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 review the progress of the research on therelationship between the central nervous system injury and the heterotopic ossification. Methods The recent articles on the central nervous system injury and the heterotopic ossification were extensively reviewed, and the related clinical signs, symptoms, pathogenesis diagnosis, risk factors, prophylaxis, and treatment of the neurogenic heterotopic ossification were investigated. Results The possible mechanism for the neurogenic heterotopic ossification might involve the roles of thebone morphogenetic protein and the basic fibroblast growth factor, which were suggested as mediators in differentiation of the progenitor cells. Sonographic, serum creatine phosphokinase, and C-reactive protein were recommended as the useful screening tools for heterotopic ossification. Colchicine and rofecoxib could be used for the prophylaxis or treatment of heterotopic ossification. Conclusion The research on the neurogenic heterotopic ossification has achieved a great development but further studies in this field are still required.
Age is the main cause of neurodegenerative changes in the central nervous system (CNS), and the loss of neurons would increase with the migration of the disease. The current treatment is also mainly used to relieve symptoms, while the function of CNS is very difficult to recover. The emergence of endogenous stem cells has brought new hope for the treatment of CNS diseases. However, this nerve regeneration is only in some specific areas, and the recovery of neural function remains unknown. More and more experts in the field of neuroscience have carried out various in vivo or in vitro experiments, in order to increase nerve regeneration and nerve function recovery through mechanism research, in the expectation that the results would be applied to the treatment of CNS diseases. This article reviews the recent progress of endogenous neural stem cells in degenerative diseases of CNS.
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.
Objective To systematically review the effect of percutaneous acupoint electrical stimulation (TEAS) on heart rate variability (HRV). Methods The PubMed, Embase, Ovid MEDLINE, Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the effects of percutaneous acupoint electrical stimulation on heart rate variability from inception to February 28, 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 14 RCTs involving 719 patients were included. The results of meta-analysis showed that SDNN (MD=12.95, 95%CI 9.18 to 16.72, P<0.01), RMSSD (MD=1.81, 95%CI 0.10 to 3.53, P=0.04), pNN50 (MD=1.75, 95%CI 1.02 to 2.48, P<0.01), HF (SMD=0.27, 95%CI 0.01 to 0.52, P=0.04), LF/HF (MD=−0.07, 95%CI −0.12 to −0.03, P<0.01), ln-LF (MD=0.63, 95%CI 0.25 to 1.01, P<0.01), ln-HF (MD=1.05, 95%CI 0.60 to 1.49, P<0.01), mean RR (MD=−11.86, 95%CI −21.77 to −1.96, P=0.02), and HR (SMD=−0.43, 95%CI −0.66 to −0.20, P<0.01) all showed improvement compared with the control group. However, there were no significant differences between the two groups in LF (SMD=0.15, 95%CI −0.10 to 0.40, P=0.23), LF norm (SMD=0.24, 95%CI −0.10 to 0.58, P=0.16) or HF norm (SMD=0.25, 95%CI −0.47 to 0.97, P=0.5). TEAS on PC6: SDNN, pNN50, HF, LF/HF, LF norm, HF norm, ln-LF, ln-HF, and HR all showed improvement compared with the control group. However, there were no significant differences between the two groups in RMSSD, LF, or RR interval. Conclusion This study supports the improvement of heart rate variability by transcutaneous acupoint electrical stimulation and PC6 acupoint selection. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo explore the expression of growth associated protein-43 (GAP-43) in spasm segment and expansion segment of hirschsprung disease (HD), and to explore the pathogenesis of HD. MethodsThe expression of GAP-43 in 30 patients with HD who underwent surgical resection for absence of enteric plexuses from Jan. 2012 to Jun. 2013 in Shen zhen Children's Hospital were analyzed by using immunohistochemistry method and real-time PCR method. Aganglionic tissues of all patients were included as spasm group, and ganglionic tissues of the same patients were served as expansion group. Then comparison of the expression levels of GAP-43 mRNA and its protein between 2 groups was performed. Resultsof real-time RCR showed that the expression level of GAP-43 mRNA in expansion group was higher than that of spasm group (0.119 0 vs. 0.052 8, P<0.05). Immunohistochemistry results showed that GAP-43 protein expressed both in the myenteric plexus and ganglionic plexus of submucos in all patients, but lighter in spasm group. Compared with ganglionic plexus of circular muscle layer and longitudinal muscle layer/ganglionic plexus of submucosa in expansion group, the average optical density values at corresponding sites of intestinal tissues in spasm group were both lower (P<0.05). ConclusionExpression of GAP-43 protein is lower in spastic intestinal tissue of patients with HD, which suggests that down-regulation of GAP-43 protein may be a risk factor for HD.
