Application of multimodal electromagnetic navigation in endoscopic endonasal skull base anatomical measurement of fresh cadavers / 解剖学报

Objective Electromagnetic navigation was used to observe and measure important anatomical structures through endoscopic endoscopic approach (EEA) to the ventral skull base to provide data for clinical surgery. Methods Using electromagnetic navigation to measure the anatomical structure of the central and paracentral ventral skull base on 10 fresh cadavers, the internal carotid artery (ICA) was the most important. Results Electromagnetic navigation helped to determine the course of important neurovascular. The ICA of the ventral skull base was divided into 5 segments+ 7 major branches, and the length and course of each were measured and recorded. Conclusion The identification and protection of ICA is the key to EEA treatment of ventral skull base lesions, and electromagnetic navigation assistance can improve the efficiency and safety of EEA surgery.

Use of a compact high-definition two-dimensional exoscope in surgical treatment of large vestibular schwannoma / 中华医学杂志(英文版)

BACKGROUND@#Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope.@*METHODS@#Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons' comfortability.@*RESULTS@#A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively).@*CONCLUSIONS@#The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.

Study on the dynamic changes of endothelial progenitor cells in peripheral blood and cognitive ability of rats with different degrees of traumatic brain injury / 天津医药

Objective To observe the dynamic changes of endothelial progenitor cells(EPCs)in peripheral blood and cognitive ability of rats with different degrees of traumatic brain injury (TBI). Methods A total of 28 male SD rats were randomly divided into 4 groups:sham group,mild traumatic brain injury group,moderate traumatic brain injury group and severe traumatic brain injury group,seven rats in each group.A hole was drilled on the right parietal skull(4.0 mm posterior from bregma and 3 mm lateral to the sagittal suture,hippocampal region)to expose the dura.Rats were subjected to different degrees of traumatic brain injury of 0.9,2.1,3.2 atm(1 atm=101.325 kPa).The dynamic changes of EPCs,white blood cell count(WBC)and platelets(PLT)in the circulating blood were measured before(0 h)and after TBI(3,6,24,48,72,168,240 and 336 h after trauma). Morris water maze (MWM) test was performed to record the escape latency and target quadrant change on day 21-25 after TBI in four groups. Results The number of circulating EPCs kept stable throughout the experiment in the sham group.The numbers of EPCs were significantly lower at 3 h after injury in mild,moderate and severe traumatic brain injury groups(17.4±3.1,15.6±5.0 and 23.6±3.0)than those in the sham group(53.6±7.9,P<0.05).The numbers of EPCs at 6 h after injury were increased rapidly,and which were significantly higher in the mild and moderate TBI group than those in sham group(P<0.05).Then the number of EPCs dropped to the normal level on 48 h after injury.The changes of EPCs was inconsistent with the WBC and PLT during the whole experiment.The positioning cruise experiment showed that the escape latency shortened over time in each group.The escape latency was longer in TBI group than that in sham group during the same period. The spatial probe test showed that the percentages of the target quadrant were significantly lower in the moderate and severe TBI groups than those in the sham group and the mild TBI group. Conclusion With the severity of traumatic brain injury,the cognitive ability reduces in model rats.The level of endothelial progenitor cells in circulating blood is related to the severity of the traumatic brain injury,and can be used as a marker to judge the prognosis.

Establishment of a rat model of craniocerebral blast injury induced by cabin explosion / 解放军医学杂志

Objective To establish a rat model of craniocerebral blast injury caused by the shock wave of cabin explosion.Methods Fifty male adult Sprague-Dawley rats were randomly divided into 5 groups (10 each):3g,5g,8g TNT with vest groups,5g TNT without vest group and control group.Uncased explosives of different equivalent were suspended in the cabin center.After anesthesia,with exception of control group,the rats were placed in prone position about 31 cm below the explosive,facing the explosive with or without vest.After the explosion,the survived rats were observed,serological and pathological examinations were performed at 3h,1d and 3d after the explosion.Results In terms of tissue damage and mortality,compared with the control group,no obvious injury formed in rats of the 3g TNT with vest group,and all of them survived;Rats in 5g TNT with vest group showed mild lung injury,brain tissue edema,enlarged blood vessel,patchy hemorrhage on the brain surface,and with a mortality of 30％;Rats in 8g TNT with vest group showed serious organ damage with a mortality of 80％;Rats in 5g TNT without vest group suffered from severe lung injury,almost all died right after the explosion.Therefore,rats in 5g TNT with vest group were more in line with the experimental needs.Further serum and pathologic examinations showed that the brain water content increased,the serum neuron specific enolase (NSE) and S-100β protein also increased markedly,and necrotic or apoptotic changes happened in the cortex and hippocampus neurons.Conclusion A stable animal model of craniocerebral blast injury may be established with rats in the case of chest and abdomen protected and then exposed to 5g TNT explosion in cabin.

