Neurological Function In Patients Research Articles

Effects of acupuncture on neurologic function and serum inflammatory factors after thrombolysis in acute ischemic stroke

To observe the effects of acupuncture on neurologic function and serum inflammatory factors in patients after thrombolysis in acute ischemic stroke (AIS).A total of 102 AIS patients with onset to treatment time (OTT) ≤3 h were randomly divided into an observation group and a control group, 51 cases each group. In the control group, thrombolysis and conventional medical treatment were applied. On the basis of the treatment as the control group, acupuncture at Shuigou (GV 26), Zhongwan (CV 12), Qihai (CV 6), Neiguan (PC 6), etc. was applied in the observation group, 30 min each time, once a day. Both groups were treated for 2 weeks. Before and after treatment, the scores of National Institutes of Health stroke scale (NIHSS), modified Rankin scale (mRS), modified Barthel index (MBI) and serum level of homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP) were compared, and the clinical efficacy was evaluated in the two groups.After treatment, the scores of NIHSS, mRS and serum level of Hcy, hs-CRP were decreased compared with those before treatment (P<0.05), while the MBI scores were increased (P<0.05) in the two groups. The scores of NIHSS, mRS and serum level of Hcy, hs-CRP in the observation group were lower than those in the control group (P<0.05, P<0.01), the MBI score in the observation group was higher than that in the control group (P<0.01). The total effective rate was 88.2% (45/51) in the observation group, which was superior to 70.6% (36/51) in the control group (P<0.05).Acupuncture could promote the recovery of neurologic function in patients after thrombolysis in AIS, improve the ability of daily living, which may be related to reducing the level of inflammatory factors, thus inhibiting inflammatory response and improving cerebral ischemia reperfusion injury.目的：观察针刺对急性缺血性脑卒中（AIS）溶栓患者神经功能及血清炎性因子水平的影响。方法：将102例发病至进行溶栓的治疗时间（OTT）≤3 h的AIS患者随机分为观察组和对照组，每组51例。对照组采用溶栓与内科常规治疗；在对照组治疗基础上，观察组予针刺治疗，穴取水沟、中脘、气海、内关等，每次30 min，每日1次，两组均治疗2周。比较两组患者治疗前后美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）、改良Barthel指数（MBI）评分及血清同型半胱氨酸（Hcy）、超敏C反应蛋白（hs-CRP）水平，并评定两组临床疗效。结果：治疗后，两组患者NIHSS、mRS评分及血清Hcy、hs-CRP水平均较治疗前降低（P<0.05），MBI评分较治疗前升高（P<0.05）；观察组患者NIHSS、mRS评分及血清Hcy、hs-CRP水平均低于对照组（P<0.05，P<0.01），MBI评分高于对照组（P<0.01）。观察组总有效率为88.2%（45/51），高于对照组的70.6%（36/51，P<0.05）。结论：针刺可促进AIS溶栓患者神经功能恢复，改善日常生活能力，可能与降低炎性因子水平从而抑制炎性反应、改善脑血管缺血后再灌注损伤有关。.

Hemodynamic Changes in Patients with Chronic Internal Carotid Artery Occlusion After Recanalization.

This study aimed to investigate the feasibility and clinical efficacy of endovascular recanalization in patients with chronic internal carotid artery occlusion (CICAO) and explore the application value of computed tomography perfusion (CTP) in endovascular recanalization. This non-randomized controlled study included 41 patients with CICAO. All patients received active medical treatment. In this study, patients with successful endovascular recanalization and those who refused endovascular recanalization were included in the recanalization and medication groups, respectively. Before and 90 days after treatment, cognitive function was evaluated using the Montreal Cognitive Function Assessment, and neurological function was evaluated using the National Institutes of Health Stroke Scale and modified Rankin scale. For patients with successful endovascular recanalization, brain CTP imaging was performed to evaluate hemodynamic changes in patients with CICAO before and three days after treatment. Overall, 41 symptomatic patients with CICAO were included, and 20 patients received endovascular recanalization therapy, with a success rate of 60% (12/20). The perioperative complication rate was 15% (3/20); there were no events such as hyperperfusion, distal embolism, vascular rupture, or cerebral hemorrhage, and no stroke-related or death-related events. Patients were divided into a medication group (n=21) and recanalization group (n=12). After 90 days of follow-up, patients in the recanalization group showed greater improvement in overall cognitive and neurological function. In addition, successful endovascular recanalization significantly improved cerebral blood perfusion on the occluded side of patients with CICAO. Successful recanalization can effectively improve the overall cognitive and neurological functions of patients in the short term. CTP can be used to quantitatively evaluate not only the cerebral hemodynamic changes after internal carotid artery occlusion but also the improvement of cerebral blood perfusion after successful endovascular recanalization, which provides a reliable method for postoperative follow-up.

