ABSTRACT
In order to compare the setting of difference coefficients in DRG point payment in different cities in Zhejiang province, the implementation rules of DRG point payment issued by 11 cities in Zhejiang province were comprehensively analyzed. It was found that the difference coefficients in different cities could be divided into three categories, including hospital coefficients alone, hospital coefficients and grade coefficients weighted, and weighted by hospital coefficients, grade coefficients, personal burden levels, case mix indexes, and head-to-time ratio. Its setting differences included four aspects: connotation composition, weight distribution, threshold value, and classification of medical institutions. The authors suggested that the adjustment cycle should be set scientifically to dynamically adjust the difference coefficient, and the scientific setting of the difference coefficient should be promoted through provincial coordination.
ABSTRACT
Objective:To evaluate the effect of clinical pathway implementation on medical efficiency and medical expenses of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" diseases by using diagnosis related group (DRG) related indicators.Methods:The data of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" included in the clinical pathway management from January 2017 to December 2019 in the Department of Rheumatology and Immunology of Jinhua Hospital, Zhejiang University School of Medicine were carried out. The impact of clinical pathway implementation on the average hospital stay, average cost and average drug cost of patients with the two diseases were analyzed and compared , so as to evaluate the effect of the implementation of the clinical pathway.Results:From the implementation of clinical pathway in 2017 to 2019, the number of patients admitted and total medical specialty services in the two groups of " rheumatoid arthritis" and " ankylosing spondylitis" increased year by year ( P<0.01). The average length of stay, average cost and average drug cost of patients in the " rheumatoid arthritis" disease group decreased year by year, with statistically significant differences between groups (all P<0.01). The average length of stay in the ankylosing spondylitis group was shortened year by year, and the difference was statistically significant ( P<0.01). Compared with 2017, the average cost in 2018 decreased significantly, and the difference was statistically significant ( P<0.01). There was no significant difference in average cost between 2018 and 2019 ( P>0.05). The average cost in 2018 was significantly higher than that in 2017 ( P<0.05). After analyzing the causes and optimizing the clinical pathway, the average cost in 2019 was significantly lower than that in 2018 ( P<0.01). Conclusions:Through the implementation of clinical pathways and continuous optimization of pathway connotation during use, the diagnosis and treatment efficiency of patients with " rheumatoid arthritis" and " ankylosing spondylitis" can be significantly improved, and medical costs can be reduced, which is in line with the current medical reform needs.
ABSTRACT
Objective To evaluate the effect of MRS-assisted stereotactic radiosurgery (SRS) for small recurrent high grade glioma (HGG).Methods A total of 54 patients with recurrent HGG were selected,the tumor diameter was less than 3 cm,the patients were divided into the conventional MRI group of 26 cases,and MRI+MRS group of 28 cases.The target region of the conventional MRI group was defined as the enhanced and short T1,long T2 area;MRI+MRS group was defined as the region of Cho/NAAindex (CNI) ≥1.6 in the surrounding short T1,long T2 and enhanced area.All the patients were followed up at least 12 months,analysed their therapeutic effect.Results Compared with the conventional MRI group,MRS+MRI group margin dose increased (19.46 Gy vs.13.58 Gy),the average diameter of target were smaller (2.6 cm vs.3.0 cm),progression-free survival was longer (6.8 months vs.5.6 months),the 1-year survival rate was higher (78.6％ vs.50.0％),and the occurrence rate of brain edema was lower (5 vs.17),the difference was statistically significant (P＜0.05).Conclusion MRI+-MRS assisted SRS helps to accurately identify the scope of HGG,its short term effect was superior.
ABSTRACT
Objective To study the factors influencing prognosis in the patients with recurrent glioblastoma muhiforme (GBM) and to investigate the effect of retreatemt.Methods The retrospective analysis method was adopted to collect the clinical and follow up data in 36 cases of recurrent GBM retreatment in the neurosurgery department of this hospital from March 2008 to March 2013.The prognosis influencing factors were analyzed.Results The univariate analysis results showed that the gender,resection degree,treatment mode and initial scheme had the influence on the progression free survival(P＜0.05).The resection degree had an impact on the overall survival(P＜0.05).The multivariate analysis results showed that KPS score,resection degree and treatment mode had effect on the progression free survival(P＜0.05).The resection degree had an influence on the overall survival (P＜0.05).Conclusion If the patients with recurrent GBM still hasthe chance of operation whole excision,the re-treatment can reach the effect for relieving the symptoms,improving the quality of life and prolonging the survival period.
