| The end of the bilateral internal carotid artery(ICA),the middle cerebral artery(MCA)and at the begin of the brain artery(ACA)before starting stenosis or atresia can be associated with vascular hyperglycemia intracranial vascular disease.The reason is not clear,and the Moyamoya disease(MMD)which relies on a blood vessel is also known as the bottom of brain abnormal vascular net sign.The hyperglycemia of abnormal intracranial vascular is different with the sexual,disease,region and gender.The difference between the incidence of men than women,it is reported that the incidence of a disease is characterized by the yellow,the ratio of men and women is about 1 to 1.8;yellow incidence is much higher than the Caucasus mortar kinds of people,than the Bao for 1:10;Asia,especially in east Asia significantly higher incidence.Moyamoya disease on the epidemiological features of familial aggregation,has certain genetic predisposition.The disease progression tendency,diverse forms,such as transient ischemic attack(TIA),and even bleeding symptoms,large area of ischemic symptoms,often observed clinically epilepsy.Moyamoya disease research often be divided into four types: the onset,cerebral infarction,the blood type,seizures cardiovascular research center(Japan).Moyamoya disease by ischemic transforms to the type,cause serious hollow in the nervous system damage,which is great harm to one's health,even a serious threat to the quality of life of patients.Clinical treatment disputes lasted for a long time,but outside the surgery of intracranial vascular has reached a consensus among experts and scholars,the vascular ridge bridge can significantly improve intracranial blood flow(CBF)and effectively prevent the occurrence of cerebral ischemia.In the present case,the intracranial vascular bridge is one of the most effective treatment protocols for the treatment of Moyamoya disease.Although the pathogenesis of Moyamoya disease is controversial,the study found that the gene mutation or loss of physical and chemical factors inside and outside causes blood change,which is the important mechanism of the Moyamoya disease mildew occurred,genetic factors may be in the pathogenesis of moyamoya disease.In Japan,expression of disease of cigarette is obvious familial aggregation,and significantly higher than in other parts of the whole society and the kind of chopsticks.Of course,also the scholar thinks,acquired factors as well as the factors,many are obtained by the day after tomorrow and come on,wait until such as immune injury.The happening mechanism of inflammation caused by Moyamoya disease mainly concentrated in intracranial vessels,cerebration fluid and plasma composition,such as,research mainly focused on intracranial vascular walls.It was the relevant scholars in vitriol,such as the research object is divided into the experimental group and control group,experimental group temporal shallow artery smooth muscle cells are patients with moyamoya disease,the control group,superficial temperamental arterial smooth muscle cells are patients with moyamoya disease,respectively with IL-1 ? stimulation group "group of arterial smooth muscle cells,the knot slimming showed the experimental group on the smooth muscle cells of PGE2 and CO X2 is apparent from the previous increases,the control is not obvious.The study may present that 101 ? can lure of PGE2 and COX2 content increases,and the key steps of the disease may be moyamoya disease,and the present studies may rarely involve intracranial investigations.When arachidonic acid shift to PGE2 needs about key enzyme COX-1?COX-2 to catalyze,and when PGH2 shift to PGE2 needs about key enzyme m PGES-1 to catalyze.In the second part of this article,we need to do surgery patients from Moyamoya disease specimens of middle cerebral artery blood vessels and plasma samples,using immunohistochemical testing specimen on the walls of blood vessels,COX-1?COX-2 and m PGES are applied to detect plasma,the content of PGE2 and COX-1?COX-2 in Elisa subjects would be improved to study COX-1?COX-2,m PGEs-1,PGE2 substances in Moyamoya disease mildew occurred within the blood vessels of mechanism,the role and status.So,in this paper,the third part mainly studies blood vessels outside factors,it aims to establish a bypass patients outside of intracranial vascular girdle surgery and equilibrium water cycle,improve the intracranial blood supply,the angiogenesis of the organism is harsh criticized by many cytokines accurate control to the directional differentiation,angiogenesis,which is formed by two kinds of regulatory mechanism of mutual checks and balances that angiogenesis stimulating factor and inhibiting