Changes of neuroglobin in the pathologic process of contusion and laceration of brain in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the role of neuroglobin (Ngb) in the pathologic process of contusion and laceration of brain in children.</p><p><b>METHODS</b>The proteins in the brain tissue were extracted by two-dimensional gel electrophoresis in 3 children undergoing brain ventricular neoplasms resection (normal brain tissue) and in 8 children with contusion and laceration of brain. The image analysis was done using the PDQuest 7.0 software. The differential protein spots were detected and analyzed with Applied Biosystems Voyager System 4307 MALDI-TOF Mass Spectrometer and bioinformatical skills. Ngb expression in the brain tissue was measured using immunohistochemisty. Ngb expression in plasma was measured using ELISA in 15 children with contusion and laceration of brain and 10 healthy children.</p><p><b>RESULTS</b>Expression maps of the brain tissue were established by two-dimensional gel electrophoresis in children with contusion and laceration of brain and healthy children. Six differential protein spots were found and 5 of them were identified by mass spectrum. Immunohistochemisty assay showed that Ngb expression in the brain tissue in children with contusion and laceration of brain was significantly higher than in normal controls (P<0.05). ELISA results showed that Ngb expression in the plasma increased significantly 6, 12, 18, 24 and 48 hours after trauma in children with contusion and laceration of brain compared with healthy children (P<0.01).</p><p><b>CONCLUSIONS</b>Ngb may play an important role in the pathologic process of contusion and laceration of brain in children.</p>

Applied anatomy for pituitary adenoma resection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pituitary adenomas are common intracranial tumors, with a rising incidence in China. Excision is a mainstay therapy for this disease, and is often carried out via transfrontal, transsphenoidal or transpterional approaches. However, few studies have systematically addressed the regional anatomy involved in these microsurgical procedures. The present study attempted to establish some key anatomic measurements relevant to pituitary adenoma resection based on cadaver and computer tomography (CT) image studies.</p><p><b>METHODS</b>Head specimens from 30 randomly selected formalin-fixed adult cadavers were used for anatomical analysis. Measurements were made on the base of the skull following removal of brain structures above the pituitary gland, and on the mid-sagittal plane of the cranium. Parameters were designed by considering the 3 above-mentioned common microsurgical approaches, and obtained on each head using a sliding caliper. Multi-level CT images from 30 individuals were also used for distance measurements between landmark structures that are relevant to these surgeries. All data were subjected to statistical analysis using the SPSS 11.5 software.</p><p><b>RESULTS</b>There was statistically significant difference (P < 0.05) of distance measured on cadavers relative to CT images in 3 sets of measurements related to the transfrontal surgical approach, i.e., distances from the midpoint of superciliary arch superior border to the cranial entrance of internal carotid arteries (ICAs), the opposite side entrance of ICA and to the genu of ICA. While regional anatomical analyses were carried out according to the transpterional approach, statistically significant difference was also found in 3 sets of distance measurements between cadaver and CT image data, with regard to the distances between the pterion and some landmark structures around the pituitary.</p><p><b>CONCLUSIONS</b>The present study provides key anatomical and CT image measurements involving the 3 conventionally used surgical approaches for pituitary tumor resection. The data implicate that while CT scan results can provide valuable guidelines for operations, cautions and adjustments are needed during surgery for sufficient tumor excision and protection of key blood vessels and nerves in the vicinity of the pituitary gland and around the surgical pathway.</p>

Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation.</p><p><b>METHODS</b>A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed.</p><p><b>RESULTS</b>Total tumor resection was achieved in 140 cases (96.6%) and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% (132/145) of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients (Grade I and Grade II, 79.3%). No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is helpful for a safe drilling of the posterior wall of the internal acoustic meatus.</p><p><b>CONCLUSIONS</b>The goal of every surgery should be the preservation of function of all cranial nerves. Using the retrosigmoid approach with small craniotomy is possible even for large schwannomas. Knowing the microanatomy of the cerebellopontine angle and internal auditory meatus, intraoperating neurophysiological monitoring of the facial nerve function, and the microsurgical techniques of the surgeons are all important factors for improving total tumor removal and preserving facial nerve function.</p>

