Recent advance in relations of programmed cell death-1/programmed cell death-ligands-1 pathway with multiple sclerosis / 中华神经医学杂志

Multiple sclerosis (MS) is an autoimmune disease characterized by demyelination, axonal injury, and neuronal loss in central nervous system. Experimental autoimmune encephalomyelitis (EAE) animal model is widely used in MS. Accumulating evidences indicate that the programmed cell death-1/programmed cell death-ligands-1 (PD-1/PD-L1) pathway participates in pathogenesis of autoimmune diseases. The authors comprehensively review the roles of PD-1/PD-L1 pathway in pathogenesis of MS and EAE animal model, and discuss the potential of this pathway as a new therapeutic target for MS, to provide reference for immunotherapy research of MS.

Risk factors for cerebrospinal fluid fistulas due to endoscopic transnasal surgery for pituitary neoplasms / 中华神经医学杂志

Objective To investigate the risk factors associated with cerebrospinal fluid (CSF) fistulas due to endoscopic transnasal surgery for pituitary neoplasms.Methods The data of 1,063patients were reviewed who had undergone transnasal surgery for pituitary adenomas between January 2009 and December 2012 at Department of Neurosurgery,General Hospital of PLA in Beijing.Intra-operative CSF fistulas were observed in 122 patients but not in the other 941 ones;post-operative CSF fistulas were observed in 29 patients but not in the other 1,034 ones.The clinical data were compared between the patients with and without intra-operative CSF fistulas and between those with and without post-operative CSF fistulas.Chi-square was used to identify the potential risk factors associated with intra-and post-operative CSF fistulas.Multivariate Logistic analysis was performed for correlated variables.Results There was a significant difference in tumor size between the patients with and without intra-operative CSF fistulas (P＜0.05).There were significantly more patients undergoing reoperation in those with intra-operative CSF fistulas than in those without (P＜0.05).The multivariate Logistic analysis revealed that giant adenoma,macroadenoma and reoperation were independently associated with intraoperative CSF fistulas.There was a significant difference in age and tumor size between the patients with and without post-operative CSF fistulas (P＜0.05).There were significantly more patients undergoing reoperation and suffering intraoperative CSF fistulas in those with post-operative CSF fistulas than in those without (P＜0.05).The multivariate Logistic analysis revealed that giant pituitary neoplasms,reoperation and intra-operative CSF fistulas were independently associated with post-operative CSF fistulas.Conclusions In endoscopic transnasal surgery for pituitary neoplasms,the risk factors for intra-operative CSF fistulas are larger tumor size and reoperation and the risk factors for post-operative CSF fistulas are giant pituitary neoplasms,intra-operative CSF fistulas and reoperation.

Clinical analysis of the technique of puncture and drainage guided by neuronavigation in treatment of brain abscesses / 中华外科杂志

<p><b>OBJECTIVE</b>To study the techniques and efficacy of neuronavigation-guided puncture and drainage in the treatment of brain abscesses.</p><p><b>METHODS</b>From February 2006 to December 2012, 31 patients with brain abscesses treated by the technique of neuronavigation-guided puncture and drainage were retrospectively analyzed. There were 27 male and 4 female patients, age ranged from 10 months to 69 years, average (34 ± 19) years.Single brain abscesses were found in 26 patients, multiple abscesses in 5 patients. The abscesses were located in eloquent regions in 19 patients. The mean diameter of the abscess was 4.1 cm (2.5-6.7 cm). The first follow-up visit was on the first month after surgery, and if residual was observed on enhanced MRI, then the patient was followed up every 3 months until the abscess disappeared completely. After residual absorbed, the patient was followed up every year.</p><p><b>RESULTS</b>Incisions of all patients were healed well and no infection. The length of hospital stay after surgery was 6-42 days, mean (14 ± 9) days. Bacterial culture of pus was performed regularly including aerobic, anaerobic and fungal culture after surgery. Thirteen patients had positive culture whereas the other 18 patients had negative culture. The duration of antibiotic use was 18-42 days, mean (22 ± 5) days. All the patients were followed up for 3 months to 3 years. Twenty-nine patients recovered well postoperatively, 1 case died 2 months after operation.One case was performed the second drainage after 10 days from the first surgery.Eighteen patients showed the improvement of neurological status within the first day following surgery, 4 patients got improvement in the next day, 1 patient with hemiplegia showed improvement in 10 days postoperatively, 1 patient with aphasia recovered gradually after 1 month, 1 patient with hemiplegia showed deterioration temporarily after surgery, and recovered gradually after 15 days.</p><p><b>CONCLUSION</b>The technique of puncture and drainage guided by neuronavigation has many advantages to treat brain abscesses, such as small trauma, short operation time, high accuracy and safety, simple surgical procedures and good prognosis.</p>

Outcome of Endoscopic Transsphenoidal Surgery in Combination with Somatostatin Analogues in Patients with Growth Hormone Producing Pituitary Adenoma

