Changes in the Vision-related Resting-state Network in Pituitary Adenoma Patients After Vision Improvement / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The aim of this research was to investigate the changes in the vision-related resting-state network (V-RSN) in pituitary adenoma (PA) patients after vision improvement, which was induced by operative treatment.</p><p><b>METHODS</b>Ten PA patients with an improved visual acuity or/and visual field after transsphenoidal pituitary tumor resection were recruited and underwent a complete neuro-ophthalmologic evaluation, as well as an magnetic resonance imaging (MRI) protocol, including structural and resting-state functional MRI sequences before and after the operation. The regional homogeneity (ReHo) of the V-RSN was evaluated. Two sample t-test was performed to identify the significant differences in the V-RSN in the PA patients before and after transsphenoidal pituitary tumor resection.</p><p><b>RESULTS</b>Compared with the preoperation counterparts, the PA patients with improved vision after the operation exhibited reduced ReHo in the bilateral thalamus, globus pallidus, caudate nucleus, putamen nucleus, supplementary motor area, and left hippocampal formation, and increased ReHo in the bilateral cuneus gyrus, calcarine gyrus, right lingual gyrus, and fusiform gyrus.</p><p><b>CONCLUSIONS</b>PA patients with improved vision exhibit increased neural activity within the visual cortex, but decreased neural activity in subareas of the multisensory and multimodal systems beyond the vision cortex.</p>

Effect of basic fibroblast growth factor and transforming growth factor β1 on the healing of reconstructed dura by carbon dioxide laser soldering in minipigs / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Carbon dioxide (CO2) laser soldering is an alternative technique for tissue bonding. Basic fibroblast growth factor (bFGF) and transforming growth factor β(1) (TGFβ(1)) are two key factors for wound healing. This study was performed to demonstrate the efficacy of CO2 laser soldering for dural reconstruction and the effect of bFGF and TGFβ(1) on healing.</p><p><b>METHODS</b>In Part I, 10 minipigs were randomized into two equal groups. Dural defects were reconstructed by conventional fibrin glue bonding (group I(a)) or CO2 laser soldering (group I(b)). The reconstructed dura was subjected to burst pressure (BP) measurement and immunohistochemical staining after 1 week. In Part II, 36 minipigs were randomized into three equal groups. Dural reconstruction was achieved by CO2 laser soldering. Exogenous bFGF (group II(b)) or TGFβ(1) (group II(c)) was administered while group II(a) served as a control group. The specimens were subjected to BP measurement after 1, 2, 3, and 4 weeks, respectively.</p><p><b>RESULTS</b>In Part I, the dura specimens displayed positive staining of only bFGF in group I(a) and of both bFGF and TGFβ(1) in group I(b). Group I(b) showed higher BP than group I(a) ((98.00 ± 21.41) mmHg vs. (70.80 ± 15.09) mmHg, respectively; P < 0.05). In Part II, BP of group II(c) was significantly higher than that of group II(a) (P < 0.01). The BP of group II(a) trended toward stabilization after 3 weeks of growth, while that of groups II(b) and II(c) trended toward stabilization after 2 weeks of growth.</p><p><b>CONCLUSIONS</b>CO2 laser soldering is a reliable technique for dural reconstruction. The superior healing of dural reconstruction by CO2 laser soldering may be related to higher expression of bFGF and TGFβ(1), and CO2 lasers may stimulate their secretion. Exogenous bFGF or TGFβ(1) may improve healing by shortening the wound healing time, and exogenous TGFβ(1) may improve the tensile strength.</p>