Application of Shouwu Yizhi prescription in decubation of patients with ischemic stroke

ABSTRACT We investigate the application of Shouwu Yizhi prescription (SYP) in decubation of patients with ischemic stroke (IS). The clinical data of 106 patients recovering from IS who came to our hospital from December 2019 to December 2020 were selected for retrospective analysis, and they were separated into experimental group (n = 53, basic treatment + SYP) and control group (n = 53, basic treatment) based on the principle of random grouping. The clinical indexes such as lipid indexes and neurological disability score (NDS) after treatment were compared between both groups to comprehensively evaluate the clinical effects of different treatment regimens. Except for high-density lipoprotein cholesterol value, the lipid indexes in the experimental group after treatment were remarkably lower than those in the control group (P < 0.001). After treatment, the levels of hypersensitive C-reactive protein, homocysteine and lipoprotein-associated phospholipase A2 were remarkably lower in the experimental group than control group (P < 0.05). After treatment, the experimental group had remarkably higher mean scores of Montreal Cognitive Assessment, Fugl-Meyer Assessment in upper and lower limbs and lower NDS than control group (P < 0.001). SYP is an efficient treatment plan in decubation of IS, which can effectively improve the blood lipid indexes and neurological function of patients, and further studies will help establish a better solution for such patients.

Effect of splenectomy based on inverse probability weighting of the propensity score on Wilson's disease with hypersplenism: A retrospective cohort study.

Hypersplenism is a long-term complication of Wilson's disease (WD). Patients often have to stop copper excretion treatment due to the decrease in blood cell count aggravation of abnormal liver function, anaemia, bleeding caused by coagulation dysfunction. The present study aimed to explore the effect of splenectomy on serum, biochemical indicators and neurological function in patients with hypersplenism of WD to evaluate the impact of splenectomy on their survival and prognosis. Due to the non-randomness of splenectomy in patients with hypersplenism in WD in the present study, the propensity scoring model and inverse probability treatment weighting were used to evaluate the age, sex, duration of the disease. A total of 86 patients (40 with and 46 without splenectomy) were included in the present study. The baseline and preoperative data were adjusted by the inverse probability weighting method using the propensity score model. There was no significant difference in distribution of propensity scores between the two groups (P>0.05). There were significant differences in time-weighted PLT levels in patients with hypersplenism of WD [after adjustment, odd ratio (OR)=0.010; 95% CI, 0.0013-0.047; P<0.001]. The time-weighted Child-Pugh scores after adjustment also suggested a significant difference (OR=0.0684; 95% CI, 0.018-0.207; P<0.001). The time-weighted modified Young scale scores demonstrated no statistical significance (after adjustment, OR=0.294; 95% CI, 0.074-1.001; P>0.05). Survival data showed a mean survival time of 11.2±3.15 years with a 10-year survival rate of 64.97% for patients with non-splenectomy and 12.9±2.62 years with a 10-year survival rate of 92.11% for patients with splenectomy, which was statistically significant (P<0.05). Due to crossover of survival curves at a later stage, the data were analysed using landmark analysis. The results suggested that splenectomy decreased death rate within 10 years by 84% compared with the non-splenectomy group (HR=0.158; 95% Cl, 0.0198-1.2545; P<0.05), but the survival rate of the two groups was not statistically significant after 10 years. (HR=0.445; 95% Cl, 0.2463-0.8022; P>0.05). In conclusion, splenectomy significantly improved levels of PLT and liver function in patients with hypersplenism of WD, neurological function did not deteriorate and survival rate was improved.

