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With the development of modern international medicine, the subject of disorders of consciousness (DOCs) has begun to be raised in mainland China. Much progress has been made to date in several specialties related to the management of chronic DOC patients in China. In this article, we briefly review the present status of DOC studies in China, specifically concerning diagnosis, prognosis, therapy, and rehabilitation. The development of DOC-related scientific organizations and activities in China are introduced. Some weaknesses that need improvement are also noted. The current program provides a good foundation for future development.
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Humans , China , Consciousness Disorders , Diagnosis , TherapeuticsABSTRACT
Objective To explore the value of the located needles guided by intraoperative ultrasound in resection of brain cavernous malformations. Methods Fourteen patients diagnosed as brain cavernous malformations confirmed by preoperative CT and MRI. Detected by the located needles under intraoperative ultrasound guidance, 14 lesions were excised. Results Intraoperative ultrasound-guided needles accurately located 14 cases of patients with brain cavernous malformations. Fourteen lesions were removed successfully. The distances between lesions and the dura mater were 1.5-2.9 cm,the sizes of lesions were 0.8-2.8 cm. Fourteen lesions by color Doppler flow imaging showed point-like blood flow. Conclusions Brain cavernous malformations can be accurately detected by the located needles under intraoperative ultrasound guidance.
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<p><b>OBJECTIVE</b>To detect the content of the basic fibroblast growth factor in blood samples of patients with Moyamoya disease, and investigate the relationship between Moyamoya disease and the basic fibroblast growth factor.</p><p><b>METHODS</b>This tissue microarray study included 24 cases of superficial temporal artery samples, 15 cases of Moyamoya disease, and 9 cases of normal arteries as control, and bFGF immunofluorescence assay was applied to test the samples. The number of positive cells and total cells of the muscular layer and the endothelium layer were counted separately in every picture, the positive rates were calculated, and the experimental data were analyzed statistically.</p><p><b>RESULTS</b>The bFGF immunofluorescence staining of smooth muscular layer cells, intima cells and endothelial cells from the moyamoya disease group were obviously stronger than that from the control group (P<0.01).</p><p><b>CONCLUSION</b>The enhancement expression of bFGF in the Moyamaya disease group implicates that bFGF plays an important part in the pathogenesis of Moyamoya disease.</p>
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , China , Fibroblast Growth Factor 2 , Blood , Fluorescent Antibody Technique , Moyamoya Disease , Blood , Tissue Array AnalysisABSTRACT
@#Objective To analyse the therapeutic effect and safety of radiofrequency thermocoagulation on refractory neuralgia after craniotomy.MethodsFourteen patients with refractory neuralgia after craniotomy were treated by radiofrequency thermocoagulation. The pain degree (Numeric Rating Scales, NRS) and the complication were observed.ResultsNRS decreased significantly after treatment(P<0.01). No serious complication was observed after radiofrequency thermocoagulation except numbness. No patients recurred after one year follow-up.ConclusionRadiofrequency thermocoagulation is effective on refractory neuralgia after craniotomy.
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@#Objective To investigate the therapeutic efficacy and side effect of regional blockade using diprospan combined with oxycodone and acetaminophen taking orally which called balanced analgesia on severe tension-type headache. Methods 32 patients diagnosed as severe tension-type headache were treated with regional blockade using diprospan mixed with 0.4% lidocaine, combined with oxycodone and acetaminophen. The severity of pain (using numeric rating scales, NRS) and the duration of headache were observed and the side effects were recorded. Results There was a significant decrease in the severity of pain and the duration of headache after treatment compared with those before (P<0.01). No serious side effects were observed. Conclusion The balanced analgesia therapy mainly including regional blockade and oxycodone and acetaminophen can be significantly effective on the severe tension-type headache.