Prevalence estimates for primary brain tumors in China: a multi-center cross-sectional study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although the first leading cause of death in China was malignant neoplasms (mortality, 374.1 per 100,000 person-years), the full impact of primary brain tumors (PBT) on the healthcare system is not completely described because there are a few well documented reports about the epidemiologic features of brain tumors. This study aimed to report a comprehensive assessment on the prevalence of PBT.</p><p><b>METHODS</b>A multicenter cross-sectional study on brain tumor (MCSBT) in China was initiated in five regional centers: Daqing (northeast), Puyang (north of China), Shiyan (center of China), Ma'anshan (center of China) and Shanghai (southeast). Prevalence rate was calculated by counting the number of people living with a PBT between October 1, 2005 and September 30, 2006 and dividing by the total population of the five communities at January 1, 2006. Estimates of prevalence were expressed as percentages and grouped according to gender and to age in fifteen-year categories. Within these strata, the rates were estimated with 95% confidence intervals (CI) using the accurate calculation of CI for Poisson distribution. A chi-square test was used to compare the various frequencies with α < 0.05. Age-standardized prevalence with the direct method was calculated with the ten-year age-specific prevalence and the age distribution of the Chinese population in 2010, obtained from World population prospects: the 2008 revision.</p><p><b>RESULTS</b>We estimated that the overall prevalence of PBT was 24.56 per 100,000 (95%CI, 14.85 to 34.27), and the overall prevalence of PBT in female population (30.57 per 100,000 and its 95%CI ranged from 19.73 to 41.41) was higher than that in male population (18.84 per 100,000 and its 95%CI ranged from 10.33 to 27.35). However, the discrepancy between genders was not statistically significant because the 95%CI overlapped. Of 272 cases of newly diagnosed PBT, the proportion of histological subtypes by age groups, gender was statistically different (χ(2) = 52.6510, P < 0.0001). More than half of all reported tumors (52.57%) were either gliomas or meningiomas. For the youngest (aged from 0 - 19) strata of the population, glioma appeared to occur more than other subtypes, accounting for 55.56% of all of cases. The majority of brain tumors presented in those aged from 20 to 59 years was pituitary adenomas (45.12%) and gliomas (31.10%). Opposed to brain tumors in adults and teenage, gliomas only accounted for 22.22%. Meanwhile, the median ages at diagnosis of the patients with PBT were similar between males and females except for pituitary adenomas (male: 59 years old; female: 45 years old).</p><p><b>CONCLUSIONS</b>Age standardized prevalence of PBT is 22.52 per 100,000 (95%CI, 13.22 to 31.82) for all populations, 17.64 per 100,000 (95%CI, 9.41 to 25.87) for men, and 27.94 per 100,000 (95%CI, 17.58 to 38.30) for women. Age standardization to China's 2010 population yielded an estimated population of 304 954 cases with PBT. Our prevalence estimates provide a conservative basis on which to plan health care services and to develop programmatic strategies for surviving. In the future, it would be helpful to have long-term observed survival rates that would make the assumptions and the resulting imprecision in the current estimates unnecessary.</p>

Preoperative 3T high field blood oxygen level dependent functional magnetic resonance imaging for glioma involving sensory cortical areas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Localization of sensory cortical areas during the operation is essential to preserve the sensory function. Intraoperative direct electrostimulation under awake anesthesia is the golden standard but time-consuming. We applied 3T high field blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to identify the relationship between glioma and cortical sensory areas preoperatively and to guide intraoperative direct electrostimulation for quick and precise localization.</p><p><b>METHODS</b>Five glioma patients with sensory cortex involvement by or next to the lesion had preoperative BOLD fMRI to determine the spatial relationship of cortical sensory areas to the tumours. Bilateral hand opposite movement was performed by these patients for fMRI. Precentral and postcentral gyri were identified by electrical stimulation during the operation. Karnofsky Performance Status scores of the patients' pre- and postoperative and the role of BOLD fMRI were evaluated.</p><p><b>RESULTS</b>The cortical sensory areas were all activated in five glioma patients involving postcentral gyrus areas by BOLD fMRI with bilateral hand opposite movement. The detected activation areas corresponded with the results from cortical electrical stimulation.</p><p><b>CONCLUSIONS</b>The relationship between cortical sensory areas and tumour can be accurately shown by BOLD fMRI before operation. And the information used to make the tumour resection could obtain good clinical results.</p>

