Clinicopathological features of T-lymphoblastic lymphoma with Langerhans cell histiocytosis in the same lymph node / 中华病理学杂志

To investigate the clinicopathological features, immunophenotypes, genetics and prognosis of T-lymphocyte lymphoma/myeloid sarcoma combined with Langerhans cell histiocytyosis (coexistence of T-LBL/MS and LCH). Clinical and pathological data of the 6 patients with coexistence of T-LBL/MS and LCH were analyzed, who were diagnosed at the Foshan Hospital of Sun Yat-sen University and the Friendship Hospital of Capital Medical University, from December 2013 to April 2019. The hematoxylin and eosin stain, immunohitochemistry (EnVision) and in situ hybridization were used. Related literatures were reviewed. Four patients were T-LBL combined with LCH, 1 was T-LBL/MS combined with LCH, and 1 was MS combined with LCH. There were 2 male and 4 female patients, with age ranged from 5 to 77 years old (median, 59 years old). Three patients represented with only multiple lymph node swelling. The other 3 displayed both multiple lymph node swelling, and skin/liver or spleen lesions. Lymph node structure was destroyed in 5 cases, while 3 cases had several residual atrophic follicles. Histologically, there were two types of tumor cells: one type of the abnormal lymphoid-cells exhibited small to medium-sized blast cells, typically showing a nested distribution, and these cells were mainly identified in residual follicles and paracortical areas; the other type of histiocytoid cells had a large cell size and abundant pale or dichromatic cytoplasm. Their nuclei were irregularly shaped, showing folded appearance and nuclear grooves. These cells were mainly present in marginal sinus, medullary sinus and interstitial area between follicles. Eosinophil infiltration in the background was not evident in any of the cases. The lymphoid-cells of medium size showed TdT+/CD99+/CD7+, with variable expression of CD34/MPO/CD2/CD3. Ki-67 index was mostly 30%-50%. However, the histiocytoid cells showed phenotype of CD1a+/S-100+/Langerin+/-, while CD163/CD68 were positive in some degree. These cells did not express any T or B cell markers. The Ki-67 index mostly ranged between 10%-20%. None of the cases had Epstin-Barr viral infection. Among the 6 patients, 4 patients were followed up (6-63 months, median time, 18.5 months), of whom 1 patient died of the disease and 3 patients were alive at the end of follow-up. T-LBL/MS combined with LCH is a rare mixed type of immature hematopoietic disease, and mainly occurs in lymph node and skin. The clinical course is overall aggressive. Therefore, it is helpful to recognize and identify the two pathologic components in the same tissue for accurate diagnosis and proper treatment.

Effect of Jiedu Hugan Decoction on Protein Expression of MIP-2 and MIP-1β in Rats with Drug-induced Liver Injury / 中国实验方剂学杂志

Objective: To observe the effect and mechanism of Jiedu Hugan decoction on drug-induced liver injury in rats by detecting serum liver function, serum biomarkers, inflammatory factors, macrophage inflammatory protein-2 (MIP-2) and macrophage inflammatory protein-1β (MIP-1β). Method: The rat model of drug-induced liver injury was induced by acetaminophen (1 g·kg-1) orally once daily for 30 days. The sixty male adult Wistar rats were divided into five groups, control group,model group,administered silybin group(44.1 mg·kg-1), Jiedu Hugan decoction high, medium and low dose groups (63,31.5,15.75 g·kg-1), normal group and model group were given normal saline gavage, and the other groups were given corresponding liquid gavage for 30 days. After the experiment, the abdominal aorta separation take blood serum aspartate amino transferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), direct bilirubin (DBIL), malate dehydrogenase (MDH), enzyme for oxygen p1 (PON1) and glutamate dehydrogenase (GLDH), arginine (ARG), purine nucleotide phosphorylase (PNP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) content. Pathological morphological changes of liver tissues were observed by hematoxylin-eosin (HE) staining. The protein expression of MIP-1β was observed by immunohistochemistry. The protein expression of MIP-2 was observed by single fluorescence immunohistochemistry, and the contents of TNF-α and IL-6 in liver homogenate were detected by enzyme-linked immunosorbent assay (ELISA). Result: Compared with normal group, levels of AST, ALT, DBIL, PON1, ARG, GLDH, MDH, PNP and TNF-α in model group were significantly increased (PPPPα in liver injury rats(PPβ protein expression, detoxification protect liver soup effect of the optimal dose group, the pathological morphology of liver cell dosage group were with different degree of protection. Conclusion: The effect of Jiedu Hugan decoction in medium dose group is better, and its mechanism may affect the chemotaxis of neutrophils induced by MIP-2 and MIP-1β by reducing the content of TNF-α, thus inhibiting the release of inflammatory factors and preventing inflammation.