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@#Objective To investigate the effect of radiofrequency on trigeminal neuralgia as the chief complaint of intracranial benign tumor. Methods 18 patients with intracranial benign tumor mainly presenting with trigeminal neuralgia were treated with radiofrequency thermocoagulation guided by CT scanning. The numeric rating scales (NRS) of pain and the complication were observed. Results The scores of NRS decreased significantly after treatment (P<0.01). The common complications included facial numbness and masticatory movement obstacle. One patient recurred 13 months and another patient recurred 24 months after operation. Both were treated with radiofrequency once again, and the pain ceased. Conclusion Radiofrequency is effective on secondary trigeminal neuralgia after intracranial benign tumor.
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Objective To analyze and estimate, the treatment of patients with histologically confirmed subependymal giant-cell astroeytoma (SEGCA). Methods The data from 23 patients with SEG-CA who were diagnosed between February 1995 and February 2008 were retrospectively evaluated. Various combinations of surgery and radiotherapy had been used for treatment. Results Total resection was 16 cases, subtotal resection was 7 cases, radiotherapy was 17 cases. The average follow-up time was 53 months.One postoperative SEGCA recurrence. Epilepsy was totally disappeared in 17.6% (3/17), partly disappeared in 47.1%(8/17). All cases survived. Conclusions The key of treatment is total resection. The significance of radiotherapy is not sure. The overall prognosis of SEGCA is favorable.
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Objective To examine the diagnosis and outcomes in the treatment of the patients with histologically confirmed central neurocytoma (CNC). Methods The data from 71 patients with CNC who were diagnosed between March 2003 and December 2007 were retrospectively evaluated. Various combinations of surgery, and radiotherapy had been used for treatment. Results The average bulk of tumors was 40 cm3. The median follow-up was 22 months. The 22 months overall survival and local control rate was 95.8%(68/71) and 95.6%(65/68), respectively. Conclusions The overall prognosis is favorable although the follow-up is not very long. Surgery and postoperative radiotherapy can significantly improve local control.
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Intracranial aneurysms are a severe cerebrovascular disease.Its incidences ranged from 2% to 4% in general population.With the population aging and the development of imaging technique,the prevalence of intracranial aneurysm is increasing year by year.The research of natural course of aneurysm has important significance for neurosurgeons to evaluate the validity of therapeutic measures.There are significant differences between the patients with aneurysm who have had subarachnoid hemorrhage and those who have not.The rates of ruptured intracranial aneurysms per year ranged from 0.066% to 2%.The risk factors that affect ruptured intracranial aneurysms including the size and place of aneurysm,whether it is multiple aneurysms or not,growth rate,and self-factors of patients,such as age,sex,and history of hypertension and smoking,etc.
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@#Objective To explore the effect of the combined therapy on tension-type headache after acute brain trauma.Methods Fourteen patients with mild brain trauma and complained severe headache diagnosed as tension-type headache were treated by nerve and pain points block with a mixture of 0.4% lidocaine, triamcinolone acetonide 10 mg accompanied by celecoxib and eperisone. After the block, the degree of pain severity and the duration of headache were observed and recorded. The therapeutic effects were evaluated with visual analogue scale (VAS).Results There was a significant decrease in the degree of pain severity and the duration of headache after treatment ( P<0.01).Conclusion The combined therapy mainly including nerve block has a significant effect on tension-type headache after acute brain trauma.
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@#ObjectiveTo investigate the changes of ultrastructure of global cerebral ischemia and reperfusion damage in rats.MethodsSix adult male Wistar rats were randomly divided into the ischemia group (n=3), and sham injury group (n=3). Global cerebral ischemia and reperfusion model were established with Pulsinelli's method. Cortical ultrastructure changes were investigated on the first hour after reperfusion.ResultsIn the ischemia group, different degrees of pyconosis neurons, abnormal organell and microtube of neurons were observed. In addition, glial cell and microvessels were damaged in ischemia group, but that in sham injury group were not demaged.ConclusionCortical neurons, neuroglia cells, cytoskeleton and blood-brain barrier changed at early stage of reperfusion damage.