Functional recovery following traumatic spinal cord injury mediated by a unique polymer scaffold seeded with neural stem cells and Schwann cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The most important objective of transplant studies in the injured spinal cord has been to provide a favorable environment for axonal growth. Moreover, the continuing discovery of new grafts is providing new potentially interesting transplant candidates. Our purpose was to observe the morphological and functional repair effects of the co-transplantation of neural stem cell (NSC), Schwann cells (SCs) and poly lactide-co-glycolide acid (PLGA) on the spinal cord injury of rats.</p><p><b>METHODS</b>A scaffold of PLGA was fabricated. NSCs and SCs were cultured, with the NSCs labeled with 5-bromodeoxyuridine, and the complex of NSC/PLGA or NSC + SCs/PLGA were constructed. Thirty-six Wistar rats were randomly divided into three groups: group A (transplantation of PLGA), group B (transplantation of NSC/PLGA) and group C (transplantation of NSC + SCs/PLGA). The 3 mm length of the right hemicord was removed under the microscope in all rats. The PLGA or the complex of PLGA-cells were implanted into the injury site. Basso-Beattie-Bresnahan (BBB) locomotion scores, motor and somatosensory evoked potential of lower limbs were examined to learn the rehabilitation of sensory and motor function at 4 weeks, 8 weeks, 12 weeks and 24 weeks after injury. All the recovered spinal cord injury (SCI) tissues were observed with HE staining, immunohistochemistry, and transelectronmicroscopy to identify the survival, migration and differentiation of the transplanted cells and the regeneration of neural fibres at 4 weeks, 8 weeks, 12 weeks and 24 weeks after injury.</p><p><b>RESULTS</b>(1) From 4 weeks to 24 weeks after injury, the BBB locomotion scores of cell-transplanted groups were better than those of the non-cell-transplanted group, especially group C (P < 0.05). The amplitudes of the somatosensory evoked potential (SEP) and motor-evoked potential (MEP) were improved after injury in groups B and C, but the amplitude of SEP and MEP at 4 weeks was lower than that at 12 weeks and 24 weeks after injury. Compared with group B, the amplitude of SEP and MEP in group C was improved. The amplitude of SEP and MEP was not improved after injury in group A. (2) HE staining revealed the volume of the scaffold decreased and the number of cells in the scaffold increased. Newly-grown capillaries also could be seen. Immunohistochemistry staining showed the transplanted NSCs could survive and migrate until 24 weeks and they could differentiate into neurons and oligodendrocytes. The regenerated axons were observed in the scaffold-cell complex with transelectronmicroscopy. The above manifestations were more extensive in group C.</p><p><b>CONCLUSIONS</b>The transplanted NSC can survive and migrate in the spinal cord of rats up to 24 weeks after injury, and they can differentiate into various neural cells. Co-transplantation of cells/PLGA can promote the functional recovery of the injured spinal cord. The effect of co-transplanting NSC + SCs/PLGA is better than transplanting NSC/PLGA alone.</p>

Establishment of intramedullary spinal cord glioma model in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Treating intramedullary spinal cord gliomas is a big challenge because of limited options, high recurrence rate and poor prognosis. An intramedullary glioma model is prerequisite for testing new treatments. This paper describes the establishment of a rodent intramedullary glioma model and presents functional progression, neuroimaging and histopathological characterization of the tumour model.</p><p><b>METHODS</b>Fischer344 rats (n = 24) were randomized into two groups. Group 1 (n = 16) received a 5 µl intramedullary implantation of 9L gliosarcomal (10⁵) cells. Group 2 (n = 8) received a 5 µl intramedullary injection of Dulbecco's modified Eagle medium. The rats were anesthetized, the spinous process of the T₁₀ vertebra and the ligamentum flavum were removed to expose the T₁₀₋₁₁ intervertebral space and an intramedullary injection was conducted into the spinal cord. The rats were evaluated preoperatively and daily postoperatively for neurological deficits using the Basso, Beattie and Bresnahan scale. High resolution magnetic resonance images were acquired preoperatively and weekly postoperatively. When score equal to 0, rats were sacrificed for histopathological examination.</p><p><b>RESULTS</b>Rats implanted with 9L gliosarcoma cells had a statistically significant median onset of hind limb paraplegia at (16.0 ± 0.4) days, compared with rats in the control group in which neurological deficits were absent. Imaging and pathological cross sections confirmed intramedullary 9L gliosarcoma invading the spinal cord. Rats in the control group showed no significant functional, radiological or histopathological findings of tumour.</p><p><b>CONCLUSIONS</b>Rats implanted with 9L cells regularly develop paraplegia in a reliable and reproducible manner. The progression of neurological deficits, neuroimaging and histopathological characteristics of intramedullary spinal cord gliomas in rats is comparable with the behaviour of infiltrative intramedullary spinal cord gliomas in patients.</p>