Role of regulatory T cell in clinical outcome of traumatic brain injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Traumatic brain injury (TBI) is a life-threatening disease worldwide. Regulatory T cells (Treg cells) were involved in the immunological system in central nervous system. It is defined as a subpopulation of CD4 + cells that express CD25 and transcription factor forkhead box P3. The level of circulating Treg cells increases in a variety of pathologic conditions. The purpose of this study was to uncover the role of circulating Treg cells in TBI.</p><p><b>METHODS</b>A clinical study was conducted in two neurosurgical intensive care units of Tianjin Medical University General Hospital and Second Hospital of Tianjin Medical University (Tianjin, China). Forty patients and 30 healthy controls were recruited from August 2013 to November 2013. Circulating Treg cells was detected on the follow-up period of 1, 4, 7, 14, and 21 days after TBI. Blood sample (1 ml) was withdrawn in the morning and processed within 2 h.</p><p><b>RESULTS</b>There was no significant difference in the level of circulating Treg cells between TBI patients and normal controls during follow-up. TBI patients exhibited higher circulating Treg level than normal controls on the 1 st day after TBI. Treg level was decreased on the 4 th day, climbed up on the 7 th day and peaked on 14 th day after TBI. Treg cells declined to the normal level on 21 th day after TBI. The level of circulating Treg cells was significantly higher in survival TBI patients when compared to nonsurvival TBI patients. TBI patients with improved conditions exhibited significantly higher circulating Treg level when compared to those with deteriorated conditions. The circulating Treg level was correlated with neurologic recovery after TBI. A better neural recovery and lower hospital mortality were found in TBI patients with circulating Treg cells more than 4.91% in total CD4 + mononuclear cells as compared to those with circulating Treg cells less than 4.91% in total CD4 + mononuclear cells in the first 14 days.</p><p><b>CONCLUSIONS</b>The level of circulating Treg cells is positively correlated with clinical outcome of TBI. The level of Treg cells predicts the progress for TBI patients and may be a target in TBI treatment.</p>

Effects of glucocorticoids on traumatic brain injury related critical illness-related corticosteroid insufficiency / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Traumatic brain injury (TBI) is a heterogeneous condition that can lead to critical LLLness-related corticosteroid insufficiency (CIRCI) causing a high mortality and morbidity. Glucocorticoids were widely used in the clinical management of TBI, but their benefit has been challenged in some studies and their efficacy, especially for treating CIRCI in TBI patients, remains unclear.</p><p><b>METHODS</b>We conducted a meta-analysis of published data to determine if the controversy is related to clinical dosing and timing of glucocorticoids (GCs) application. We analyzed published reports in four databases (MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and CBMdisc). The published data were stratified into not only low- and high-dose GCs group but also short- and long-term GCs group to compare their effectiveness in improving TBI outcomes.</p><p><b>RESULTS</b>We totally identified 16 reports. For low-dose patients, the pooled relative risks (RRs) for two clinical outcomes of death or a combination of death and severe disability were 0.95 (95% confidence interval (CI): 0.80 to 1.13) and 0.95 (95% CI: 0.83 to 1.09), respectively. The risks for infection and gastrointestinal bleeding were 0.85 (95% CI: 0.50 to 1.45) and 0.64 (95% CI: 0.15 to 2.70), respectively. For high-dose group, the pooled RR of death is 1.14 (95% CI: 1.06 to 1.21). The pooled RRs for infection and gastrointestinal bleeding for the high-dose patients were 1.04 (95% CI: 0.93 to 1.15) and 1.26 (95% CI: 0.92 to 1.75), respectively. For long-term use group, the pooled RRs for two clinical outcomes of death or a combination of death and severe disability were 0.98 (95% CI: 0.87 to 1.12) and 1.00 (95% CI: 0.90 to 1.11), respectively. The risks for infection and gastrointestinal bleeding were 0.88 (95% CI: 0.71 to 1.11) and 0.96 (95% CI: 0.35 to 2.66), respectively. For short-term use group, the pooled RR of death is 1.15 (95% CI: 1.07 to 1.23), and importantly the effects on infections were beneficial in terms of TBI patients suffering from CIRCI.</p><p><b>CONCLUSIONS</b>This meta-analysis suggests an increased risk of death for TBI patients on a high dose and short term of glucocorticoids compared with those on a low dose and long term, for whom a trend towards clinical improvement is evident. In addition, stress-does of GCs further decrease the pneumonia incidence in TBI patients suffering from CIRCI. A large-scale multicenter randomized controlled trial is warranted for testing (1) the efficacy of stress-dose GCs treatment in the sub-acute phase of TBI (4-21 days after initial trauma), when CIRCI is most likely to occur; (2) the hypothesis that stress-dose GCs could boost patients' stress function and ensure survival.</p>

