Volume 86  ·   Issue 23  ·  2006

Microneurosurgery requires surgical anatomy to describe and locate the structures and lesions of the central nervous system in three dimensionals.A complete three-dimensional anatomical description of the exact location of a structure or lesion of the central nervous system (CNS) should include two parts: site and hierarchy.The anatomical site represents the "geographical location" of the structure or lesion, while the anatomical hierarchy represents the "stratigraphic structure" of the structure or lesion.

Pituitary adenoma is a common intracranial benign tumor derived from adenopituitary cells, accounting for about 10% of nervous system tumors [1]. In recent years, with the development of modern imaging examination technology and the popularization of hormone examination methods, the detection rate of pituitary adenoma has increased significantly, reaching 15% ~20% [2]. Pituitary adenoma can occur at any age, but most of them are aged 30~50 years old. Because of the different clinical manifestations and different treatment methods of pituitary adenoma patients, if improper treatment, not only will bring great pain to patients, but also will cause adverse effects to families and society. At present, in clinical work, there are some cases with unsatisfactory treatment effect. The problem lies in excessive treatment or too conservative treatment, which may affect the quality of life of patients, including physiological and psychological effects, and bring unnecessary burden to patients and their families. Therefore, it is particularly important to choose appropriate treatment plan according to the specific situation of patients.

Objective to investigate the expression and regulation of hypoxia-inducible factor (HIF) -1 α in mouse embryonic vertebral body development. Methods the evolution of bone development in mouse embryonic vertebral body was observed under dissection microscope and light microscope; Reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry were used to detect the expression of HIF-1 α in mouse embryonic vertebral body at different stages of development, and the relationship between HIF-1 α and the expression of vascular endothelial growth factor (VEGF), cartilage and bone marker genes. At E15.5, small ossification nuclei were formed in the vertebrae, and then the primary ossification center gradually increased and extended to both ends of the head and tail. At E13.5, the mRNA expression of HIF-1 α could be detected, and at E14.5, the expression level of HIF-1 α reached its peak (P<0.05), and then gradually decreased, and only a small amount was expressed before birth; The expression of VEGF mRNA was the same as that of HIF-1 α; The expression of cartilage and bone marker genes is consistent with the morphological evolution.At E14.5, immunohistochemistry detected the expression of HIF-1 α protein in the center of vertebral body, and the expression time was longer than that of mRNA. Conclusion The development of vertebral body is a process of intrachondral osteogenesis, with hypoxic environment, accompanied by the increase of HIF-1 α mRNA and protein content and the expression of its downstream gene VEGF, which may be related to the activation of downstream genes by HIF-1 α to initiate the process of intrachondral ossification in vertebral body.

Objective to explore the feasibility of constructing large-segment cell-carrier complexes by perfusion culture method in vitro.Methods Dynamic perfusion culture of large-segment tricalcium phosphate columnar carrier of composite bone marrow stromal stem cells was carried out by perfusion bioreactor (dynamic culture group) for 1, 2, 4 weeks or traditional static culture group (static culture group) for 2, 4 weeks. The daily glucose consumption, cell viability (MTT colorimetric assay) and hard tissue sections were detected to detect the expansion of stem cells in the carrier. Results The daily glucose consumption increased with the prolongation of culture time, and the daily glucose consumption in the dynamic culture group was significantly higher than that in the static culture group. The cell viability in the dynamic culture group was significantly higher than that in the static culture group. The cell viability in the dynamic culture group was significantly higher than that in the static culture group at 4 weeks (9.04±0.79 vs 7.98±0.67, P<0.05), but the cell viability did not change significantly at 2 and 4 weeks (2.55±0.23 vs 2.65±0.31, P>Bone marrow stromal stem cells can survive and proliferate in the center and periphery of large segments of carrier, but under static culture, bone marrow stromal stem cells can survive and proliferate only in the periphery of carrier, and the number of cells is significantly less than that of dynamic culture group.The pore ratio of tissue in dynamic culture 4 weeks is significantly greater than that in 2 weeks (67.92% ± 12.28% vs 50.04% ± 8.44%, P<0.05). There is no significant change in pore ratio in static culture 4 weeks and 2 weeks (6.78% ± 1.85% vs 6.63% ± 2.73%, P>0.05). Conclusion The perfusion bioreactor can make bone marrow stromal stem cells survive and proliferate in large segments of three-dimensional carrier, and improve the cell compounding efficiency in carrier.