factor,the existence of these two kinds of regulatory mechanism which plays a key role is the angiogenesis.Angiogenesis excitation factor is a compound component in the presence of the protein,which can stimulate the formation of blood vessels.Currently,the most representative of the research is the basic fibroblastgrowth facto L bFGF,and the vascular endothdimgrowth.In this part,we studied the changes in the content of cerebrospinal fluid in the patients before and after the operation of the two factors,and the application of the angiogenesis of the patients with the disease was investigated.The study consists of the following three parts: the first part: the clinical efficacy analysis of the angiotomy for the treatment of moyamoya disease.The second part: Analysis of expression factors of the patients of the Moyamoya disease with the intracranial blood vessels COX-1?COX-2 and m PGES-1.The third part: the analysis of the change of the content of the patients with the disease.Part I The analysis of the clinical efficacy of vascular reconstruction in the treatment of Moyamoya diseasesMethods:1.Research object: in this paper,the research object from January 2012 during December—20 data is complete,complete follow-up,34 cases of patients with moyamoya disease were from the fifth affiliated hospital of zhengzhou university of neurosurgery,compared with when men and women,age range for 6.5 to 67(an average of 30.3 years old,all selected patients underwent rigorous screening,including physical examination and DSA examination,and were clearly diagnosed.2.Surgical methods: 34 patients with Moyamoya disease performed the arterial cerebral artery(STA-MCA)(M4)anastomosis and combined the brain with the cerebral artery(EDAMS).3.Postoperative radio-graphic inspection: all the patients on the first day after the surgery and the seventh-day conventional SPECT for CBF inspection.Results:After a period of follow-up [patient compliance],the average time of follow-up was 37.8 months.On the day of the month,it was examined and described by the family members to strictly monitor the patient's presence of cerebrovascular events,including cerebral ischemia,TIA,subarachnoid hemorrhage,ICH,etc.In 34 cases,the patient underwent reexamination in the 6th month after the operation,and the blood supply of the intracranial vessels was clear,and 30 patients(30/34)(88.2%)were been showed that no obvious cerebral vascular accident occurred in the hemispheres of the operation in the follow-up period;however it has 2 patients(2/34,5.9%)in the process of follow-up monitoring with transient cerebral ischemia symptoms occur,but in the 2 patients did not happen again before the end of follow-up T patients(1/34,2.9%)In the fourth month after surgery,the symptoms of cerebral infarction were performed in the same hemicerebral hemisphere,but it was mild,and the symptoms were relieved after normal treatment: another patient(1/34,2.9%).In the second year after surgery,there were symptoms of intracranial hemorrhage,but the neurological dysfunction was relieved after treatment.Patients who were included in the study for 6 months after the operation showed that the vascular unobstructed benign and benign images were not significantly narrowed or closed.In conclusion:1.By intracranial vascular bypass surgery,moyamoya disease patients significantly lower risk of stroke,and symptoms have been improved,the surgery is the most safety and efficient way for patients with moyamoya disease to be healed,although a certain complications after surgery.2.Temporal postoperative pathology: patients with moyamoya disease was shallow than conventional blood vessels inside the artery thickening,elastic tissue rupture,the original blood vessels elastic structure is destroyed,but increased susceptibility,capillary hyperplasia of reactivity,the generation of all dwellings cass increase blood supply.Part II Analysis of the expression factors of COX-1 and m PGES-1 in the intracranial vessels of the patients with Moyamoya diseasesMethods:The continuation of the first part of the study was completed from January,2012 to December,2012,and the complete 34 patients with the disease were treated with combined reconstruction surgery,which was set up as the experimental group.In addition,eight patients who underwent intracranial bypass surgery were selected as the control group.During the surgery microscope,obtained superficial temporoparietal artery(superficial temporal artery,STA)samples,at the same time,get the middle cerebral artery(middle cerebral artery,MCA)specimens.With HE staining method,namely hematoxylin-eosin HE)staining,which could roughly measured the thickness of intravascular