Human umbilical cord-derived Schwann-like cell transplantation combined with neurotrophin-3 administration in dyskinesia of rats with spinal cord injury.

Mesenchymal stem cells are capable of differentiating into Schwann-like cells. In this study, we induced human umbilical-cord mesenchymal stem cells (HUMSCs) in vitro into neurospheres constituted by neural stem-like cells, and further into cells bearing strong morphological, phenotypic and functional resemblances with Schwann-like cells. These HUMSC-derived Schwann-like cells, after grafting into the injured area of the rats' spinal cord injury (SCI), showed a partial therapeutic effect in terms of improving the motor function. Neurotrophin-3 (NT-3) was reported to improve the local microenvironment of the grafted cells, and we, therefore, further tested the effect of Schwann-like cell grafting combined with NT-3 administration at the site of cell transplantation. The results showed that NT-3 administration significantly promoted the survival of the grafted cells in the host-injured area. Significant improvement in rats treated by Schwann-like cell grafting combined with NT-3 administration was demonstrated in the behavioral test as compared with that in animal models received the cell grafting only. These results suggest that transplantation of the Schwann-like cells combined with NT-3 administration may represent a new strategy of stem cell therapy for spinal cord injury.

Diagnostic value of cerebrospinal fluid procaicitonin level in intracranial infection after craniotomy / 中华神经医学杂志

Objective To explore the diagnostic value of cerebrospinal fluid procalcitonin (PCT) level in intracranial infection after craniotomy.Methods Forty post-craniotomy patients with suspicious intracranial infection were chosen in our study; these patients were divided into infected and disinfected group (n=20).PCT and white blood cell (WBC) counts in the serum and cerebrospinal fluid were detected and analyzed,respectively.Results Both PCT and WBC values in the cerebrospinal fluid and serum in the infected group were significantly higher than those in the disinfected group (P＜0.05).Both PCT and WBC in the CSF had good sensitivity,and PCT in the cerebrospinal fluid and serum had high specificity.Correlation analysis indicated that CSF WBC and serum PCT were positively correlated to CSF PCT (r=0.729,P=0.000; r=0.679,P=0.000).Conclusion CSF PCT could be proposed as an effective diagnostic marker for intracranial infection and it is superior to serum PCT and WBC count.

Effect of hemoglobin on blood-brain barrier in rat models after intracerebral hemorrhage / 中华神经医学杂志

Objective To investigate the effect of hemoglobin on structure and function of blood-brain barrier (BBB) in rat models after intracerebral hemorrhage.Methods One hundred and eight male SD rats were randomized into normal control group (n=12),intracerebral hemoglobin injection group (Hb group,n=48) and sham-operated group (n=48); according to the different observation time points,rats in the Hb group and sham-operated group were divided into 4 subgroups (6 and 24 h,3 and 7 d after the injection,n=1 2).Histological changes and iron deposition of the brain tissues were examined with HE staining and iron staining,respectively.BBB permeability was evaluated by the permeation of Evens blue.The expressions of claudin-5 and ZO-1 in perihematomal brain tissues were detected by immunofluorescence staining and real-time fluorescence quantitative PCR.Results Evident edema and necrosis were observed in the perihematomal zone of Hb group,and iron deposition was found 3 and 7 days after the injection.The permeation of Evens blue in Hb group was significantly increased as compared with that in sham-operated group (P＜0.05).Immunofluorescence staining indicated that expressions ofclaudin-5 and ZO-1 were low and discontinuous in Hb group; the mRNA expression levels of claudin-5 and ZO-1 in Hb group were significantly lower than those in the sham-operated group (P＜0.05).Conclusion After intracerebral hemorrhage,Hb may induce the damage of BBB and participate in the course of brain edema.