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OBJECTIVE To determine the distribution and antibiotic resistance of bacteria isolated from cerebral spinal fluid in neurosurgical patients. METHODS Bacterial isolates from cerebral spinal fluid specimens in Department of Neurosurgery,Beijing Tiantan Hospital were collected from Jan 2000 to Dec 2004.Distribution and antibiotic resistance of pathogens were analyzed retrospectively. RESULTS Of 438 isolates,Gram positive cocci and Gram negative bacilli accounted for 72.1%(316 isolates) and 27.9%(122 isolates),respectively.The most frequently isolated pathogen was coagulasenegative staphylococci(53.7%) followed by Staphylococcus aureus(10.5%),Enterobacter spp(6.2%),Acinetobacter spp(6.2%),and Pseudomonas aeruginosa(3.7%).The most active compounds against Gram-negative bacilli were imipenem(87% susceptibility),piperacillin/tazobactam(77%),amikacin(68%),cefepime(64%) and ceftazidime(63% susceptibility).Imipenem,cefepime,ceftazidime,and piperacillin/tazobactam demonstrated excellent activity against most of Gram negative bacilli.In S.aureus and coagulase-negative staphylococci,oxacillin resistance strains accounted for 76% and 100%,respectively. CONCLUSIONS Prevailing pathogens are Gram positive cocci in intracranial infection after neurosurgical operation,especially coagulase-negative staphylococci and S.aureus.Data collected in present study will provide valuable information for prophylactic and empirical antibiotic use in post-operative intracranial infection.
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Objective Moyamoya disease is a progressive cerebrovascular occlusive disease. The etiology of the disease is unknown. most think that Moyamoya usually presents with cerebral ischemia in children and intracranial hemorrhage in adults. But we have some adults present with cerebral ischemia .This article will help us know better about moyamoya disease in adults present with cerebral ischemia. And will let us know better about treatment and prognosis of this disease.Methods We reviewed our experience 88 adults angiographically diagnosed patients with moyamoya. There are 49 patients with moyamoya disease initially present with cerebral ischemia. We report their clinical presentation, radiological findings, management, and clinical outcomes. Results The incidence of moyamoya disease presents with cerebral ischemia is 55.7% in adults .The mean age of patients at symptom onset was 32 years (range, 18~64 years). Ischemic strokes or transient ischemic attacks were the predominant initial presentations.7 cases present intracranial haemorrhage in follow-up period. There was no difference in clinical representation, image and cerebral infarction in this 7 case.Conclusions Moyamoya usually presents with cerebral ischemia in adults higher than we think. diagnosis and treatment of moyamoya disease in adults is essential to minimize residual mental and physiologic deficits. If we find patients 30-40 years old ,with cerebral infarction that can’t explain in conventional mode, we should pursuit these patients, in order to exclude Moyamoya disease .Structured multicenter randomized clinical trials are needed to further assess the best treatment modalities for patients with moyamoya.
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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.
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BACKGROUND: Quiet a number of researches has reported the morphological changes of global ischemic reperfusion model. However, there are few reports on the ultrastructural changes of cortex in early reperfusion, especially the change of blood brain barrier.OBJECTIVE: To explore the changes of brain cortex neurons, glial cells and blood brain barrier in order to provide reliable evidence for clinical treatment.DESIGN: A randomized and controlled trial.SETTING: Department of Neurosurgery, Departnent of Anesthesia and Electron Microscope Room of Beijing Tiantan Hospital.MATERIALS: The experiment was conducted to 6 Wistar rats in Beijing Neurological Surgery Research Institute of Capital University of Medical Sciences during February 2003 to February 2004. The rats were randomly divided into two groups with one of ischemia-reperfusion group and sham operation group with 3 rats in each group.INTERVENTIONS: To prepare global ischemic reperfusion model of rats. Brain was removed from ischemic group in one hour of reperfusion and from sham operation group one hour after the operation. Electronic microscope technique was used to observe the ultrastructural changes of cortex.MAIN OUTCOME MEASURES: Ultrastructural changes of cortex.RESULTS: The neurons of cortex shrank to certain degree in the early stage of ischemic reperfusion(1 hour) . The glial cells were swollen with dissolved chromosome in nucleus and unclear nuclear membrane. The foot protrusions around blood vessel slightly swelled and separated from basement membrane. Mircro-tubes were partially dissolved.CONCLUSION: In early stage of reperfusion injury, the cortex neurons, glial cells, cellular framework and blood brain barrier already changed which suggested that the protective treatment such as reducing brain edema, protecting blood brain barrier should start as early as possible.