ObjectiveTo summarize the current research progress on the changes of enteric glial cells (EGCs) in intestinal motility disorders and its possible molecular mechanisms in regulating intestinal motility.MethodThe literatures related to the EGCs and intestinal dysmotility were collected and analyzed.ResultsThe EGCs were involved in the occurrence and development of intestinal motility disorders, and there were abnormalities in the quantity, receptor, and phenotype in the different dysmotility diseases such as the postoperative ileus, Hirschsprung disease, inflammatory bowel disease, diabetes and so on. It could sense the neuronal signals and communicate with the enteric neurons via Ca2+ response and connexin-43 to affect the intestinal motility.ConclusionStudy of role and mechanism of EGCs in intestinal motor dysfunction is helpful to discovery new targets for treatment of these diseases.
In recent years, due to the emergence of ultrafast ultrasound imaging technology, the sensitivity of detecting slow and micro blood flow with ultrasound has been dramatically improved, and functional ultrasound imaging (fUSI) has been developed. fUSI is a novel technology for neurological imaging that utilizes neurovascular coupling to detect the functional activity of the central nervous system (CNS) with high spatiotemporal resolution and high sensitivity, which is dynamic, non-invasive or minimally invasive. fUSI fills the gap between functional magnetic resonance imaging (fMRI) and optical imaging with its high accessibility and portability. Moreover, it is compatible with electrophysiological recording and optogenetics. In this paper, we review the developments of fUSI and its applications in neuroimaging. To date, fUSI has been used in various animals ranging from mice to non-human primates, as well as in clinical surgeries and bedside functional brain imaging of neonates. In conclusion, fUSI has great potential in neuroscience research and is expected to become an important tool for neuroscientists, pathologists and pharmacologists.
Objective〓〖WTBZ〗To observe the clinical features of autoimmune optic neuropathy (AON). 〖WTHZ〗Methods〓 〖WTBZ〗The clinical data of 58 patients with AON from Jan. 2006 to Dec. 2007 were retrospectively analyzed. The patients had undergone routine ophthalmological, neurological examination, visual field test, all set of autoimmune antibody test, brain MRI. 〖WTHZ〗Results〓〖WTBZ〗In 93 eyes of 58 patients with AON, the lowest best corrected visual acuity (BCVA) was lt;01 in 68 eyes (731%), 10 patients (172%) had other symptoms of nervous system, 14 patients (241%) had lesions of nonneurological system. Positive antinuclear antibody was found in 43 patients (796%); other abnormal antibodies were also found, including antiSSA/SSB, antidsDNA, antihistonic, anticardiolipin, and antihuman leukocyte antigen B27 antibodies. Systematic connective tissue disease presented in 20 patients (345%), such as sicca syndrome, systemic lupus erythematosus, and Behcet disease. 32 patients (552%) had abnormal brain MRI, and the BCVA of 49 eyes (777%) improved significantly after hospitalization. 〖WTHZ〗Conclusion〓〖WTBZ〗Patients with AON always have poor visual function, some of whom associate with other systems, as well as damages to other parts of the nervous system. While some AON patients are secondary to systemic connective tissue disease involving the optic nerve, the majority of these patients are isolated autoimmune optic neuropathy.
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.