ABSTRACT
Objective To investigate the clinical effect of using uninterrupted vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis in treating frontal sinusitis after craniotomy.Methods The clinical data in 31 cases of frontal sinusitis after craniotomy in our hospital from January 2006 to December 2014 were retrospectively analyzed.Seventeen cases adopted simple debridement and drainage treatment and 14 cases were treated with continuous vacuum sealing drainage combined with routine debridement treatment.Postoperative follow up lasted over 1 year.Results In simple debridement and drainage,12 cases were cured,the other 5 cases recurred after operation,and the cure rate was 70.6 ％.But in the continuous vacuum sealing drainage combined with routine debridement treatment,14 cases were cured,no case recurred after operation,and the cure rate was 100％.Therefore,the cure rate of continuous vacuum sealing drainage treatment combined with routine debridement was higher than that of simple debridement and drainage treatment(P＜0.05).Conclusion Adopting vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis can promote the infection focus clearance and wound healing,and increases the cure rate.
ABSTRACT
Objective To evaluate the efficacy of endovascular embolization in intracranial aneurysm treatment .Methods We retrospectively analyzed 130 patients with different locations and types intracranial aneurysms treated by variety endovascular em‐bolization .The postoperative and long‐term follow up results was examined .Results 124 cases with 139 aneurysms was successful‐ly embolized ,1 case failed but clipping successfully .6 cases suffered from intraoperative bleeding ,3 cases died ,3 cases had a good recovery .The results of Glasgow Outcome Scale after operation:1 score 3 cases ,2 score 0 case ,3 score 1 case ,4 score 3 cases ,5 score 123 cases .119 cases(91% ) were followed up for 3‐48 months with an average of 12 months .33 cases(27% ) achieved long‐term follow‐up(exceeded 6 months) .During follow‐up ,1 case had severe stenosis of the parent artery and received angioplasty .The other cases didn′t see aneurysms in cerebral angiography and showed different degree of neurological function recovery .Conclusion According to the different intracranial aneurysm with endovascular treatment of corresponding intravascular can effectively im‐prove the clinical treatment effect ,reduce the risk of aneurysm rupture ,improve the prognosis of the patients .
ABSTRACT
Objective To explore the role of glucose-regulated protein 78 (GRP78),p38 mitogen-activated protein kinase(p38MAPK) signal pathway in seizure-reduced brain injures and the regulatory effect of Nimodipine on it.Methods Sprague-Dawley(SD) rats were randomly divided into status convulsion group (SC group),Nimodipine group(NM group),and a normal control group(NC group).The expressions of GRP78/Bip and p38MAPK mRNA and protein were detected by reverse transcription(RT)-PCR and immunohistochemistry.The expression of apoptosis cells was observed by TdT-mediated dUTP nick end labeling (TUNEL).Results (1) Immunohistochemistry:at 4 h after induction of status convulsion,the expression of GRP78 protein in the hippocampus CA1 domain began increasing slightly,and reached a maximum at 24 h,and then began decreasing slowly ; at 4 h after induction of status convulsion,the expression of p38MAPK protein in the hippocampus CA1 domain began increasing,and reached a maximum at 24 h,and decreased remarkably at 48 h.(2) RT-PCR:at 4 h after induction of status convulsion,the expression of GRP78 protein in the hippocampus CA1 domain began increasing slightly,and reached a maximum at 24 h,and then began decreasing slowly.The NM group was much higher than the SC group and the NC group(all P ＜ 0.05) ; at 4 h after induction of status convulsion,the expression of p38MAPK protein in the hippocampus CA1 domain began increasing,and reached a maximum at 24 h,and decreased remarkably at 48 h;the NM group was much lower than the SC group,and higher than the NC group (all P ＜ 0.05).(3) TUNEL:at 4 h after induction of status convulsion,the expression of the TUNEL positive cells in the hippocampus CA1 domain began increasing slightly,and reached a maximum at 48 h,and then began decreasing,and there was no difference between SC group and NC group;the NM group was much lower than the SC group(all P ＜ 0.05).Conclusions The correlation of the increased expression of p38MAPK and neuronal apoptosis indicates that GRP78 signal pathway may be mediated to cell apoptosis through p38MAPK.Nimodipine can affect the expression of GRP78/Bip and p38MAPK,and relieve endoplasmic reticulum stress,and lessen the pathologic damage to the hippocampus.