Correction to: Gender difference in acquired seizure susceptibility in adult rats after early complex febrile seizures / 神经科学通报·英文版

In the original publication of the article, the representative EEG of female rat pups with FS in Figure 1 C and D was incorrectly intercepted from that of male rat pups. This correction does not affect the conclusions of the paper. Figure 1 has been corrected on the online PDF version and displayed below.

Advances in targets of pharmacotherapy and discovery of new drugs for Alzheimer disease:do we have any novel strategies? / 中国药理学与毒理学杂志

Alzheimer disease (AD), the most common dementia, is a chronic, progressive and neuro-degenerative disorder. With an increasing prevalence, AD has been the third cause of death after cardio-vascular diseases and cancer in the elderly population. However, the pathogenesis of AD remains unclear, which has led to a fairly slow development of drugs for AD and a dim view of future treatments of AD. It has been a hot spot and a big challenge to develop effective, therapeutic drugs for AD. Recently, this topic was discussed via WeChat by experts from the Neuropsychiatric WeChat Group, which consists of 300 Chinese-origin neuroscientists and neuropsychiatrists in China or overseas. The experts pointed out the problems that might have misled researches on drug discovery, such as the misleading but dominating AD pathology hypotheses and problems with the platforms for drug screening. Therefore, it is important to review the pathology of AD and the treatment strategies from big data and the overall view of the disease, which may shed new light on AD therapy to develop drugs for multiple targets, leading to omni-direc-tional, comprehensive treatments of AD. The development of AD can be further classified into different stages based on the upstream factors of AD pathology. Interestingly, it has been found that the AD brain has mitochondria damage and dysfunction; long-term exposure to low doses of ionizing radiation can also cause AD-like pathological changes. These provide novel views and ideas in terms of the path-ological process and preventive and therapeutic strategies for AD.

Research progress on ubiquitin-specific protease in antiviral immunity / 浙江大学学报·医学版

Ubiquitin-specific protease(USP), which belongs to cysteine protease, is an important member of the deubiquitinating enzyme family(DUB). USP plays an important role in the immune response against viral infections, in which it can regulate the production of type I interferon through various ways to initiate or weaken the antiviral immune response. USP2b, USP3, USP18, USP25, UL36USP and HAUSP play a role of antivirus; while USP4, USP13, USP15 and USP17 negatively regulate antiviral immune response. In this article we review the recent progress on roles of USP family in antiviral immune response.

