等并发症及住院时间差异均无统计学意义。结论 盐酸戊乙奎醚可下调肺叶切除术患者OLV时血清炎性因子和气道黏蛋白MUC5AC的表达,减轻炎症反应和肺损伤。     

血清miR-133a在脓毒症并发ARDS中表达及预后的关系

目的分析血清微小核糖核酸(miR)-133a在脓毒症并发急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者中的表达及与预后的关系。 方法选取2019年6月至2021年5月我院收治的65例脓毒症患者,根据是否并发ARDS,分为并发ARDS 35例和无ARDS 30例。随访28 d,统计脓毒症并发ARDS者预后,检测患者入住ICU第1天、第2天、第3天血清miR-133a水平,比较存活者和死亡者临床特征,采用Logistic回归分析判定影响脓毒症并发ARDS预后的因素,采用受试者工作曲线(ROC)分析血清miR-133a水平预测脓毒症并发ARDS者预后的价值。 结果并发ARDS入住ICU第1天、第2天、第3天血清miR-133a水平均高于无ARDS者(P<0.05);随访28 d,脓毒症并发ARDS者病死率为40.00%;死亡者入住ICU第1天、第2天、第3天血清miR-133a水平均高于存活者(P<0.05);死亡者序贯器官衰竭(SOFA)评分、血管外肺水指数、第1天血清miR-133a水平与存活者比较,差异均有统计学意义(P<0.05);Logistic多因素回归分析显示SOFA评分、第1天血清miR-133a水平均是影响脓毒症并发ARDS者死亡的危险因素(P<0.05);ROC分析显示,第1天血清miR-133a水平预测脓毒症并发ARDS者死亡的最佳截断点为1.47,灵敏度为85.71%,特异度为90.48%,AUC为0.857。 结论脓毒症并发ARDS者血清miR-133a水平升高,血清miR-133a水平是影响脓毒症并发ARDS者死亡的危险因素,监测血清miR-133a水平变化,作为预测患者预后的指标。     

Preoperative predictors of choledocholithiasis in patients presenting with acute calculous cholecystitis

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Intraoperative 3D imaging control during subthalamic Deep Brain Stimulation procedures using O-arm® technology: Experience in 15 patients

ObjectiveO-arm^® now gives us the opportunity not only to perform 2D but also 3D scans during deep brain stimulation (DBS) procedures. We present our experience with the intraoperative use of this device. Our objective was to measure the geometrical accuracy of electrode placement during surgical procedures driven under O-arm^® control.MethodsFifteen patients underwent STN-DBS. For the first 4 patients, 3D scans were performed at the end of the procedure. We calculated the accuracy of electrode positioning, i.e. the distance between final electrode positioning and the planned trajectory. For the next 11 patients, who underwent both intraoperative and final 3D scan, we also calculated the accuracy of the microelectrode positioning.ResultsAverage stimulation-induced improvement of UPDRS-III score was 52.5 ± 15%. For the first 4 patients, the mean electrode positioning accuracy was 1.46 ± 0.56 mm. For the 11 patients who underwent intraoperative 3D scan, the mean microelectrodes positioning accuracy was 1.59 ± 1.1 mm. Aberrant positioning was detected in two cases, and was analyzed by fusing 3D scan with preoperative MR images. The definite electrodes positioning accuracy was 1.05 ± 0.54 mm.ConclusionIntraoperative 3D scan is feasible, and can help us detect and correct early aberrant trajectories.