Surgical treatment of childhood craniopharyngioma: clinical analysis of 31 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the diagnosis, surgical treatment and outcome of craniopharyngioma in 31 children.</p><p><b>METHODS</b>The clinical data of 31 children (aged 7-14 years) with craniopharyngioma were studied retrospectively.</p><p><b>RESULTS</b>Headache, visual disorder and growth retardation were main manifestations in the 31 children. The 31 children were definitely diagnosed with craniopharyngioma by CT and MRI. In the 31 cases, 19 (61.3%) underwent total tumor removal, 5 (16.1%) subtotal removal, and 7 (22.6%) partial removal. After tumor removal, transient diabetes insipidus occurred in 19 cases (61.3%) and long-term diabetes insipidus in 3 cases. Six cases (19.4%) presented hypothalamic injuries after surgery. No patient died after surgery. Five patients (16.1%) had recurrent tumor in a mean follow-up of 32.5 months.</p><p><b>CONCLUSIONS</b>The diagnosis of childhood craniopharyngioma may be based on clinical manifestations and CT/MRI examinations. Craniotomy is a preferred surgical treatment. Proper extent of tumor resection should be determined in order to reduce the tumor recurrence and the incidence of postoperative complications.</p>

Microsurgical treatment of tentorial meningiomas / 中南大学学报(医学版)

OBJECTIVE@#To discuss microsurgery in the treatment of tentorial meningiomas to reduce the operative mortality.@*METHODS@#Clinical data of 32 patients were retrospectively analyzed. The operative approaches and outcomes and postoperative management of tentorial meningiomas were discussed.@*RESULTS@#Of the 32 patients, tumors in 27 patients(84.37%) were removed totally, and 5(15.63%) were removed subtotally. In the 5 patients whose tumors were resected subtotally, 3 patients were related to major sinus, and the other 2 related to adhering compactly to the brain stem invaded by tumors, major vessels, or cranial nerves.@*CONCLUSION@#Total resection can be achieved in most patients with microneurosurgical technique. Proper choice of operative approaches may raise the total removal rate and lower the operative mortality.

Multivariate analysis of impact of different neck treatment and prognostic factors affecting disease-free survival in patients with early-staged squamous cell carcinoma of tongue / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To analyze the prognostic factors affecting the disease-free survival in T1/T2N0M0-staged patients with squamous cell carcinoma of tongue and compare the effectiveness of different neck treatment modalities.</p><p><b>METHODS</b>97 consecutive patients with early-staged squamous cell carcinoma of tongue were included in this study. The treatment and following-up records were reviewed retrospectively. Cox proportional hazard model was used to identify the statistically significant prognostic factors in the 6 potential factors. Kaplan-Meier method was used to estimate the disease-free survival and analyze the survival rate among the different levels, and log-rank method for comparison of the different distribution of the survival. A special focus was on the effectiveness of different neck treatment modalities.</p><p><b>RESULTS</b>T stage, treatment methods of primary tumor, the modalities of neck treatment and cell differentiation were statistically significant prognostic factors. The value of P and relative risk (RR) were P < 0.001, RR = 4.387; P = 0.04, RR = 0.496; P = 0.003, RR = 0.504; P < 0.001, RR = 2.620, respectively. The difference of disease-free survival was statistically significant among the different levels under the different factors.</p><p><b>CONCLUSION</b>The disease-free survival was affected by neck treatment modalities remarkably in cN0 stage patients. Selected neck dissection together with adjuvant irradiation could decrease the recurrence risk by 49.6% according to the results of this study. TNM stage system could describe the characteristics of the patients with early-staged squamous cell carcinoma of tongue reasonably.</p>

Thrombin preconditioning reduces brain injury caused by intracerebral infusion of high dose thrombin / 中南大学学报(医学版)

OBJECTIVE@#To explore the effect of the cerebral thrombin preconditioning on the thrombin-induced brain edema, to detect the expression of tumor necrosis factor-alpha (TNF-alpha), and to analyse the relationship between TNF-alpha and the thrombin-induced brain edema.@*METHODS@#Forty SD rats were randomly divided into a ST group and a TT group. The rats received 50 L saline (ST group) or 1 U thrombin infusion (TT group), and received the second infusion (10 U thrombin) 24 h later. The rats were sacrificed at 24 and 72 h after the second infusion in order to examine the changes of brain water and sodium contents as well as the expression of TNF-alpha in the brain.@*RESULTS@#The brain water and sodium contents in the ST group were significantly higher than those on the TT group, and those on the 1st day were higher than those on the 3 th day. The positive expression of TNF-alpha and in the change of water content were identical in the TT group and the ST group.@*CONCLUSION@#Thrombin preconditioning can alleviate the thrombin-induced brain edema. The increase of TNF-alpha expression after thrombin treatment may be related to the thrombin-induced brain edema.

