V ein of Galen aneurysmal malformations (VGAMs) are cerebral arteriovenous malformations of the choroidal system draining into the vein of Galen forerunner. Although they represent approximately 1% of all intracranial vascular lesions, they account for 30% of vascular malformations in the pediatric age group.7 Endovascular embolization is the first option for VGAMs. 15,20,30,36 obJect There have been many multidisciplinary approaches to the treatment of vein of Galen malformations. Endovascular embolization is the first option for treatment. However, the effects of the treatment remain controversial. The aim of this study is to assess the efficacy and safety of endovascular embolization to treat patients with vein of Galen malformations. methods This paper includes a retrospective analysis of a sample of 667 patients who underwent endovascular embolization to treat vein of Galen malformations. The data were obtained through a literature search of PubMed databases. The authors also evaluate the efficacy and safety of the treatment. Mortality within the follow-up period is analyzed. Pooled estimates of proportions with corresponding 95% CIs were calculated using raw (i.e., untransformed) proportions (PRAW). results In the 34 studies evaluated, neonates accounted for 44% of the sample (95% CI 31%-57%; I 2 = 92.5%), infants accounted for 41% (95% CI 30%-51%; I 2 = 83.3%), and children and adults accounted for 12% (95% CI 7%-16%; I 2 = 52.9%). The meta-analysis revealed that complete occlusion was performed in 57% (95% CI 48%-65%; I 2 = 68.2%) of cases, with partial occlusion in 43% (95% CI 34%-51%; I 2 = 70.7%). The pooled proportion of patients showing a good outcome was 68% (95% CI 61%-76%; I 2 = 77.8%), while 31% showed a poor outcome (95% CI 24%-38%; I 2 = 75.6%). The proportional meta-analysis showed that postembolization mortality and complications were reported in 10% (95% CI 8%-12%; I 2 = 42.8%) and 37% (95% CI 29%-45%; I 2 = 79.1%), respectively. Complications included cerebral hemorrhage, cerebral ischemia, hydrocephalus, leg ischemia, and vessel perforation. coNclusioNs The successful treatment of vein of Galen malformations remains a complex therapeutic challenge. The authors' analysis of clinical history and research literature suggests that vein of Galen malformations treated with endovascular embolization can result in an acceptable mortality rate, complications, and good clinical outcome. Future large-scale, multicenter, randomized trials are necessary to confirm these findings.

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BackgroundPrevious studies suggested that expression of cyclin-dependent kinase 5 (CDK5) may promote the migration and invasion of human glioma cells. In this study, we aimed to evaluate the clinical value of CDK5 in different grades of glioma in relation to Ki-67 labeling index (LI).MethodsWe firstly assessed by immunohistochemistry the expression of CDK5 in 152 glioma tissues and 16 normal brain tissues and further explored the relationship between CDK5 expression and other clinical features.ResultsThe positive ratio of CDK5 in gliomas (57.2 %) was higher than that in normal brain tissues (12.5 %, P = 0.001). Difference of CDK5 expression among four World Health Organization (WHO) grades was statistically significant (P = 0.001). The significant differences of CDK5 expression were also observed between WHO I glioma (34.8 %) and WHO III glioma (62.5 %), as well as WHO IV glioma (82.8 %; P = 0.026, P < 0.001, respectively). Furthermore, Spearman’s rank correlation confirmed that CDK5 was positively correlated with the pathological grade of glioma (r = 0.831, P < 0.001). The CDK5 expression was also positively correlated with Ki-67 LI (r = 0.347, P < 0.001).ConclusionsThe current result suggests that CDK5 may play an essential role in the tumorigenesis and aggressiveness of gliomas.

Citrulline (Cit) supplementation was proposed to serve as a therapeutic intervention to restore arginine (Arg) concentrations and improve related functions in sepsis. This study explored whether citrulline had positive effects on liver injury and cytokine release in the early stages of sepsis. The cecal ligation and puncture (CLP) model was utilized in our study. Rats were divided into four groups: normal, Cit, CLP, and CLP+Cit. The CLP group and CLP+Cit group were separated into 6-, 12-, and 24-hour groups, according to the time points of sacrifice after surgery. Intragastric administration of L-citrulline was applied to rats in Cit and CLP+Cit groups before surgery. Serum AST and ALT levels and levels of MDA, SOD, NO, and iNOS in the liver tissues were evaluated. Plasma concentrations of Cit and Arg were assessed using HPLC-MS/MS. Serum concentrations of cytokines and chemokines were calculated by Luminex. Results showed SOD activities of CLP+Cit groups were significantly higher than that of CLP groups, contrasting with the MDA and NO levels which were significantly lower in CLP+Cit groups than in CLP groups. In addition, plasma concentrations of TNF-α, IL-6, and IL-1β were significantly lower in the CLP+Cit 6-hour group than in the CLP 6-hour group.

