Effect of the proactive percutaneous catheter drainage strategy in the treatment of acute pancreatitis with infected necrosis / 局解手术学杂志

Objective To investigate the effect of the proactive percutaneous catheter drainage(PCD)strategy in the treatment of acute pancreatitis(AP)complicated with necrotic infection.Methods A total of 70 patients with AP complicated with necrotic infection and trea-ted by PCD from January 2016 to November 2017 were prospectively enrolled.The patients were randomly divided into the routine group(n=35)and the modified group(n =35)according to the random number table method.The same indication and principle were performed performed during the first time PCD in both of the two groups.However,the subsequent treatment strategy was different between the two groups.The routine group was given a maximum of 1 adjustment of the drainage tube position or another catheterization.If the drainage effect was still poor,the necrosectomy would be taken through laparoscope,nephroscope or laparotomy directly.While the modified group was given frequent and early drain revision and upsizing of drains in case of lack of clinical improvement.The general data,the total number of PCD pro-cedures,the maximal final drain size,the duration between the first two times of PCD,the total drainage duration,the number of patients need for necrosectomy,the length of hospital stay after drainage,the number of patients need for new ICU admission,the number of patients need for readmission,complications and mortality were compared between the 2 groups.Results The total number of PCD procedures and the maxi-mal final drain size of the modified group was significantly higher than that of the routine group(P<0.05 or P<0.01).The duration be-tween the first two times of PCD in the modified group was significantly shorter than of the routine group(P<0.01).The ratio of patients need for necrosectomy and suffered new-onset multiple organ failure significantly decreased in the modified group,and the difference was sta-tistically significant(P<0.05).There was no significant difference between the two groups in total days of drainage,length of hospital stay after drainage,number of patients need for new ICU admission,number of patients need for readmission,complications and mortality.Conclu-sion The proactive PCD strategy of frequent and early drain revision and upsizing of drains for patients with acute infected necrotizing pan -creatitis when lack of clinical improvement can reduce the proportion of recurrent multiple organ failure and the need for necrosectomy,and it does not increase the risk of related complications.

Safety and efficacy of frameless stereotactic brain biopsy techniques / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To explore the safety and efficacy of frameless stereotactic brain biopsy.</p><p><b>METHODS</b>Diagnostic accuracy was calculated by comparing biopsy diagnosis with definitive pathology in 62 patients who underwent frameless stereotactic brain biopsy between January 2008 and December 2010 in Xiamen University Southeast Hospital. Preoperative characteristics and histological diagnosis were reviewed and then information was analysed to identify factors associated with the biopsy not yielding a diagnosis and complications.</p><p><b>RESULTS</b>Diagnostic yield was 93.5%. No differences were found between pathological diagnosis and frozen pathological diagnosis. The most common lesions were astrocytic lesions, included 16 cases of low-grade glioma and 12 cases of malignant glioma. Remote hemorrhage, metastasis, and lymphoma were following in incidence. Multiple brain lesions were found in 17 cases (27.4%). Eleven cases were frontal lesions (17.7%), 8 were frontotemporal (12.9%), 6 were frontoparietal (9.7%), and 5 each were temporal, parietal, and parietotemporal lesions (8.1%). Postoperative complications occurred in 21.0% of the patients after biopsies, including 10 haemorrhages (16.1%) and 3 temporary neurological deficits (1 epilepsy, 1 headache, and 1 partial hemiparesis). No patient required operation for hematoma evacuation.</p><p><b>CONCLUSION</b>Frameless stereotactic biopsy is an effective and safe technique for histologic diagnosis of brain lesions, particularly for multifocal and frontal lesions.</p>

Emergent burr hole drainage followed by decompressive craniotomy improves the clinical outcome of traumatic intracerebral haematoma-induced cerebral hernia / 中华神经医学杂志

Objective To investigate the clinical benefits of emergent burr hole drainage in combination with decompressive craniotomy for patients with traumatic intracerebral haematoma-induced cerebral hernia. Methods A total of 291 patients with brain hernia caused by acute traumatic epidural and/or subdural hematoma were chosen in our study; 143 of them were treated with decompressive craniotomy alone (ordinary decompression group, admitted to our hospital from January 2003 to December 2006) and 148 of them were treated with emergent burr hole drainage in combination with decompressive craniotomy (emergent surgical intervention group,admitted to our hospital from January 2007 to June 2011).Clinical parameters,including Glasgow Outcome Scale (GOS) scores,incidence of massive cerebral infarction,pupil retraction rate,and Glasgow Coma Scale (GCS) scores,were evaluated retrospectively analyzed. Results Patients in ordinary decompression group had higher GOS scores than those in emergent surgical intervention group (Z=-4.012,P=0.000); mean rank indicated that the treatment efficacy in the emergent surgical intervention group was better than that in the other group.Patients in ordinary decompression group had significantly reduced incidence of massive cerebral infarction (45/148) as compared with patients in ordinary decompression group (70/143,P=0.000).Much more patients (124/148) enjoyed increment of GCS scores in the emergent surgical intervention group as compared with those in the ordinary decompression group (65/143,P=0.000). Conclusion Emergent burr hole drainage followed by decompressive craniotomy is an effective method in saving patients with brain hernia caused by acute traumatic intracerebral haematoma, which can notably resolve intracranial hypertension as soon as possible and give longer time for surgery,therefore,it can improve the prognosis.

Photodynamic effect mediated with 5-aminolevulinic acid on U251 human glioma cells / 中华神经医学杂志

Objective To investigate the photodynamic effect mediated with 5-aminolevulinic acid (5-ALA) on U251 human glioma cells. Methods Fluorescence microscope and confocal laser scanning microscope were used to detect the localization of Pp Ⅸ in U251 human glioma cells. The cells with/without 5-ALA were irradiated at the wavelength of 635 nm. MTT assay was used to measure the cell survival after laser irradiation. Results 5-ALA cocultured with U251 cells successfully produced endogenous Pp Ⅸthat was observed distributively in the cytoplasm, but not in nuclear region. The overall survival rates of the U251 glioma cells photodamaged by ALA-PDT decreased as the incubation time went by or the 5-ALA concentration increased, while peaked at the incubation time of 6 h and the 5-ALA concentration of 2.0mmol/L. Without one of 5-ALA and light irradiation, the survival rate of the cells had no significant difference compared with that of cells of the control group. Conclusion The 5-ALA-induced PDT appears to be a promising therapy for human glioma. The optimal incubation time may be 6 h and the optimal 5-ALA concentration be 2.0 mmol/L.

The study of 3-dimensional structures of IgG with atomic force microscopy / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To detect 3-dimensional images of anti-N-methyl-D-aspartate receptor Nr1 (NMDAr1) polycolonal IgG affixed on mica in physiological environment.</p><p><b>METHODS</b>The images and data were obtained from a contact mode and commercial Si3N4 probed tip by using atomic force microscope (AFM).</p><p><b>RESULTS</b>The anti-NMDAr1 polycolonal IgG has a characteristic structure described as an ellipse spherical shape of 136.4 A x 62.8 A x 26.1 A. On the section of the ellipse edge there were two peaks about 13 nm in width.</p><p><b>CONCLUSIONS</b>Using AFM to investigate biomacromolecule can make us deeply understand the structure of IgG, which will instruct us to detect the membrane receptor protein as a labelling agent.</p>