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@#ObjectiveTo determine whether the β2-agonist, clenbuterol, can improve recovery of locomotor function following spinal cord injury.MethodsThe spinal cords of rats were contused with a weight-drop apparatus similar to the NYU impactor at the lever of T10. Locomotor function was determined with the Basso, Beattie, Bresnahan (BBB) Scale. Following 6 weeks of behavioral evaluation, the spinal cords were received histological examination.ResultsClenbuterol improved the recovery of locomotor function and increased the amount of spared spinal cord tissue.ConclusionClenbuterol caused the enhancement of recovery of locomotor function and spared spinal cord tissue following contusion.
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BACKGROUND: Disoprofol has anti-apoptosis impact so that it can protect the neurons from damage caused by ischemia. However, it needs further study on the mechanism of anti-apoptosis of it. OBJECTIVE: To investigate the effects of disoprofol to cell apoptosis and expression of apoptosis-associated gene in rats during reperfusion after global ischemia.DESIGN: A randomized controlled trial.SETTING: Department of Neurosurgery of Beijing Tiantan Hospital.MATERIALS: The experiment was conducted in Beijing Neurological Surgery Research Institute of Capital University of Medical Sciences during January 2003 to January 2004. A total of 23 adult male Wistar rats were randomly divided into ischemic group( n =9), disoprofol group( n =9) and sham operation group( n = 5).INTERVENTIONS: To prepare global ischemia-reperfusion model of rats. Disoprofol was injected into vein with dose of 1.5 mL/hour after reperfusion started in disoprofol group and lasted for 30 minutes. Five rats were selected from each group to be removed brain after reperfusion for 24 hours. Apoptosis rate and necrosis rate were detected by flow cytometer. Four rats selected from ischemic and disoprofol group were detected differential expression of apoptosis associated genes by gene chip combining image analysis techniques.MAIN OUTCOME MEASURES: ① apoptosis rate and necrosis rate; ②expression of apoptosis-associated gene detected by gene chip.RESULTS: The apoptosis rate[(7.01 ±0.79)% ] and necrosis rate[ ( 12. 80 ± 0. 92) % ] of neurons of hippocampus in disoprofol group were much lower than those of ischemic group [ (10. 89 ± 0. 80)%, (16. 67 ± 1.04)% ](P ＜ 0.01) . Compared with ischemic group, the three apoptosis associated genes including apoptotic prote ase activating factor 1 (APAF1), death effector domain containing testicular molecular mRNA(DEFT) and STM-2 were down regulated.CONCLUSION: Disoprofol can protect the brain and its mechanism might be related to the down regulation of three apoptosis associated genes including APAF1, DEFT and STM-2.
