ObjectiveTo analyze the effect of carotid artery stenosis degree and intervention for carotid artery stenosis on the incidence of central nervous system complications after off-pump coronary artery bypass grafting (OPCABG) and explore the influencing factors. MethodsA total of 1 150 patients undergoing OPCABG in our hospital from June 2018 to June 2021 were selected and divided into two groups according to whether there were central nervous system complications, including a central nervous system complication group [n=61, 43 males and 18 females with a median age of 68.0 (63.0, 74.0) years] and a non-central nervous system complication group [n=1 089, 796 males and 293 females with a median age of 65.5 (59.0, 70.0) years]. The risk factors for central nervous system complications after OPCABG were analyzed. ResultsUnivariate analysis showed that age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intra-aortic ballon pump (IABP), postoperative arrhythmia, postoperative thoracotomy and blood transfusion volume were associated with central nervous system complications. The incidence of central nervous system complications in patients with severe carotid artery stenosis or occlusion (11.63%) was higher than that in the non-stenosis and mild stenosis patients (4.80%) and moderate stenosis patients (4.76%) with a statistical difference (P=0.038). The intervention for carotid artery stenosis before or during the operation did not reduce the incidence of central nervous system complications after the operation (42.11% vs. 2.99%, P<0.001). Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion were independent risk factors for postoperative central nervous system complications (P<0.05). Conclusion The age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intraoperative use of IABP, postoperative arrhythmia, secondary thoracotomy after surgery, blood transfusion volume and OPCABG are associated with the incidence of postoperative central nervous system complications in patients. Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion are independent risk factors for postoperative central nervous system complications. In patients with severe carotid artery stenosis, preoperative treatment of the carotid artery will not reduce the incidence of central nervous system complications.
Objective To investigate the cl inical features of mal ignant melanoma (MM) in the central nervous system (CNS) and to improve the diagnosis and treatment of this disease. Methods Seven MM-in-CNS patients’ records between September 1996 and April 2007 were analyzed retrospectively, including 6 males and 1 female aged 18-74 years. The 5 cases were located in the supra-tentorial area, 1 in the spinal cord and 1 in the whole brain. CT or MRI scan was appl ied. The lesion was in the right frontal area in 4 cases, in the right temporal are in 1 case, in the left temporal area in 1 case, in the left apex area in 1 case and in the cervical spinal cord of C5-7 in 1 case. Six patients underwent neurosurgical operation and1 patient received the Gamma Knife therapy. The pathological examination revealed that 2 cases were metastatic MM and 5 were primary. Results One patient with primary MM received no follow-up, and the rest 6 patients were followed up for 2 weeks to 2 years with the time of median 8 months. One patient with metastatic MM died 2 months after operation, 1 patient to with metastatic MM died 2 weeks after Gamma-Knife treatment, 1 patient with metastatic MM with primary MM died 2 years after operation, and 3 patients with primary MM were still al ive and self-independent 6, 10 and 24 months after operation, respecti vely. Conclusion Since MM-in-CNS is short of specificity in cl inical symptoms and signs, its diagnosis mainly rel ies on the pathological examination and is assisted by MRI. The combined therapy giving priority to operation is recommended.
Objective To study the distribution of P2 Y2 receptor in spine cord, dorsal root ganglia and sciatic nerve in rat, and to provide the basis for clarifying the mechanism of the effect of adenosine triphosphate(ATP) on the peripheral nerve regeneration. Methods Six specimens of the spine cord, dorsal root ganglia and sciatic nerve from SD rats were fixed rapidly in 4% paraformaldehyde which included DEPC, imbedded by paraffin and made into ultrathin section. According to the sequence of P2 Y2 receptor’s gene, DNA needle was adopted to detect the distribution of P2 Y2 receptor by hybridization technique in section under the light microscope after theyhad been stained in NBT liquid（50 mg/ml） and BCIP liquid （75 mg/ml）. In thecontrol group, the ultrathin section was only covered with hybridism buffer solution. The result of staining was observed. ResultsHybridization in section showed that P2 Y2 receptor was distributed mainly in the anterior horn cell of spine cordgray matter and Schwann cell of the dorsal root ganglia. No P2 Y2 receptor was observed in the sciatic nerve of both groups. Conclusion P2 Y2 receptor is located mainly in the spine cord and the dorsal root ganglia. Extracellular ATP can affect the cell of spine cord, dorsal root ganglia through P2 Y2 receptor.