Mixed craniopharyngioma: long-term results after gamma knife combined with stereotactic brachytherapy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term results of combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for mixed cystic and solid craniopharyngiomas.</p><p><b>METHODS</b>Sixty-seven consecutive patients with mixed cystic and solid craniopharyngioma treated by Gamma Knife radiosurgery combined with stereotactic brachytherapy from October 1996 to December 2005 were selected for retrospective analysis. The inclusion criterion was the patients who survived for at least 5 years after combined treatment. There were 39 male and 28 female patients and the mean age was 31.5 years (ranged from 3 to 70 years). The clinical evaluations including neurological, neuro-ophthalmological, and neuro-endocrinological examinations, assessment of comprehensive quality of life and neuroimaging examinations were performed periodically. The actuarial survival rates and the mean survival time were calculated by using Kaplan-Meier product limit method. The rates were compared using the χ(2) test.</p><p><b>RESULTS</b>Follow-up period varied from 60 to 168 months, with an average of 114 months. The tumor response rate gained from combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for predominantly solid and cystic craniopharyngiomas were 10/12 and 90.9% respectively, and 89.6% in all. Mean survival after combination treatment was (110 ± 9) months. The mean survival of patients with predominantly solid and cystic craniopharyngioma were (97 ± 12) months and (120 ± 14) months and the actuarial 10-year survival rates were 7/12 and 69.1%. There was no statistics difference in tumor response rate and 10-year survival rate between 2 groups of patients with predominantly solid and cystic craniopharyngioma. The actuarial 5-, 6-, 7-, 8-, 9- and 10-year survival rates were 90.5%, 85.7%, 83.3%, 76.4%, 69.4% and 60.0% respectively. The decreased visual acuity had improved in 68.3% at 6 months postoperatively and in 70.0% in long term results. Comprehensive quality of life in long term follow-up of 67 patients was excellent in 28 cases(41.8%), good in 19 cases(28.4%), fair in 17 cases(25.4%) and poor in 3 cases(4.5%), respectively. The side effects that occurred 6 to 12 months after treatment were worsening of visual acuity (4 patients), dysfunction of hypothalam (4 patients) and third nerve palsy was found in 1 patents 5 years after treatment. The rate of complications was 13.4%.</p><p><b>CONCLUSION</b>Combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy is highly effective and safety in the treatment of mixed cystic and solid craniopharyngiomas.</p>