Early magnesium sulfate combined with Nimodipine injection in treating patients with diffuse axonal injury / 中华神经医学杂志

Objective To explore the serum level of magnesium in patients with diffuse axonal injury (DAI) and the effect of early magnesium sulfate combined with Nimodipine injection on the prognoses of these patients with DAI. Methods Ninety-nine patients with DAI, admitted to our hospital from September 2006 to June 2010,were randomly divided into 2 groups.The serum level of magnesium was detected on admission. And both groups were treated with Nimodipine injection intravenously 0.5-1.0 mg/h for 7 consecutive d after admission.The experimental group was treated with 250 g/L MgSO4 injection for 3 consecutive d and the control group was treated without MgSO4.Follow-up was performed to observe the relationship between prognoses and both serum level of magnesium on admission and early MgSO4 treatment. Results No significant difference on fatality rate was noted between the experimental group and the control group; however,the experimental group enjoyed a significantly higher good recovery rate and moderate disability rate than the control group (P＜0.05); No significant correlation between the serum level of magnesium and Glasgow outcome scale was noted in both groups. Conclusion The serum level ofmagnesium on admission can't affect the prognoses.As compared with use of nimodipine alone,combined early treatment of 250 g/L magnesium sulfate with continuous intravenous infusion couldn't decrease the mortality rate,but can decrease the severe disability rate and improve the prognoses of patients and enhance their life qualities.

Correlation between NAD(P)H oxidase and malignancy grade of glioma / 中华神经医学杂志

[Objective] To detect the expression of NAD(P)H oxidase (Nox) and the content of ROS in different malignant gliomas,and explore the influence of Nox and intracellular ROS levels in the survival,proliferation,and malignant phenotype of gliomas.[Methods]Thirty human glioma specimens (10 with grade Ⅰ and I1,10 with grade II and 10 with grade IV),performed resection in our hospital from August 2007 to August 2010,were collected in our study;another 10 normal brain tissues were collected as controls.Real time PCR was used to detect the mRNA expressions of Nox(1-5);ROS level was detected by flow cytometry and Nox4 protein level was detected by immunofluorescence and Western blotting.[Results] The Noxl-5 mRNA and protein levels and ROS content were significantly different between each 2 groups (P＜0.05);Nox4 mRNA expression and ROS level significantly increased following the increment of malignancy degrees (controls＜low-grade gliomas＜grade III gliomas＜ grade IV gliomas,P＜0.05);the Nox protein expression was low in controls while that in gliomas was high,and the higher malignancy of the tumors,the higher expression levels of the tumors.[Conclusion] Nox expression and ROS content have significantly positive relations with the malignancy of the tumors,which indicates that Nox expression and ROS content might paly important roles in the occurrence of glioma and malignant proliferation.

Surgical management of infra and supra tentorial menmingiomas:a treatment experience analysis of 30 cases / 中华神经医学杂志

[Objective]To discuss the microsurgical approaches of 30 patients with tentorial meningiomas and conclude their treatment experiences.[Methods]A retrospective analysis of clinical data was performed on 30 patients underwent microsurgical approaches from July 2004 to September 201 1.The pathology of these patients was confirmed after operation.The outcome and follow-up were evaluated.[Results] The meningiomas were totally removed in 19 patients subtotally in 6,and partially in 5.All the patients received 8 months to 5 years of follow-up:no mortality or death were found;no surgical related complications were noted.[Conclusion] Appropriate approaches according to the size and site of the tumors,intraoperative protection of venous sinus,facial and acoustic nerves and brain stem are the key points to improve the therapeutical outcomes and the post-operative quality of patients with infra and supra tentorial menmingiomas.

The photodynamic effects of a novel photosensitizer ZnPcS4-BSA on human U251 glioma cells in vitro / 中华神经医学杂志

Objective To report the phototoxicity effects of a novel photosensitizer ZnPcS4-BSA on photodynamic therapy (PDT) towards human U251 glioma cells in vitro. Methods The cellular uptake of ZnPcS4-BSA by U251 glioma cells was quantified by UV-spectra to determine the optimal incubation time. Human U251 glioma cells were incubated with ZnPcS4-BSA of various concentrations and received laser irradiation of different energy densities. Cell survival rates were measured by CCK-8 assay.Flow cytometer was used to detect apoptosis.Gene expressions of vascular endothelial growth factor (VEGF) were detected by Real-Time PCR in the U251 cells after PDT and β-actin was used as an internal standard. The normal U251 cells severed as controls. Results The uptake of ZnPcS4-BSA by U251 glioma cells reached the maximum after incubation for 4 hours.ZnPcS4-BSA of different concentrations without laser irradiation had no significant effects on cell survival rates (P＞0.05).Without ZnPcS4-BSA incubation,compared with 0,25,50,100,200 J/cm2 groups, the cell survival rate of the 400 J/cm2 group was significantly lower (P＜0.05), whereas no significant difference was found between any other two groups. When the U251 glioma cells incubated with 30 μ mol/L ZnPcS4-BSA for 4 hours underwent laser irradiations of 25,50,100,200 J/cm2,the cellular survival rates significantly decreased with the increased energy densities (P＜0.05). When the U251 glioma cells incubated with ZnPcS4-BSA of 20,40,60,80,100 μ mol/L for 4 hours underwent laser irradiation of 200 J/cm2, the cellular inhibition rates significantly increased with the increased concentrations (P ＜0.05). Compared with controls, the cellular apoptosis and VEGF expression significantly increased in the U251 glioma cells incubated with ZnPcS4-BSA of 20 μmol/L after laser irradiation of 100 J/cm2 (P＜0.05). Conclusion The novel ZnPcS4-BSA is a good photosensitizer for PDT towards U251 glioma cells,because the ZnPcS4-BSA-mediated PDT can induce effective apoptosis of the targeted cells.