Optimal microsurgical treatment of dorsum sellae meningioma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are few reports of microsurgical treatment of dorsum sellae meningiomas-which, because of location, size, and differences in growth direction, clinical presentations, degree of surgical difficulty, have varied posttreatment sequelae. In pursuit of an optimal microsurgical treatment option for dorsum sellae meningioma patients, we performed a retrospective analysis of eight microsurgery-treated patients in our set up.</p><p><b>METHODS</b>Clinical data of eight microsurgery-treated dorsum sellae meningioma patients were analyzed. Dorsum sellae meningiomas were classified into 2 types based on tumor location, size, and direction of growth. Type I tumors (dorsum sellae-inferior third ventricle type, four cases) were resected by craniotomy via the frontotemporal or orbitozygomatic approach. Type II tumors (dorsum sellae-third ventricle type, 4 cases) were resected by frontal craniotomy via the transcallosal-interforniceal approach.</p><p><b>RESULTS</b>Complete tumor resection was achieved in all the eight patients. In Type I tumor patients, the only postoperative complication was oculomotor nerve palsy. In Type II tumor patients, the postoperative complications included hyperthermia, electrolyte imbalances, endocrinologic disturbances, and hydrocephalus. The mean follow-up was 2.1 years. Four patients returned to normal life and found a job, two were able to live independently, one required assistance, while one died.</p><p><b>CONCLUSIONS</b>Dorsum sellae meningioma surgery is challenging, and resection of Type II tumors is more difficult than Type I tumors. The selection of a suitable microsurgical approach based on tumor type, and the active treatment of postoperative complications are important means of increasing therapeutic efficacy.</p>

Prognostic factors influencing clinical outcomes of glioblastoma multiforme / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Glioblastoma multiforme (GBM) is the most malignant kind of astrocytic tumors and is associated with a poor prognosis. In this retrospective study, we assessed the clinical, radiological, genetic molecular and treatment factors that influence clinical outcomes of patients with GBM.</p><p><b>METHODS</b>A total of 116 patients with GBM who received surgery and radiation between January 2006 and December 2007 were included in this study. Kaplan-Meier survival analysis and Cox regression analysis were used to find the factors independently influencing patients' progression free survival (PFS) time and overall survival (OS) time.</p><p><b>RESULTS</b>Age, preoperative Karnofsky Performance Scale (KPS) score, KPS score change at 2 weeks after operation, neurological deficit symptoms, tumor resection extent, maximal tumor diameter, involvement of eloquent cortex or deep structure, involvement of brain lobe, Ki-67 expression level and adjuvant chemotherapy were statistically significant factors (P < 0.05) for both PFS and OS in the univariate analysis. Cox proportional hazards modeling revealed that age <or= 50 years, preoperative KPS score >or= 80, KPS score change after operation >or= 0, involvement of single frontal lobe, non-eloquent area or deep structure involvement, low Ki-67 expression and adjuvant chemotherapy were independent favorable factors (P < 0.05) for patients' clinical outcomes.</p><p><b>CONCLUSIONS</b>Age at diagnosis, preoperative KPS score, KPS score change at 2 weeks postoperation, involvement of brain lobe, involvement of eloquent cortex or deep structure, Ki-67 expression level and adjuvant chemotherapy correlate significantly with the prognosis of patients with GBM.</p>

