To evaluate the cognitive level of proton pump inhibitors from tertiary hospitals / 中国医师杂志

Objective To evaluate the cognitive level of proton pump inhibitors for the clinicians who prescribe these drugs often. Methods 10 cognitive latitudes for proton pump inhibitors were selected, which were receptor site, indication, indication of prophylaxis during perioperation, patients in contraindi-cated, high risk factors of stress ulcer, standard dose, daily dosing frequency, solvent selection for intrave-nous drip and main adverse reactions. Every cognitive latitude was assigned to points and one evaluation form was assigned 120 points. 175 clinicians participated the assessment voluntarily. Results Overall,the total average score is 58. 89. Each average score of 10 cognitive level is 10. 63, 1. 07, 6. 99, 5. 23, 3. 81, 11. 86, 11. 66, 3. 81, 7. 49 and 3. 81 respectively. The error rate is 10. 86％, 84. 57％, 45. 14％, 80. 00％, 59. 43％, 4. 00％, 2. 86％,80. 57％, 21. 71％ and 28. 00％ accordingly. Conclusions Over-all, the clinicians'cognitive level is low, while the senior doctors'are high in surgical prophylaxis;the physi-cians'are high in compatibility than surgeons ;the clinicians who used proton pump inhibitors ( PPI) more frequently are high in solvent selection for intravenous drip.

Effect of apicidin on glioblastoma U87 cells and its regulation of OCT-4 gene expression / 肿瘤研究与临床

Objective@#To investigate the effect of histone deacetylase inhibitor apicidin on the glioblastoma U87 cells and its regulation of OCT-4 gene expression.@*Methods@#Glioblastoma U87 cells were treated with different concentrations of apicidin, and dimethyl sulfoxide instead of apicidin was negative control. Methyl thiazolyl tetrazolium (MTT) assay was used to detect the proliferative ability of U87 cells treated by apicidin. The cell apoptosis was observed under the fluorescence microscope, and the cell cycle was detected by using flow cytometry. Reverse transcription-polymerase chain reaction and Western blot was used to detect the expression of mRNA and protein of U87 cells, respectively relative to the expression of GAPDH.@*Results@#MTT assay results showed that apicidin inhibited U87 cells proliferation in a dose-dependent and time-dependent manner, and half of the inhibitory concentration of cell proliferation at 48 h was (1.74±0.13) μmol/L. The cell proportion of U87 cells in S-phase of the negative control, 0.2, 0.5, and 1.0 μmol/L apicidin was (32.68±0.49)%, (33.73±0.76)%, (42.92±0.56)%, and (56.95±0.53)%, respectively after 48 h apicidin administration (P < 0.05), while the proportion of G1 and G2 phase cells was decreased. The karyopyknosis and other apoptotic changes were detected in U87 cells after 48 h treatment of 1.0 μmol/L apicidin under the confocal fluorescence microscope. Western blot and RT-PCR showed that the mRNA and protein relative levels of U87 cells OCT-4 were reduced after 1.0 μmol/L apicidin treatment for 48 h compared with the negative control group (mRNA: 72.44±0.00 vs. 56.66±0.23; protein: 86.59±0.19 vs. 56.04±0.15, both P < 0.01).@*Conclusions@#Apicidin can inhibit the growth of glioblastoma U87 cells, induce cell cycle arrest and apoptosis. Its mechanism may be related to the expression of OCT-4 inhibited by apicidin.