Management of Spinal Dysraphism-Our Clinical Experience

Background: Spinal dysraphism refers to a group of developmental abnormalities that affect the spinal cord and its surrounding structures. The main goals of treatment of spinal dysraphism are to prevent further damage to the spinal cord and to improve the patient's neurological function and quality of life.Aim of the Study: The aim of this study was to assess the management of spinal dysraphism .Methods: This cross-sectional study was conducted in Department of Pediatric Neuro Surgery, Bangladesh Shishu Hospital and Institute, Sher E Bangla Nagar, Dhaka 1207, Bangladesh, during the period from 1st April 2020 to 31st March 2021. Total 1052 patients were admitted under Neurosurgery department (SU IV) from them 93 patients had spinal dysraphism. After excluding patients with encephalocele, lipomeningocele, meningocele and DORB, total 60 patients with myelomeningocele were included in this study.Result: Majority of the subjects (71%) were less than a week old. there was a slight female preponderance (54%) among the study subjects. The most affected (83.33%) region of the spine among the study subjects was lumbosacral. The data showed that 65% of the study subjects had no lower limb movement, while 35% of them had slight movement. In the study, all study subjects had abnormal bowel and bladder habits. In the study, the majority (62%) had a moderate ventricular index level before operation. About 83.33% of the study subjects had a satisfactory outcome after the surgery, while 6.66% had poor outcomes, and 1.66% of the study subjects died after the surgery. The data showed that 80% of the study subjects had a severe Ventricular Index after two weeks of surgery, while 20% had a moderate Ventricular Index. The data also indicated that 85% of the study subjects had a healthy wound after surgery, while 15% had an unhealthy wound.Conclusion:From the findings of our study, it can be concluded that for improving the quality of life of the patients with spinal dysraphism, surgery is the prominent treatment accompanied by optimal post-operative care. Surgery of spinal dysraphism is associated with higher satisfactory rate and lower post-operative complications.

Inhibition of the Fibrillation of Amyloid Aβ1-40 by Hybrid-Lipid-Polymer Vesicles.

The transformation of functional proteins into amyloidic plaques is responsible for the impairment of neurological functions in patients fallen victim to debilitating neurological conditions like Alzheimer's, Parkinson's, and Huntington's diseases. The nucleating role of amyloid beta (Aβ1-40 ) peptide into amyloids is well established. Herein, lipid hybrid-vesicles are generated with glycerol/cholesterol-bearing polymers aiming to alter the nucleation process and modulate the early phases of Aβ1-40 fibrillation. Hybrid-vesicles (±100nm) are prepared by incorporating variable amounts of cholesterol-/glycerol-conjugated poly(di(ethylene glycol)m acrylates)n polymers into 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC) membranes. The in vitro fibrillation kinetics coupled to transmission electron microscopy (TEM) is employed to investigate the role of hybrid-vesicles on Aβ1-40 fibrillation without destroying the vesicular membrane. Both polymers, when embedded in hybrid-vesicles (up to 20%) significantly prolonged the fibrillation lag phase (tlag ) compared to a small acceleration in the presence of DOPC vesicles, irrespective of the amount of polymers inside the hybrid-vesicles. Along with this notable retardation effect, a morphological transformation of the amyloid's secondary structures to amorphous aggregates or the absence of fibrillar structures when interacting with the hybrid-vesicles is confirmed by TEM and circular dichroism (CD) spectroscopy.

Effect of Repetitive Transcranial Magnetic Stimulation on the Nutritional Status and Neurological Function of Patients With Postischemic Stroke Dysphagia.

This project aimed to explore the effects of repetitive transcranial magnetic stimulation (rTMS) on the nutritional status and neurological function of patients with postischemic stroke dysphagia. After recruiting 70 inpatients with cerebral infarction combined with dysphagia hospitalized in the Cerebrovascular Center of Guangdong Second Provincial General Hospital from June 2017 to June 2020, we assigned them randomly into a control group and an rTMS group. Patients in the control group received swallowing training, while patients of the rTMS group received swallowing training and rTMS. Fifteen days after treatment, serum nutrition indexes and neurotrophic indexes of both groups were higher than before treatment, and their serum nerve injury indexes were lower than before treatment. After 15 days of treatment, the body nutrition indexes and neuronutrition indexes of the rTMS group were higher than those of the control group, while the nerve injury indexes of the rTMS group were lower than those of the control group. rTMS in the treatment of dysphagia after stroke can better improve nutritional status and nerve function, reducing nerve damage.