Surgical strategies for glioma involving language areas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Successful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia when performed prior to resective glioma surgery.</p><p><b>METHODS</b>Thirty patients with gliomas and left-hemisphere dominance and, who underwent language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia before resective glioma surgery, were analyzed retrospectively. All patients had tumors in or adjacent to cortical language areas. The brain lesions were removed according to anatomic-functional boundaries with preservation of areas of language function. Both preoperative and postoperative functional findings were evaluated.</p><p><b>RESULTS</b>Intraoperative language areas were detected in 20 patients but not in four patients. Language mapping failure for reasons attributable to the anaesthesia or to an intraoperative increase in intracranial pressure occurred in six cases. Seven patients presented with moderate or severe language deficits after six months of follow-up. Total resection was achieved in 14 cases, near-total resection in 12 cases and subtotal resection in four cases.</p><p><b>CONCLUSIONS</b>Intraoperative cortical electrical stimulation is an accurate and safe approach to identification of the language cortex. Awake craniotomy intraoperative cortical electrical stimulation, in combination with presurgical neurological functional imaging to identify the anatomic-functional boundaries of tumor resection, permits extensive tumor excision while preserving normal language function and minimizing the risk of postoperative language deficits.</p>

Transvenous embolization with a combination of detachable coils and Onyx for a complicated cavernous dural arteriovenous fistula / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Treatment of cavernous dural arteriovenous fistulas (DAVF) is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach.</p><p><b>METHODS</b>From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins.</p><p><b>RESULTS</b>Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external carotid artery were embolized, and transient facial palsy was appeared after operation. The fistula was fully embolized with Onyx via the inferior petrosal sinus after two months with no complications. One bilateral cavernous sinus DAVF was embolized with Onyx via the inferior petrosal sinus by two operations, and transient abducens nerve palsy occurred after embolization.</p><p><b>CONCLUSIONS</b>Because Onyx may be injected via a transvenous approach and the microcatheter is easily withdrawn, cavernous sinus via transvenous catheterization and embolization is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulas, especially those for which operations via transarterial approaches have failed, or spontaneous cavernous dural arteriovenous fistulas.</p>

Preoperative blood oxygen level-dependent functional magnetic resonance imaging in patients with gliomas involving the motor cortical areas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) plays an important role in identifying functional cortical areas of the brain, especially in patients with gliomas. This study aimed to assess the value of fMRI in presurgical planning and functional outcome of patients with gliomas in the motor cortical areas.</p><p><b>METHODS</b>Twenty-six patients with gliomas in the motor cortex were recruited in the study. Before operation, fMRI was performed in each patient to obtain the mapping of bilateral hands area on the primary sensorimotor cortex. This examination was performed on a 3.0T scanner with a bilateral hands movement paradigm. During microsurgery under awake anesthesia, the motor area was identified using direct electrical stimulation and compared with preoperative mapping. Finally the tumor was resected as much as possible with the motor cortex preserved in each patient. Karnofsky performance status (KPS) was evaluated in all patients before and after operation.</p><p><b>RESULTS</b>Twenty-three patients showed a successful fMRI mapping. Among them, 19 were classified to be grade III; 4, grade II; 3, grade I. The operation time was about 7 hours in the 23 patients, 8.5 hours in the other 3. The pre- and postoperative KPS score was 82.3 +/- 8.6 and 94.2 +/- 8.1, respectively.</p><p><b>CONCLUSIONS</b>Preoperative fMRI of the hand motor area shows a high consistency with intraoperative cortical electronic stimulation. Combined use of the two methods shows a maximum benefit in surgical treatment.</p>