Microsurgical treatment of giant epidermoid cysts in the central region of the skull base / 中南大学学报(医学版)

OBJECTIVE@#To explore microsurgical treatment of giant epidermoid cysts in the central region of the skull base in 36 cases.@*METHODS@#The clinic characteristics and the operation experience about the microsurgical treatment of giant epidermoid cysts in the central region of the skull base were retrospectively analyzed.@*RESULTS@#In the 36 cases, 32 had total removal of the tumor, and the other 4 experienced subtotal removal. Thirteen presented nerve system damage or nerve damage aggravation, but there was no operative mortality.@*CONCLUSION@#According to the epidermoid cyst area, the ratio of total resection can be elevated and the complication can be lowered by suitable approach and microneurosurgical technique.

Detection and clinical significance of urinary epidermal growth factor in brain tumor patients / 中南大学学报(医学版)

OBJECTIVE@#To investigate the clinical significance of urinary epidermal growth factor (EGF) in patients with brain tumors.@*METHODS@#The levels of EGF in urine samples collected from 20 patients (9 low grade astrocytomas, 6 anaplastic astrocytomas, and 5 meningiomas) and 5 healthy individuals were determined. EGF levels were measured by radioimmunoassay technique. A preoperative and one postoperative determination were performed.@*RESULTS@#Preoperative urinary EGF levels of astrocytoma patients were statistically higher than those of meningioma patients and the controls (P 0.05).@*CONCLUSION@#The urinary EGF levels of astrocytoma patients correlate with the WHO grade of malignance and significantly decrease after gross total removal. Urinary EGF may be of practical value in diagnosing and evaluating the surgical efficacy of astrocytomas.

Mononostril-septum-transsphenoidal approach for pituitary adenoma / 中南大学学报(医学版)

OBJECTIVE@#To summarize the mononostril-septum-transsphenoidal approach for pituitary adenoma.@*METHODS@#The clinical features, operative techniques, and outcome of 36 patients with pituitary adenoma were analyzed retrospectively.@*RESULTS@#Tumors were totally removed in 28 cases, and subtotally resected in 8 patients. No patient died after the operation. Endocrine symptom of 31 patients returned to the normal level, the symptom of the other 5 cases were improved. Thirty patients with visual field defects recovered after the operation. Cerebrospinal fluid leakage occurred in one patient, and was cured with conservative treatment in 2 weeks.@*CONCLUSION@#Mononostril-septum-transsphenoidal approach can make use of the natural space of the nasal cavity, which has many advantages, such as direct approach, short operative time, minimal invasion, and few complications. It is a effective transsphenoidal surgical approach.

Gamma knife treatment for pituitary prolactinomas / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the outcome of gamma knife for prolactinomas.@*METHODS@#Eighty-nine patients were treated by gamma knife and 51 were followed up. The dose to the tumor margin ranged from 18 Gy to 35 Gy (mean 26.1 Gy). The maximum radiation dose varied from 36 Gy to 60 Gy (mean 50.41 Gy). The mean tumor diameter was 15.5 mm (5 - 26 mm).@*RESULTS@#The follow-up data were available for 51 patients ranging from 6 to 108 months (mean 37 months). The tumor growth control rate was 100%. The endocrinological remission rate was 40%. The rate of hypopituitarism was 17.6%.@*CONCLUSION@#Gamma knife radiosurgery can be used as a primary treatment for selected prolactinomas,especially for pituitary microadenomas.

Primary study of the method for repair of severe unilateral complete cleft lip / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the probability of repairing the severe cleft lip and nose in one time.</p><p><b>METHODS</b>35 patients were included. A revised method was presented based on the popular methods used.</p><p><b>RESULTS</b>Among 35 patients, the length of lip in two sides was equal in 33 patients, and the appearance of the nose shape was satisfactory in 31 patients evaluated by third expert group.</p><p><b>CONCLUSION</b>The method presented in this paper could repair the abnormalities of the lip and nose effectively in severe cleft lip patients in one time and was adapted in the patients who could not be treated with serial methods because of a bad economic state.</p>

Preliminary study on transformation of the biological function of the cryopreserved osteoblasts cultured in vitro / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To culture and amplify the young rabbit's bone marrow stromal cells (BMSCs) in vitro, and to observe the effect of hypothermia on the cells' growing behavior and biological function.</p><p><b>METHODS</b>BMSCs were acquired from the rabbit' tibia bone marrow and induced to mature osteoblasts in vitro. The cultured cells growing well in vitro were preserved in liquid nitrogen. The anabiotic cells having cryopreserved for 1 week were chosen as the experimental group, and the routine 7th generation as the control group. Their biological function in comparion by the examination of morphological changes, cells' proliferation ability, colone forming ratio, synthesis ability of ALP and protein, mineralized nodes forming ability were observed.</p><p><b>RESULTS</b>As contrast to the control groups, the anabiotic cells also grew and proliferated well in vitro except a little more slowly than before. They had the similar general shape in all the time segments, but a little differences in cells' ultrastructure. The experimental groups also had the typical characters of mature osteoblasts, and high abilities of the synthesis of ALP and proteins. The statistic data showed that these two groups had no significant difference (P > 0.05).</p><p><b>CONCLUSION</b>The cryopreserved osteoblasts had the same biological functions and the similar growing behaviors as before. These results suggest that it is practical to use the cryopreserved osteoblasts for further study on bone tissue engineering.</p>