ABSTRACT
Objective To retrospectively review the epidemiological data from 159,242 patients hospitalized after traumatic brain injury in traffic accidents and provide epidemiological evidences for the prevention and treatmentmeasures.Methods Patient data were collected using the Chinese Trauma Database for the years 2001-2007.Epidemiological features of age,gender,time distribution,length of hospital stay,state of injury,and treatment outcome were recorded.Results Age of the patients was (33.01 ± 15.20) years and ratio of male to female patients was 2.39∶ 1.The majority were aged 21-50 years with the 31-40 age group were more vulnerable.Annual average growth of age was 3.92％.Within a year,number of the patients accounted for 54.10％ from July to December with it reached the peak in October.Mean length of stay was 20.20 days with the longest stay in the ≥90 age group and shortest stay in the ≤10 age group.Mean hospital charges was 13 689.8 yuan with the ≤10 age group occupying the least and 51-60 age group occupying the most.Overall cure rate was 66.92％ and mortality was 4.22％.Proportion of severe traumatic brain injury in traffic accidents increased and related cure rate decreased with increased age.Male patients showed higher death rate and lower cure rate compared with female patients.Conclusions Incidence of traffic accidents-related traumatic brain injury is the most in the young and middle-aged population and is prevalent in the second half year.There should be emphasis on the aged or male patients.Measures to prevent and treat the injury may produce better results when defined based upon these epidemiologic features.
ABSTRACT
Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome, characterized by the association of facial port-wine hemangiomas in the trigeminal nerve distribution area, with vascular malformation(s) of the brain (leptomeningeal angioma) with or without glaucoma. Herein, we reported Sturge-Weber syndrome in a 50-year-old man, who presented port-wine hemangiomas and epilepsy. In this case, the patient's epilepsy episodes from his first year of life had been ignored and separated from the entity of SWS by his physicians, which led to delayed treatment. This case illustrates the importance of careful examination of patients of any age with hemangiomas in the trigeminal nerve with concomitant episodes of epilepsy. In such cases, there should be yearly neuroimaging screenings to guaranteed early interdisciplinary interventions from the time of definite diagnosis.
Subject(s)
Humans , Middle Aged , Brain , Epilepsy , Glaucoma , Hemangioma , Mass Screening , Neurocutaneous Syndromes , Neuroimaging , Sturge-Weber Syndrome , Trigeminal NerveABSTRACT
Objective To study the characteristics of craniocerebral injury caused by the handgun bullet impacting on the bulletproof helmet.Methods Fourteen healthy landrace pigs were involved and randomly divided into injury group(n =9)and control group(n =5).The landrace pigs of the injury group were shot vertically on the head under the protection of helmet plate with 9 mm handgun bullet at velocity of 360 m/s.While the landrace pigs of the control group were dealt with the same process as the injury group except for use of unarmed handgun bullet of the same ammunition dose.The changes of vital sign in the early period and the retina injury at two hours after injury were observed.Porcine cerebrospinal fluid (CSF)at pre-injury and at three hours post-injury were obtained for investigating the levels of neuron specific enolase(NSE)andαⅡ-spectrin protein.Then,the landrace pigs were sacrificed and dissected to examine the general morphological changes of the brain.The brain cortex was taken,fixed and stained with hematoxylin-eosin for microscopic observation.Results The landrace pigs in the injury group manifested decrease of the blood pressure and increase of the heart rate and respiratory rate in the early stage after injury.General morphological observation found retinal hemorrhage(3/9),skull fracture(3/9)and brain surface damage including local impact lesion(9/9)and contrecoup lesion(9/9),with severe impact lesion than contrecoup lesion.Optical microscopic observation revealed acute injury of the cerebral cortex neuron both on the impact and contrecoup locations.The concentrations of NSE and αⅡ-spectrinwere significantly increased in CSF three hours after injury(P ＜ 0.05).Conclusions The handgun bullet impacts on the pig head protected by the bulletproof helmet may induce blunt craniocerebral injury in the early period,with severe impact lesion than contrecoup lesion.Therefore,traumatic brain injury of the soldiers armed with the helmets should be stressed and managed early.