OBJECTIVE: To determine the efficacy of endoscopic surgery in combination with long-acting somatostatin analogues (SSAs) in treating patients with growth hormone (GH)-secreting pituitary tumor. METHODS: We performed retrospective analysis of 133 patients with GH producing pituitary adenoma who underwent pure endoscopic transsphenoidal surgery in our center from January 2007 to July 2012. Patients were followed up for a range of 3-48 months. The radiological remission, biochemical remission and complication were evaluated. RESULTS: A total of 110 (82.7%) patients achieved radiological complete resection, 11 (8.2%) subtotal resection, and 12 (9.0%) partial resection. Eighty-eight (66.2%) patients showed nadir GH level less than 1 ng/mL after oral glucose administration. No mortality or severe disability was observed during follow up. Preoperative long-acting SSA successfully improved left ventricle ejection fraction (LVEF) and blood glucose in three patients who subsequently underwent success operation. Long-acting SSA (20 mg every 30 days) achieved biochemical remission in 19 out 23 (82.6%) patients who showed persistent high GH level after surgery. CONCLUSION: Endoscopic transsphenoidal surgery can biochemically cure the majority of GH producing pituitary adenoma. Post-operative use of SSA can improve biochemical remission.

The level and clinical significance of interleukin-17 in primary Sj(o)gren's syndrome with interstitial lung disease / 中华风湿病学杂志

Objective To investigate the level of IL-17 and its clinical significance in patients with primary Sj(o)gren's syndrome (pSS) complicated with interstitial lung disease (ILD).Methods IL-17 levels were detected by enzyme linked immunosorbent assay (ELISA) in 53 untreated patients with pSS (25patients with only lacriminal and/or salivary gland involvement,28 with only interstitial lung disease involvement) and 15 healthy controls.The related clinical and laboratory data were recorded.ANOVA,LSDtest and Pearson test were used for statistical analysis.Results There were significant differences between the 3 groups(F=22.504,P=0.000).The mean concentration of sera IL-I7 in the patients with ILD was significantly higher than in patients with only lacriminal or salivary gland involvement (P＜0.05).There was no difference in the levels of sera IL-17 between the patients with only lacriminal and/or salivary gland involvement and healthy controls (P＞0.05).Conclusion Our results show that patients with pSS concomitant with ILD have high serum IL-17 levels,which highlight the role of IL-17 in Sj(o)gren's syndrome interstitial lung injury.

DISTRIBUTION OF NEUROGLOBIN IN SPINAL CORD OF ADULT RAT / 解剖学报

Objective In order to explore the localization of NGB protein in spinal cord of adult rat. Methods Spinal cord of adult rat was used to make frozen section. The localization of NGB protein in the spinal cord of adult rat was examined by immunohistochemistry method. Results NGB protein immunoreactive cells were mainly distributed in the gray matter of spinal cord, including in the ventral horn, intermediate zone and dorsal horn. NGB-immunoreactive product located in the plasm of neurons.Conclusion The results indicated that NGB widely expressed in the neurons of spinal cord, suggested that NGB might play an important role in the physiological function of the spinal cord.

Preliminary study of StealthStation neuronavigation in the operation of intracranial lesions / 解放军医学杂志

Objective To evaluate the value of the StealthStation neuronavigation in the operation of intracranial lesions. Methods 22 patients with different intracranial lesions, including 14 cases of glioma, 2 cases of meningioma,4 cases of cavernous angioma,1 case of lymphoma and 1 case of metastatic cancer, were operated on with the aid of StealthStation neuronavigational system. The neuronavigational accuracy and surgical effect were analysed. Results All intracranial lesions were found accurately with StealthStation neuronavigational system, the predicted accuracy (PA) value was 2.53?0.73mm, accuracy sphere of intracranial lesions in the neuronavigational system was within 2mm in all patients. 13 cases out of 14 gliomas were totally removed under microscope, in 1 case removal was subtotal. In 2 patients, neurological symptoms became worse immediately after the operation but improved within 3 months after the operation. The other 12 patients recovered very well. In another 8 cases total removal under microscopy was successful, but one lymphoma patient showed exacerbation of neurological symptoms immediately after operation, but improved within 1 week after operation. The other 7 cases recovered very well. Conclusion The StealthStation neuronavigational system is reliable and accurate in neurosurgical operation, thus it is helpful to facilitate total resection of intracranial lesions with less operative complications.

Changes in neuroglobin expression in cerebral cortex and hippocampus after cerebral ischemia-reperfusion injury / 解放军医学杂志

Objective To observe the dynamic changes in neuroglobin (NGB) expression in cerebral cortex and hippocampus after cerebral ischemia-reperfusion injury in gerbils. Methods The global cerebral ischemia of gerbils was induced by clamping bilateral carotid arteries for 20 minutes, then they were released to allow reperfusion for 2h, 8h, 16h, 24h, 48h and 72h. The NGB expression in cerebral cortex and hippocampus was measured with immunohistochemical methods coupled with computer-assisted image analysis. Results The changes in NGB expression were different in cerebral cortex and in the hippocampus. NGB protein was up-regulated from 16h to 48h after ischemia-reperfusion insult to cerebral cortex, whereas it was down-regulated hippocampus. Conclusion The different expressions of NGB in cerebral cortex and hippocampus are suggestive of compensatory and repair mechanisms in ischemia-damaged neurons after transient global cerebral ischemia. The increased expression of endogenous NGB in the brain after ischemia-reperfusion may be associated with the protective response to ischemic damage.