CASE REPORT: PITUITARY APOPLEXY

Pituitary apoplexy is a rare surgical emergency. This condition involves the rapid progression, which can threaten patients’ life and is caused by haemorrhage or infarction in the pituitary gland. In most cases, a pituitary apoplexy occurs on a pre-existing pituitary tumor. The patient presents with a clinical syndrome of headache, visual deficits, ophthalmoplegia, and altered mental status and hormonal dysfunction. We report a 28-year-old male patient with no previous history of pituitary gland disease. There was a sudden onset and rapid progression, and the patient underwent emergency endoscopic nasal surgery. After surgery, the patient's neurological function was improved and stable.

Efficacy of mesenchymal stromal cells intraspinal transplantation for patients with different degrees of spinal cord injury: A systematic review and meta-analysis

Background aimsSeveral studies have reported that mesenchymal stromal cells (MSCs) may improve neurological functions in patients with spinal cord injury (SCI). In this study, we conducted a systematic review and meta-analysis to summarize the effects of MSC treatment on different degrees of severity of SCI. MethodsSystematic searching of studies reporting outcomes of MSCs on specific injury severities of patients with SCI was performed in The National Library of Medicine (MEDLINE), Embase and Cochrane for published articles up to the 6 July 2022. Two investigators independently reviewed the included studies and extracted the relevant data. The standardized mean differences of American Spinal Injury Association (ASIA) motor score, ASIA light touch scores, ASIA pinprick scores and the Barthel index between baseline and follow-ups were pooled. ResultsA total of eight studies were included. A large majority focused on patients with ASIA grade A classification. The pooled mean differences of ASIA motor scores, ASIA light touch scores, ASIA pinprick scores and the Barthel index were –2.78 (95% confidence interval [CI] –5.12 to –0.43, P = 0.02), –18.26 (95% CI –26.09 to –10.43, P < 0.01), –17.08 (95% CI –24.10 to –10.07, P < 0.01) and –4.37 (95% CI –10.96 to 2.22, P = 0.19), respectively. ConclusionsMSC transplantation was a significantly effective therapy for patients with SCI with ASIA grade A. In the future, further studies are warranted to confirm the potential beneficial effects of MSC therapy.

Zhuang medicine Shuanglu Tongnao Compound Recipe treats stroke by affecting the intestinal flora regulated by the TLR4/NF-κB signaling pathway.

The standardized treatment of ischemic stroke (IS) with Shuanglu Tongnao Compound Recipe (SLTNCR) combined with Western medicine has improved the life quality and neurological function of patients and achieved a satisfactory clinical effect. However, the underlying mechanisms of SLTNCR in the treatment of IS remain unclear. A rat model of IS was prepared using Longa's wire bolus method. SLTNCR was administered by gavage with following doses: low dose, 7.16 g·kg-1; middle dose, 14.33 g·kg-1; high dose, 28.66 g·kg-1. The expressions of toll-like receptor 4 (TLR4), tumor necrosis factor (TNF-α), interleukin-1β (IL-1β), IL-6, nuclear factor-κB (NF-κB), etc., brain neuron damage, small intestine structure, and the structure of intestinal flora of rats in the high, medium, and low dose SLTNCR groups as well as the Injury + Clostridium butyricum and Injury + Edaravone groups were detected by 16SrRNA gene sequencing, western blot, hematoxylin-eosin (HE) staining, enzyme-linked immunosorbent assay (ELISA), and polymerase chain reaction (PCR). SLTNCR significantly reduced the brain water content, decreased the cerebral infarct size, and improved the neurological deficits, neuronal damage, small bowel tissue damage, and expression of inflammatory factors [B-cell CLL/lymphoma 2 (Bcl-2), BCL2 associated agonist of cell death (Bad), cleaved-caspase-3] in brain tissue. SLTNCR administration significantly inhibited expressions of TLR4, NF-κB, and inhibitor of nuclear factor kappa B (IκB), and decreased phosphorylation levels of NF-κB and IκB in the small intestinal tissues of IS rats. Moreover, SLTNCR also significantly upregulated the expression of intestinal barrier function-related molecules [zona occludens 1 (ZO-1), occludin, claudin-5] and regulated the expression of colonic TLR4, TNF-α, IL-6, and IL-1β. SLTNCR can improve the symptoms of IS rats by improving brain and small intestinal function, particularly by regulating the TLR4/NF-κB signaling pathway, apoptotic proteins, and inflammatory factors in brain tissue. Gut microbiota analysis helped to identify the pharmacological mechanisms underlying the effects of SLTNCR on intestinal bacterial diversity and flora structure in IS rats. SLTNCR can alleviate symptoms of IS and the potential mechanism of its effect is to protect brain tissue by suppressing inflammation. SLTNCR can also alter the structure and diversity of the bacterial community in IS.