Traditional Chinese medicine can promote the proliferation of bone marrow-derived mesenchymal stem cells (BMSCs). We chose four “Kidney-tonifying” Chinese herbal medicines, Radix Astragali, Salvia, Herba Epimedii, and Saussurea Involucrata, to evaluate whether they had positive effects on the proliferation of BMSCs and TGF-β1-induced chondrogenic differentiation of BMSCs. The four Chinese herbal medicines were intragastrically administered to Sprague-Dawley rats, respectively, to prepare drug-containing serums of corresponding Chinese herbs. BMSCs were isolated, cultured, and exposed to culture solution containing 1%, 5%, 10%, and 15% (v/v) Radix Astragali-, Salvia-, Herba Epimedii-, and Saussurea Involucrata-containing serum, respectively. TGF-β1-induced BMSCs were addressed in the same manner. Collagen type II protein was assessed by immunofluorescence methods. To assess whether the drug-containing serums had positive effects on the proliferation of BMSCs and TGF-β1-induced BMSCs, MTT method was assessed. The proliferation of BMSCs was significantly enhanced when exposed to culture solutions containing 1% and 5% Radix Astragali-, 1% and 5% Salvia-, 5% Herba Epimedii-, and 1%, 5%, and 10% Saussurea Involucrata-containing serum. The proliferation of TGF-β1-induced BMSCs was significantly enhanced when exposed to 1%, 5%, and 15% Radix Astragali-, 10% and 15% Salvia-, 5%, and 15% Herba Epimedii-, and 1%, 5%, and 10% Saussurea Involucrata-containing serum.

Over time, the rate of preoperative sudden death in patients with VGAM gradually declined and the rate of emergency operations gradually increased. The outcome of patients with early spontaneous thromboses was good. Our study provides a definitive description of the natural progression of VGAMs and the need for urgent medical attention.

Background: Decompressive craniectomy (DC) in traumatic brain injury (TBI) patients has been subject of debate for neurosurgeons since long time. Our goal in this study is to evaluate the quality of life of these patients and to look at the problem from their point of view. Methods: Quality of Life after Traumatic Brain injury (QOLIBRI) instrument is was applied to 105 TBI patients who performed DC. Age, gender, the mode of injury and level of education, time from TBI to DC, lowest GCS score post-injury, presence of a corneal reflex, whether patients performed reconstructive cranioplasty or not, blood pressure, patient temperature, midline shift on CT scan, fasting blood glucose, whether patients performed rehabilitation therapy, days of use of mannitol and barbiturates sedation were recorded. Results: Sex of the patient, educational background, time between TBI to perform DC surgery, pupillary response of patient before surgery, systolic and diastolic blood pressures, fasting blood glucose, rehabilitation and use of barbiturates did not prove to have any statistical significant impact on the patient's QOLIBRI score. Young patients were found to be scoring more in the social domain (P = 0.02). Higher Glasgow Coma Score (GCS) patients scored statistically better in the cognitive (p = 0.00), self (0.00), daily life (p = 0.00), social (p = 0.00), emotion (p = 0.00) and total QOLIBRI (p = 0.00) score. Interestingly, the longer the time interval between TBI and time at QOLIBRI instrument application, the lower the score for cognitive (p = 0.00), self (p = 0.04), daily life (p = 0.02), emotion (p = 0. 05) and total QOLIBRI (p = 0.02) score. Reconstructive cranioplasty proved to positively affect the emotion (p = 0.05), social life (p = 0.01) and total QOLIBRI (p = 0.05) score. Temperature had a negative influence on the cognitive (p = 0. 01), self (p = 0.01) and daily life score (p = 0.01). Midline shift on CT imaging had a negative influence on cognitive (p = 0.00), self (p = 0.00), daily life (p = 0.00), social (p = 0.00), emotion (p = 0.05) and total QOLIBRI (p = 0.00) score.

Blood blister-like aneurysms (BBLAs) are aneurysms from the non-branching sites of the internal carotid artery (ICA). Though rare lesions, they pose a high risk of intraoperative aneurysmal rupture. Definite treatment of these types of aneurysms has been debatable, but surgical approach is the ultimate rescue treatment. Microsuture of the intraoperative ruptured BBLA has been reported scarcely in literature, but no review of these cases has ever been reported. We here present our experience of a case of BBLA intraoperative rupture requiring microsuture of the ICA and conduct meticulous review of all similar cases.