Detection of cytokeratin20 mRNA in peripheral blood from colonic cancer patients by fluorescence quantitative polymerase chain reaction / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expression level of cytokeratin20 mRNA (CK20 mRNA) of cancer cells in peripheral blood from colorectal cancer patients, detected by fluorescence quantitative polymerase chain reaction (FQ-PCR), and to evaluate its clinical value.</p><p><b>METHODS</b>To systemically study the reproducibility, quantitative range and amplification efficiency of CK20 mRNA detection by FQ-PCR, analyze and compare the result consistency with conventional RT-PCR and immunohistochemistry, separately. The expression level of CK20 mRNA of cancer cells in peripheral blood was examined in 136 colorectal cancer cases with or without hepatic metastasis.</p><p><b>RESULTS</b>The within-run and between-run CV of FQ-PCR to assay CK20 mRNA were 3.6% and 5.3%, respectively, quantitative range was from 10(3) copies/ml to 10(8) copies/ml and amplification efficiency was 87.4%. Comparing with traditional RT-PCR and immunohistochemistry, the Kappa value was 0.87 and 0.83, respectively. The expression level of CK20 mRNA of cancer cells in peripheral blood from colorectal cancer patients was (3.52 +/- 1.47) x 10(4) copies/ml, and the expression positive rate was 48.5%. None was found among the 75 cases in the control group. The positive rate of CK20 mRNA of cancer cells in peripheral blood was 9.5%, 25.0%, 48.8% and 87.5% in the patients at Dukes stage A, B, C and D, respectively (P < 0.05). The positive rate of CK20 mRNA was 87.5% in patients with hepatic metastasis and 32.3% in patients without hepatic metastasis (P < 0.05). CK20 mRNA showed a tendency to decline in 35 cases of colorectal cancer within the 1st, 3rd and 5th week after operation. There was no difference among the data of pre-operation cases and on the 1st, 3rd week (P > 0.05), but a significant difference between pre-operation and the 5th week (P < 0.05).</p><p><b>CONCLUSION</b>FQ-PCR is a rapid and sensitive method for quantitating CK20 mRNA. The expression of CK20 mRNA of cancer cells in peripheral blood from colorectal cancer patients has a correlation with recurrence and metastasis of the tumors. Detection of CK20 mRNA is helpful to monitor hematogenous dissemination of colorectal cancers.</p>

Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.</p><p><b>METHODS</b>From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.</p><p><b>RESULTS</b>All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.</p><p><b>CONCLUSIONS</b>Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.</p>

Management of intracranial invasive olfactory neuroblastoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Olfactory neuroblastoma (ONB) is a rare tumor that often arise from the nasal cavity. The aim of this study was to investigate the clinical characteristics and treatments of intracranial invasive ONB.</p><p><b>METHODS</b>Between July 2001 and August 2005, 5 patients with intracranial invasive ONB were treated in our department. Their clinical features, radiological and pathological characteristics, and surgical treatments were analyzed. Among the 5 patients, 1 received transnasal biopsy, and 4 were operated through the transfrontal or extended bifrontal approaches to reconstruct the skull base. After the operation, all the patients received radiotherapy, and one received chemotherapy. They were followed up for 6 to 45 months.</p><p><b>RESULTS</b>The ONB was resected totally in the 4 patients. In all the patients, nasal obstruction was alleviated without cerebrospinal fluid leakage. The visual acuity was improved in 3 patients, who had a decreased visual acuity before the operation. Two patients had metastasis into the lumbosacral spinal canal 6 and 8 months after the operation, one of them received a second operation and the other died.</p><p><b>CONCLUSION</b>ONB has no specific symptoms. Intracranial ONB should be resected as far as possible, and treated by radiotherapy after the operation.</p>