Changes and significance of PAO activities and polyamine levels at different time of reperfusion after transient focal cerebral ischemia in rats / 中南大学学报(医学版)

OBJECTIVE@#To assay the changes of polyamine oxidase (PAO) activities and polyamine levels in the cortex and subcortex at different time of reperfusion following 2 h focal cerebral ischemia in rats in order to explore the regularity and signifiance ofh these changes.@*METHODS@#Rats of 2 h reversible focal cerebral ischemia were produced by ameliorated method of Longa's intraluminal suture occlusion of middle cerebral artery (MCA). PAO activities and polyamine levels in the cortex and subcortex were measured by homovanillic acid fluorometry and high-performance liquid chromatograph (HPLC) after 2, 4, 8, and 24 h reperfusion following 2 h ischemia, respectively.@*RESULTS@#PAO activity of the experimental group increased after 8 h reperfusion (P < 0.01). The peak value of PAO activity appeared after 24 h reperfusion (P < 0.01). Putrescine level of the experimental group was elevated after 4 h reperfusion (P < 0.05), and the peak value of putrescine appeared after 24 h reperfusion (P < 0.05). Spermidine and spermine levels of 8, 24 h reperfusion in the experiment group decreased significantly c eompared with the control group (P < 0.05).@*CONCLUSION@#PAO activities increased significantly after reperfusion following transient focal cerebral ischemia, which promoted the later peak production of putrescine. It may be contributed to the brain damage after cerebral ischemia.

Effect of alpha-difluoromethylornithine on the expression of ODC mRNA in the cortex and hippocampus in rats after cerebral ischemia reperfusion / 中南大学学报(医学版)

OBJECTIVE@#To explore the mechanism of alpha-difluoromethylornithine (DFMO) inhibiting ODC activity in the cortex and hippocampus in rats.@*METHODS@#Forty male rats was randomly divided into ischemal control group and DFMO pretreatment group. DFMO was given intravenously half an hour before global cerebral ischemia, and expression of ODC mRNA was measured by comparative reverse transcription-polymerase chain reaction (RT-PCR) in the cortex and hippocampus in rats after 2, 4, 6 h and 8 h of reperfusion. The variations of the expression of ODC mRNA were studied in the DFMO pretreatment group and the ischemal control group respectively.@*RESULTS@#After 2, 4 and 6 h of reperfusion, the expression of ODC mRNA in the cortex and hippocampus in the pretreatment group was lower than that in the ischemia control group significantly (P 0.05).@*CONCLUSION@#DFMO suppressed the expression of ODC mRNA after different lengths of reperfusion following 10-minute global cerebral ischemia in rats and it may be one of the ways for DFMO to inhibit ODC activity.

Microsurgical treatment for craniopharyngioma combined transorbital-subfrontal and temporal craniotomy / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in microsurgical removal of craniopharyngioma using combined transorbital-subfrontal and temporal craniotomy.</p><p><b>METHODS</b>Eighteen patients with craniopharyngioma varied from 3.1 cm to 6.2 cm in diameter. The tumor was located in the suprasellar region in 7 patients, extended to the third ventricle in 6, and down to the intrasellar from the suprasellar region in 4, and in the third ventricle in 1. Complete or partial cystic tumor was seen in 13 patients, and solid tumor in 5, and calcified tumor in 12. All the patients were operated on via combined transorbital subfrontal and temporal approach. The tumor was dissected in the spaces I, II and IV with great attention to the preservation of the perforating arteries from the carotid, posterior communication and anterior choroidal arteries to the structure of the hypothalamus. The solid portion of the tumor was removed by piecemeal.</p><p><b>RESULTS</b>The tumor was totally removed in 14 patients and subtotally in 4. Postoperation, follow-up for 8 to 41 months showed no change in 3 residual tumors and one lost to follow-up. All patients Postoperative Karnofsky scales showed 80 - 90, in 12 patients, 60 - 70 in 5 patients, and 50 in 1.</p><p><b>CONCLUSIONS</b>Combined transorbital-subfrontal and temporal approach can provide an excellent exposure to the sellar region, craniopharyngioma and its surrounding structures. This approach ensures less cerebral retraction for easy access to craniopharyngioma, including other large neoplasm of the middle cranial base with ventricle or posterior cranial base extension. Microsurgical techniques play an important role in removing tumor and preserving hypothalamic function.</p>