Clinical features and predictors of early neurological deterioration in acute isolated pontine infarction

Objective: To investigate the clinical and imaging characteristics of early neurological deterioration (END) in acute isolated pontine infarction (AIPI) and analyze the predictive factors of END. Methods: Patients with AIPI who were confirmed by magnetic resonance imaging (MRI) in Zhengzhou University People's Hospital from January 2020 to December 2021were collected and divided into END group and non-END group (NEND group). General data and imaging characteristics of the patients were compared between the two groups, the neurological function of patients was evaluated by using the modified Rankin scale (mRS) at 1 and 3 months after stroke. Multivariate binary logistic regression model was used to analyze the risk factors of END after isolated pontine infarction, and the receiver operating characteristic curve(ROC) curve was drawn. Z-test was used to compare the area under the curve to determine the best predictor of END. Results: A total of 113 patients with AIPI were enrolled, including 72 males and 41 females, aged (62±11) years, with 40 cases in the END group and 73 cases in the NEND group. The incidence of END in AIPI was 35.4% (40/113). The National Institutes of Health Stroke Scale (NIHSS) score in the END group (5.15±1.88) was higher than that in the NEND group (4.10±1.63), and the infarcts size in the END group [(2.15±0.39) mm2] was larger than that in the NEND group [(1.61±0.46) mm2] (P=0.002 and P<0.001, respectively). Multivariate binary logistic regression analysis showed that NIHSS score on admission (OR=1.393, 95%CI: 1.017-1.909, P=0.039), infarct size (OR=11.539, 95%CI: 3.574-37.255, P<0.001) were associated with END. Comparing the area of ROC curve, infarct size [area under curve (AUC)=0.787, with a sensitivity of 0.750 and specificity of 0.545] and NIHSS score on admission (AUC=0.688, with a sensitivity of 0.700 and specificity of 0.589) showed no significant difference in the value of predicting END (P=0.056). Conclusion: Patients with AIPI had higher NIHSS score and larger infarct size on admission, and both of them exhibit good predictive performance for END.

Functional level of lesion scale: Validating fourteen years of research with the national spina bifida patient registry.

Functional level of lesion (FLOL) is a grading of the level of neurological function in patients with myelomeningocele and other forms of spina bifida. It has been widely used as an independent variable in studies of spina bifida, but its inter-rater reliability has not previously been tested. The purpose of this study was to measure inter-rater reliability of FLOL testing and compare testing performed by a non-medically trained research associate to testing performed by a pediatric rehabilitation medicine specialist. Children in a multi-disciplinary spina bifida clinic underwent FLOL grading by a non-medically trained research associate. On the same day, these children were also graded by a pediatric rehabilitation medicine specialist. Cohen's weighted kappa statistic was used to compare grading, with the rehabilitation medicine specialist considered the gold standard. A total of 71 patients participated. FLOL was graded for left and right leg for each participant, resulting in 142 measurements. Cohen's weighted kappa was κ= 0.809, with a standard error of 0.034 and 95% confidence interval 0.723-0.875, indicating substantial agreement. FLOL as measured according to the instructions of the National Spina Bifida Patient Registry by a non-medically trained researcher is a reliable method to grade lower extremity function in spina bifida.

Recombinant human erythropoietin plus methylprednisolone versus methylprednisolone in treatment of acute spinal cord injury：protocol for a systematic review and meta-analysis

IntroductionRecent studies in animal models indicate that recombinant human erythropoietin (rHuEPO) is very effective in enhancing neurological recovery after spinal cord injury (SCI). We described a protocol aimed at evaluating...