Investigation of diagnosis and treatment for primary central nervous system lymphoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of primary central nervous system lymphoma (PCNSL) so as to improve comprehension of that unusual lesions.</p><p><b>METHODS</b>Forty-three cases of immunocompetent patients with a confirmed diagnosis of PCNSL were retrospectively reviewed. The clinical presentation, laboratory examination, imaging characteristics, histopathologic types and treatment were analyzed.</p><p><b>RESULTS</b>Single-locus lesion was found in thirty-six patients and multi-locus lesions were found in seven patients. Forty-seven operations were performed. The main characteristics including increased intracranial pressure in 22 cases (51.2%) followed by hemiparesis, seizure and speech problems in 16 cases (37.2%), disturbance of intellectual function and mental confusion in 10 cases (23.3%), contents of cerebrospinal fluid protein concentrations increased in 8 of 12 tested cases (66.7%). Histopathologic exam showed B-cell lymphoma in 40 (40/41, 97.6%) and T-cell lymphoma in 1 case (1/41, 2.4%). Ki-67 positive expression is 42.8% +/- 23.3% in 3 samples.</p><p><b>CONCLUSIONS</b>CT, MRI and CSF cytological examination are mainly diagnostic methods for PCNSL. Elevated lymphocyte counting in peripheral blood can not be the diagnostic criteria for PCNSL. The purpose of operation is alleviating symptom, increasing quantity of life and making histopathologic diagnosis. Adjuvant chemotherapy plus whole-brain radiation is an efficient treatment for PCNSL.</p>

Research about schwann cells and PLGA implanted to rat transected spinal cord / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the recovery of rat transected spinal cord injury after implantation of Schwann cells combined with poly (lactide-co-glycolide) (PLGA).</p><p><b>METHODS</b>Schwann cells were expanded, co-cultured with PLGA for 9 days in vitro, and then analyzed with scanning electron microscope (SEM). Rat spinal cord at the level of T(9) was transected. Schwann cells labeled with BrdU and PLGA scaffold were implanted to injury site. After 1, 3, 6 months, BrdU/MBP immunohistochemistry double staining, semi-thin sections stained thionin and ultra-thin section were performed to investigate myelin renew. BBB open field locomotion, motor evoked potential (MEP), compound muscle action potential (CMAP) and somatosensory evoked potential (SEP) were recorded.</p><p><b>RESULTS</b>Schwann cells grew well on PLGA under SEM. BrdU/MBP double positive cells would been seen, remyelination was thin and formed by Schwann cells at 6 months later under electron microscope (EM). BBB behavioral tests revealed no significant difference in recovery comparing with experiment group and control group. The results of MEP, CMAP and SEP showed no significant improvement in the conduction of spinal cord.</p><p><b>CONCLUSIONS</b>There are the compatibility between Schwann cells and PLGA. Although remyelination was found in morphology, function conduction of spinal cord failed to be established.</p>

Deep brain stimulation in the treatment of secondary dystonia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Dystonia is one of the most challenging movement disorders to treat. Medications and surgeries are the two methods to control dystonic symptoms. For patients with dystonia in whom symptoms are inadequately controlled with pharmacologic measures, the use of deep brain stimulation (DBS) can improve symptoms and enhance functional capacity. The best candidate for DBS is believed to be primary generalized dystonia, especially the DYT-1 type. Here, we report 9 cases of secondary dystonia to explore the feasibility, indications and complications of DBS in the treatment of secondary dystonia.</p><p><b>METHODS</b>From July 2003 to June 2006, nine patients with secondary dystonia underwent surgery at Beijing Tiantan Hospital. Among them, 2 were diagnosed as having tardive dystonia, 1 had posttraumatic dystonia, 3 had a history of perinatal anoxia, 1 had neonatal pathologic jaundice, and 2 had no exact contributory history; MRI showed bilateral lentiform nuclei degeneration in one patient. Six patients underwent bilateral subthalamic nucleus (STN)-DBS, two underwent unilateral STN-DBS, the other underwent left STN and right globus pallidus internus (GPi)-DBS.</p><p><b>RESULTS</b>With intraoperative microelectrode recording, the targeted nucleus was accurately localized. Tentative stimulation could decrease muscle tension to the same extent, but twisting was not obviously improved. Follow-up for 3 months to 3 years showed satisfactory results in 3 patients with tardive dystonia and posttraumatic dystonia and that Burke-Fahn-Marsden Dystonia Scale (BFMS) decreased by more than 90%. The improvement of symptoms was progressive along with time. The other 6 patients had slight to moderate improvement. None of them had severe surgery-related complications. One had lead fracture 16 months after surgery and the lead was then evacuated.</p><p><b>CONCLUSIONS</b>DBS could be an ideal treatment for patients with tardive and posttraumatic dystonia. For patients with perinatal anoxia and diffuse impairment in the basal ganglia, DBS seemed not to be a good choice. STN could be an ideal target. Intraoperative microelectrode recording and mild amelioration of muscle tension are indicators of correct target location. No severe complications occurred.</p>