Objective to investigate the progression of allergic rhinitis to asthma in patients with hay fever in summer and autumn. Methods 1096 patients (5-75 years old) diagnosed with pollen allergic rhinitis in summer and autumn were investigated by inhaled allergen intradermal test and serum specific immunoglobulin IgE test from August 2001 to December 2003. The age of first onset of rhinitis, the age of first onset of asthma, the time of first onset, the time of rhinitis to asthma and the time of onset of rhinitis and asthma in patients with allergic rhinitis and allergic asthma were investigated by standard clinical questionnaire at the same time. Results The age of first onset of hay fever in summer and autumn ranged from 2 to 68 years old, and the age of 15 to 44 years old was the high incidence of rhinitis; In the group of rhinitis complicated with asthma, 33% (194/585) had the first attack of rhinitis and asthma in the same year; 66% (386/585) had rhinitis before asthma attack, only 0.8% (5/585) had asthma before rhinitis attack, and 18% (194/1096) had simultaneous rhinitis and asthma attack among all hay fever rhinitis patients in summer and autumn; 37% (410/1096) developed seasonal asthma within 5 years, 46.7% (506/1096) within 9 years, 5% (58/1096) within 10-19 years, and 1.5% (16/1096) within 20-40 years. Conclusion Nearly half of pollen allergic rhinitis in summer and autumn may develop seasonal allergic asthma within 9 years.

Objective to investigate the expression of RASSF1A mRNA in esophageal carcinoma tissues and its role in the development of esophageal carcinoma. Methods The expression of RASSF1A mRNA in 66 esophageal carcinoma tissues and their corresponding adjacent tissues and adjacent normal tissues was detected by reverse transcription-polymerase chain reaction (RT-PCR). The relationship between the expression of RASSF1A mRNA and clinicopathological features in esophageal carcinoma tissues was analyzed. Results The expression loss rate of RASSF1A mRNA in esophageal carcinoma tissues, adjacent tissues and adjacent normal tissues was 42.4% (28/66), 15.2% (10/66) and 0 (0/66), respectively. The expression loss rate of RASSF1A mRNA in esophageal carcinoma tissues of lymph node metastasis patients (61.1%) was significantly higher than that of patients without lymph node metastasis (20.0%) (x2=11.323, P<0.01); The expression loss rate of RASSF1A mRNA in advanced stage (Ⅲ ~ Ⅳ) esophageal cancer was significantly higher (61.5%) than that in early stage (Ⅰ ~ Ⅱ) (30.0%) (x2=6.417, P<0.05); There was no significant correlation between the loss of RASSF1A mRNA expression and the degree of tumor differentiation in esophageal carcinoma (P>0.05). Conclusion the loss of RASSF1A mRNA expression may play an important role in the occurrence and development of esophageal carcinoma and affect its prognosis.

Objective to investigate the efficacy and clinical significance of matched pressure support servo ventilation (APSSV) in the correction of sleep Chan-Shi respiration (CSR) in patients with congestive heart failure (CHF). Methods Fourteen patients with stable CHF with sleep CSR were selected and treated with sleep oxygen therapy and APSSV, respectively. The parameters of sleep respiration, sleep structure and quality, left ventricular ejection fraction, 6 min walking distance, and plasma endothelin-1 level were compared before and after the two therapies. Results The index of sleep apnea-hypopnea was significantly lower during oxygen therapy than before treatment (P<0.05), but decreased further during APSSV treatment (6.5±0.8), significantly lower than before treatment (34.5±6.1) (P<0.01) and after two weeks of oxygen therapy (27.8±8.2) (P<0.05). The minimum pulse oxygen saturation was higher during oxygen therapy than before treatment (P<0.05), but increased further during APSSV treatment (92.1%±4.9%), significantly higher than before treatment (84.3%±2.9%) It was significantly lower than that before treatment (30.4±8.1) (P<0.05) and at 2 weeks of oxygen therapy (25.6±5.7) (P<0.01). Compared with that before treatment and during oxygen therapy, the sleep ratio of stage Ⅰ + Ⅱ during APSSV treatment was significantly lower, while the sleep ratio of stage Ⅲ + Ⅳ was significantly higher. There was no statistically significant difference between the sleep ratio of stage Ⅰ + Ⅱ and stage Ⅲ + Ⅳ before treatment and during oxygen therapy (P>0.05). The left ventricular ejection fraction was significantly higher at 2 weeks of APSSV treatment (37.2%±4.1%) than before treatment (30.2%±4.6%) and at 2 weeks of oxygen therapy (33.2%±5.1%) (P<0.05). The 6 min walking distance was the lowest before treatment, and the highest at 2 weeks of APSSV treatment, and the difference was statistically significant before treatment (226.2m±28.1m), at 2 weeks of oxygen therapy (289.3m±25.7m) and at 2 weeks of APSSV treatment (340.7m±27.3m) (P<0.01). There was no statistically significant difference in plasma ET-1 concentration before and after oxygen therapy