A distinct pattern of memory and attention deficiency in patients with depression / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Depression related cognitive deficits are frequently considered as simple epiphenomena of the disorder. However, whether or not the depression might directly bring about cognitive deficits is still under investigation. This study was to investigate the distinct pattern of cognitive deficits in patients with depression by comparing the cognitive function before and after anti-depressive drug therapy.</p><p><b>METHODS</b>Sixty cases of patients, first-time diagnosed with depression, were assessed by 17-item Hamilton Rating Scale for Depression (HAMD17scale). The memory ability was tested by quantitatively clinical memory scale, while the attention ability by modified Ruff 2&7 Selective Attention Test. Forty-two healthy volunteers were recruited as controls. The depressive patients were treated with Venlafaxine (75 - 300 mg/d), Fluoxetine (20 - 40 mg/d), Paroxetine (20 - 40 mg/d), and Sertraline (50 - 150 mg/d). After 12 weeks treatment, patients were tested again by HAMD17scale, quantitatively clinical memory scale, and modified Ruff 2&7 selective attention test to assess the effect of anti-depressive drugs on cognitive deficits.</p><p><b>RESULTS</b>The memory quotient (MQ) was significantly lowered in depressive patients. The selection speed was also significantly decreased and the number of missing and error hits increased in the depression group as compared to control. However, there was no significant difference in clinical memory scale and Ruff 2&7 selective attention test between mild-to-moderate and severe depression group. Importantly, after anti-depressive drug therapy, the HAMD17 scale scores in depressive patients were significantly decreased, but the MQ, directional memory (DM), free recall (FR), associative learning (AL), and face recognition were comparable with those before the treatment. Furthermore, the selection speed and the number of missing and error hits were also not significantly different after anti-depressive drugs treatment.</p><p><b>CONCLUSIONS</b>Depressive patients suffer from short-term memory deficits, and attention extent, stability and rearrangement deficiency. Even though anti-depressive drugs sufficiently relieve the cardinal presentation of depression, they could not successfully alleviate the accompanying cognitive deficits. This might indicate a distinct pattern of cognitive deficits in patients with depression.</p>

An intervention study of differential expressions of miRNA-21 in rats with traumatic brain injury / 中华神经医学杂志

Objective To evaluate the dynamic changes ofmiRNA-21 expression in injured brain tissues of rats with traumatic brain injury (TBI),and explore the effect of ectogenic miRNA-21 on neuronal apoptosis of the rats and their neurological functions.Methods Eighty-four rats were randomly divided into sham-operated group,TBI model group,blank-intervention group and miRNA-21-intervention group (n=21).Rats in the sham-operated group were only performed scalp incision and window bone removal without beating,and those in the other three groups were performed beating to induce TBI models; liposomes with/without miRNA-21 were injected into the latter two groups.Several time points after the brain injury/intervention:12,24,48 and 72 h,and 1 and 2 weeks,respectively,were chosen to measure the neurological functions using Modified Neurological Severity Scale (mNSS) and footfault test.Then,the animals were sacrificed to observe the miRNA-21 expression levels by using quantitative real-time-PCR and to examine the neuronal apoptosis in rat cerebral corticesby TUNEL.Results The miRNA-21 expression began to obviously increase in injured brain tissues at 2 h after TBI,peaked at 48 h after TBI in the cerebral cortices; the miRNA-21 expression level was still higher than that in the sham-operated group 7 d after TBI (P＜0.05); the miRNA-21 expression level was higher than that in the TBI model group and blank-intervention group at 24,48 and 72 h after TBI (P＜0.05).Began with 24 h of TBI,mNSS showed that the scores of miRNA-21-intervenion group were significantly lower than those in the TBI model group and blank-intervention (P＜0.05).TUNEL indicated that the count of apoptotic cells in the traumatic area of miRNA-21-intervenion group was significantly smaller than that in the TBI model group (P＜0.05) Conclusion MiRNA-21 may be involved in the process of recovery after traumatic brain injury to inhibit the apoptosis in the traumatic area.

Effect of glucocorticoids therapy on mortality and secondary brain injury in rats after traumatic brain injury / 中华神经医学杂志