Adverse effects of methotrexate in the treatment of acute lymphoblastic leukemia in Uyghur and Han children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study blood concentrations of methotrexate (MTX) in Uyghur and Han children with acute lymphoblastic leukemia (ALL), and to provide criteria for judging the incidence of adverse effects of MTX.</p><p><b>METHODS</b>Twenty-eight children with ALL (15 Han children and 13 Uyghur children), who received high-dose MTX chemotherapy, were divided into >10 μmol/L and ≤10 μmol/L groups according to 24-hour blood concentration of MTX, and divided into >1.0 μmol/L and ≤1.0 μmol/L groups according to 48-hour blood concentration of MTX. Enzyme multiplied immunoassay was used to measure blood concentrations of MTX in the MTX-treated children at 24 and 48 hours after MTX administration, and the adverse effects were observed.</p><p><b>RESULTS</b>There was no significant difference in the incidence of adverse effects between the >10 μmol/L and ≤10 μmol/L groups (P>0.05). The >1.0 μmol/L group showed higher incidences of gastrointestinal reactions and mucosal injuries than the ≤1.0 μmol/L group (P<0.05), but no significant difference was found between the two groups with respect to the incidence of abnormal liver function and bone marrow suppression (P>0.05). Compared with Uyghur children, Han children showed higher 24- and 48-hour blood concentrations of MTX (P<0.05) and higher incidence of abnormal liver function, mucosal injuries, and bone marrow suppression (P<0.05).</p><p><b>CONCLUSIONS</b>The 24-hour blood concentration of MTX cannot be used to predict the incidence of adverse effects in MTX chemotherapy, but 48-hour blood concentration of MTX is helpful in this regard. There are significant differences in 24- and 48-hour blood concentrations of MTX and the incidence of adverse effects between Uyghur and the Han children with ALL who receive MTX chemotherapy. Monitoring of blood MTX concentration maybe significant for timely adjustment of MTX dosage and individualized MTX chemotherapy.</p>

Diphenhydramine interferes with MTT reduction assay / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine the effects of organic amine diphenhydramine on the 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide dye (MTT) reduction assay.</p><p><b>METHODS</b>The primarily cultured cortical astrocytes were incubated with various concentrations of diphenhydramine for 24 h. To analyze the effects of diphenhydramine and other organic amines on the MTT assay, the data obtained from the MTT assay were compared with the results obtained from morphological observation and hoechst 33342 and propidium iodide (PI) nucleus double staining.</p><p><b>RESULT</b>The MTT assay showed that diphenhydramine (10(-4)mol/L), pyrilamine (10 (-4)mol/L) and zolantidine (10 (-5)mol/L) caused a significant increase in MTT reduction in astrocytes. However there was no proliferation, apoptosis or necrosis detected by hoechst and PI nucleus double staining. Light microscopy revealed that exocytosis of formazan granules was inhibited by diphenhydramine.</p><p><b>CONCLUSION</b>Diphenhydramine and other organic amines may enhance MTT reduction by suppression of MTT formazan exocytosis in astrocytes, which may affect the results of cell viability studies.</p>

Value of ER, VIM, CEA and p16 detection in the diagnosis and differential diagnosis of primary endocervical and endometrial adenocarcinomas / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the value of the detection of a 4-marker (ER, VIM, CEA and p16) panel in the differential diagnosis of primary endocervical and endometrial adenocarcinomas.</p><p><b>METHODS</b>Immunohistochemical EnVison method was used to detect the expressions of ER, VIM, CEA and p16 in paraffin-embedded tissues from 31 cases of primary endocervical adenocarcinomas and 30 cases of endometrial adenocarcinomas. The specificity, sensitivity, predictive value and accuracy were compared between the 4-marker and 3-marker (ER, VIM and CEA) panels.</p><p><b>RESULTS</b>The positivity rates of ER, VIM, CEA and p16 in endocervical adenocarcinomas were 35.5%, 19.4%, 77.4% and 67.7%, respectively; those in endometrial adenocarcinomas were 70%, 73.3%, 40% and 13.3%, respectively, showing significant frequency differences (P<0.05) between primary endocervical and endometrial adenocarcinomas. The specificity, sensitivity, positive predictive value and accuracy of the 4-marker panel in endocervical adenocarcinomas were significantly higher than those of the 3-marker panel (96.3% vs 90.2%, 65.1% vs 57.6%, 94.9% vs 89.4%, and 85.8% vs 80.6%, respectively). These values were almost similar for both panels in endometrial carcinoma except for better negative predictive value and accuracy value with the 4-marker panel (58.7% vs 51.9% and 75.4% vs 68.6%, respectively).</p><p><b>CONCLUSION</b>Adding the p16 marker to the traditional 3-marker panel may have significant clinical importance in the differential diagnosis of primary endocervical and endometrial adenocarcinomas to improve the diagnostic accuracy, although there is only a slight increase in the diagnostic sensitivity.</p>