Objective to explore the approach and fixation method for surgical treatment of scapular neck fracture.Methods 14 patients with scapular neck fracture with severe inward overlapping and displacement of the inferior margin of the glenoid were treated by posterior approach in the decubital position, and the plate and screw were inserted to fix the scapular spine and axillary margin respectively.9 cases of left limb and 5 cases of right limb were treated; All of them were fresh scapular neck fractures, and the direction of fracture line was as follows: starting from the suprascapular notch, passing through the scapular ridge, and ending at 2~4 cm below the axillary glenoid, with an average of 3 cm; The degree of inward overlapping displacement of the inferior margin of the glenoid was 2~4 cm, with an average of 3 cm. According to the classification of Miller et al., they were all type Ⅱ-B scapular fractures. The surgical indication was that the degree of inward overlapping displacement of the inferior margin of the glenoid was more than 1 cm. Time from injury to operation: 3~10 d. Results 14 cases with no neurovascular injury were successfully operated. The wound healed in one stage after operation. X-ray plain film showed that the fracture reached anatomical reduction or close to anatomical reduction, and the inclination angle of the glenoid was normal. The fracture healed in all cases, and the clinical healing time of the fracture was from 4 weeks to 8 weeks after operation, with an average of 6 weeks. All cases were followed up, with an average of 3.5 years after operation, and the follow-up time was from 1 to 7 years after operation. No complications such as traumatic arthritis, heterotopic ossification and acromial impingement sign of the shoulder were found. According to Hardegger's evaluation criteria, 8 cases were excellent, 4 cases were good, and 2 cases were acceptable. Conclusion The scapular neck fracture with severe inward overlapping and displacement of the inferior margin of the glenoid directly affects the function of the upper limb, so it should be treated by surgery. The scapular ridge and axillary margin are regular and hard, which are suitable for implant placement. The posterior approach in prone position is easy to reduce and fix the fracture, and the scapular ridge and axillary margin should be fixed by plate and screw respectively. The surgery not only restores the anatomical shape and triangular mechanical structure of the scapula, but also fixes it firmly. It is a better fixation method for the treatment of scapular neck fracture, and can carry out early shoulder joint function calcination, which is beneficial to the recovery of shoulder joint function.

Objective to systematically evaluate the effect of glutamine dipeptide in nutritional therapy on the clinical prognosis of postoperative patients. Methods Searching the Chinese Biomedical Literature Database, Cochrane Library, Medline database, EMBASE database, and searching the SCI database from the Chinese Academy of Sciences Library, and identifying the quality of randomized controlled studies (RCTs). Eight studies were included. The combined weighted mean difference was-3.25 d, and the 95% CI was-4.87 to-1.62, P =0.00009. It indicated that the average hospital stay in the study group was 3.25 d shorter than that in the control group. Conclusion Glutamine dipeptide in parenteral nutrition of postoperative patients can reduce the risk of infection and shorten the hospital stay.