Role of ubiquitin ligase FBW7 in the sensitivity of glioma to temozolomide and its mechanism / 肿瘤研究与临床

Objective To study the role of ubiquitin ligase FBW7 in the sensitivity of glioma to temozolomide and its mechanism in glioma cells. Methods FBW7 overexpression lentivirus was constructed. Glioma cell line U251 was divided into 4 groups: the control group, temozolomide group, FBW7 overexpression group, and FBW7 overexpression + temozolomide group. Compared with the intervention on U251 cell lines, the differences of cell inhibitory rates in 4 different groups were analyzed by using contrast microscopy and methyl thiazolyl tetrazolium (MTT) colorimetric assay after 36 h and 72 h respectively. Flow cytometry (FC) was used to determine the cell cycle and apoptosis rate. Results The survival number of U251 cells in the three treatment groups was increased compared with the control group at both 36 h and 72 h. The inhibitory rates of temozolomide group, FBW7 overexpression group, and FBW7 overexpression +temozolomide group at 36 h were (17.6±0.8) ％, (10.4±0.6) ％, (18.6±0.6) ％ respectively compared with the control group (F=67.02, P<0.01); while at 72 h, the inhibitory rates of the three treatment groups were (25.1 ±0.4) ％, (16.7 ±0.7) ％, (29.0 ±0.9) ％ respectively compared with the control group (F= 74.61, P<0.001). Moreover, FBW7 overexpression + temozolomide group presented much greater inhibitory rate than temozolomide group (P<0.01). The G2/M arrest ratio and the cell apoptotic rate at 72 h in the three treatment groups were higher than those in the control group (F=41.63, P<0.001;F=42.30, P<0.01). The increased degree of G2/M arrest ratio and the cell apoptotic rate in FBW7 overexpression + temozolomide group were more obvious compared with temozolomide group (P<0.05, P<0.01). Conclusion FBW7 could enhance the sensitivity of glioma cells to temozolomide treatment, which is associated with G 2/M arrest and the increased apoptosis rate induced by FBW7.

Influencing Factors Analysis of Facial Nerve Function after the Microsurgical Resection of Acoustic Neuroma

OBJECTIVE: To explore and analyze the influencing factors of facial nerve function retainment after microsurgery resection of acoustic neurinoma. METHODS: Retrospective analysis of our hospital 105 acoustic neuroma cases from October, 2006 to January 2012, in the group all patients were treated with suboccipital sigmoid sinus approach to acoustic neuroma microsurgery resection. We adopted researching individual patient data, outpatient review and telephone followed up and the House-Brackmann grading system to evaluate and analyze the facial nerve function. RESULTS: Among 105 patients in this study group, complete surgical resection rate was 80.9% (85/105), subtotal resection rate was 14.3% (15/105), and partial resection rate 4.8% (5/105). The rate of facial nerve retainment on neuroanatomy was 95.3% (100/105) and the mortality rate was 2.1% (2/105). Facial nerve function when the patient is discharged from the hospital, also known as immediate facial nerve function which was graded in House-Brackmann: excellent facial nerve function (House-Brackmann I–II level) cases accounted for 75.2% (79/105), facial nerve function III–IV level cases accounted for 22.9% (24/105), and V–VI cases accounted for 1.9% (2/105). Patients were followed up for more than one year, with excellent facial nerve function retention rate (H-B I–II level) was 74.4% (58/78). CONCLUSION: Acoustic neuroma patients after surgery, the long-term (≥1 year) facial nerve function excellent retaining rate was closely related with surgical proficiency, post-operative immediate facial nerve function, diameter of tumor and whether to use electrophysiological monitoring techniques; while there was no significant correlation with the patient’s age, surgical approach, whether to stripping the internal auditory canal, whether there was cystic degeneration, tumor recurrence, whether to merge with obstructive hydrocephalus and the length of the duration of symptoms.