ABSTRACT
Objective To explore the relationship of phosphatase and tensin homology deleted on chromosome ten ( PTEN ) expression with the positioning of AMPA recepter subunit GluR2 in hippocampal neuron after stretch injury. Methods The primary rat hippocampal neuron from neonate rats were cultured and the model of stretch injury established. Western blot and TUNEL staining were used to detect PTEN expression and the positioning of AMPA receptor subunit GluR2 in rat hippocampal neuron at different time intervals after stretch injury. Results The PTEN expression was increased obviously after stretch injury, while the expressions of AMPA receptors GluR1, GluR2 and GluR3 showed no evident differences at every time point. However, AMPA receptor subunit GluR2 located at cytomembrane was down-regulated obviously after stretch injury. Conclusion The intracellular PTEN expression and the expression of AMPA receptor subunit GluR2 located at cytomembrane are on the contrary, indicating that PTEN phosphatase may participate in the transport and reintegration process of AMPA receptor subunit GluR2 located at cytomembrane.
ABSTRACT
Objective To investigate the accuracy of predicting acute postoperative pain by assessment of intravenous propofol injection-induced pain.Methods Seventy-one ASA I or Ⅱ patients aged 20-40 yr scheduled for induced abortion operation were enrolled in this study. The patients were unpremedicated. ECG, HR, BP and SpO_2 were continuously monitored before and during anesthesia. Anesthesia was induced with 2 mg/kg propofol. A third of the induction dose was injected via a dorsal hand vein. Pain induced by iv propofol injection was assessed with verbal rating scale (VRS) (0 = no pain, 3 = severe pain) . Postoperative abdominal pain was assessed with visual analog scale (VAS) (0 = no pain, 100 = most severe pain) at 20 min after operation. Results The propofol injection pain occurred in 66% of patients. Postoperative VAS scores at rest and during activity and intravenous propofol injection-induced pain were significantly correlated (r = 0.561, P<0.01; r = 0.608, P<0.01). The sensitivity and specificity of iv propofol injection-induced pain (VRS > 1) in predicting clinically significant acute postoperative pain (VAS > 30) were 96% and 52% respectively. Conclusion Preoperative iv propofol injection induced pain is a reliable factor in predicting acute postoperative pain and is useful in identifying those women who will experience greater pain after operation.
ABSTRACT
BACKGROUND:It has been reported that blast wave and haze can lead to hemodynamics disturbance.However,studies on blast-haze combined injury on hemodynamics changes are few.OBJECTIVE:To investigate the effect of blast-haze on the hemodynamics parameters during early period following cabin explosion,additionally,to evaluate the feasibility of brain natriuretic polypeptide(BNP) to serve as the damage criterion in early detection.DESIGN,TIME AND SETTING:Randomization,experimental observation of animal was performed at the Research Institute of Surgery,Daping Hospital,Third Military Medical University between August 2006 and August 2007.MATERIALS:One hundred and four healthy,male SD rats were randomly divided into the normal control(n=8),blast injury(n=48),and combined injury(n=48) groups.METHODS:The rats were fixed in the cabin according to the position of the war sitting,0.4 g cyclotrimethylene trinitramine were used to explosion in the centre of the cabin.The rats in the blast injury and combined injury group were took out immediately and 100 s after explosion,respectively.No treatment was performed in the normal control group.MAIN OUTCOME MEASURES:The heart function changes,the level of BNP,as well as the pathological change of lung tissues were analyzed by ELISA,double antibody sandwich method,and the microscope at 1,3,6,12,24,and 72 hours after injury,respectively.RESULTS:Compared with the normal control group,there were significantly differences of pathomorphological changes in the blast injury and combined injury groups,even,more severe in the combined group than the blast injury group.The level of BNP at each time point was higher than that of the normal control group(P
ABSTRACT
BACKGROUND: The activation of hypothalamus-pituitary-adrenal cortex axis may play key role in the increasing expression of hypothalamic corticotropin-re-leasing hormone (CRH) during stress reaction. However by what way to induce the CRH expression in hypothalamic neuron, and whether CRH can activate hypothalamic neurons are still not very clear.OBJECTIVE: To observe the changes of intracellular cyclic adenosine monophosphate (cAMP) and cytoplasmic Ca2+ concentration in the hypothalamic neurons cultured in vitro due to exogenous CRH stimulation.DESIGN: Comparative observation experiment.SETTING: Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA; Department of Neurosurgery , Tiantan Hospital, Capital University of Medical Sciences MATERIALS: This experiment