Neutrophil to lymphocyte ratio is a prognosis factor for post-operative pneumonia in aneurysmal subarachnoid hemorrhage patients / 中华医学杂志(英文版)

BACKGROUND@#Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm (post-operative pneumonia [POP]) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have been studied, the predictive model of POP after aSAH has still not been well established. Thus, the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio (NLR) to predict the occurrence of POP in aSAH patients.@*METHODS@#We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data. We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression. After screening out the prognosis-related factors, the predictive value of these factors for POP was further assessed.@*RESULTS@#POP occurred in 219 patients (30.4%) in this cohort. Patients with POP had significantly higher NLR than those without (14.11 ± 8.90 vs. 8.80 ± 5.82, P 10 had significantly worse POP survival rate than patients having NLR ≤10. NLR at admission might be helpful as a predictor of POP in aSAH patients.

Activation of mTOR in maldeveloped balloon cells and dysmorphic neurons of type II focal cortical dysplasia / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate whether mammalian target of rapamycin (mTOR) kinase was abnormally activated in maldeveloped balloon cells and dysmorphic neurons of focal cortical dysplasia (FCD) with refractory epilepsy.</p><p><b>METHODS</b>A total of 12 archival cases of FCD typeIIwith medically intractable epilepsy treated between 2008 and 2010 were retrieved. Perilesional brain tissue was used as control specimens (n = 8). The expression of phosphorylated p-AKT (Ser473), p-mTOR (Ser2448) and p-P70S6K (Thr389) was investigated by imunocytochemistry.</p><p><b>RESULTS</b>The expression of p-AKT (Ser473), p-mTOR (Ser2448) and p-P70S6K (Thr389) was found in meldeveloped balloon cells and dysmorphic neurons of FCD. A weak stain in a small amount of pyramid neurons was also found in the control group.</p><p><b>CONCLUSION</b>Abnormal activation of mTOR in maldeveloped balloon cells and dysmorphic neurons of FCD may be a key molecular mechanism underlying the histological changes and repeated seizures.</p>

Language fMRI activation declines in patients with left medial temporal lobe epilepsy

Patients with epilepsy commonly have language deficits. This study investigates whether language fMRI activation and language dysfunction are systematically related in patients with left medial temporal lobe epilepsy [left-mTLE]. We studied sixteen patients with left-mTLE and 16 healthy controls. Semantic judgment task functional MRI scanning and neuropsychological tests were performed. Activation maps of language function MRI analyzed by analysis of functional neuroimages [AFNI]. There was no difference in activation maps of the semantic judgment task fMRI between left-mTLE and healthy controls group. Compared with a healthy control group, in the left-mTLE group, there was significantly less activation volume in the left language regions of the inferior frontal and Superior temporal gyrus; the left-mTLE group also had significantly lower neuropsychological language scores. Language dysfunction in left-mTLE patients is associated with decline of language fMRI activation

Effects of endostatin on C6 glioma-induced edema / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Glioma-induced edema is considered as one of the most pathological characteristics of glioma and a significant source of morbidity and mortality. New strategies are needed for the treatment of peritumoral edema in glioma. Endostatin has been proven to be beneficial as an anti-angiogenic agent in experimental gliomas, but the effects are unclear. This study aimed to investigate the effects of endostatin on C6 glioma-induced edema.</p><p><b>METHODS</b>Tumorigenic mice were established by subcutaneous injection of three glioma cell lines, C6-null cells and stable transfected-C6 cells overexpressing mock vector (C6-mock cells) and endostatin (C6-endo cells). Endostatin expression in xenograft C6 glioma was determined by immunostaining and Western blotting. Glioma-induced edema and tumor vessel permeability were assayed. The effect of endostatin on vascular enodothelial growth factor (VEGF) expression in vivo was analyzed by quantitative polymerase chain reaction (Q-PCR) and enzyme-linked immunosorbent assay (ELISA). The number of vesiculo-vascuolar organelles (VVOs) formed in tumor endothelia was calculated using electron microscopy. Data were analyzed by using one-way analysis of variance (ANOVA) followed by Dunnett's post hoc test for multiple comparisons to the control groups.</p><p><b>RESULTS</b>Overexpression of endostatin (C6-endo cells) significantly suppressed tumor growth and reduced tumor edema and vessel permeability. ELISA analysis showed that the level of VEGF protein was markedly decreased in tumor from C6-endo cells compared with tumor from C6-null cells and C6-mock cells. Similar results were obtained by Q-PCR. Furthermore, the number of VVOs observed in tumor from C6-endo mice was significantly reduced compared with tumor from C6-null cells or C6-mock cells.</p><p><b>CONCLUSIONS</b>Our data provide primary evidence that endostatin reduces glioma-induced edema and vascular permeability. Using endostatin may be an effective strategy for treating glioma edema.</p>