Multivariate analysis on recurrent hemorrhage after operation of hypertensive intracerebral hemorrhage / 安徽医科大学学报

To analyze the influence of related factors on recurrent hemorrhage after operation of hypertensive intrac-erebral hemorrhage,and investigate the countermeasures against recurrent hemorrhage. 124 patients with surgical treated hypertensive intracerebral hemorrhage were analyzed retrospectively. Logistic regression analysis was applied to analyze the function of various possible factors that might induce recurrent hemorrhage. The incidence of recur-rent postoperative hemorrhage was 16. 1% . Univariate logistic analysis disclosed that timing of operation,the hem-orrhage site and coagulation factor disorders,difficulties met during the operation and inadequate hemostasis,and postoperative blood pressure fluctuation were significantly related with recurrence of hemorrhage(P < 0. 05). Multi-variate logistic regression analysis showed that timing of operation,difficulties met during the operation and inade-quate hemostasis and postoperative blood pressure fluctuation were risk factors of recurrent hemorrhage(P < 0. 05). The optimal operative time,strict hemostasis in operation and appropriate postoperative blood pressure control are important measures in preventing recurrent hemorrhage.

Neuro-endoscopic endonasal transsphenoidal surgery for the large pituitary adenoma:78 cases report / 中华显微外科杂志

Objective To summarize the experience of the simple neuroendoscopic endonasal transsphenoidal surgery for the large pituitary adenoma and discuss it's application value.Methods Seventy-eight cases of the large pituitary adenoma treated by simple neuroendoscopic endonasal transsphenoidal surgery from July,2011 to May,2014 were analyzed retrospectively.Tumors were resected using 0 and 30 degree endoscope after opening the same side of the anterior wall of the sphenoidal sinus and sellar bone using the abrasive drilling during operation.Results The tumor removal was total in 62 (79.49％),subtotal in 12 (15.38％),major in 3(3.85％) and part in 1 (1.28％).Seventy-one cases were followed up for 2 months to 2 years after operation and no recurrence was founded,the symptoms of headache disappeared in 49 cases;The vision of patients was improved in 47 cases,menstruation resumed in 12 cases;The acromegaly of patients reduced in 21 cases.Hormone level review of PRL returned to normal in 32 cases,GH returned to normal in 21 cases,ACTH returned to normal in 2 cases.Conclusion The endoscopic transsphenoidal surgery for large pituitary tumors is the safely,minimally invasive surgical techniques.With the development of endoscopic equipment constantly updated and the operational flexibility and comfort is improved ceaselessly,endoscopic transsphenoidal surgery for the sellar tumor will be carried out more widely.

Spinal Cord Ependymoma Associated with Neurofibromatosis 1 : Case Report and Review of the Literature

Patients with neurofibromatosis 1 (NF1) are predisposed to develop central nervous system tumors, due to the loss of neurofibromin, an inactivator of proto-oncogene Ras. However, to our knowledge, only three cases of ependymomas with NF1 have been reported in the literature. The authors present a case of NF1 patient with a spinal cord ependymoma. She was referred for about half a year history of increasing numbness that progressed from her fingers to her entire body above the bellybutton. Magnetic resonance imaging revealed a relative-demarcated, heterogeneously enhanced mass lesion accompanied by perifocal edema in C5-7 level, a left-sided T11 spinous process heterogeneously enhanced mass in soft tissue, intervertebral disk hernia in L2-5 level, and widespread punctum enhancing lesion in her scalp and in T11-L5 level. The patient underwent C5-7 laminectomies and total excision of the tumor under operative microscope, and intraoperative ultrasonography and physiological monitoring were used during the surgery. Histopathologically, her tumor was found to be a ependymoma without malignant features (grade II in the World Health Organization classification). Therefore, no adjuvant therapy was applied. Following the operation, the patient showed an uneventful clinical recovery with no evidence of tumor recurrence after one year of follow-up.