Objective To develop a novel prediction model based on cerebrospinal fluid (CSF) lactate for early identification of high-risk central nervous system (CNS) infection patients in the emergency setting. Methods Patients diagnosed with CNS infections admitted to the Department of Emergency Medicine of West China Hospital, Sichuan University between January 1, 2020 and December 31, 2023 were retrospectively selected. Patients were classified into a survival group and a death group according to their 28-day survival status, and clinical characteristics were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of 28-day mortality, which were subsequently used to construct a nomogram. Results A total of 173 patients were included, comprising 135 in the survival group and 38 in the death group. Multivariate analysis identified the Acute Physiology and Chronic Health Evaluation Ⅳ (APACHE Ⅳ) score [odds ratio (OR)=1.027, 95% confidence interval (CI) (1.002, 1.055), P=0.034], CSF lactate [OR=1.147, 95%CI (1.025, 1.286), P=0.018], and interleukin-6 [OR=1.002, 95%CI (1.001, 1.004), P=0.002] as independent predictors of 28-day mortality. The integrated model combining APACHE Ⅳ score, CSF lactate, and interleukin-6, demonstrated superior predictive performance compared with the APACHE Ⅳ score alone (P=0.020), and showed good calibration (Hosmer-Lemeshow P=0.50). Conclusions This tool may provide a useful instrument for emergency physicians to assess the 28-day mortality risk in patients with CNS infections, potentially facilitating early and targeted interventions for high-risk individuals. However, as the findings of this study are derived from a single-center retrospective dataset, the clinical applicability of this model requires further external validation through large-scale, prospective, multicenter studies to evaluate its generalizability.
This article investigates the role of AMP-activated protein kinase (AMPK) and its downstream signaling targets in mediating cellular processes such as autophagy, apoptosis, and inflammation, offering insights into how acupuncture may treat common central nervous system (CNS) diseases, including ischemic stroke, spinal cord injury, Parkinson disease, and Alzheimer disease. AMPK and its downstream effectors are pivotal in the signaling pathways that underlie the pathophysiology of CNS diseases. These pathways are implicated in a variety of cellular responses that contribute to the progression of neurological disorders. During CNS injury, AMPK can be activated through phosphorylation, triggering the regulation of downstream molecules and exerting protective effects on neuronal function. Acupuncture has been shown to promote neuroprotection and enhance recovery in CNS diseases through multiple mechanisms, one of which involves the activation of AMPK-related signaling pathways. Nevertheless, numerous unresolved challenges remain in this research field.
ObjectiveTo investigate the clinical characteristics, treatment and prognosis of primary vitreoretinal lymphoma (PVRL) diagnosed and treated in our hospital during the past 10 years. MethodsA retrospective clinical study. From 2011 to 2021, 126 eyes of 67 patients with PVRL who were diagnosed and treated in Department of Ophthalmology, Eye-ENT Hospital, Fudan University were included in the study. Among them, there were 23 males (34.3%, 23/67) and 44 females (65.7%, 44/67); the average age was 57.1 years. There were 59 cases with both eyes (88.1%, 59/67) and 8 cases with one eye (11.9%, 8/67). At the initial eye diagnosis, 22 cases had a clear history of primary central nervous system lymphoma (PCNSL); 5 cases were found to have intracranial lesions by head imaging examination; 40 cases had no central nervous system involvement. Twenty cases were treated with glucocorticoids due to misdiagnosed uveitis. All patients received intravitreal injection of methotrexate (IVM) treatment. The treatment regimen was twice a week in the induction period for 2 weeks, once a week in the consolidation period for 1 month, and once a month in the maintenance period. Patients with PCNSL or both eyes received concurrent systemic chemotherapy (chemotherapy), and some in combination with radiation therapy to the brain (radiotherapy). The mean follow-up time was 39.3 months. The clinical manifestations, treatment and prognosis of the patients were retrospectively analyzed. The visual acuity before and after treatment was compared by t test. ResultsAmong the 22 cases with a clear history of PCNSL at the initial eye