was carried out in the Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA between December 1999 and March 2002. Hypothalamus was obtained from fetus rat at pregnancy of 17 days for the in vitro culture of hypothalamic neurons.METHODS: Hypothalamic neurons were co-cultured with exogenous CRH,with or without pretreatment with specific CRH 1 receptor antagonist -CP-154526. hypothalamic neurons were randomized into: ① CRH (10-12,10-10, 10-8, 10-6 mol/L) stimulation group. ② CP-154526(500 μmol/L)pretreatment aud CRH ( 10-12, 10-10, 10-8,10-6 mol/L) stimulation group. ③Hypothalamic neurons in corresponding normal control group were exposed to the isotonic saline stimulation. PTI fluorescence image system was used to determine and analyze the change of cytoplasmic free Ca2+ concentration in hypothalamic neurons due to exogenous CRH stimulation and RIA was used to detect the neuronal cAMP content.MAIN OUTCOME MEASURES: ①Cytoplasmic free Ca2+ concentration in hypothalamic neurons. ②cAMP content in hypothalamic neurons.RESULTS: The cytoplasmic free Ca2+ concentration and cAMP content were relatively lower in the hypothalamic neurons in normal control group,which obviously increased due to CRH stimulation [(240±22),(153±11)nmol/L; (3.26±0.19),(0.44±0.02) pmol/dish,P ＜ 0.01];CP-154526 could remarkably suppress the CRH (10-6 mol/L)induced increase in cytoplasmic free Ca2+ concentration and cAMP content in hypothalamic neurons [Ca2+ concentration: (240±22),(171±16)nmol/L; cAMP content:(3.26±0.19), (2.33±0.21) pmol/dish, P ＜ 0.01].CONCLUSION: CRH can directly act on hypothalamic neurons via type 1-receptor,thereby increase the cytoplasmic free Ca2+ concentration and cAMP content in hypothalamic neurons,playing the key role in the modulation of the synthesis and secretion of CRH during the activation of hypothalamic neurons.
ABSTRACT
BACKGROUND: Through what signal pathway does corticotropin release hormone (CRH) regulate hypothalamic neuronal neuroendocrine activity during acute stress?OBJECTIVE: To probe into the regulatory effects of CRH on CREB secretion in hypothalamic neurons.DESIGN: Repetitive measurement design.SETTING: At Field Surgery Research Institute of Daping Hospital, Third Military Medical University of Chinese PLA; Neurosurgery Department,Tiantan Hospital Affiliated to the Capital University of Medical Sciences.MATERIALS: This experiment was carried out in Daping Hospital of Third Military Medical University of Chinese PLA between December 1999and March 2002. Rat fetuses were selected from Wister rats of 17-day gestation.METHODS: In vitro cultured cells were divided into the following groups:① CRH (10-12, 10-10, 10-8 and 10-6 mol/L) stimulation groups. ② Pretreated with nimodipine (5 μmol/L) or CP-154526 (500 μmol/L) followed by CRH (10-12, 10-10, 10-8 and 10-6 mol/L ) stimulation groups. ③ Corresponding control groups stimulated with isotonic physiological saline. PTI fluorescence imaging system was used to detect the changes of neuronal cytoplasmic free calcium concentration; meanwhile, Western blot technique was used to determine the changes of neuronal P-CREB content.MAIN OUTCOME MEASURES: ① Changes of neuronal cytoplasmic free calcium concentration. ② Changes of neuronal P-CREB content.RESULTS: The content of cytoplasmic free calcium in hypothalamic neurons was lower in normal control group, and it increased immediately after exogenous CRH stimulation. However, such increase could be suppressed by pretreatment with nimodipine or CP-154526 before CRH stimulation,and the increase of neuronal P-CREB content was also obviously suppressed.CONCLUSION: During acute stress, the combination of CRH with hypothalamic neuronal CRH 1 receptor leads to the opening of membrane Ltype calcium ions channels, thus enhancing the influx of calcium ions and increasing cytoplasmic free calcium ions content, which would further activate P-CREB signal transduction pathway in neurons. It suggests that CRH may play a vital role in hypothalamic neuronal activation.
ABSTRACT
Objective To investigate the signal regulatory mechanism of expression of corticotropin releasing hormone (CRH) stimulated neurons of hypothalamic slices in rats in vitro . Methods Model of hypothalamic slices of rats was established. After CRH stimulatation of corticotropin releasing hormone type 1 receptor (CRH1R) of hypothalamic slices in rats in vitro , the changes of activity of protein kinase A (PKA) signal passway were observed by immunocytochemical method and Western blotting. The relationship between the changes and CRH mRNA expression was also observed. Results CRH could cause the remarkable increase in phosphorylated PKA, phosphorylated CREB, and CRH content in hypothalamic slices in rats. However, CPl54526 or H89 could have significant inhibitory effect on the synthesis of P PKA, P CREB, and CRH. Conclusion PKA signal passway can regulate the ultrashort positive feedback of CRH secretion in the rat hypothalamus in stress due to severe trauma.