Objective To investigate the effect of glucocorticoids of different dosages on mortality and hippocampal neuron apoptosis in rats after traumatic brain injury (TBI).Methods All the adult male Wistar rats were allocated into normal control group,dexamethasone (DXM) treatment group,methylprednisolone (MP) treatment group,injury control group,low-dose DXM treatment group,moderate-dose DXM treatment group,high-dose DXM treatment group,low-dose MP treatment group,moderate-dose MP treatment group,and high-dose MP treatment group (n=22).Rats in the later seven groups (the injuried groups) accepted fluid percussion injury to induce TBI models,and then,treatments were given.The injury severity was evaluated with modified Neurological Severity Scale 24 h after injury.The number ofhippocampal neuron apoptosis was examined using TUNEL after 24 and 48 h,and 7 and 14 d of injury.The mortality of rats in each group was also observed during a 14-day-follow-up period.The changes of brains,pituitaries,hearts and lungs in the dead rats were examined by H.E.staining.Results No significant difference on the scores of modified Neurological Severity Scale was noted in the injuried groups 24 h after the injury (P＞0.05).The hippocampal neuron apoptosis began to appear 24 h after inju~,peaked at 48 h,and declined in 7 to 14 d.At 48 h after injury,the number of hippocampal neuron apoptosis in high-dose DXM treatment and high-dose MP treatment groups was significantly higher than that in the injury control group (P＜0.05).The mortality of rats in high-dose DXM treatment and high-dose MP treatment was significantly higher than that in the injury control group (P＜0.05).The autopsy of dead rats in each group revealed various degrees of interstitial pneumonia and hypophysial congestion in rats receiving high-dose glucocorticoids.Conclusion TBI could induce hippocampal neuron apoptosis,and early administration of high-dose glucocorticoids aggravates the apoptosis and increases the mortality,for which interstitial pneumonia and hypophysial congestion would account.

A meta-analysis of carotid endarterectomy versus stenting in the treatment of symptomatic carotid stenosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Carotid stenosis is one of the common reasons for patients with ischemic stroke, and the two invasive options carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the most popular treatments. But the relative efficacy and safety of the methods are not clear.</p><p><b>METHODS</b>About 521 articles related to CAS and CEA for carotid stenosis published in 1995 - 2011 were retrieved from MEDLINE, Cochrane Library (CL), and China National Knowledge Infrastructure (CNKI) China Journal Full-Test database. Of them, eight articles were chosen. Meta-analysis was used to assess the relative risks.</p><p><b>RESULTS</b>The eight studies included 3873 patients with symptomatic carotid artery stenosis, including 1941 cases in the carotid stent angioplasty group, and 1932 cases in the carotid endarterectomy group. Fixed effect model analysis showed that within 30 days of incidence of all types of strokes, surgery was significantly highly preferred in CAS patients (CAS group) than the CEA patients (CEA group), and the difference was statistically significant (relative ratio (RR) = 1.80, 95% confidence interval (CI): 1.380 - 2.401, P < 0.0001). But the incidence of death in the two groups is not showed and is not statistically significant after 30 days (RR = 1.52, 95%CI: 0.82 - 2.82, P = 0.18). The rate of cranial nerve injury in the CAS group is lower than the CEA group (RR = 0.14, 95%CI: 0.05 - 0.43, P = 0.0005). The incidence of CAS patients with myocardial infarction is lower than the CEA group after 30 days, but statistically meaningless (RR = 0.22, 95%CI: 0.05 - 1.02, P = 0.05). The stroke or death in CAS patients were higher than the CEA group after 1 year of treatment (RR = 2.58, 95%CI: 1.03 - 6.48, P = 0.04).</p><p><b>CONCLUSIONS</b>Compared to CAS, carotid endarterectomy is still the preferred treatment methodology of symptomatic carotid artery stenosis. Future meta-analyses should then be performed in long-term follow-up to support this treatment recommendation.</p>

Ultrastructural observation of the outer membrane of chronic subdural hematoma / 中华神经医学杂志

Objective To explore the pathophysiological mechanisim underlying the development and progression of chronic subdural hematoma (CSDH) through an ultrastructural observation of the outer membrane of CSDH. Methods A total of 8 samples of CSDH outer membrane were obtained from the 8 patients who had uncergone surgery of hematoma removal in our department from January 2008 to January 2009.CT scanning revealed 2 cases of low hematoma density,2 cases of hematoma isodensity, 2 cases of high hematoma density and 2 cases of mixed hematoma desity.Conventional light microscopy and electron microscopy were used to observe the ultrastructure of the outer membrane. Results Light microscopy showed numerous dilatated and congested macrocapillaries with a wide vascular lumen in the outer membrane of the hematoma capsule.Electron microscopy showed weak, discontinous or partially dissolved endothelial cells in the macrocapillaries.Scattered red blood cells in the extracellular space were found, indicating bleeding within the outer membrane.Eosinophils increased with enlarged granules within the cellular cytoplasm.Neutrophils and macrophages were also present in some specimens.Fibroblasts showed a state of significant proliferation and activation. Conclusions There are abundant newly formed vascular networks in the outer membrane of CSDH. Neomembrane formation, neovascularization and repeated micro-haemorrhages from these fragile new vessels may play a key role in the development and progression of CSDH.