Association between socioeconomic status and esophageal squamous cell carcinoma in the population of Taixing area, Jiangsu province / 中华流行病学杂志

Objective To study the relationship between socioeconomic status (SES) and esophageal squamous cell carcinoma(ESCC) in Taixing city,Jiangsu province.Methods A populationbased case-control study was carried out to collect data including demography,socioeconomic status indicators and possible risk factors.Unconditional logistic regression was used to compare different SES indicators and composite wealth scores constructed between cases and controls,using the principal component analysis methodology.Results Factors as:having received high school or higher education (OR=0.66,95％CI:0.46-0.96),living space over 67 m2 per-capita (OR=0.71,95％CI:0.54-0.94),drinking tap water longer than 5 years (OR=0.76,95％ CI:0.59-0.98) and wealth score ＞0.93 (OR=0.63,95％CI:0.48-0.83) were associated with increased risk of ESCC.Compared to those worked in farming,forestry,animal husbandry,fishery and water conservancy,the individuals who worked in business-service industry were at lower risk of ESCC (OR =0.65,95％CI:0.43-0.97).Conclusion An inverse association of low SES and ESCC were found in Taixing people that called for further explanation.

Microanatomical study of the endoscopy-assisted extreme lateral supracerebellar infratentorial keyhole approach to the dorsolateral mesencephalon region / 中华显微外科杂志

Objective To explore the microanatomy technique of the endoscopy-assisted extreme lateral supracerebellar infratentorial keyhole approach and clinical significance.Methods The extreme lateral supracerebellar infratentorial keyhole approach was imitated in 10 vascular perfusion adult cadaveric heads fixed in formalin,the dorsolateral mesencephalon region was dissected and observed by microscopy and neuroendoscopy from December 2012 to March 2013.Results The extreme lateral supracerebellar infratentorial keyhole approach could be fully exposed the ambient cisterns,the posteromedial tentorial incisura,the dorsolateral mesencephalon region,the trochlear nerve,the root of the trigeminal nerve,the superior cerebellar artery,the posterior cerebral artery and other important anatomical structures.The temporal lobe and parahippocampal gyrus could be exposed when the tentorial was incised.The application of neuroendoscopy could clearly reveal the trigeminal nerve and surrounding structures.Conclusion The extreme lateral supracerebellar infratentorial keyhole approach is suitable for the surgical resection in dorsolateral mesencephalon region.The application of neuroendoscopy can make up for the lack of the trigeminal nerve observed under microscopy and expand the operative field.

Resection of the fourth ventricle tumors through lateral wall type of the cerebellomedullary fissure approach under endoscope / 中华显微外科杂志

Objective To investigate the therapeutic effect of the fourth ventricle tumors through lateral wall type of the transcerebellomedullary fissure approach under endoscope.Methods Clinical data of 14 cases with the fourth ventricle lesions were analyzed retrospectively.All the patients were treated by lateral wall type of the transcerebellomedullary fissure approach surgery.The endoscope was used if the lesions develop to the aqueduct and hard to be exposed.Both neurophysiological monitoring and intraoperative ultrasound were used regularly.Results Tumors were totally removed in 12 cases,subtotally in 1,and partially in 1.All the patients were diagnosed in postoperative histopathology,including 4 medulloblastoma,three epidermoid cyst,two ependymoma,two hemangioblastoma,one meningioma,one cavernous hemangioma and 1 astrocytoma.Hypopnea occurred immediate after operation in 1 patient.Ventilatory support was performed by Ventilator,and the respiration was restored 1 day later.Normal cerebrospinal fluid circulation was return in all cases.Neither aggravation of preoperative symptoms nor nuclei injury related complication had been found.The follow-up interval between 3 months to 28 months,one patient was dead with unexplained,and 1 medulloblastoma patient was relapse.Conclusion Lateral wall type of the transeerebellomedullary fissure approach,under endoscope,combined with the usage of neurophysiological monitoring and intraoperative ultrasound,can degrade the surgical related complications such as facial palsy and amblyacousia.