Effect of all-trans retinoic acid on expressions of vascular endothelial growth factor and basic fibroblast growth factor in glioma stem cells / 中华神经医学杂志

Objective To investigate the effect of all-trans retinoic acid (ATRA) on expressions of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in glioma stem cells (GSCs). Methods GSCs were isolated from human glioblastoma cell line U87 and identified by detecting the expressions of CD133 and nestin with immunofluorescence staining. The obtained GSCs were divided into control group,empty vector group (cultured with dimethyl sulfoxide [DMSO]) and ATRA treatment group (cultured with 10 nmool/L ATRA).After 10 d of differentiation; the proliferation of the treated GSCs was evaluated using CCK8 assay; the expressions of glial fibrillary acidic protein (GFAP),β-tubulin Ⅲ and galactoeerebroside (GralC) in the cells were detected by immunofluorescence.VEGF and bFGF levels in cultured supernatant were measured by ELISA; the mRNA expressions of VEGF and bFGF were detected by RT-PCR. Results The target antibodies of neural stem cells (NSCs), CD133 and nestin,positively expressed in the GSCs; differentiated GSCs can differentiate several kinds of homologous daughter cells,which expressed the cell markers of astrocytes,neurons and oligodendrocytes: GFAP, β-tubulin LⅢ and GalC, respectively. The percentage of GFAP-positive differentiated GSC s in the ATRA treatment group was significantly higher as compared with that in the other 2 groups after 10 d of differentiation (P＜0.05); the speed of proliferation of GSCs in ATRA treatment group was obviously slower than that in the other 2 groups 3-7 d after differentiation (P＜0.05).The VEGF and bFGF levels and the mRNA expression levels of VEGF and bFGF in GSCs of the ATRA treatment group 24 h after differentiation were also significantly lower than those in the other 2 groups (P＜0.05). Conclusion ATRA can induce the differentiation of GSCs and inhibit its proliferation.It may exerts its anti-glioblastoma effect through the VEGF and bFGF signaling pathways.

Correlation between promoter methylation of O(6)-methylguanine-DNA-methyltransferase gene in malignant brain gliomas and clinical prognosis of these patients / 中华神经医学杂志

Objective To study the correlations between O (6) -methylguanine-DNA-methyltransferase (MGMT) gene promoter methylation status in malignant glioma tissues and both MGMT protein expression and survival prognosis in these patients, and evaluate the significance of MGMT gene methylation status analyzing with methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) method in chemotherapy of brain glioma.Methods Thirty-nine patients with gliomas confirmed by pathology (WHO grade Ⅲ and grade Ⅳ)were collected in our study; the patient's overall survival (OS) after chemotherapy was tracked.MGMT protein expression of glioma tissues was detected by immunohistochemical staining,and MGMT promoter methylation status was detected by MS-MLPA method. Results Statistical difference of OS time was noted between patients with MGMT-negative and patients with MGMT-positive/-weak-positive (P=0.003).The prognosis in patients with positive MGMT protein expression was obviously poorer than that in patients with negative expression. In the groups of MGMT promoter un-methylation, mild hypermethylation, moderate hypermethylation and extensive hypermethylation, significant statistical difference of OS time was noted between each 2 groups (P＜0.05); the higher degree of methylation,the better prognosis. Statistical correlation was noted between MGMT protein expression and promoter methylation status (r=0.697,P=0.000); the higher degree ofmethylation,the lower protein exression of MGMT. Conclusion Both MGMT protein expression and promoter methylation status can be regarded as prognostic indicator of OS in patients with malignant glioma accepted alkylating agent chemotherapy; MS-MLPA is a reliable method to detect MGMT gene promoter methylation status.