Microsurgical management of acoustic neuroma and protection of facial nerve / 中华神经医学杂志

Objective To discuss the microsurgical skills of management of acoustic neuroma and the protection of facial nerve. Methods One hundred and sixty-eight patients with acoustic neuroma, admitted to our hospital from August 2002 to December 2010, received microsurgery through suboccipital retrosigmoid approach. Under intraoperative electromyography (EMG) monitoring, the facial nerve was separated sharply from both sides, and the tumors were removed by alternate intracapsular excision and capsule wall excision. The microsurgical skill and the method of protection of facial nerve were evaluated retrospectively. Results Total resection was performed in 149 cases (88.69％), partial resection in 19 cases (11.31％). Facial nerve was protected in 146 cases (86.9％) during the operation. Two patients were dead shortly after the surgery. The facial nerve functions were evaluated 6 months after the surgery: 91 (54.26％) belonged to grade Ⅰ and grade Ⅱ, and 52 (30.95％) belonged to grade Ⅲ and grade Ⅳ, while 52 (14.89％) belonged to grade Ⅴ and grade Ⅵ according to House-Brackmann grade. Conclusion The microsurgical removal of acoustic neuroma through suboccipital retrosigmoid approach is safe and effective. The intraoperative electromyography monitoring could improve the reservation rate of facial nerve. Skilled microsurgical technique is the key to the total removal of acoustic minor and the protection of facial nerve.

Applied values of three-dimensional digital subtraction angiography and CT angiography in individualized keyhole operation of intracranial aneurysms / 中华神经医学杂志

Objective To explore the values of three-dimensional digital subtraction angiography(3D-DSA)and CT angiography(CTA)in keyhole surgery of intracranial aneurysms.Methods A retrospective analysis of 175 patients with 192 intracranial aneurysms,treated by keyhole approaches in our hospital from April 2007 to June 2009,was performed.The imaging features of the aneurysms via 3D-DSA and CTA were analyzed; the designed individualized approaches were performed on these patients:supraorbital keyhole approach in 38 patients(40 aneurysms),pterion keyhole approach in 132 patients(146 aneurysms),inferior-temporal keyhole approach in 2(2 aneurysms)and trans-frontal keyhole longitudinal fissure approach in 3(4 aneurysms).The application and significance of 3D-DSA and CTA in keyhole surgery of intracranial aneurysms were summarized.Results All 175 patients successfully finished the one-time surgery:188 aneurysms were clipped and the other 4 were wrapped.All the aneurysms enjoyed satisfactory clipping under DSA or CTA.According to the modified GOS scores,good result was achieved in 165 patients,mild disability in 6,severe disability in 2,and death in 2.Conclusion 3D-DSA and CTA can clearly show the characteristics of three-dimensional shape about intracranial aneurysms and precisely provide a basis for the design of individual keyhole approach which is prerequisite for a successful surgery.

Th-1 drift induced by glioma cell vaccine with high immunogenicity in vitro / 中华神经医学杂志

Objective To observe Th-1 drift induced in vitro by high immunogenic glioblastoma multiforme (GBM) U251 cell vaccine with high expression of membrane-enriched heat shock protein 70 (Hsp70) and major histocompatibility complex class Ⅰ (MHC-Ⅰ) molecules. Methods The high expression of MHC-Ⅰ and Hsp70 in U251 cells were induced by 500 U/ml IFN-γ for 48 h, heat shock at 43 ℃ for 2 h, or their combination. The cells were then inactivated by the mitomycin C (MMC) to prepare the cell vaccine. Peripheral blood mononuclear cells (PBMCs) from healthy donators were incubated with GBM U251 cell vaccines as the effector cells. Flow cytometry was applied to analyze the changes of CD4<'+> and CD8<'+>T lymphocytes in the PBMCs. The secretion of IFN-γ and IL-2 of the effector cells, after assaulting the target cells, was evaluated by ELISA. Results The percentages of CD4<'+> and CD8<'+> T lymphocytes of the PBMCs incubated with the U251 cell vaccine increased significantly as compared to that stimulated by the membrane-enriched MHC class Ⅰ or Hsp 70 molecule U251 cell vaccines (P<0.05), and so was the secretion of IFN-γ and IL-2 (P<0.05). Conclusions Th-1 drift stimulated by GBM U251 cell vaccine with high immunogenicity, high expression of Hsp 70 and membrane-enriched MHC class Ⅰ molecules plays an important role in antitumor mechanism in vitro.