Advance in Treatment of Spinal Cord Injuries with Schwann Cells Transplantion(review) / 中国康复理论与实践

@#Schwann cells (SCs) have potently neuroprotective and myelinization abilities. They are one of the earliest and the most frequently used cells that are applied to therapeutic studies in spinal cord injury. At present, SCs are usually used as a platform for therapeutic alliance to integrate various interventions. This review will mainly discuss the issues met in therapeutic alliances with SCs for spinal cord injuries, results of various therapeutic alliances with SCs, positive effects of co-transplantation with SCs on neural stem cells, survival, migration of SCs after transplantation and roles of endogenetic SCs in repairing spinal cord injury.

Induction of Endogenous Neural Stem Cells with Hyperbaric Oxygen after Half Cut-off of Spinal Cord in Rats / 中国康复理论与实践

@#ObjectiveTo investigate the effect of hyperbaric oxygen (HBO) on proliferation and differentiation of endogenous neural stem cells after acute spinal cord half cut-off in rats. MethodsThe differences of proliferation and differentiation of endogenous neural stem cells between injured group and intervention group were compared. ResultsThere were remarkable differences between injured group and intervention group. ConclusionHBO can promote the proliferation and differentiation of the neural stem cells in rats after spine cord injury.

Influence of polysaccharide from Aloe vera on the proliferation of the human epithelial cells cultured in vitro / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of polysaccharide from Aloe Vera (AP) on the proliferation of the human epithelial cells cultured in vitro.</p><p><b>METHODS</b>The human epithelial cells undergoing 3 to 4 passages of confluence culture were randomly divided into control and 25, 50, 100, 200 and 400 mg/L AP groups according to different dosage of the polysaccharide (AP) added into the culture medium. In the control group (C), equal volume of DK-SFM medium was added to the culturing cells. The conjugation time of epithelial cells, the changes in the cell morphology and ultrastructure were observed under inverted phase contrast microscope and transmission electron microscope, respectively. The cell proliferation was measured by MTT, cell count analysis and [(3)H]-TdR incorporation. Flow cytometry analysis was employed to detect the cell cycle. The leakage rate of lactate dehydrogenase (LDH) was assayed for the evaluation of the epithelial cell injury.</p><p><b>RESULTS</b>There was no significant difference in the morphology of the epithelial cells among the groups under inverted phase contrast microscope. But under the transmission electron microscope (TEM), the cells in 100 to 400 mg/L AP groups were seen to have proliferated actively, with euchromatin dominant in the nuclei, while heterochromatin was dominant in the cellular nucleus in control and 25 mg/L AP groups. The confluence time of epithelial cells in 50, 100, 200, 400 mg/L AP groups (154 +/- 12, 141 +/- 20, 130 +/- 19, 124 +/- 13) h preceded noticeably than that in control group (182 +/- 8) h, (P < 0.01). The cell proliferation in 100, 200, 400 mg/L groups reached the peak on the 5th day after AP treatment, while that in control and other groups was delayed by 1 to 2 days. The survival rate of the cells in 25 to 400 mg/L AP groups increased dramatically compared with that in control group, with its [(3)H]-TdR incorporation levels significantly increased in a dose dependent manner. The leakage rate of LDH in 200 and 400 mg/L AP groups was lower than that in control group (P < 0.01). The flow cytometric analysis of the cell cycle distribution revealed that the percentage of cell cycle from phase G0/G1 to G2/M and S in 25 to 400 mg/L AP groups increased significantly in a dose dependent manner compared with that in control group (P < 0.01).</p><p><b>CONCLUSION</b>AP might be beneficial to the protection of epithelial cells by promoting cell proliferation through inducing the progression of epidermal cells from phase G0/G1 into G2/M and S phases.</p>