Conus medullary arteriovenous malformation mimicking intramedullary tumor: a case report

BackgroundVascular malformation of the spine accounted for 3–4% of all intradural lesions. Spinal arteriovenous malformation (AVM) is often missed because of overlapping symptoms with other pathology and ambiguous imaging. Here, we report a conus medullary AVM that mimics intramedullary tumours either from clinical findings or MR imaging.Case presentationWe report a 24-year-old man with left foot monoparesis, paresthesia, and intermittent claudication for the last 3 months. Magnetic resonance imaging revealed a strongly enhanced intramedullary lesion with a hypointense signal on T1-weighted images and a hyperintense signal on T2-weighted images without flow void, suggesting an intramedullary tumour of ependymoma. Left-sided hemilaminectomy was performed, revealing an AVM on conus medullary. Microsurgical resection was performed by subsequently ligating the arterial feeder and draining vein using a temporary clip. Improvement of neurological status without postoperative sequelae was noted.ConclusionsBecause of the similarity in epidemiology, symptoms, clinical progression, and imaging, suspicion of spinal AVM should remain. This case highlights that appropriate and meticulous surgical resection can preserve the patient's neurological function.

Effect of Cluster Nursing on Recovery Effect and Hospitalization Time of Patients with Acute Cerebral Infarction After Thrombectomy.

To explore the effects of cluster nursing on self-care ability, length of hospital stay, complications and neurological function of patients with mechanical thrombectomy of large vessel occlusion in acute cerebral infarction. A total of 83 patients with acute cerebral infarction who underwent thrombolectomy in a tertiary hospital in Anhui Province from June 2019 to March 2021 were randomly divided into observation group and control group. The observation group was treated with cluster nursing intervention mode, and the control group was treated with routine nursing mode. Barthel index scores and National Institute of Health Stroke Scale (NIHSS) scores were compared between the two groups at admission and at 1 week, 1 month and 3 months of nursing intervention. The length of stay and incidence of complications were compared between the two groups. There was no significant difference in baseline data, Barthel index and NIHSS score between the two groups at admission (P>0.05). The Barthel index at 1 week, 1 month and 3 months after operation in the observation group was significantly higher than that in the control group (P<0.05), while the NIHSS score, incidence of complications and length of hospital stay were significantly lower than those of the control group (P<0.05). Cluster nursing can improve the neurological function, improve the self-care ability, reduce the incidence of complications, shorten the hospitalization period, improve the prognosis and promote the recovery of patients with acute cerebral infarction thrombolysis.

Posterior Injured Vertebra Column Resection and Spinal Shortening for Thoracolumbar Fracture Associated with Severe Spinal Cord Injury: A Retrospective Case-Control Observational Study.

Background Thoracolumbar spinal fracture associated with severe spinal cord injury (sSCI) is a kind of severe traumatic spine injury. Although various approaches are currently used to treat sSCI-related thoracolumbar fractures, the neurological function of patients has not been significantly improved by surgery. Objective To evaluate the therapeutic effects of the new procedure of posterior injured vertebra column resection (PIVCR) and spinal shortening for the treatment of thoracolumbar fracture associated with sSCI. Methods In this retrospective case-control observational study, we included 66 patients with thoracolumbar fractures associated with sSCI in our institution from January 2015 to December 2017. According to the different surgical approaches, the patients were allocated to group A (n = 32, received simple posterior decompression and fixation) and group B (n = 34, received PIVCR and spinal shortening). All patients' clinical and radiologic outcomes were collected to evaluate retrospectively. The clinical outcomes were gathered, including the intraoperative blood loss, operative time, visual analog scale (VAS) score, and American Spinal Injury Association (ASIA) impairment scale. The radiologic outcomes were collected involving the range of spinal shortening, canal encroachment, heights of the anterior edge of the vertebral body, and the Cobb angle. Results There was no significant difference in the two groups regarding preoperative demographic data, VAS scores, segmental kyphosis Cobb, canal encroachment, and neurological status. The range of spinal shortening in group B was an average 1.57 ± 0.40 cm and 36.45 ± 6.56% of the height of the single spinal motion segment. Due to the characteristics of the surgical procedure, group B got complete decompression of the spinal cord and better postoperative canal decompression than group A. Thus, better clinical outcomes, including neurological improvement, loss of corrective Cobb angle, and VAS improvement, were shown in group B at the follow-up investigation than those in group A (P < 0.05). Conclusion PIVCR and spinal shortening surgical procedure is a safe, reliable, and effective approach to treating thoracolumbar fracture associated with sSCI.