Objective to investigate the cell morphology, the expression of differentiation-related markers and the proliferation kinetics of brain tumor stem cells (BTSC) during differentiation in vitro, and to provide experimental basis for further study of the differentiation trend of BTSC. Methods CD133+ cells were isolated from surgical specimens of patients with anaplastic ependymoma with initial onset and recurrence in the same case. The cells were differentiated with CD133 immunomagnetic beads and serum. The morphology of the cells was observed under phase contrast microscope. The cells were collected on the 3rd, 7th, 10th and 21st days after undifferentiation and differentiation. The expressions of CD133+, Nestin, glial fibrillar acidic protein (GFAP) and Tubulin β-Ⅲ were detected by flow cytometry. The proliferation cycle was measured on the 7th day after undifferentiation and differentiation. Normal neural stem cells (NSC) were taken as controls. Results (1) Morphology: BTSC changed from round to short fusiform and polygonal, to long fusiform and a few star shapes. After the 7th day, the cell morphology returned to short fusiform and round shape, and the cell aggregation appeared (2) Markers: CD133+ and Nestin were highly expressed in BTSC and NSC when they were undifferentiated, and CD133+ and Nestin were expressed in the whole process after BTSC differentiation, and the expression rates were (3.65±0.17) % and (28.99±1.26) % on the 7th day, and (14.63±1.16) % and (45.46±1.27) % on the 21st day, respectively; The expression levels of GFAP and β-Tubulin Ⅲ were low, but the positive expression rate of GFAP was higher than that of β-Tubulin Ⅲ; The expressions of CD133+ and Nestin were lost in NSC on the 10th day of differentiation, and the expressions of GFAP and β-Tubulin Ⅲ were significantly increased, (88.94±1.23) % and (11.94±0.36) %, respectively. (3) Proliferation cycle and ploidy: BTSC was subdiploid before differentiation, and there were a small number of diploid, a large number of subdiploid and superdiploid after differentiation. The proportion of cells in G2-M phase and S phase was greater than that of NSC, and the cell composition of recurrent BTSC was more complex than that of primary BTSC after differentiation; The neural stem cells were euploid before and after differentiation, mainly in G0-G1 phase.Conclusion Cell morphology, expression of markers, proliferation cycle and ploidy changes reflect that the differentiation trend of brain tumor stem cells is different from that of neural stem cells, and the former has obvious differentiation barriers.

Objective to investigate the feasibility of ultrasound-guided minimally invasive surgery for intracranial tumors. Methods 35 patients with intracranial tumors were retrospectively analyzed. CT and magnetic resonance examination were performed before operation, and the diagnosis of brain tumors was made according to the imaging data. After craniotomy, the location, size and depth of tumors were judged according to intraoperative ultrasound, and the best surgical plan was formulated. Conclusion Ultrasound-guided minimally invasive surgery is a feasible and real-time method to locate the tumor, which can provide a meaningful reference for minimally invasive neurosurgery.

Objective to investigate the surgical methods and curative effects of lacrimal gland tumors invading anterior and middle cranial fossa through cranio-orbital approach.Methods the clinical data of 23 cases of lacrimal gland tumors invading anterior and middle cranial fossa were retrospectively analyzed.Among 23 cases, 15 males and 8 females, aged from 2 to 76 years, with an average of 42.5 years, the medical history ranged from 2 months to 27 years, with an average of 43 months. The main clinical manifestations were exophthalmos and local pain. All patients were treated by surgical resection through cranio-orbital approach.Among 23 patients, 11 were adenoid cystic carcinoma, 6 malignant mixed tumors, 2 lacrimal gland adenocarcinoma, 1 squamous cell carcinoma, 1 ductal carcinoma, 1 myoepithelial carcinoma and 1 benign mixed tumor. There was no surgical death and other surgical complications in one patient. Follow-up results: 4 patients had tumor recurrence, and 1 case died of systemic metastasis of lacrimal adenocarcinoma. Conclusion Adenoid cystic carcinoma is the most common malignant tumor of lacrimal gland, which is easy to destroy the skull and invade the anterior and middle cranial fossa. Sufficient orbital apical decompression and tumor exposure can be obtained through cranio-orbital approach. However, the tumor is difficult to be totally resected and easy to relapse, and it needs radiotherapy and chemotherapy after operation, and the prognosis is bad.