Development of three-dimensional visual neurosurgical station and its preliminary clinical practice / 中华神经医学杂志

Objective To develop a three-dimensional visual neurosurgical tool enjoying simple,fast and accurate characteristics at moderate cost for visual positioning and imaging information storage and processing. Methods Seven patients with epidural hematoma or depressed fracture resulted from severe craniocerebral trauma, 8 patients with hypophysoma, 5 with glioma and 3 with meningeoma were chosen in our study; CT three-dimensional reconstruction of their imaging data were performed and used for preoperative planning before surgery assisted by neurosurgical station.According to CT three-dimensional reconstruction results, appropriate neurosurgical approach was planned and patients were treated by surgery. Results Neurosurgical station performed three-dimensional reconstruction could show three-dimensional quantitative relationship between the above lesions and anatomical landmarks directly,which could help direct positioning and designing the best-individualized approach to improve the surgical accuracy and efficacy. Neurosurgical station could improve the efficiency of scientific research and clinical work by managing,storing,editing and using the imaging and video of the patients. Conclusion Neurosurgical station, which can show three-dimensional quantitative relationship between the above lesions and anatomical landmarks directly, is a simple, fast and accurate preoperative planning and information processing tool for clinical neurosurgical practice.

Immunotherapy effect of dendritic cells pulsed by lysate of tumor cell Ar-He cryoablation on rat models of intracraniai gliomas / 中华神经医学杂志

Objective To investigate the role of C6 glioma cells mediated by rapid freezing and thawing ofAr-He cryoablation in the maturation of marrow-derived dendritic cells (BM-DCs) in Wistar rats,and the anti-tumor effect of these DCs on rat models of intracranial gliomas. Methods C6 glioma cells were routinely cultured in vitro; rapid freezing and thawing of Ar-He cryoablation was employed in C6 glioma cells of the experimental group, and C6 glioma cells of the negative control group were only performed insertion of the probe; blank control group (using rapid freezing and thawing of Ar-He cryoablation on the same amount of PBS) was also employed.Bone marrow-derived mononuclear cells (MNCs) were first prepared from tibia and femur bones of Wistar rats. These cells were cultured with such cytokines as recombinant granulocyte-macrophage colony-stimulating factor (rmGM-CSF),recombinant interleukin-4 (rmIL-4) and tumor necrosis factor-alpha (TNFα) to induce their maturation; BM-DCs were pulsed with or without tumor cell lysate obtained by rapid freezing and thawing of Ar-Hecryoablation at a ratio of (DC:tumor cells =1:3) 7 d after that.Morphological observation of BM-DCs was performed by light microscopy and the expression of DCs costimulatory molecules CD80 and CD86 were measured by flow cytometry 48 h after the addiction; the IL-12 level in the supematant of DCs was detected by ELISA. In order to determine whether or not vaccination with C6 TP DCs can induce the therapeutic potential in the established glioma-bearing models, the C6 cells cultured in vitro were stereotaxically implanted into the left caudate nucleus of Wistar rat brain; glioma-bearing rats were injected with vaccination with DCs,cells from the blank control group and negative control group on the 3rd and 10th d. Survival time was observed and determined using the method of Kaplan-Meier and Log-Rank analysis. Results DCs from rats' bone marrow cells cultured with cytokines and pulsed with tumor lysates showed the characters of typical mature DCs.Morphologically,these cells were large with oval or irregularly shaped nuclei and with many small dendrites. Phenotypically, they expressed high levels of CD80 and CD86 antigens (71.8 1％± 1.10％ and 74.66％± 1.48％ in experimental group,49.49％±1.08％ and 51.20％±2.06％ in negative control group, and 48.47％±1.09％ and 49.53％±1.89％ in blank control group); significant difference was noted between each 2 groups (P＜0.05).Functionally,the IL-12level in the supernatant of DCs showed obvious increment in the experimental group (245.99 ±3.20pg/mL) as compared with that in the negative control group (138.68±3.20 pg/mL) and blank control group (135.16±2.88 pg/mL,P＜0.05).These cells gained the capacity of mediating immunotherapy against intracranial gliomas in rats:the median survival in the experimental group (33 d) was significantly higher than that in the negative control and blank control groups (22 and 24 d, respectively, P＜0.05).Conclusion C6 glioma cells mediated by rapid freezing and thawing of Ar-He cryoablation can induce maturation of BM-DCs in Wistar rats; these BM-DCs pulsed with tumor lysates, as new therapeutic vaccines,can mediate immunotherapy against intracranial gliomas in rats.