Intranasal administration of low dosage recombinant human erythropoietin inhibits seizure in rats / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effect of intranasal administration of low dosage recombinant human erythropoietin (r-HuEPO) on seizure in rats.</p><p><b>METHODS</b>After intranasal or intraperitoneal administration of r-HuEPO, the behavioral and electroencephalographic changes were observed in pentylenetetrazol (PTZ) and maximal electroshock (MES) induced seizure or electrical amygdaloid-kindled seizure of rats.</p><p><b>RESULT</b>Intranasal administration of low dosage r-HuEPO increased the seizure latency, and decreased the seizure grade and duration, and the number of convulsive episodes in PTZ induced seizure, with the most potential dosage of 2.4 IU. Intraperitoneal administration of r-HuEPO (3 000, 4 000 IU/kg) only decreased the seizure duration and number of convulsive episodes. The seizure grade, forelimb or hindlimb extension duration were decreased in MES-induced seizure by intranasal administration of 2.4 IU r-HuEPO. In addition, intranasal administration of 2.4 IU r-HuEPO decreased the seizure grade, generalized seizure duration and afterdischarge in electrical amygdaloid-kindled rats stimulated with generalized seizure threshold.</p><p><b>CONCLUSION</b>Intranasal administration of low dosage r-HuEPO can inhibit the seizure in rats.</p>

Effect of endogenous histamine on ischemic preconditioning induced cerebral ischemic tolerance / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effect of endogenous histamine on ischemic preconditioning induced cerebral ischemic tolerance in rats.</p><p><b>METHODS</b>Wild-type (WT) mice and histidine decarboxylase knock-out (HDC-KO) mice were preconditioned by bilateral carotid artery occlusion (BCCAO) for 6, 10,or 14 min and reperfused for 48 h,then subjected to permanent BCCAO and the survival time of WT and HDC-KO mice subjected to permanent BCCAO was observed. Histamine levels in the hypothalamus, hippocampus, striatum and cortex at 0.5 h,5 h or 48 h after 10 min BCCAO were determined with high-performance liquid chromatography.</p><p><b>RESULT</b>Ten minutes ischemic preconditioning significantly prolonged the survival time of WT mice subjected to permanent BCCAO. However,in HDC-KO mice, the ischemic tolerance was not induced with 10 min preconditioning. The histamine levels at 0.5 h or 48 h increased after 10 min preconditioning, but not at 5 h.</p><p><b>CONCLUSION</b>Endogenous histamine in brain may be an essential mediator in ischemic preconditioning induced cerebral ischemic tolerance.</p>

Recent advances in treatment of glial scar-induced inhibition of nerve regeneration / 浙江大学学报·医学版

Glial scar formed by central nervous system (CNS) injury is the main inhibitory barrier of nerve regeneration. How to promote axonal regeneration after injury,how to accelerate neural network reconstruction and how to improve brain function recovery have become a hot problem to be solved in the field of neuroscience. This article focuses on the recent advances of therapeutic strategies for axonal regeneration.