Interdisciplinary surgical approach enables complete tumor resection with preservation of neurological function in specific conditions of pediatric solid malignancies

PurposeSuccess of pediatric solid tumor surgery is regularly hampered by infiltration of essential neurovascular structures. A surgical dilemma arises when imaging data suggest a conflict between complete resection and preservation of neurological function. The aim of the study was to analyze data of children harboring tumors with involvement of neurovascular structure treated by an interdisciplinary pediatric surgical/neurosurgical team.MethodsWe retrospectively analyzed data of 25 children undergoing surgery for solid tumors, in whom preoperative imaging showed a relevant involvement of nerve structures. Surgery was simultaneously performed by a pediatric onco-surgeon and a pediatric neurosurgeon with peripheral nerve expertise, including intraoperative electrophysiological monitoring.ResultsThe following tumors were treated: NF1 associated neurofibromas (10), neuroblastomas (5), desmoid tumors (2), MPNST (2), ganglioneuroma (1), Ewing sarcoma (1), infantile fibromatosis (1), PNET (1), rhabdomyosarcoma (1), angiolipoma (1). The most frequent tumor localizations were the pelvis (n = 7) and retroperitoneal region (n = 6). Median age at surgery was 8 years (1.5–16). Macroscopically complete tumor resection was achieved in 24/25 patients. In 2/4 patients with limb tumors an amputation was planned externally. In both, a limb-salvage procedure was possible. Transient postoperative neurological deficits occurred in 2/25 patients. Four patients had tumor relapses. All but one are alive after a median follow-up of 46 months (2–155).ConclusionsSimultaneous interdisciplinary pediatric surgical/neurosurgical approach enables radical tumor resection with preservation of neurological function in patients suffering from solid tumors with involvement of relevant neurovascular structures. This approach should be performed by experienced surgeons in reference pediatric onco-surgical centers.

Early Rehabilitation Exercise after Stroke Improves Neurological Recovery through Enhancing Angiogenesis in Patients and Cerebral Ischemia Rat Model.

Among cerebrovascular diseases, ischemic stroke is a leading cause of mortality and disability. Thrombolytic therapy with tissue plasminogen activator is the first choice for clinical treatment, but its use is limited due to the high requirements of patient characteristics. Therefore, the choice of neurological rehabilitation strategies after stroke is an important prevention and treatment strategy to promote the recovery of neurological function in patients. This study shows that rehabilitation exercise 24 h after stroke can significantly improve the neurological function (6.47 ± 1.589 vs. 3.21 ± 1.069 and 0.76 ± 0.852), exercise ability (15.68 ± 5.95 vs. 162.32 ± 9.286 and 91.18 ± 7.377), daily living ability (23.37 ± 5.196 vs. 66.95 ± 4.707 and 6.55 ± 2.873), and quality of life (114.39 ± 7.772 vs. 168.61 ± 6.323 and 215.95 ± 10.977) of patients after 1 month and 3 months, and its ability to promote rehabilitation is better than that of rehabilitation exercise administered to patients 72 h after stroke (p < 0.001). Animal experiments show that treadmill exercise 24 h after middle cerebral artery occlusion and reperfusion can inhibit neuronal apoptosis, reduce the volume of cerebral infarction on the third (15.04 ± 1.07% vs. 30.67 ± 3.06%) and fifth (8.33 ± 1.53% vs. 30.67 ± 3.06%) days, and promote the recovery of neurological function on the third (7.22 ± 1.478 vs. 8.28 ± 1.018) and fifth (4.44 ± 0.784 vs. 6.00 ± 0.767) days. Mechanistic studies have shown that treadmill exercise increases the density of microvessels, regulates angiogenesis, and promotes the recovery of nerve function by upregulating the expression of vascular endothelial growth factor and laminin. This study shows that rehabilitation exercise 24 h after stroke is conducive to promoting the recovery of patients’ neurological function, and provides a scientific reference for the clinical rehabilitation of stroke patients.