of patients with moyamoya disease,again through the method of immunohistochemical could get the expression on the walls of blood vessels of COX-1?COX-2 and m PGES-1,and adopt the method of ELISA to test the COX-1?COX-2 and prostaglandin(PG)E2,and the levels of plasma in the subjects.Results:HE staining results showed that the centigrade of MCA endometrium in patients was significantly larger than that in the control group(t=7.498,P<0.001).Most MMD patients have the expression of COX-1 on MCA was positive and confirmed by immunohistochemistry(29/34,85.29%),and in m PGEs-1,MCA showed positive expression of 34/34,100 %.The expression intensity of COX-1 and m PGES-1 was positively correlated with MCA in patients with Moyamoya diseases(rs=0.620,p=0.004).The positive expressions of COX-1 and m PGES-1 in the experimental group were not seen in the experimental group STA and MCA.The content of COX-1 and PGE2 in the serum of the experimental group and the control group showed little difference between the experimental group and the control group.And that has no significant statistical significance.(P > 0.05)In conclusion:The positive expression of COX-1?COX-2 / m PGES-1 in MMD patients may have significant influence on the pathogenesis of MMD.Part III Changes of bFGF and VEGF-A in the cerebrospinal fluid of patients with Moyamoya diseasesMethods:This part of the experimental group still comes from the first part,from January 2012 to December 2014,in the fifth affiliated hospital of zhengzhou university,the patients with the disease of the hospital,34 cases,the data integrity.Among them,9 males and 25 females were diagnosed by DSA and the surgery was performed in parallel intracranial vascular surgery.In the operation,a small number of patients with cerebrospinal fluid were collected from subarachnoid cavity,about 3ml;2 weeks after surgery,3ml cerebrospinal fluid was retained by lumbar puncture.In the control group,12 patients with hydrocephalus from the same period were selected,and the samples of the cerebrospinal fluid of about 3ml were collected as a control group during the operation of V-P bypass surgery.In the end,the method of ELISA was used to detect the difference of b FGF and VEGF-A in the study subjects.Results:The examination results showed that the patients who were preoperative and postoperative and control group which b FGF average data is: 71.08 ±18.08 pg/ml,85.48±22.41pg/ml,14.82±2.36pg/ml.The b FGF of MMD patients was significantly higher than the control group,and the difference was statistically significant(t=17.722,p< 0.001);regardless of preoperative and postoperative patients with MMD levels in the cerebrospinal fluid were higher than the control group,MMD patients with preoperative and postoperative cerebrospinal fluid containing VFGF exists obvious difference,postoperative significantly higher than before.The average content of cerebrospinal fluid in patients with VEGF-A,preoperative,postoperative and control group was:18.07±3.30pg/ml,25.75±4.35pg/ml,12.58±2.07 pg/ml.MMD patients of the preoperative VEGF-A was significantly higher than the control group,and the difference was statistically significant(t=5.379,p<0.001);The content of VEGF-A in the cerebrospinal fluid of MMD patients was significantly higher than that of b FGF before surgery,and the difference was statistically significant(t=8.530,p<0.001).There were significant differences in VEGF-A content in MMD patients before and after surgery,and the content that after surgery was significantly higher than that before operation.Furthermore,the analysis of the number of studies was conducted,and the results showed that the factor of gender has no significant difference in the amount of VEGF-A in the brain spinal fluid and VEGF-A.(p > 0.05)The patients in this study were classified into the group with the name,middle stage and advanced stage,and the contents of b FGF and VEGF-A in the brain liquid which were respectively in the preoperative and postoperative period have no significant difference.(p > 0.05).In conclusion:According to the data from experimental group and control group on the study of b FGF and VEGF-A,in which both of them participated the pathophysiological process of Moyamoya disease of blood vessel changes,including the increase of the postoperative b FGF and VEGF-A would promote the new angiogenesis,improve the intracranial blood flow,increase the field woven brain blood supply,and microvascular permeability.On the other hand,b FGF and VEGF-A could rapidly heal the wound by a variety of physical and chemical factors,which would also protect the neuron system. |
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