Clinical characteristics and treatments of patients with multiloculated pyogenic brain abscess / 中华神经医学杂志

Objective To investigate the clinical characteristics and treatment choice of patients with multiloculated pyogenic brain abscess (MLPBA).Methods The clinical data of 89 patients with pyogenic brain abscess (including 20 with MLPBA and 69 with uniloculated pyogenic brain abscess [ULPBA]) treated during the recent 21 years (1991-2011) were collected and analyzed retrospectively.Results MLPBA patients counted for 22.5％ of our patients with pyogenic brain abscess.The male-female ratio,age distribution,history duration,location of abscess,kinds of isolated microorganisms,predisposing factors and clinical manifestations of patients with MCPAB were similar to those of patients with ULPBA.The ratio of positive isolated microorganism and ratio breaking into ventricles in patients with MLPBA were significantly higher than those in patients with ULPBA (P＜0.05); and the average volume of abscess was 8.8 mL in patients with MLPBA and 13.3 mL in patients with ULPBA.A higher rate of abscess recurrence after stereotactic surgery in patients with MLPBA (26.7％) was found as compared with that in patients with ULPBA (3.2％).The mortality in patients with MLPBA was 0％ and that in patients with ULPBA was 4.3％.Conclusion MLPBA is not rare; the volume of abscess in patients with MLPBA is significantly smaller than that in patients with ULPBA,but the abscess in patients with MLPBA is significantly easier broken into the ventricles than that of ULPBA.Stereotactic operation is the first treatment choice; the prognosis for patients with MLPBA can be as good as that for patients with ULPBA,although the possibility of recurrent abscess formation after surgery is higher.

Influence of visual and auditory masking on the brain glucose metabolism in an idiopathic tinnitus patient / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the influence of the audio-visual block (AB) on the brain glucose metabolism of idiopathic tinnitus patients.</p><p><b>METHODS</b>The brain positron emission tomography (PET) test was performed on one chronic idiopathic tinnitus patient under audio-visual block and non-block (NB) conditions respectively. The visual analysis and statistical parameter mapping (SPM) analysis were both used to detect the brain glucose metabolism difference under AB and NB conditions.</p><p><b>RESULTS</b>Under NB conditions, significant hyperactivity was detected at auditory and visual cortex on both sides of the brain. However, this phenomenon was not shown under AB conditions. Instead, a hyperactivity of brain was presented in the left Wernicke's area.</p><p><b>CONCLUSIONS</b>The generation of chronic idiopathic tinnitus probably has no relationship with the auditory cortex abnormity. Wernicke's area might be involved in the central perception of tinnitus.</p>

Study on reliability and validity of the Tinnitus Evaluation Questionnaire / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the value of the Tinnitus Evaluation Questionnaire (TEQ) in clinical application.</p><p><b>METHODS</b>Cronbach's α coefficient was used to examine the reliability of the TEQ internal consistency. Examined the re-measured reliability by the correlation coefficient by two doctors' 1 - 3 hours interval questionnaires' scores. And inspected criteria validity according to the correlation coefficient of the TEQ and Tinnitus Handicap Inventory (THI).</p><p><b>RESULTS</b>In the 202 tinnitus patients, the TEQ Cronbach's α coefficient was 0.76 and re-measured reliability was 0.938. The THI correlation coefficient was 0.769. Among which, 99 patients feel tinnitus alleviated obviously after the treatment, the TEQ scores were significantly lower than that before the treatment (t = 21.42, P < 0.001).</p><p><b>CONCLUSIONS</b>The TEQ reflects the severity of tinnitus completely, and has preferable reliability and validity. The characteristics are concise, practical and exact. It is worthy of clinical application.</p>