A microelectrode array for chronic in vivo single-unit recording in subthalamic nucleus of freely behaving rats / 中华神经医学杂志

Objective To introduce a bundled microelectrode array of chronic in vivo single-unit recording in subthalamie nucleus (STN) of freely behaving rats. Methods STN single cell discharge was recorded by a self-designed bundled microelectrode array.Our microelectrode array design consisted of 3 parts:(1) a 29-guage stainless steel tube was served as a guide tube to facilitate the brain penetration of microwire tips,and as a ground electrode of the brain tissues as well. (2) Five 20μm platiniridium wires were used as recording electrodes and a 50.8 μm stainless steel wire with 1 mm bare tip was employed as local potential reference; all the above resembled a guiding-hand-shaped arrangement in microwire tips,and was fixed by trny plot of carbowax moreover.(3) A male connector with end screw receptors was employed to make the array connection more stable so as to minimize the movement artifacts; six normal rats were implanted with this kind of electrode arrays,and the stability of STN single-unit recording was evaluated in the following 5 weeks. Results Twenty-seven firing units were captured during operation,of which 70.4％ (19/27) survived more than 2 d,and 9 new units were acquired within 5 weeks.No significant linear correlation of peak-to-peak amplitude was noted between each 2 different recording sections (Pearson r=-0.047,P=0.655),and whilst signal-to-noise ratio was stable with significant correlation to peak-to-peak amplitude (r=0.934,P=0.000).More than half of the initial acquired STN units retained more than 3 weeks. And there were more than 75％ r values of waveform similarities large than 0.90 of the same units across different periods. Conclusion This methodology may be appreciated for STN long-term single-unit recording with stable recording quality and favorable cell retained rate.

Distribution and expression changes of tight junctional protein JAM-1 in rat models after intracerebral hemorrhage / 中华神经医学杂志

[Objective]To explore the distribution and expression changes of tight junctional protein JAM-1 in rat models after intracerebral hemorrhage (ICH) and their significance.[Methods]One hundred and twenty-eighty healthy male SD rats were randomly divided into normal control group (n=16) and ICH group (n=112),and the ICH models were induced by stereotactically injecting 75 uL autologous blood into the right caudate nucleus.Seven time points after ICH (6,12,24 and 48 h,and 3,7 and 14 d after ICH,16 rats for each time point) were chosen.BBB permeability was evaluated by Evans blue dye extravasation.The distribution and expression of JAM-1 were detected by immunofluorescence and real-time quantitative PCR.[Results] As compared with that in the normal control group,BBB permeability in the ICH group significantly increased at 24 and 48 h,and 3 and 7 d after ICH (P＜0.05).JAM-1 expression decreased at blood vessels at 12,24 and 48 h after ICH,and JAM-1 expressed at the circulatingleukocytes3 dafterlCH,and abundant JAM-1 positive cells around hematoma were noted in the ED-l-positve macrophages 7 d after ICH.JAM-I mRNA significantly decreased at 12,24 and 48 h after ICH,and significantly increased 7 d after ICH as compared with that in the normal control group (P＜0.05).[Conclusion] JAM-1 experssion changes not only participate in regulation of BBB permeability but also play roles in inflammatory insult after ICH.

Blockage of transforming growth factor-β signaling pathway inhibits vasculogenic mimicry in gliomas / 中华神经医学杂志