ABSTRACT
Objective To investigate the expression of receptor tyrosine kinase EphB2 and its relationship with peritumoral brain edema (PTBE) in meningiomas and to explore the possible mechanism of PTBE in meningiomas. Methods A total of 44 meningioma tissue samples from patients undergoing surgery and 14 normal meninges samples as the control were collected for the examination of the immunoreactive EphB2 expression. The expressions of EphB2 in different types of meningiomas were determined by immunohistochemical method. Peritumoral brain edema was assessed on a subjective 5 point(0～4) scale based on the data from preoperative magnetic resonance imaging scan. Results ① The expressions of EphB2 in 44 cases of meningiomas were: scale 4 in 7 cases, scale 3.5 in 5 cases, scale 3 in 6 cases, scale 2.5 in 2 cases, scale 2 in 8 cases, scale 1 in 13 cases, scale 0 in 3 cases, mean scale 2.19 . ② No expression of EphB2 was found in 10 out of the 14 normal meninges samples, but minimal (scale 1) expression of EphB2 was found in only 4 cases. ③ Preoperative MRI results showed different levels of PTBE in 33 out of 44 cases. Conclusion There is expression of EphB2 in the cytoplasm in most meningiomas. The expression of EphB2 in meningnioma is positively correlated with peritumoral brain edema, suggesting that EphB2 participates in PTBE of meningiomas.
ABSTRACT
Objective To evaluate the therapeutic efficacy of gamma knife for the treatment of idiopathic trigeminal neuralgia Methods An analysis of 87 cases with idiopathic trigeminal neuralgia treated by gamma knife in our department in the past 5 years was performed In all cases, 4 mm isocenter was targeted at the proximal nerve at the root entry zone located by MRI The target dose varied from 70-90 Gy Results After a follow up of 6-67 months, complete relief of pain occurred in 66 patients (75 9%), 50%-90% relief in 18(20 7%), relief less than 50% in 2(2 3%) but no relief in 1(1 1%) Repeated radiosurgery was performed in 2 patients (2 3%) with recurrent pain After the second radiosurgical procedure, complete relief of pain was found in the 2 patients Two patients(2 3%) experienced facial numbness after radiosurgical procedure Conclusion Gamma knife radiosurgery is a minimally invasive technique for the treatment of trigeminal neuralgia with few complications Repeated radiosurgical procedure may result in relief of pain, but the long term outcome of gamma knife surgery for trigeminal neuralgia needs to be further studied
ABSTRACT
Objective To analyse the therapeutic outcome of cavernous sinus meningiomas by gamma knife radiosurgery. Methods Retrospective analysis was conducted of 37 patients with cavernous sinus meningiomas. The median maximum diameter was 2.6 cm (1.4～3.2 cm) with the median dose to the tumor margin of 15.7Gy(8～22 Gy), the isodose curve to the tumor margin of 40%～60% and the target numbers of 1～9. The radiosurgical dose to the optic nerve and brain stem was not more than 10 Gy and 15 Gy, respectively. Results After an average follow up of 22.6 months(ranging 4～43 months), unchanged symptoms were found in 22 cases(59.5%), alleviated in 12 cases(32.4%) and complications of optic and trigeminal nerve in 3 cases(8.1%). By MR image analysis, unchanged size was found in 18 cases(48.6%), smaller size in 15 cases(40.5%) and larger size in 4 cases(10 8%). One factor analysis of variance revealed that tumor recurrence was associated with marginal dosage(
ABSTRACT
Objective To investigate protein kinase A (PKA) signal regulatory mechanism of corticotropin-releasing hormone (CRH) mRNA expression, after CRH stimulated neuron of hypothalamic slices in rats in vitro. Methods After CRH stimulated corticotropin-releasing hormone type 1 receptor (CRH1R) of hypothalamic slices in rats in vitro, the changes of activity of PKA signal pathway and their relationship with CRH mRNA expression were observed by reverse transcription-polymerase chain reaction (RT-PCR), Western blotting. Results CRH may cause the remarkable increase in phosphorylated PKA (P-PKA), phosphorylated cyclic adenosine monophosphate response element-binding protein (P-CREB) and CRH mRNA content in hypothalamic slices in rats. However, CP-l54526 or H89 could have significant inhibition effects on the synthesis of P-PKA, P-CREB and CRH. Conclusion PKA signal pathway in ultrashort positive feedback control of CRH secretion in hypothalamus in the stress due to severe traumas.