Diagnosis and micro-neurosurgery for the fourth cerebral ventricle tumors / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the diagnostic method and analyze the result of microneurosurgical treatment for tumors of the fourth cerebral ventricle.</p><p><b>METHODS</b>Tumor of the fourth ventricle was clinically diagnosed in 86 patients basing on the preliminary assessment of symptom and CT or MRI findings. Of these 86 patients treated with micro-neurosurgery, the tumors in 62 were totally removed, subtotally in 19, and partially in 5. Forty-two patients received postoperative radiotherapy.</p><p><b>RESULTS</b>Three patients died postoperatively within ten days, and symptoms in 83 were improved after treatment. The average survival period was over 3 years. The pathology included 32 medulloblastomas, 23 ependymoma, 15 astrocytoma, 10 hemangiblastomas, 2 choroid plexus papillomas, and 4 epidermoid cysts.</p><p><b>CONCLUSION</b>Medulloblastoma, astrocytoma and hemangiblastoma are suggested to be removed totally whenever technically possible according to the site, character and volume of the tumor. For ependymoma, if close to the brain stem, is recommended to be subtotally removed. Postoperative radiotherapy may be beneficial for malignant types.</p>

Carnosine and diseases of central nervous system / 浙江大学学报·医学版

The naturally-occurring dipeptide carnosine (beta-alanyl-L-histidine) is found exclusively in animal tissues, such as brain and skeletal muscle tissues. Carnosine is a potent hydrophilic antioxidant, antiglycating agent, reactive oxygen species scavenger and pH-buffer. Recent reports suggest that carnosine has potential therapeutic applications in many diseases of central nervous system, such as Alzheimer's disease, Parkinson's disease and cerebral ischemic diseases. To investigate the relationship between carnosine and diseases of central nervous system, and to research and develop carnosine drugs will shed light on a new way for treatment of diseases of central nervous system.

Association of p16, p53, Ki-67 expressions with high-risk human papilloma virus infection in cervical intraepithelial neoplasia / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the association between p16, p53 and Ki-67 expression and high-risk human papilloma virus (HPV) infection in cervical intraepithelial neoplasia (CIN).</p><p><b>METHODS</b>Using a self-prepared tissue microarray, p16, p53, and Ki-67 expression was detected in 243 cases of CIN and 30 cases of normal cervical epitheliums by immunohistochemistry, and high-risk HPV infection was detected by gene hybridization capture II.</p><p><b>RESULTS</b>p16, p53 and Ki-67 expressions were all negative in normal cervical epitheliums, but all positive in CIN. The expression of p16 and Ki-67 was 88.2 (67/76) and 92.1% (70/76) in CIN grade 1, respectively, and both were 100% in CIN grades 2 and 3, and the intensity of positive expression was significantly correlated with CIN grade (P<0.001). The positive cells in CIN grade 1 were mostly within the lower 1/3 of the squamous epithelium, while in CIN grade 2, the positive cells involved the lower 2/3 of the epithelium layers; in CIN grade 3, more than 2/3 or almost the full thickness of the epithelium was involved, suggesting significant correlation between the involvement and CIN grades (P<0.001). p53 expression was positive in 31.6% (24/76) of the cases in CIN grade 1, 53.4% (47/88) in CIN grade 2 and 58.2% (46/79) in CIN grade 3, and the intensity of positive expression was in significantly correlation with CIN grades (P<0.001), but no significant difference occurred between CIN 2 and CIN 3. High-risk HPV were detected in 37/52 (71.2%) of the cases in CIN grade 1, 50/58 (86.2%) in CIN 2 and 50/55 (90.9%) in CIN 3, and the relative DNA amount was significantly correlated with CIN grade (P<0.001), but there as no significant difference between CIN 2 and CIN 3.</p><p><b>CONCLUSIONS</b>High-risk HPV infection and p16, p53, Ki-67 overexpression all play important roles in the carcinogenesis of cervical precancerous lesion, and both p16 and Ki-67 expression are useful markers in diagnosis and staging of CIN.</p>