Objective To study the effect of transforming growth factor-β (TGF-β) signaling pathway blockage on vasculogenic mimicry (VM) in gliomas and explore its possible mechanism.Methods Three-dimentional culture was performed on the glioma cell lines U251 and SHG44; the effects of U251 culture supematant and TGF-β on VM formation of SHG44 cells were observed; the capability of VM formation of U251 and SHG44 cells after being treated with 0 μg/mL (PBS group),15 μg/mL TGF-β neutralizing antibody (Ab15 group) and 30 μg/mL TGF-β neutralizing antibody (Ab30 group) was evaluated.ELISA was used to detect the concentrations of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) in the supematant of U251 cells from the blank group,PBS group,Ab 15 group and Ab30 group and the concentrations of VEGF and PDGF in the supernatant of SHG44 cells from the blank group,TGF-β treatment group,PBS group,Ab15 group and Ab30 group.Results VM was formed in the U251 cells while not in the SHG44 cells during the three-dimentional culture; SHG44 cells could only gather into colonies of different sizes.U251 culture supernatant could induce SHG44 cells to form VM,enjoying the most obvious effect at 24-48 h of culture; TGF-β could not induce SHG44 cells to form VM.The number of U251 cells annulation in PBS group,Ab15 group and Ab30 group decreased in sequence with significant difference (P＜0.05).The number of U251 cells armulation in SHG44 cells cultured in U251 culture supematant from the PBS group,Ab15 group and Ab30 group decreased in sequence after being added TGF-β antibody with significant difference (P＜0.05).As compared with that in the blank group and PBS group,significant decrease of VEGF and PDGF concentrations in the U251 cells from Ab15 group and Ab30 group was noted (P＜0.05); as compared with that in the blank group and TGF-β treatment group,significant increase of VEGF and PDGF concentrations in the SHG44 cells from PBS group,Ab15 group and Ab30 group was noted.Conclusion Blockage of TGF-β signaling pathways inhibits VM in glioma,and it maybe probably due to the decrease of VEGF and PDGF expressions..

Relationship between Rac1 expression of human gliomas and their pathological grades / 中华神经医学杂志

Objective To investigate the protein and mRNA levels of Rac1 in glioma tissues,and explore the correlation of Rac1 with pathological grades. Methods Immunofluorescence,RT-PCR and Western blotting were used to detect the protein and mRNA levels of Rac1 in 45 cases of gliomas tissues and 10 cases of normal brain tissues. Results The results indicated that normal brain tissues showed no protein and mRNA expressions of Rac1, and that of Rac1 highly expressed in glioma tissues (42/45 at most). The spearman correlation analysis revealed that the levels of transcription and expression of Rac1 were positively correlated to the tumor grades; positive expression rate of Rac1 in high grade of glioma was statistically higher than that in low grade of glioma. Conclusion The high expressions of Rac1 in the glioma are closely correlated to the tumor cell invasion and metastasis, which can be used as a marker indicating the malignance and proliferation of glioma.

Double-blind, placebo-controlled, randomized, multicenter studies of oxiracetam in the treatment of brain injury / 中华神经医学杂志

Objective To evaluate the efficacy and safety of oxiracetam in the treatment of neurological deficits resulting from brain injury through the comparison of oxiracetam for injection and piracetam for injection in clinical trials. Methods A multiple-center, randomized, double-blind,parallel study was performed on 239 patients; these patients were divided into experimental group (oxiracetam for injection, n=120) and control group (piracetam, n=119). National institutes of health stroke scale (NIHSS), Glasgow coma scale (GCS), myodynamia grading, mini-metal state examination (MMSE) were employed to evaluate the therapeutic effects; electrocardiogram and laboratory examination were performed, and the side effects were also observed. Results The scores of NIHSS,GCS and myodynamia grading after treatment in the 2 groups were all significantly higher than those before treatment (P＜0.05); however, no significant differences on these scores were noted between the experimental group and control group (P＞0.05). No serious adverse events were noted in both groups.Conclusion Oxiracetam, the same as piracetam, is safe and effective in the treatment of neurological deficits secondary to brain injury.

Three-dimensional reconstruction of CT imaging in endoscopic surgery of patients with hypertensive intracerebral hemorrhage / 中华神经医学杂志

Objective To develop a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with hypertensive intracerebral hemorrhage (HICH).Methods Eighteen patients with HICH, admitted to our hospital from June 2008 to August 2010, were performed endoscopic minimally invasive surgery; CT three-dimensional reconstruction was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery.The clinical data and treatmem efficacy were analyzed.Results According to the results of CT three-dimensional reconstruction, our neurosurgeons could design the best endoscopic approach; the three-dimensional relationship between intracerebral hematoma and scalp markers was shown directly and accurate positioning of the location of drilling was achieved; therefore, the time for preoperative preparation, anesthesia and operation was shortened. The mean operating time of these 18 patients was about 1.5 h; the volume of blood loss was only 30-40 mL; and the evacuation ratio was about 89.2%.After the elimination of hematoma, the brain tissues were flabby, so decompressive craniectomy was not needed. Conclusion CT three-dimensional reconstruction is a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with HICH.