Magnetic resonance spectroscopy-guided stereotactic biopsy for brain lesion / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical value of magnetic resonance spectroscopy (MRS) image in stereotactic biopsy for brain lesion.</p><p><b>METHODS</b>From April 2008 to April 2010, 126 cases (72 male and 54 female, aged from 10 to 82 years, mean 45 years) of brain lesion which were difficult to diagnose were divided into two groups by random number table, 62 cases were executed for MRI-guided frameless stereotactic biopsy (MRI group), 64 cases were executed for MRI and MRS-guided frameless stereotactic biopsy (MRS group). Operation used MRI and Three-dimensional MRS image to locate, and used frameless CAS-R-2 robots to carry out the positioning operating.</p><p><b>RESULTS</b>No surgery-related deaths and infections. Pathological diagnosis was 106 cases of brain tumors, 6 cases of inflammatory disease, 4 cases of tumor-like demyelinating disease and multiple sclerosis, 3 cases of neurodegenerative disease, 7 cases failed to obtain positive pathological diagnosis. The total rate of positive diagnosis was 94.4%, the positive rate in MRS-guided stereotactic biopsy group was 98.4% (63/64), the positive rate of conventional MRI-guided biopsy group was 90.3% (56/62), and there was statistically significant difference between the two groups (χ(2) = 3.92, P = 0.047). Four cases presented with postoperative complications, the complication rate was 3.2% (4/126); the complications were cerebral hemorrhage associated with aphasia, epilepsy, subcutaneous hematoma, gastrointestinal bleeding, which were improved after treatment.</p><p><b>CONCLUSIONS</b>MRS-guided stereotactic biopsy group has a higher positive rate than MRI-guided stereotactic biopsy group, indicating that this method can improve the positive rate of diagnosis, and thus will help to formulate treatment plan for brain lesion.</p>

Endothelial progenitor cells with Alzheimer's disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endothelial dysfunction is thought to be critical events in the pathogenesis of Alzheimer's disease (AD). Endothelial progenitor cells (EPCs) have provided insight into maintaining and repairing endothelial function. To study the relation between EPCs and AD, we explored the number of circulating EPCs in patients with AD.</p><p><b>METHODS</b>A total of 104 patients were recruited from both the outpatients and inpatients of the geriatric neurology department at General Hospital, Tianjin Medical University. Consecutive patients with newly diagnosed AD (n = 30), patients with vascular dementia (VaD, n = 34), and healthy elderly control subjects with normal cognition (n = 40) were enrolled after matching for age, gender, body mass index, medical history, current medication and Mini Mental State Examination. Middle cerebral artery flow velocity was examined with transcranial Doppler. Endothelial function was evaluated according to the level of EPCs, and peripheral blood EPCs was counted by flow cytometry.</p><p><b>RESULTS</b>There were no significant statistical differences of clinical data in AD, VaD and control groups (P > 0.05). The patients with AD showed decreased CD34-positive (CD34(+)) or CD133-positive (CD133(+)) levels compared to the control subjects, but there were no significant statistical differences in patients with AD. The patients with AD had significantly lower CD34(+)CD133(+) EPCs (CD34 and CD133 double positive endothelial progenitor cells) than the control subjects (P < 0.05). In the patients with AD, a lower CD34(+)CD133(+) EPCs count was independently associated with a lower Mini-Mental State Examination score (r = 0.514,P = 0.004). Patients with VaD also showed a significant decrease in CD34(+)CD133(+) EPCs levels, but this was not evidently associated with the Mini-Mental State Examination score. The changes of middle cerebral artery flow velocity were similar between AD and VaD. Middle cerebral artery flow velocity was decreased in the AD and VaD groups and significantly lower than the normal control group (P < 0.01). There was no significant difference of the blood flow velocity between the AD and VaD patients (P > 0.05).</p><p><b>CONCLUSIONS</b>The results provided evidence that patients with AD have reduced circulating EPCs. Endothelial function is impaired in patients with AD and vascular factors have a role in the pathogenesis of AD. CD34(+)CD133(+) EPCs may be a novel biomarker of AD dementia.</p>