diagnosis, the average time from intracranial diagnosis to eye diagnosis was 22.9 months. Among the 40 cases without central nervous system involvement at first, 14 cases (20.9%, 14/67) developed central nervous system lesions during follow-up period. The mean time from ocular diagnosis to intracranial diagnosis was 9.9 months. Among the 126 eyes, 42 eyes (33.3%, 42/126) had anterior segment inflammation. vitreous inflammation type, retinal type, and vitreous retinal type were 58 (46.0%, 58/126), 7 (5.6%, 7/126), and 61 (48.4%, 61/126) eyes, and 9 of them (7.1%, 9/126) had optic nerve involvement at the same time. Patients received an average of 12 IVM treatments. IVM combined with systemic chemotherapy in 59 cases (88.1%, 59/67), of which 16 cases were combined with brain radiotherapy. All patients achieved complete remission after completing the treatment cycle (100.0%, 67/67). After treatment, 21 eyes (16.7%, 21/126) had ocular recurrence; 22 (32.8%, 22/67) had intracranial recurrence; 8 cases (11.9%, 8/67) died. The mean progression-free survival of patients was 23.7 months; the mean survival time was 43.6 months; the 5-year overall survival rate was 72.5%. ConclusionsThe manifestations of PVRL are complex and diverse, and most of them are accompanied by involvement of the central nervous system. It can be divided into vitreitis type, retinal type and vitreoretinal type, and the optic nerve can be involved at the same time; IVM combined with systemic treatment can completely relieve the disease.
Glucocorticoids are the first-line therapy of many neurological disorders, with the treatment regimen varying across types and characteristics of neurological disorders. This article reviews the national and international guidelines and expert consensuses in the past decade on glucocorticoids treatment for neurological disorders, and summarizes recommendations from the latest Chinese guidelines and consensuses. In summary, the most frequently used pulse therapy of glucocorticoids in China is intravenous infusion of high-dose (usually 1000 mg/d) methylprednisolone in a short period (often <5 d), followed by gradual tapering, bridging with oral prednisone or direct discontinuation. The treatment regimen for children and juveniles is similar to that for adults but the dose is adjusted by body weight. Pharmacodynamics of glucocorticoids should be considered for the treatment of perinatal women. To provide appropriate glucocorticoids treatment for patients with neurological disorders, clinicians should fully understand features of each neurological disorder and clinical characteristics of individual patient.
Objective To investigate the clinical features, diagnosis and treatment of symptomatic epilepsy complicated with central nervous system leukemia (CNSL) recurrence after acute lymphoblastic leukemia (ALL) treatment in children. MethodsThe clinical data of a child with secondary recurrence of CNSL complicated with symptomatic epilepsy after ALL treatment admitted to the Department of Pediatrics of the Second Affiliated Hospital of Auhui Medical University from December 2020 to February 2023 were retrospectively analyzed, and the relevant literature was reviewed and discussed. ResultsPatient was ALL for nealy two years after treatment in the central nervous system leukemia relapse of concurrent symptomatic epilepsy, two of the central nervous system leukemia relapse when starting symptoms are seizure, the first recurrence was status epilepticus, second recurrence of concurrent limb hemiplegia symptoms, cerebrospinal fluid, cranial magnetic resonance (MRI) and abnormal changes of electroencephalogram and clinical features, the abnormal changes of brain MRI lesions and electroencephalogram did not disappear. Chemotherapy, intrathecal injection and radiotherapy were given for the primary treatment, follow up CAR-T immunotherapy, and the treatment was successively combined with nalproate and levetiracetam. Currently, the seizures were controlled. ConclusionFor children with ALL, the recurrence of CNSL should be warned after the end of treatment. Cerebrospinal fluid, cranial imaging and electroencephalogram examination should be completed in time to confirm the diagnosis. If the crania imaging lesions persist after treatment and abnormal electroencephalogram discharge does not disappear, the possibility of CNSL recurrence should be warned when the epileptic seizures are repeated. On the basis of primary disease active treatment, combination of antiseizure medications is preferable.