Traumatic features and surgical treatment of fronto-orbital injury / 中华神经医学杂志

Objective To summarize the traumatic features of fronto-orbital injury and evaluate its outcome with primary surgical treatment. Methods The clinical data and surgical operative procedures of 26 patients with fronto-orbital injury were analyzed retrospectively.Results The traumatic characteristics of the 26 patients with fronto-orbital injuries are as follows: mild disturbance of consciousness, severe fronto-orbital deformities, and high frequency of cerebrospinal fluid leakage and cranial nerve injuries. Follow-up of 6-12 months was performed; according to Glasgow outcome scale (GOS), 19 patients had good results, 6 moderate disability, and 1 severe disability; according to scale of Jennett and Bond's plastic surgical outcome, among the 17 patients received correction of fronto-orbital deformities, excellent scores were noted in 12 patients and good in 5. Cerebrospinal leakage was effectively obstructed in 7 patients. Visual acuity improved obviously in 2 patients after decompression of optic canal.Conclusion For patients with fronto-orbital injuries, the primary surgical operative procedures include evacuation of intracranial hematoma and contused brain tissue, correction of fronto-orbital deformities, decompression of optic canal, repair of CSF leak, which may be conductive to improving the neural function and decreasing the intracranial infection.

Changes of tight junctions of blood-brain barrier in human glioma / 中华神经医学杂志

Objective To investigate the changes and the molecular mechanism of tight junctions of blood-brain barrier (BBB) in human glioma. Methods A retrospective analysis was conducted in 21 patients with glioma of different grades and 6 healthy adults and thus we divided them into normal tissue group (n=6), low-grade glioma group (n=11) and high-grade glioma group (n=10).Each group was sampled for ultrastructural observation of the tight junctions of BBB using transmission electron microscope. Double immunofluorescence staining and RT-PCR were used to observe andanalyze the protein and mRNA expressions of Claudin-5 in the glioma, respectively. Results In normal brain tissues, the para-cellular cleft between the adjacent endothelial cells was sealed by continuous strands of tight junctions. In low-grade glioma, most of the tight junctions were intact and no fenestration was found in the endothelium. In high-grade glioma, the amount of pinocytosis vesicle was increased and significant paracellular cleft was found between the adjacent endothelial cells; in addition,typical fenestrations were found in the endothelial cells. Double immunofluorescence staining showedstrong expression of Claudin-5 in the microvascular endothelial cells in the normal brain tissues but weakexpression of that in the high-grade glioma. In the low-grade glioma, expression of Claudin-5 wasdecreased slightly in the microvascular endothelial cells. Compared with the high-grade glioma, the low-grade glioma and normal brain tissues showed significantly higher mRNA expression level of Claudin-5 (P<0.05). Conclusion In the development of brain glioma, glioma cells can decrease the expressions of Claudin-5 and interrupt the continuity of the tight junctions in BBB; and the decrease of Claudin-5 may be one of the important molecular mechanisms explaining the paracellular cleft of tight junction in BBB.

Neuroendoscope-assisted micro-invasive surgical treatment of hypertensive thalamic hemorrhage / 中华神经医学杂志

Objective To develop a minimally invasive operating technique for the treatment of hypertensive thalamic hemorrhage. Methods The clinical data of 15 patients with hypertensive thalamic hemorrhage performed neuroendoscope-assisted micro-invasive surgical treatment in our hospitals from July 2007 to June 2010 were retrospectively analyzed; their treatment efficacy were also concluded. Results The mean operation time of these patients was (1.5±0.4) h and the amount of blood loss was 30-40 mL; the mean clearance rate of hematoma in the thalamus was (86.2 ±7.9)percentage. Patients were followed up and evaluated by Glasgow outcome scale for at least 3 months.Three patients (21.4%) showed good recovery, 4 (28.6%) moderate disability, 4(28.6%) severe disability and 2 (14.3%) vegetative survival; 1 patient (7.1%) died. Conclusion Neuroendoscope-assisted micro-invasive surgical treatment is a fast and minimally invasive operating technique with little blood loss in the treatment of hypertensive thalamic hemorrhage.