The micro-anatomical study of joint the high cervical with jugular foramen approach / 中华显微外科杂志

Objective To investigate the micro-anatomical approach to resect both intracranial and extracranial jugular foramen tumors in one-stage. Methods With the aid of surgical microscope, fifteen cadaver heads were used to study the microsurgical anatomy of high cervical part and jugular foramen, measure relative data. Results Detailed dissection was performed on high cervical part between the 1st cervical vertebra and the 4th cervical vertebra, resect foramen processus transversi of the 1st cervical vertebra, free vertebral artery 2nd and 1st cervical vertebra segment and horizontal segment. The jugular tubercle, jugular tunisia and part of the occipital condylus was drilled away as much as possible, total exposure of lateral semicircular canal was completed after the removal of the mastoid revealed labyrinthinem. Then the sigmoid sinus and jugular bulb were skeletonized. The vertical of segment of facial nerve was fully skeletonized to study the necessity of the facial nerve translocation. Full exposure to the sigmoid sinus, open jugular foramen. JF areas expanded, and the measured parameters revealed. The distance was (29.65 ± 3.24)mm from mastoidalec to oncentrated focus of condyle (10.18 ± 0.81)mm from hinder margin of condyle to endostoma of hypoglossal canal. The left distance was (6.8 ± 0.35)mm from jugular foramen to perpendicular part of facial nerve, right was (4.6 ± 0.33)mm. Conclusions Total exposure of JF can be achieved through the approach we described, and will enable the facial nerve, cochlea, and the structure of the vertebral artery to be performed. Both intracranial and extracranial tumors can be removed in a one-stage procedure related to anatomical parameters. Improve the cure, reduce complication and lower mortality.

Approach of operative technique in treatment of chronic subdural hematoma / 中国医师进修杂志

Objective To approach operative technique for chronic sub, dural hematoma (CSDH).Method The clinical information including general state of health, operative technique and prognosis of the 250 cases with CSDH were retrospectively analyzed. Results Within the 250 cases, 202 were old people with age over 50 and 176 had definite trauma history. In 25 cases treated by burr hole and drainage, 5 cases who had hematoma recurrence and 10 cases who had pneumocephalus, among whom, 6 had tensional pneumoeephalus, were all cured by second operation while the rest got cured. In 207 cases treated by burr hole, douche and drainage, no pneumocephalus or intracranial infection occurred. Twenty of them relapsed and were cured by second operation. Cerebral contusion eccurred in 1 case for pipe was inserted into the brain tissue by mistake, but it got better after active therapy. The other 18 cases were all cured through eraniotomy,hematomas removal as well as envelope excision. Conclusions CSDH is common in the old with age over 50 and it has relationship with head injury,mostly. The single hole trepanation, douche and drainage is simple, safe ,with minimal trauma and high cure rate. To master the operative technique including douching thoroughly, drainage through a pipe and brain protection is very important to the success of the operation.

Study the antitumor mechanisms of extract of centipede on HCC Bel-7404 cell line / 中国医师杂志

Objective To investigate the cell cycle and mechanisms of HCC Bel-7404 cell line by treatment of extract of centipede ( ECP). Method Bel-7404 cell line was cultured in vitro. ECP was applied to the interference of the growth of Bel-7404 with different drug concentration. Cell cycles and apoptosis ratios of ECP group were detected by flow cytometry (FCM). To investigate the expression of apop-tosis related genes XIAP and Bax, we also detect HCC Bel-7404 cell line after 48 hours treated with ECP by immunohistochemical method. Result The results of FCM displayed that ECP in treatment group mainly retard cell cycle phase in G0/G1 after 48 hours. The ratios of G0/ G1 .proliferation index (PI) and apoptosis ratios were significantly different between treatment group and control group when the concentrations were different. It was also significantly different between treatment group and control group when the same concentration of ECP was used. It showed that XIAP gene expression decreased gradually while Bax gene expression increased with the increase of ECP concentration, and these were statistical significance in contrast to control group ( P <0.05). Conclusion ECP mainly retarded cell cycle phase of Bel-7404 in G0/G1, suppressed the proliferation, and could induce it to apoptosis. The inhibitory effect was time - concentration dependent. The mechanisms were due to promote Bax gene and inhibit XIAP gene expression in HCC Bel-7404 cell line.