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BACKGROUND: Cerebral ischemia and reperfusion affects not only cellular necrosis at acute stage, but also delayed neuronal apoptosis in central neural system.OBJECTIVE: To observe apoptosis rate, necrosis rate and expression of Bcl-2 and Bax apoptpsis-regulating proteins in hippocampal neurons at various reperfusion stages of complete cerebral ischemia in rats so as to probe into the regulation of injury induced by complete cerebral ischemia and reperfusion.DESIGN: Randomized control experiment.SETTING: Department of Neurosurgery and Department of Anesthesiology in Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences.MATERIALS: The experiment was performed in Beijing Institute of Neurosurgery Affiliated to Capital University of Medical Sciences from January 2003 to January 2004. Totally 33 healthy adult male Wistar rats of clean grade were employed, randomized in 5 groups, named ischemia +reperfusion 24 hours group (24 hours group) (7 rats), ischemia + reperfusion 48 hours group (48 hours group) (7 rats), ischemia + reperfusion 72hours group (72 hours group) (7 rats), ischemia + reperfusion 7 days group (7 days group) (7 rats) and sham-operation control (control) (5 rats).INTERVENTIONS: Model of complete cerebral ischemia and reperfusion was prepared in rat. Cerebral hippocampal tissues were collected in 24, 48,72 hours and 7 days after reperfusion successively. The flow cytometer was used to determine cellular apoptosis rate and necrosis rate and expression of Bcl-2 and Bax proteins in cerebral hippocampal neurons in rats.percentages of Bcl-2 and Bax proteins.hippocampal neurons in 7 days group was the highest [(24.59±0.97) %].The peak value of necrosis rate presented in 24 hours group [(16.67±1.04)%], which was remarkably higher than the control [(1.28±0.50)%,low [(1.07±0.27)%], but high expression of Bax presented [(46.09±5.37)%].and reperfusion [(14.41±0.67)%] and the peak value of Bax protein presented in 72 hours after ischemia and reperfusion [(77.38±1.52)%].CONCLUSION: Hippocampal neuronal apoptosis rate is increased gradually and expression of Bcl-2 and Bax apoptosis-regulating genes was increased abnormally after injury induced by complete cerebral ischemia and reperfusion, which suggests that Bcl-1 and Bax proteins are involved in apoptosis regulation in the injury induced by complete cerebral ischemia and reperfusion.
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BACKGROUND: Cerebral vascular spasm is the main complication of intracranial aneurysm during perioperative period. Anesthesia of clamp operation of intracranial aneurysm not only meet the basic requirement of anesthesia, but also prevent cerebral vascular spasm and protect cerebral function possibly.OBJECTIVE: To observe the changes of angiotensin Ⅱ and endothelins of paitents with intracranial aneurysm under the anesthesia of desflurane during the clamp operation so as to discuss the effect of desflurane on cerebral protection.DESIGN: Case analysis.SETTING: Department of Neurosurgery and Department of Anesthesiology of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences.PARTICIPANTS: Totally 64 patients, 30 males and 34 females, who were prepared for clamp operation of intracranial aneurysm, were selected from Department of Neurosurgery of Beijing Tiantan Hospital Affiliated to Capital University of Medical Sciences between October 2002 and June 2004.METHODS: After anesthesia induction, tracheal cannula was used to control respiration and desflurane was used to maintain the anesthesia. Totally 4 mL arterial blood were collected at the four time points: before anesthesia induction, cutting dura mater, clamp aneurysm and 30 minutes after clamp aneurysm. Levels of angiotensin Ⅱ and endothelins in plasma were assayed with radioimmunoassay.MAIN OUTCOME MEASURES: Levels of angiotensin Ⅱ and endothelins at the four time points: before anesthesia induction, cutting dura mater,clamp aneurysm and 30 minutes after clamp aneurysm.RESULTS: Aneurysm of two patients was disrupted during the operation of angiotensin Ⅱ was ranged normally before operation, and that at the other three time points during the anesthesia of desflurane did not changed endothelins: Level of endothelins at the three time points of cutting dura mater, clamp aneurysm and 30-minutes after clamp aneurysm was lower than that at the time point of pre-an esthesia induction [(40.4±10.3),(40.0±9.6), (40.7±12.3), (49.3±12.7) ng/L, (P=0.002, 0.001, 0.009)].CONCLUSION: Levels of angiotensin Ⅱ and endothelins which anesthetizes by desflurane are not increased during the whole clamp operation of intracranial aneurysm. However, level of endothelins is obviously lower than that at the time point of pre-anesthesia induction, and there is not significantly different from that at various time points of the operation. This suggests that anesthesia of desflurane can avoid the onset of acute cerebral vascular spasm induced by the increasing liberation of angiotensin Ⅱ and endothelins and decrease the onset of secondary cerebral ischemic injury so as to protect brain.
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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.