Bone mineral density of the spine and femur in healthy Chinese men / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To establish bone mineral density (BMD) reference database in healthy Chinese men of Han ethnicity, and to estimate the prevalence of osteoporosis in the population.</p><p><b>METHODS</b>The BMD in the lumbar spine 1-4 (L1-4) and proximal femur was measured using dual energy X-ray absorptiometry in a total of 1 385 healthy Chinese men of Han ethnicity aged 20-89 years old in Shanghai.</p><p><b>RESULTS</b>The highly significant negative correlation between age and BMD at any sites of proximal femur was found in the studied population, wheras no correlation between age and BMD at lumbar spine was observed. The peak BMD of the lumbar spine and any sites of hip in Chinese men was defined as the mean BMD for the subjects aged 20-89 years. According to World Health Organization (WHO) criteria, the BMD cut-off values for osteoporosis of the L1-4, total hip, femoral neck, trochanter and intertrochanter in Chinese men are 0.719, 0.638, 0.575, 0.437 and 0.725 g/cm(2), respectively. Using the current Chinese reference data, the prevalence of osteoporosis at the L1-4, total hip, femoral neck, trochanter and intertrochanter is 5.4%, 3.8%, 6.3%, 1.8% and 2.8% in 1 084 men aged 50 years or older, respectively. However, using a database for US non-Hispanic white men (NHANES III), the prevalence of osteoporosis or osteopenia at any sites of the hip was significantly higher than that while using the current Chinese reference data.</p><p><b>CONCLUSION</b>The BMD reference database was established in healthy Chinese men of Han ethnicity, and will facilitate more accurate diagnosis of osteoporosis in Chinese men.</p>

Establishment of a mechanical injury model of rat hippocampal neurons in vitro / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To establish a simple, reproducible, and practical mechanical injury model of hippocampal neurons of Sprague-Dawley rats in vitro.</p><p><b>METHODS</b>Hippocampal neurons isolated from 1-2-day old rats were cultured in vitro. Mild, moderate and severe mechanical injuries were delivered to the neurons by syringe needle tearing, respectively. The control neurons were treated identically with the exception of trauma. Cell damage was assessed by measuring the Propidium Iodide (PI) uptaking at different time points (0.5, 1, 6, 12 and 24 hours) after injury. The concentration of neuron specific enolase was also measured at some time points.</p><p><b>RESULTS</b>Pathological examination showed that degeneration, degradation and necrosis occurred in the injured cultured neurons. Compared with the control group, the ratio of PI-positive cells in the injured groups increased significantly after 30 minutes of injury (P<0.05). More severe the damage was, more PI-positive neurons were detected. Compared with the control group, the concentration of neuron specific enolase in the injured culture increased significantly after 1 hour of injury (P<0.05).</p><p><b>CONCLUSIONS</b>The established model of hippocampal neuron injury in vitro can be repeated easily and can simulate the damage mechanism of traumatic brain injury, which can be used in the future research of traumatic brain injury.</p>

Relationship between the polymorphism of start codon and CDX2 site in vitamin D receptor gene and the effect of calcium supplementation on bone mineral density of postmenopausal women / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the association of polymorphisms of start codon (Fok I site) and CDX2 binding site in vitamin D receptor gene (VDR) concerned with the effect of calcium supplementation on bone mineral density (BMD) and bone turnover markers of postmenopausal women.</p><p><b>METHODS</b>Two hundreds unrelated postmenopausal women of Han ethnicity in Shanghai were randomly divided into 2 groups of 100 women: high calcium group (1000 mg element calcium and 400 units of vitamin D were given daily for 12 months) and low calcium group (300 mg element calcium and 300 units of vitamin D were given daily for 12 months). BMD and bone turnover markers were measured at baseline and 12 months after calcium supplementation. VDR gene Fok I and CDX2 polymorphisms were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and allele-specific multiplex PCR, respectively.</p><p><b>RESULTS</b>One hundred and seventy-one women completed 12-month study period. The frequency of VDR Fok I genotypes was 48.0 % for Ff, 31.0 % for FF, and 21.0 % for ff, and the frequency of CDX2 genotypes was 56.7 % for AG, 25.7% for GG, and 17.6% for AA. The frequencies distribution of Fok I and CDX2 alleles in the entire population or in two subgroups all followed the Hardy-Weinberg equilibrium. No significant difference of baseline BMD and bone turnover markers in Fok I genotypes or CDX2 genotypes was observed in the entire population or in two subgroups. Moreover, regardless of calcium supplementation given for 12 months, no significant association was found between Fok I or CDX2 polymorphisms and the endpoint values or percentage changes of any BMD and bone turnover markers in either high calcium group or low calcium group.</p><p><b>CONCLUSION</b>There is no significant relationship between VDR gene Fok I or CDX2 polymorphisms and the effect of high or low doses calcium supplementation on BMD and bone turnover markers in Shanghai postmenopausal women of Han ethnicity.</p>