Assessment of Primary Collateral Grades Based on the Integrity of Willis' Circle: Predicting the Prognosis of Acute Intracranial Internal Carotid Artery Occlusion Before Thrombectomy

Endovascular mechanical thrombectomy (EVMT) has shown significant efficacy in improving neurological functions in patients with intracranial internal carotid artery occlusion (IICAO), but its clinical outcomes are variable. We examined the relationship between favorable clinical outcomes after EVMT in IICAO and a set of predictors. In this retrospective study, 189 patients with IICAO treated by EVMT at 3 centers from November 2015 to December 2020 were included and analyzed. Non-contrast computed tomography and computed tomography angiography were evaluated on admission. The morphology of IICAO was categorized into Ia, Ib, L, or T types, depending on the involvement of the posterior communicating artery origin, proximal anterior cerebral artery, and middle cerebral artery. The Willis' circle was categorized as integrated or compromised Willis' circle. In combination with the involvement of the IICAO and the integrity of Willis' circle, we used the primary collateral grade (PCG) to describe the presence of functional Willisian collaterals. Baseline data including demographics, characteristics, vascular risk factors, and initial National Institutes of Health Stroke Scale scores were collected. Hemorrhagic transformation was evaluated using the 24-hour non-contrast computed tomography after EVMT. Favorable outcomes based on modified Rankin scale, were defined as 0-2 at 90days. A total of 189 patients were included (median age, 69years; 126 male [66.7%]). 104 patients [55.0%] showed reperfusion after EVMT, but 72 patients [38.1%] achieved favorable outcomes at 90days. The mortality rate of type Ib was significantly higher than that with type Ia (χ2=14.21, P= 0.001). The outcome with different structure of Willis' circle was not statistically different between the 2 groups. A multivariate logistic regression analysis showed that IICAO T-type (odds ratio, 0.028 [95% confidence interval: 0.323-3.829], P= 0.042) and PCG 2 (odds ratio 9.427[95% confidence interval:1.863-47.698], P= 0.007) were predictors of favorable outcomes. Evaluation of PCG by determining the type of IICAO and the integrity of Willis' circle may serve as a valuable indicator for the prognosis and as an essential reference for screening patients before EVMT.

The effect of early vs. late CT-guided stereotactic hematoma aspiration on neurological function recovery in patients with hypertensive cerebral hemorrhage in the basal ganglia: a retrospective comparative cohort study.

Surgery plays a major role in treating hypertensive cerebral hemorrhage in the basal ganglia; however, some patients suffer from neurological impairment after surgery. Studies have confirmed that stereotactic hematoma aspiration guided by computed tomography (CT) has significant value for patients with hypertensive intracerebral hemorrhage in the basal ganglia, but little is known about the optimal timing for the operation. This study sought to explore the effect of CT-guided stereotactic hematoma aspiration timing on the recovery of neurological function in patients with hypertensive cerebral hemorrhage in the basal ganglia. The data of 110 patients with hypertensive cerebral hemorrhage in the basal ganglia admitted to the Union Hospital Tongji Medical College Huazhong University of Science and Technology from January 2021 to December 2021 were retrospectively collected. Based on the timing of their operations, the patients were allocated to the early treatment group (within 24 hours, n=50) and late treatment group (after 24 hours, n=60). The postoperative recovery of the 2 groups was compared. There were no significant differences in terms of age, gender, amount of cerebral hemorrhage, hemorrhage ruptured into ventricle rate, Glasgow Coma Scale score, hypertension grade, hyperlipidemia, diabetes, and operation duration between the 2 groups (P>0.05). Additionally, there was no difference in the preoperative National Institute of Health Stroke Scale scores of the patients in the 2 groups (22.50±4.90 vs. 23.83±5.35, P=0.179). Compared to the late treatment group, the National Institute of Health Stroke Scale score of the patients in the early treatment group was significantly lower 3 and 6 months after the operation (5.90±4.02 vs. 9.23±3.47, P<0.001; 4.54±2.56 vs. 6.50±3.07, P<0.001, respectively). The Glasgow Outcome Scale score of patients in the early treatment group was significantly better than that of patients in the late treatment group (P=0.035). No significant difference was found in the incidence of postoperative pulmonary infection, intracranial infection, rebleeding, and lower extremity deep venous thrombosis between the 2 groups (P>0.05). Early CT-guided stereotactic hematoma aspiration may improve the postoperative neurological function of patients with hypertensive cerebral hemorrhage in the basal ganglia.