Neruomodulation treatment for patients under persistent vegetative state / 中华神经医学杂志

Objective To investigate the effect of neruomodulation treatment,including deep brain stimulation (DBS) and spinal cord stimulation (SCS),on patients under persistent vegetative state (PVS).Methods Fifty-three patients diagnosed as having PVS,admitted to our hospital from July 2011 to December 2012,were chosen in our study; after selection,42 patients were enrolled (27 males and 15 females,mean 42.9±5.47 years old) and prospectively divided into control group (n=20) and surgical group (n=22).Patients from surgical group received DBS (n=5) and SCS (n=17) treatments,while patients from control group underwent routine rehabilitation activities.Behavioral assessments were repeatedly performed using Revised Coma-Recovery Scale (CRS-R).Some patients underwent functional magnetic resonance imaging (fMRI) to further assess the outcomes.Clinical baseline values were collected and compared to follow-up data.Results No statistical significant differences of age,duration of coma and CRS-R scores were noted between the two groups before treatment.Thirty-seven patients (17 in control group and 20 in surgical group) got follow-up for 6-24 months (median 11.2 months); seven patients in the surgical group emerged from PVS to achieve consistent discemible behavioral evidence of consciousness with a recovery rate of 35 ％ (7/20),while only 1 from the control group with a recovery rate of 5.9％(1/17); significant difference was noted between the two groups (P＜0.05).Improvement in behavioral assessments (CRS-R scores) in the surgical group was significantly better than that in the control group (P＜0.05); however,no significant difference of CRS-R scores was noted between patients received DBS and SCS treatment (P＞0.05).The fMRI showed good consistency of activation of resting state default network key area and function connected degree with clinical assessment.Conclusion Neuromodulation therapy can effectively promote awareness of PVS patients based on rigorous selection criteria; DBS and SCS treatments show no difference in the clinical efficacy.

Decreased expression of β-nerve growth factor correlated with histological changes in a cryptorchidism rat model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Nerve growth factor (NGF) is well-known for its important role in the development and maintenance of the nervous system. Along with its neurotrophic role, NGF has been detected in the testis of mouse, rat and human, suggesting an additional non-neurotrophic effect in the male reproductive system. The expression of β-NGF in the undescended testes (cryptorchidism) has not been detected at present. The aim of this study was to evaluate the expression of β-nerve growth factor mRNA and protein in experimental cryptorchidism.</p><p><b>METHODS</b>A unilateral mechanical cryptorchidism model in the Sprague-Dawley rat was established and the expression of β-NGF with histologic changes in experimental cryptorchidism were investigated using one step quantitative real-time reverse transcription-polymerase chain reaction, in situ hybridization histochemistry, immunofluorescence and hematoxylin-eosin staining.</p><p><b>RESULTS</b>The expression of β-NGF mRNA and protein were both significantly decreased in the development of unmarred testis and cryptorchidism-induced testis, and the decrease of β-NGF in cryptorchidism-induced testis was far greater than that in uninjured testis.</p><p><b>CONCLUSION</b>From this investigation, we confirmed a lower expression of β-NGF in undescended testes than in the development of testis.</p>

Relationship of sphenoid intersinus septa with transsphenoidal resection of sellar area tumor / 中华神经医学杂志

Objective To study the relationship of sphenoidal intersinus septa with transsphenoidal resection of sellar area tumor. Methods The pre-operative MRI and CT images of the sphenoid intersinus septa and its importance in transsphenoidal resection of sellar area tumor were studied in 107 patients, admitted to our hospital from January 2008 to December 2010. The amounts, locations, anatomic specialties of the septa and its relationships with the floor of selle, the internal carotid artery canals and the tumors were analyzed to guide the operative procedures during the operation. Results Total removal of the tumors in seller region was obtained in 67 patients, subtotal removal in 21 and partial removal in 19. According to the MRI and CT images of the sphenoid intersinus septa, the location of the tumor and the carotid artery in 47 patients were quickly determined; complex sphenoid intersinus septa was noted in 11 patients, and the relation of sellar floor with the septa was quickly determined and the scope and direction of removal were determined too. Rupture of the internal carotid artery occurred in 1 patient, and damages of the cavernous sinuses occurred in 4. Conclusion Careful study of the pre-operative MRI or CT images of the sphenoidal intersinus septa and its relationship with the floor of seller, the internal carotid artery and the tumor will assure the transspenoidal surgery more precisely and safely, and the complication can be efficiently prevented and decreased.

Microsurgical treatment of multiple intracranial aneurysms / 中华神经医学杂志

Objective To explore the problems of microsurgical treatment of multiple intracranial aneurysms with regard to the indications,surgical timing,operative approaches and the prevention of complications, and improve their diagnoses and treatments. Methods We retrospectively reviewed the data of 33 patients with multiple intracranial aneurysms admitted to our hospital from Jan.2000 to Dec.2008 and their clinical manifestations,imaging features and microsurgical treatments were summarized. Results In the 33 cases of multiple intracranial aneurysms,the male-to-female sex ratio was 1:1.75 and the average age at onset of symptoms was 56.52.Twenty-four patients showed good postoperative prognosis(Glasgow Outcome Scale IV-V) with 2 deaths.Conclusion Individual treatment should be adopted in the treatment of differently localized multiple intracranial aneurysms with different sizes and clinical classifications,and the utilization of temporary blockade and ultrasound during the operation can improve the therapeutic effects and reduce the postoperative complication rates.

Stereotactic surgery in treating intracranial cystic lesions / 中华神经医学杂志

Objective To explore the methods, efficacy and advantages ofstereotactic surgery.Methods A retrospective analysis of 29 consecutive patients with 37 lesions (mean age, 34.6 years),received surgery between Dec 2002 and Nov 2009, was performed. Histological findings showed 11 craniopharyngiomas, 5 cystic gliomas, 3 metastases and 10 cerebral abscesses. Eighteen patients underwent cyst aspiration by the Ommaya reservoir system combined with 32P endocavitary irradiation;median irradiation doses were 800 μCi. One was treated with aspiration and then radiotherapy only. Ten patients with cerebral abscesses received cystic drainage (8 cases) and aspiration (2 cases). Results No operative bleeding and death were found in this experiment. Follow up was performed for a median of 10.6 months (range, 1-60 months) and 4 were out of contact. All patients with craniopharyngiomas remained stable without recurrence after treatment; complete resolution was achieved in all patients with cerebral abscess; in the other 8 patients with tumors(12 lesions), 5 were under control of the symptoms for an average of 14 months and 3 (2 with metastases and 1 with glioblastoma) did not get improvement after the treatment. Two patients with craniopharyngioma experienced a transient slightly worsening of hypothalamic functions, including transient diabetes insipidus, low fever and vomit. Conclusion Stereotactic technique has its advantages in treating patients with cerebral abscess, craniopharyngiomas,metastatic tumors and gliomas that were small size, while it does not that effective in the cystic metastases that are in large size and difficult to control in a short term.