Neuroprotective effects of nimodipine and MK-801 on acute infectious brain edema induced by injection of pertussis bacilli to neocortex of rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the mechanism and type of acute infectious brain edema induced by injection of pertussis bacilli (PB) in rat neocortex, to study the neuroprotective effect of non-competitive antagonist of N-methl-D-aspartate (NMDA) receptor (MK-801) and antagonist of Ca(2+) channels (nimodipine) on brain edema, and to investigate the relationship between percentage of water content and cytosolic free calcium concentration ([Ca(2+) ](i)) in synaptosomes or content of Evans Blue (EB).</p><p><b>METHODS</b>95 SD rats were randomly divided into five groups, ie, normal control group, sham-operated control group, PB group, nimodipine treatment group and MK-801 pretreatment group. The acute infectious brain edema was induced by injection of PB into the rats. Quantitative measurements of water content and the concentration of EB were performed. [Ca(2+) ](i) was determined in calcium fluorescent indication Fura-2/AM loaded neuronal synaptosome with a spectrofluorophotometer. To observe the effect of MK-801 and nimodipine, we administered MK-801 48 hours and 24 hours before the injection of PB in MK-801 pretreatment group, and nimodipine after the injection of PB in nimodipine treatment group. The specific binding of NMDA receptor was measured with [(3)H]-MK-801 in the neuronal membrane of cerebral cortex.</p><p><b>RESULTS</b>The levels of water content and EB content of brain tissues, and [Ca(2+) ](i) in the neuronal synaptosomes increased more significantly in the PB-injected cerebral hemisphere in the PB group than those of normal control group and sham-operated control group (P<0.05). The water content and [Ca(2+) ](i) increased with the duration of infectious brain edema. Nimodipine administered after the injection of PB could significantly decrease the water content, EB and [Ca(2+) ](i) (P<0.05). MK-801 could significantly decrease the water content, EB and [Ca(2+) ](i) in 4 h and 24 h groups (P<0.05). The Kd values were 30.5 nmol/L+/-3.0 nmol/L and 42.1 nmol/L+/-4.2 nmol/L in PB group and NS group respectively (P<0.05), and Bmax were 0.606 pmol/mg.pro+/-0.087 pmol/mg.pro and 0.623 pmol/mg.pro+/-0.082 pmol/mg.pro respectively, without statistical significance (P>0.05).</p><p><b>CONCLUSIONS</b>The changes in the permeability of blood-brain barrier (BBB) and Ca(2+)-overload may participate in the pathogenesis of infectious brain edema. Treatment with nimodipine can dramatically reduce the damage of brain edema and demonstrate neuroprotective effect on brain edema by inhibiting the excess of Ca(2+) influx and reducing the permeability of BBB. MK-801 pretreatment may inhibit the delayed Ca(2+) influx into the neurons. The infectious brain edema is not only cytotoxic brain edema (intracellular edema) but also vasogenic brain edema (extracellular edema) followed by earlier BBB breakdown, so infectious brain edema is complicated with brain edema.</p>

Role of erythrocyte on brain edema development after traumatic intracerebral hemorrhage in rats / 中华创伤杂志

Objective To study the effects of erythrecyte on brain edema after traumatic intrace- rebral hemorrhage(TICH)and explore the mechanisms of erythrocyte in brain edema development follow- ing TICH.Methods Firstly,the brain injury model of SD rat was established by applying a free-fall- ing device,then whole blood(WB),lysed RBC(LRBC)or parked RBC(PRBC)were infused with ste- reotactic guidance into injured cortex to produce the model of TICH.All rats were killed at 1,3,and 5 days after injury.The brain water content was measured,immunohistochomistry(SABC)was applied to test HO-1 and TNF-?expressions.Results 1.In WB group,PRBC group and TBI group,the brain water content was the highest on the third day.The brain water content of LRBC group was markedly higher on the first day than on the third and fifth days.Comparison among the four groups showed the wa- ter content was the highest on the 1st day in LRBC group,and on the 3rd day in WB and PRBC groups; there was no significant difference among the four groups on 5th day.2.The positive expression of HO-1 and TNF-?coincided with the change of the water content in groups of WB,PRBC and LRBC.Conclu- sions In rat model of TICH,RBC plays an important role in delayed brain edema formation(3 days after injury),but has no influence at early stage(1 day after injury).The mechanisms of delayed brain edema involves RBC breakdown and inflammation reaction.