Effect of probucol on vascular remodeling due to atherosclerosis in rabbits: an intravascular ultrasound study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Probucol is known to reduce the development of atherosclerotic lesions, but its impact on vascular remodeling associated with de novo atherosclerosis is incompletely understood. We therefore examined the effect of probucol on vascular remodeling in a rabbit model of established atherosclerosis.</p><p><b>METHODS</b>Aortic atherosclerosis was induced by a combination of endothelial injury and 10 weeks' atherogenic diet. Animals were then randomized to receive the foregoing diet without or with 1% (wt/wt) probucol for 16 weeks. At the end of week 26, in vivo intravascular ultrasound, pathological, immunohistochemical and gene expression studies were performed.</p><p><b>RESULTS</b>Probucol significantly decreased vessel cross-sectional area, plaque area and plaque burden without effect on lumen area. More negative remodeling and less positive remodeling occurred in the abdominal aortas of probucol group than the control group (56% vs. 21%, 18% vs. 54%, respectively, both P < 0.01). In addition, the probucol group showed a smaller mean remodeling index relative to the control group (0.93 ± 0.13 vs. 1.05 ± 0.16, P < 0.01). Furthermore, probucol treatment decreased macrophage infiltration, inhibited apoptosis of cells within plaques, and reduced the production of matrix metalloproteinases-2, -9, cathepsin K and cathepsin S (all P < 0.01).</p><p><b>CONCLUSIONS</b>These findings suggest that probucol may attenuate the enlargement of atherosclerotic vessel walls and be associated with a negative remodeling pattern without affecting the lumen size. This effect may involve inhibition of extracellular matrix degradation and prevention of apoptosis in atherosclerotic plaques.</p>

Clinical features of middle cranial fossa arachnoid cyst and its surgical intervention / 中华神经医学杂志

Objective o investigate the clinical characteristics of middle cranial fossa arachnoid cyst (MCFAC) and its therapeutic effects with different surgical methods. Methods Three hundred and fifty-two patients with MCFAC (about 2.58% of patients with intracranial space occupying lesion),admitted to our hospital from May 2001 to May 2008, were chosen in out study; their clinical data,surgical approach and prognosis were analyzed retrospectively. The gender ratio of patient with MCFAC adopted resection of arachnoid cyst and arachnoid cyst-peritoneal shunt was performed in 28 patients.Results Follow-up was performed for 3 months to 3 years. The headache completely disappeared in 75 patients (58.59%) and partial remission in 41 (32.03%) after the operation. The frequency and degree of seizures obviously decreased in 8 of the patients with MCFIAC. Eleven patients with dystropy,attention-deficit disorder or difficulty of learning got improvement. The head circumference and local skull eminentia was stable. The cyst disappeared completely in 46 patients (13.07%), partially in 257 (73.01%) and no changes in 49 (13.92%). Conclusion The clinical features of MCFAC is that it mainly occur in the left side of male. The younger the patient with MCFAC is, the better the treatment effect in the surgical intervention is. good outcome can be achieved by resection of the parietal layer of arachnoid cysts. The indication of shunt with meso-low pressure shunt system is for larger arachnoid cyst.

Relation between number of endothelial progenitor cells and Alzheimer' s disease / 中华神经医学杂志

Objective To study such clinical characteristics as number of circulating endothelial progenitor cells (EPCs), cerebral blood flow velocity (CAFV) and platelet count in patients with Alzheimer' s disease (AD). Methods A total of 78 patients were recruited from the outpatient and inpatient departments of our hospital. Patients with AD (n=23), patients with vascular dementia (VaD,n=25) and healthy elderly controls with normal cognition (n=30) were enrolled after matching for clinical data, carotid intima-media thickness (IMT) and Mini Mental State Examination (MMSE). The CAFV was examined with transcranial Doppler (TCD). Peripheral blood EPCs were counted by flow cytometry.Results No statistical significant differences were noted between patients with AD and VaD, and controls on gender, age, body mass index, blood pressure, total cholesterol, triglycerides, platelet and IMT (P＞0.05). Compared with those in control group, the number of circulating EPCs and scores of MMSE and CAFV in patients with AD and VaD were significantly decreased (P＜0.05). After the adjustment of traditional risk factors, thc number of circulating EPCs had a positive correlation with the scores of MMSE (r=0.541, P=0.000). Liner regression analyses showed that body mass index, diastolic pressure,platelet and scores of MMSE were positively correlated to the circulating EPCs number in patients with AD (P＜0.05). Conclusion The reduction of number of circulating EPCs, decreasing the repair capability of cerebrovasculars and inducing poor cerebral perfusion, plays important roles in the cognitive dysfunction of patients with AD.