Combined monitoring of evoked potentials during microsurgery for lesions adjacent to the brainstem and intracranial aneurysms / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Neurophysiologic monitoring during surgery is to prevent permanent neurological injury resulting from surgical manipulation. To improve the accuracy and sensitivity of intraoperative neuromonitoring, combined monitoring of transcranial electrical stimulation motor evoked potentials (TES-MEPs), somatosensory evoked potentials (SSEPs) and brainstem auditory evoked potentials (BAEPs) was attempted in microsurgery for lesions adjacent to the brainstem and intracranial aneurysms.</p><p><b>METHODS</b>Monitoring of combined TES-MEPs with SSEPs was attempted in 68 consecutive patients with lesions adjacent to the brainstem as well as intracranial aneurysms. Among them, 31 patients (31 operations, 28 of posterior cranial fossa tumors, 3 of posterior circulation aneurysms) were also subjected to monitoring of BAEPs. The correlation of monitoring results and clinical outcome was studied prospectively.</p><p><b>RESULTS</b>Combined monitoring of evoked potentials (EPs) was done in 64 (94.1%) of the 68 patients. MEPs monitoring was impossible for 4 patients (5.9%). No complication was observed during the combined monitoring in all the patients. In 45 (66.2%) of the 68 patients, EPs were stable, and they were neurologically intact. Motor dysfunction was detected by MEPs in 8 patients, SSEPs in 5, and BAEPs in 4, respectively.</p><p><b>CONCLUSIONS</b>A close relationship exists between postoperative motor function and the results of TES-MEPs monitoring. TES-MEPs are superior to SSEPs and BAEPs in detecting motor dysfunction, but combined EPs serve as a safe, effective and invasive method for intraoperative monitoring of the function of the motor nervous system. Monitoring of combined EPs during microsurgery for lesions adjacent to the brainstem and intracranial aneurysms may detect potentially hazardous maneuvers and improve the safety of subsequent procedures.</p>

Effect of N-acetyl-cysteine and depakine pretreatment on ferrous chloride-induced membrane potential and peroxidate changes in rat cortex neurons / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of N-acetyl-cysteine (NAC) and depakine (DP) on the changes of membrane potential and peroxidate in rat cortex neurons exposed to ferrous chloride (FeCl(2)).</p><p><b>METHODS</b>Cultured cortex neurons of newly born SD rats were randomly divided into control group (PBS group), model group (FeCl(2) group), NAC pretreatment group (NAC group), DP pretreatment group (DP group) and NAC+DP pretreatment group (NAC+DP group). In the latter three groups, NAC (0.08 mg/ml) and DP (0.1 mg/ml) were added in the cell culture 2 and 3 h before FeCl(2) (1 mmol/L) exposure, respectively. After exposure to FeCl(2), the membrane potential of the neurons was detected with fluorescent dye DiBAC4(3) (bis-(1,3-dibutylbarbituric acid) trimethine oxonol), and the peroxidate level with 2,7-dichlorofluorescin diacetate (H(2)DCF) by laser confocal scanning microscope (LCSM) and nuclear factor-KappaB (NF-KappaB) level with immunocytochemistry.</p><p><b>RESULTS</b>Compared with FeCl(2) group, the expression of NF-KappaB and peroxidate level in the neurons were decreased significantly in NAC and NAC+DP groups (P<0.01), but not in DP group (P>0.05). FeCl(2) depolarized the membrane potential and increased the expression of NF-KappaB in the neurons. Compared with FeCl(2) group, significant changes in the membrane potential were observed in DP and NAC+DP groups (P<0.01) but not in NAC or PBS group (P>0.05).</p><p><b>CONCLUSION</b>Both NAC and DP can protect the neurons from FeCl(2)-induced damage but through different pathways, and their combined use can significantly alleviate neuronal damages due to FeCl(2) exposure. Antioxidants such as NAC in combination with antiepileptic drugs may produce favorable effect in prevention and treatment of posttraumatic epilepsy.</p>

Infratentorial-supracerebellar keyhole approach for microsurgical treatment of pineal region tumors / 中华显微外科杂志

Objective This study is to explore the infratentoriat-supracerebellar keyhole approach for microsurgical treatment of pineal region tumors and to evaluate its curative efficacy and safety.Methods According to hi-fi quality MRI images,individual operation schemes were designed.Microsurgical infratentori- al-supracerebellar keyhole approach was used to resect lesions in 7 consecutive patients with prone postition.A 2.0 cm?2.5 cm surgical bone window was performed with its superior margin reaching to the inferior margin of the transverse sinus and confluence sinus.Results Among the 7 pineal region tumors,there were 2 ger- minomas,2 pineocytomas,1 pineoblastoma,1 glioma and 1 chlesteatoma.All cases were re-examined with MRI after operation and it was found that 6 lesions were totally removed and 1 was subtotally removed.The outcome of the treatment was satisfying.There was no infection,bleeding or death after surgery.The follow-up result in the near future was good.Conclusion The infratentorial-supracerebellar keyhole approach for the excision of pineal region tumors was proved to be a satisfactory means with a total removal rate,an excellent curative effect and small surgical trauma.