Objective to improve the understanding of the clinical characteristics and diagnosis and treatment methods of skull base myxoma. Methods the clinical data, imaging characteristics and treatment methods of 23 patients with skull base myxoma confirmed by pathology were retrospectively analyzed. All patients were treated by surgery, and 8 patients were treated with radiotherapy after surgery. 11 patients were followed up for an average time of 64.5 months. Results the skull base myxoma was mostly located in the parasellar middle fossa floor and jugular foramen, and the clinical manifestations were headache and multiple groups of cranial nerve damage symptoms. The imaging showed that calcification or bone components were located in the tumor center. The surgical approach was selected according to the tumor site. 16 cases were subtotal resection, 7 cases were subtotal resection, and 2 cases were improved after surgery. There were no changes in 11 cases; 9 cases were aggravated; 1 case died. Follow-up results: 6 cases returned to normal life; Conclusion Total resection of skull base myxoma is difficult, the effect of radiotherapy is uncertain, the mucus matrix is the essential part of the tumor, and it is difficult to differentiate from skull base cartilage tumor and chordoma in clinical and imaging aspects.

The first choice of treatment for esophageal cancer is esophagectomy and esophageal reconstruction. Clinically, autologous colon, jejunum and stomach are commonly used to reconstruct the esophagus. The surgical trauma is large, and there are many complications such as anastomotic leakage, stenosis, necrosis and reflux after operation, and some digestive tract functions are sacrificed at the cost. The application of artificial materials for esophageal reconstruction is faced with many problems such as poor compatibility between artificial materials and host tissues, unsatisfactory epithelialization, immune and inflammatory reactions, etc. Therefore, people have been trying to find more suitable esophageal substitutes. The development of tissue engineering has brought new hope to solve this problem. All kinds of cells used to reconstruct tissues and organs by tissue engineering are collectively called seed cells, which are the basic elements of tissue engineering. The seed cells of tissue engineering esophagus mainly come from autologous, allogeneic and xenogeneic tissues, etc. Only by obtaining sufficient number of seed cells and maintaining specific biological activity can the success of tissue construction be guaranteed.

brain death (BD) is a clinical concept, and it is a clinical diagnosis based on the functional examination of brain stem and whole brain nervous system. Because of the development of science (including ethics) and the progress of society, death can no longer be based only on respiratory and heartbeat arrest. Although this paper does not involve various concepts of BD, it is generally accepted that BD is a state of irreversible loss of whole brain function, including brain stem.

A new study confirms that left ventricular dysfunction can only identify a small number of patients at risk of sudden cardiac death (SCD).

Current studies suggest that the level of low density lipoprotein (LDL) in plasma is positively correlated with the risk of coronary heart disease, that is, the lower the concentration of LDL in plasma, the lower the risk of coronary heart disease, but this view lacks the support of long-term large-scale clinical epidemiological data.

lung cancer is one of the malignant tumors with the fastest increasing incidence in recent years, among which non-small cell lung cancer (NSCLC) accounts for more than 80%. Most patients are in the middle and late stage when they are discovered, and the comprehensive treatment of surgery plus chemotherapy and radiotherapy has always been the mode of NSCLC treatment. Because of the introduction of the concept of preoperative neoadjuvant chemotherapy in recent years, people have a new understanding of the treatment of NSCLC. This paper summarizes the situation of 27 patients with NSCLC during and around surgery after preoperative neoadjuvant chemotherapy in recent two years, and the results are analyzed as follows.

deprenyl is used as a neuroprotective agent to delay the progression of Alzheimer's disease (AD) [1]. It is now believed that abnormal metabolism of amyloid precursor protein (APP) is the central link in the pathogenesis of AD [2, 3]. mitotgen activated protein kinase (MAPK) and protein kinse C (PKC) are important signal transduction molecules that regulate APP metabolism.

A 55-year-old female was found to have a patch shadow at the level of the first anterior rib in the upper lobe of the left lung, about 2 cm ×2 cm, with scattered calcification spots around the chest X-ray film in November 2001. In November 2004, the chest X-ray film and chest CT examination showed that the shadow of the upper lobe of the left lung increased to 7 cm ×5 cm, extending to the hilum, surrounding the initial part of the upper lobe bronchi and the distal end of the left pulmonary artery trunk, and scattered with enlarged lymph nodes in the mediastinum. She was admitted to the hospital with "left upper lung cancer".