Role of brain mast cell in multiple sclerosis and Wernicke's encephalopathy / 浙江大学学报·医学版

Mast cell which is considered to participate in immune response has long been studied. However its true role in center nervous system is still unknown. Recently,mast cell has been found to play an important function during the process of multiple sclerosis and Wernicke's encephalopathy in the brain. Multiple sclerosis is an inflammatory demyelinating disease, and Wernicke's encephalopathy is caused by deficiency of thiamine. Mast cell deteriorates the neuronal damage and the course of diseases by their mediators. Such studies may supply new idea on the therapy of these diseases.

Correlation of cell apoptosis with brain edema and elevated intracranial pressure in traumatic brain injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the correlation between brain edema, elevated intracranial pressure (ICP) and cell apoptosis in traumatic brain injury (TBI).</p><p><b>METHODS</b>In this study, totally 42 rabbits in 7 groups were studied. Six of the animals were identified as a control group, and the remaining 36 animals were equally divided into 6 TBI groups. TBI models were produced by the modified method of Feeney. After the impact, ICP of each subject was recorded continuously by an ICP monitor until the animal was sacrificed at scheduled time. The apoptotic brain cells were detected by an terminal deoxynucleotide-transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay. Cerebral water content (CWC) was measured with a drying method and calculated according to the Elliott formula. Then, an analysis was conducted to determine the correlation between the count of apoptotic cells and the clinical pathological changes of the brain.</p><p><b>RESULTS</b>Apoptotic cell count began to increase 2 h after the impact, and reached its maximum about 3 days after the impact. The peak value of CWC and ICP appeared 1 day and 3 days after the impact, respectively. Apoptotic cell count had a positive correlation with CWC and ICP.</p><p><b>CONCLUSIONS</b>In TBI, occurrence of brain edema and ICP increase might lead to apoptosis of brain cells. Any therapy which can relieve brain edema and/or decrease ICP would be able to reduce neuron apoptosis, thereby to attenuate the secondary brain damage.</p>

Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth? / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%. The aim of this study was to determine the value of decompressive craniectomy in patients presenting malignant MCA infarction compared with those receiving medical treatment alone.</p><p><b>METHODS</b>Patients with malignant MCA infarction treated in our hospital between January 1996 and March 2004 were included in this retrospective analysis. The National Institute of Health Stroke Scale (NIHSS) was used to assess neurological status on admission and at one week after surgery. All patients were followed up for assessment of functional outcome by the Barthel index (BI) and modified Rankin Scale (RS) at 3 months after infarction.</p><p><b>RESULTS</b>Ten out of 24 patients underwent decompressive craniectomy. The mean interval between stroke onset and surgery was 62.10 h. The mortality was 10.0% compared with 64.2% in patients who received medical treatment alone (P<0.001). The mean NIHSS score before surgery was 26.0 and 15.4 after surgery (P<0.001). At follow up, patients who underwent surgery had significantly better outcome with mean BI of 53.3, RS of 3.3 as compared to only 16.0 and 4.60 in medically treated patients. Speech function also improved in patients with dominant hemispherical infarction.</p><p><b>CONCLUSION</b>Decompressive craniectomy in patients with malignant MCA infarction improves both survival rates and functional outcomes compared with medical treatment alone. A randomized controlled trial is required to substantiate those findings.</p>